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