NUR 242 Exam 2 – Med-Surg Concepts (2026)
Galen College of Nursing | Actual Questions &
Answers with Rationales
Section 1: Cardiovascular Disorders – Hypertension and Heart Failure
(Questions 1-70)
1. A patient with hypertension has a blood pressure of 150/95 mmHg. The
nurse understands that this reading is classified as:
A. Normal
B. Elevated
C. Stage 1 hypertension
D. Stage 2 hypertension
Answer: C. Stage 1 hypertension
Rationale: Stage 1 hypertension is defined as systolic 130-139 or
diastolic 80-89. Stage 2 is ≥140/90 .
2. 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 .
3. A patient with hypertension is prescribed hydrochlorothiazide (HCTZ).
Which electrolyte imbalance should the nurse monitor?
A. Hypokalemia
,B. Hyperkalemia
C. Hyponatremia
D. Hypercalcemia
Answer: A. Hypokalemia
Rationale: Thiazide diuretics cause potassium wasting. Hypokalemia
can cause muscle weakness and cardiac arrhythmias .
4. A patient with hypertension is prescribed spironolactone (Aldactone).
Which finding requires immediate intervention?
A. Serum potassium 5.8 mEq/L
B. Serum sodium 138 mEq/L
C. Blood pressure 130/80 mmHg
D. Weight loss of 2 pounds
Answer: A. Serum potassium 5.8 mEq/L
Rationale: Spironolactone is a potassium-sparing diuretic.
Hyperkalemia (K+ >5.0) is a serious adverse effect .
5. A patient with heart failure has an ejection fraction of 30%. The nurse
understands that this indicates:
A. Heart failure with reduced ejection fraction (HFrEF)
B. Heart failure with preserved ejection fraction (HFpEF)
C. Normal heart function
D. Diastolic heart failure
Answer: A. Heart failure with reduced ejection fraction (HFrEF)
Rationale: HFrEF is defined by EF ≤40%. HFpEF has EF ≥50% .
6. 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, and hepatomegaly .
7. A patient with heart failure has crackles in the lung bases and orthopnea.
These findings indicate:
A. Left-sided heart failure
B. Right-sided heart failure
C. Pericarditis
D. Myocardial infarction
Answer: A. Left-sided heart failure
Rationale: Left-sided heart failure causes pulmonary congestion,
leading to crackles, dyspnea, and orthopnea .
8. A patient with heart failure is prescribed furosemide (Lasix). Which
assessment is most important?
A. Daily weight
B. Intake and output
C. Potassium level
D. All of the above
Answer: D. All of the above
Rationale: Furosemide causes diuresis and potassium loss; monitor
weight, I&O, and electrolytes .
9. A patient with heart failure is on a 2,000 mL fluid restriction. Which
breakfast choice is most appropriate?
A. Dry toast, eggs, coffee (4 oz)
B. Cereal with milk, orange juice
C. Oatmeal, milk, tea
D. Smoothie, yogurt
Answer: A. Dry toast, eggs, coffee (4 oz)
Rationale: Fluids include all liquids; dry toast and eggs have minimal
fluid content .
, 10. A patient with heart failure is prescribed digoxin (Lanoxin). Which sign
of toxicity should the patient report?
A. Yellow-green halos around lights
B. Increased appetite
C. Weight gain
D. Constipation
Answer: A. Yellow-green halos around lights
Rationale: Visual disturbances (yellow-green halos) are classic signs of
digoxin toxicity .
11. A patient taking digoxin has a potassium level of 3.0 mEq/L. The nurse is
concerned because:
A. Hypokalemia increases risk of digoxin toxicity
B. Hypokalemia decreases digoxin effect
C. Hyperkalemia increases risk of toxicity
D. No effect on digoxin
Answer: A. Hypokalemia increases risk of digoxin toxicity
Rationale: Hypokalemia enhances digoxin binding to cardiac Na+/K+
ATPase, increasing toxicity risk .
12. A patient with heart failure is prescribed carvedilol (Coreg). The nurse
understands that beta-blockers in heart failure:
A. Decrease myocardial oxygen demand and reduce remodeling
B. Increase heart rate
C. Increase contractility
D. Cause bronchodilation
Answer: A. Decrease myocardial oxygen demand and reduce remodeling
Rationale: Beta-blockers decrease heart rate and contractility, reducing
oxygen demand and preventing adverse remodeling .
13. A patient with heart failure is prescribed an ACE inhibitor. Which finding
indicates a therapeutic effect?
A. Decreased blood pressure, decreased dyspnea
Galen College of Nursing | Actual Questions &
Answers with Rationales
Section 1: Cardiovascular Disorders – Hypertension and Heart Failure
(Questions 1-70)
1. A patient with hypertension has a blood pressure of 150/95 mmHg. The
nurse understands that this reading is classified as:
A. Normal
B. Elevated
C. Stage 1 hypertension
D. Stage 2 hypertension
Answer: C. Stage 1 hypertension
Rationale: Stage 1 hypertension is defined as systolic 130-139 or
diastolic 80-89. Stage 2 is ≥140/90 .
2. 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 .
3. A patient with hypertension is prescribed hydrochlorothiazide (HCTZ).
Which electrolyte imbalance should the nurse monitor?
A. Hypokalemia
,B. Hyperkalemia
C. Hyponatremia
D. Hypercalcemia
Answer: A. Hypokalemia
Rationale: Thiazide diuretics cause potassium wasting. Hypokalemia
can cause muscle weakness and cardiac arrhythmias .
4. A patient with hypertension is prescribed spironolactone (Aldactone).
Which finding requires immediate intervention?
A. Serum potassium 5.8 mEq/L
B. Serum sodium 138 mEq/L
C. Blood pressure 130/80 mmHg
D. Weight loss of 2 pounds
Answer: A. Serum potassium 5.8 mEq/L
Rationale: Spironolactone is a potassium-sparing diuretic.
Hyperkalemia (K+ >5.0) is a serious adverse effect .
5. A patient with heart failure has an ejection fraction of 30%. The nurse
understands that this indicates:
A. Heart failure with reduced ejection fraction (HFrEF)
B. Heart failure with preserved ejection fraction (HFpEF)
C. Normal heart function
D. Diastolic heart failure
Answer: A. Heart failure with reduced ejection fraction (HFrEF)
Rationale: HFrEF is defined by EF ≤40%. HFpEF has EF ≥50% .
6. 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, and hepatomegaly .
7. A patient with heart failure has crackles in the lung bases and orthopnea.
These findings indicate:
A. Left-sided heart failure
B. Right-sided heart failure
C. Pericarditis
D. Myocardial infarction
Answer: A. Left-sided heart failure
Rationale: Left-sided heart failure causes pulmonary congestion,
leading to crackles, dyspnea, and orthopnea .
8. A patient with heart failure is prescribed furosemide (Lasix). Which
assessment is most important?
A. Daily weight
B. Intake and output
C. Potassium level
D. All of the above
Answer: D. All of the above
Rationale: Furosemide causes diuresis and potassium loss; monitor
weight, I&O, and electrolytes .
9. A patient with heart failure is on a 2,000 mL fluid restriction. Which
breakfast choice is most appropriate?
A. Dry toast, eggs, coffee (4 oz)
B. Cereal with milk, orange juice
C. Oatmeal, milk, tea
D. Smoothie, yogurt
Answer: A. Dry toast, eggs, coffee (4 oz)
Rationale: Fluids include all liquids; dry toast and eggs have minimal
fluid content .
, 10. A patient with heart failure is prescribed digoxin (Lanoxin). Which sign
of toxicity should the patient report?
A. Yellow-green halos around lights
B. Increased appetite
C. Weight gain
D. Constipation
Answer: A. Yellow-green halos around lights
Rationale: Visual disturbances (yellow-green halos) are classic signs of
digoxin toxicity .
11. A patient taking digoxin has a potassium level of 3.0 mEq/L. The nurse is
concerned because:
A. Hypokalemia increases risk of digoxin toxicity
B. Hypokalemia decreases digoxin effect
C. Hyperkalemia increases risk of toxicity
D. No effect on digoxin
Answer: A. Hypokalemia increases risk of digoxin toxicity
Rationale: Hypokalemia enhances digoxin binding to cardiac Na+/K+
ATPase, increasing toxicity risk .
12. A patient with heart failure is prescribed carvedilol (Coreg). The nurse
understands that beta-blockers in heart failure:
A. Decrease myocardial oxygen demand and reduce remodeling
B. Increase heart rate
C. Increase contractility
D. Cause bronchodilation
Answer: A. Decrease myocardial oxygen demand and reduce remodeling
Rationale: Beta-blockers decrease heart rate and contractility, reducing
oxygen demand and preventing adverse remodeling .
13. A patient with heart failure is prescribed an ACE inhibitor. Which finding
indicates a therapeutic effect?
A. Decreased blood pressure, decreased dyspnea
