Galen NUR 242 Exams 1-4 – Med-Surg Concepts
(2026) Complete A+ Guide with Rationales
1: Cardiovascular Disorders (Questions 1-50)
1. A patient is admitted with chest pain. The nurse understands
that the pain of myocardial infarction (MI) is caused by:
A. Inflammation of the pericardium
B. Obstruction of coronary blood flow leading to myocardial
ischemia
C. Spasm of the pulmonary artery
D. Rupture of the aortic valve
Answer: B. Obstruction of coronary blood flow leading to
myocardial ischemia
Rationale: Myocardial infarction occurs when coronary artery
blood flow is obstructed, causing ischemia and necrosis of
myocardial tissue. The resulting pain is from ischemic
myocardium releasing inflammatory mediators .
2. A patient with acute coronary syndrome (ACS) has ST-segment
elevation on ECG. Which intervention is most urgent?
A. Administer morphine for pain
B. Prepare for percutaneous coronary intervention (PCI)
C. Draw cardiac enzymes
D. Insert an indwelling urinary catheter
Answer: B. Prepare for percutaneous coronary intervention
(PCI)
Rationale: ST-elevation myocardial infarction (STEMI)
,requires immediate reperfusion therapy. PCI is the preferred
method if available within 90 minutes of presentation. Time
to reperfusion is critical for myocardial salvage .
3. The nurse is caring for a patient post-cardiac catheterization.
Which assessment finding requires immediate intervention?
A. Report of mild groin discomfort
B. Pulse distal to the insertion site 2+ and equal to other extremity
C. Expanding hematoma at the insertion site
D. Blood pressure 118/76 mmHg
Answer: C. Expanding hematoma at the insertion site
Rationale: An expanding hematoma indicates bleeding at the
arterial puncture site, which can lead to hemorrhage and
compartment syndrome. This requires immediate pressure
and notification of the provider .
4. A patient with heart failure has jugular venous distention (JVD)
and peripheral edema. These findings indicate:
A. Right-sided heart failure
B. Left-sided heart failure
C. Pericarditis
D. Myocardial infarction
Answer: A. Right-sided heart failure
Rationale: Right-sided heart failure causes systemic venous
congestion, resulting in JVD, peripheral edema,
hepatomegaly, and ascites. Left-sided failure causes
pulmonary congestion (crackles, dyspnea) .
5. A patient with heart failure is prescribed furosemide (Lasix).
Which electrolyte imbalance is a priority for the nurse to monitor?
,A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypermagnesemia
Answer: B. Hypokalemia
Rationale: Furosemide is a loop diuretic that causes
potassium wasting. Hypokalemia can lead to cardiac
arrhythmias and increase the risk of digoxin toxicity .
6. A patient with hypertension is prescribed lisinopril (Zestril).
Which finding indicates an adverse effect that should be reported?
A. Dry, nonproductive cough
B. Weight gain of 2 pounds in 2 days
C. Dizziness when standing
D. All of the above
Answer: D. All of the above
Rationale: Dry cough is a common side effect of ACE
inhibitors (due to bradykinin accumulation). Weight gain
may indicate fluid retention. Dizziness may indicate
hypotension. All should be reported .
7. The nurse is assessing a patient with peripheral arterial disease
(PAD). Which finding is expected?
A. Dependent rubor (redness when legs are dependent)
B. Edema and brownish skin discoloration
C. Warm, pink extremities
D. Bounding pulses
Answer: A. Dependent rubor (redness when legs are
dependent)
, Rationale: Dependent rubor is a sign of severe arterial
insufficiency. The affected extremity becomes pale when
elevated and red when dependent. Edema and brown
discoloration are signs of venous insufficiency .
8. A patient with varicose veins asks about prevention. Which
instruction is most appropriate?
A. "Cross your legs when sitting to improve circulation"
B. "Wear tight-fitting pants to support veins"
C. "Elevate your legs when resting and wear compression
stockings"
D. "Avoid walking because it increases pressure"
Answer: C. "Elevate your legs when resting and wear
compression stockings"
Rationale: Elevating legs promotes venous return.
Compression stockings provide external support to improve
venous circulation. Crossing legs impairs circulation .
9. A patient is prescribed warfarin (Coumadin) for atrial
fibrillation. Which statement by the patient indicates
understanding of the medication?
A. "I will increase my intake of green leafy vegetables"
B. "I will report any unusual bleeding or bruising to my provider"
C. "I can take aspirin for headaches because it is also a blood
thinner"
D. "I will stop this medication when my heart rhythm is normal"
Answer: B. "I will report any unusual bleeding or bruising to
my provider"
Rationale: Warfarin increases bleeding risk. Patients should
(2026) Complete A+ Guide with Rationales
1: Cardiovascular Disorders (Questions 1-50)
1. A patient is admitted with chest pain. The nurse understands
that the pain of myocardial infarction (MI) is caused by:
A. Inflammation of the pericardium
B. Obstruction of coronary blood flow leading to myocardial
ischemia
C. Spasm of the pulmonary artery
D. Rupture of the aortic valve
Answer: B. Obstruction of coronary blood flow leading to
myocardial ischemia
Rationale: Myocardial infarction occurs when coronary artery
blood flow is obstructed, causing ischemia and necrosis of
myocardial tissue. The resulting pain is from ischemic
myocardium releasing inflammatory mediators .
2. A patient with acute coronary syndrome (ACS) has ST-segment
elevation on ECG. Which intervention is most urgent?
A. Administer morphine for pain
B. Prepare for percutaneous coronary intervention (PCI)
C. Draw cardiac enzymes
D. Insert an indwelling urinary catheter
Answer: B. Prepare for percutaneous coronary intervention
(PCI)
Rationale: ST-elevation myocardial infarction (STEMI)
,requires immediate reperfusion therapy. PCI is the preferred
method if available within 90 minutes of presentation. Time
to reperfusion is critical for myocardial salvage .
3. The nurse is caring for a patient post-cardiac catheterization.
Which assessment finding requires immediate intervention?
A. Report of mild groin discomfort
B. Pulse distal to the insertion site 2+ and equal to other extremity
C. Expanding hematoma at the insertion site
D. Blood pressure 118/76 mmHg
Answer: C. Expanding hematoma at the insertion site
Rationale: An expanding hematoma indicates bleeding at the
arterial puncture site, which can lead to hemorrhage and
compartment syndrome. This requires immediate pressure
and notification of the provider .
4. A patient with heart failure has jugular venous distention (JVD)
and peripheral edema. These findings indicate:
A. Right-sided heart failure
B. Left-sided heart failure
C. Pericarditis
D. Myocardial infarction
Answer: A. Right-sided heart failure
Rationale: Right-sided heart failure causes systemic venous
congestion, resulting in JVD, peripheral edema,
hepatomegaly, and ascites. Left-sided failure causes
pulmonary congestion (crackles, dyspnea) .
5. A patient with heart failure is prescribed furosemide (Lasix).
Which electrolyte imbalance is a priority for the nurse to monitor?
,A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypermagnesemia
Answer: B. Hypokalemia
Rationale: Furosemide is a loop diuretic that causes
potassium wasting. Hypokalemia can lead to cardiac
arrhythmias and increase the risk of digoxin toxicity .
6. A patient with hypertension is prescribed lisinopril (Zestril).
Which finding indicates an adverse effect that should be reported?
A. Dry, nonproductive cough
B. Weight gain of 2 pounds in 2 days
C. Dizziness when standing
D. All of the above
Answer: D. All of the above
Rationale: Dry cough is a common side effect of ACE
inhibitors (due to bradykinin accumulation). Weight gain
may indicate fluid retention. Dizziness may indicate
hypotension. All should be reported .
7. The nurse is assessing a patient with peripheral arterial disease
(PAD). Which finding is expected?
A. Dependent rubor (redness when legs are dependent)
B. Edema and brownish skin discoloration
C. Warm, pink extremities
D. Bounding pulses
Answer: A. Dependent rubor (redness when legs are
dependent)
, Rationale: Dependent rubor is a sign of severe arterial
insufficiency. The affected extremity becomes pale when
elevated and red when dependent. Edema and brown
discoloration are signs of venous insufficiency .
8. A patient with varicose veins asks about prevention. Which
instruction is most appropriate?
A. "Cross your legs when sitting to improve circulation"
B. "Wear tight-fitting pants to support veins"
C. "Elevate your legs when resting and wear compression
stockings"
D. "Avoid walking because it increases pressure"
Answer: C. "Elevate your legs when resting and wear
compression stockings"
Rationale: Elevating legs promotes venous return.
Compression stockings provide external support to improve
venous circulation. Crossing legs impairs circulation .
9. A patient is prescribed warfarin (Coumadin) for atrial
fibrillation. Which statement by the patient indicates
understanding of the medication?
A. "I will increase my intake of green leafy vegetables"
B. "I will report any unusual bleeding or bruising to my provider"
C. "I can take aspirin for headaches because it is also a blood
thinner"
D. "I will stop this medication when my heart rhythm is normal"
Answer: B. "I will report any unusual bleeding or bruising to
my provider"
Rationale: Warfarin increases bleeding risk. Patients should
