Galen NUR 242 – MedSurg Nursing Exam Bank (2026/2027)
Galen NUR 242 Exams 1–4 – MedSurg Nursing (2026/2027)
Medical-Surgical Nursing Comprehensive Exam Bank
Complete Course Exam Bank Format | Expert-Aligned Structure
Total: 260 Questions Across 4 Unit Exams
This structured Galen NUR 242 Exams 1–4 Complete Exam Bank for 2026/2027 provides comprehensive
question sets for all four unit exams with correct answers and rationales. It encompasses the full spectrum of
medical-surgical nursing, from foundational concepts of fluid/electrolyte balance and perioperative care through
complex cardiovascular, respiratory, endocrine, renal, gastrointestinal, musculoskeletal, neurological, and
oncologic disorders, preparing students for course assessments, HESI/ATI specialty exams, and NCLEX-RN
licensure. Each question is presented in NCLEX-style format with clinical scenarios that test application and
analysis-level thinking. Correct answers are highlighted in bold cyan blue, accompanied by concise rationales
explaining the pathophysiological basis, priority nursing assessments, pharmacological interventions, diagnostic
data interpretation, and patient teaching points.
Answer Format: All correct answers appear in bold and cyan blue, accompanied by concise rationales
explaining the pathophysiological basis of the disorder, the priority nursing assessment for a given scenario, the
appropriate pharmacological intervention, the correct interpretation of diagnostic data, key patient teaching points,
and why alternative options are incorrect, contraindicated, or represent a lower priority in comprehensive medical-
surgical nursing care.
Exam 1: Foundations, Fluid/Electrolyte, Perioperative, Inflammation,
Pain Management & Integumentary
Domains: Fluid/Electrolyte/Acid-Base Imbalances, Perioperative Nursing, Inflammation & Infection, Pain
Management, Integumentary Disorders
Total Questions: 65 | Select the BEST answer for each question. Correct answers are indicated in bold cyan.
1. A client with heart failure is receiving furosemide (Lasix) intravenously. Which finding should the nurse
identify as the priority to report to the health care provider?
A. Blood pressure decrease from 130/80 to 118/74 mmHg
B. Serum potassium level of 2.8 mEq/L
C. Urine output of 400 mL over the past 4 hours
D. Serum sodium level of 138 mEq/L
Answer: B. Furosemide is a loop diuretic that causes potassium wasting, placing the client at risk for hypokalemia. A
potassium level of 2.8 mEq/L is critically low and increases the risk for lethal cardiac dysrhythmias, making it the
priority finding to report. The other findings are expected or within normal limits.
2. A nurse is reviewing the arterial blood gas (ABG) results of a client with chronic obstructive pulmonary disease
(COPD): pH 7.32, PaCO2 58 mmHg, HCO3- 32 mEq/L. Which interpretation of these results is correct?
A. Respiratory acidosis with partial compensation
B. Metabolic alkalosis with respiratory compensation
C. Respiratory alkalosis with metabolic compensation
D. Uncompensated respiratory acidosis
1
, Galen NUR 242 – MedSurg Nursing Exam Bank (2026/2027)
Answer: A. The pH is below 7.35 (acidosis), the PaCO2 is elevated (respiratory cause), and the HCO3- is elevated
(renal compensation). In COPD, the kidneys retain bicarbonate to compensate for chronic CO2 retention. Since the pH
is not yet normalized, this represents partial compensation.
3. A client presents with muscle weakness, paresthesias, and abdominal cramping. The nurse notes a serum
sodium level of 120 mEq/L. Which intervention should the nurse anticipate?
A. Administering 3% hypertonic saline intravenously
B. Infusing 0.9% normal saline at a rapid rate
C. Restricting all oral and IV fluid intake
D. Administering regular insulin with dextrose
Answer: A. The client has severe hyponatremia (normal 136-145 mEq/L) with neurologic and neuromuscular
manifestations. Hypertonic saline (3% NaCl) is indicated for symptomatic hyponatremia to safely raise serum sodium
levels. The sodium must be corrected slowly to avoid osmotic demyelination syndrome. Insulin with dextrose is used for
hyperkalemia, not hyponatremia.
4. A client with hypernatremia has a serum sodium level of 158 mEq/L. Which clinical manifestation is most
consistent with this electrolyte imbalance?
A. Diminished deep tendon reflexes
B. Lethargy and confusion
C. Bounding pulse and flushed skin
D. Bradycardia and hypotension
Answer: B. Hypernatremia causes water to shift out of cells by osmosis, leading to cellular dehydration. Cerebral cells
are most sensitive, producing neurologic symptoms such as lethargy, confusion, restlessness, and in severe cases
seizures or coma. Bounding pulse and flushed skin are associated with hyperkalemia, and diminished reflexes are seen
with hypokalemia.
5. The nurse is caring for a client with a serum potassium level of 6.8 mEq/L. Which action should the nurse take
first?
A. Administer oral potassium binders as prescribed
B. Place the client on a cardiac monitor immediately
C. Prepare to administer intravenous calcium gluconate
D. Restrict potassium intake in the diet
Answer: B. A potassium level of 6.8 mEq/L is critically high and can cause life-threatening cardiac dysrhythmias,
including peaked T waves, widened QRS complexes, and ventricular fibrillation. The first priority is continuous cardiac
monitoring to detect lethal arrhythmias. Calcium gluconate may then be administered to stabilize the cardiac
membrane, but monitoring must be established first.
6. A client with chronic kidney disease reports muscle cramps and tingling around the mouth. The nurse observes
positive Chvostek's and Trousseau's signs. Which electrolyte imbalance should the nurse suspect?
A. Hypercalcemia
B. Hypocalcemia
C. Hypermagnesemia
2
, Galen NUR 242 – MedSurg Nursing Exam Bank (2026/2027)
D. Hypomagnesemia
Answer: B. Positive Chvostek's sign (facial muscle twitching when the facial nerve is tapped) and Trousseau's sign
(carpal spasm when a blood pressure cuff is inflated) are classic indicators of hypocalcemia. In chronic kidney disease,
the kidneys cannot activate vitamin D or excrete phosphate adequately, leading to decreased serum calcium. Muscle
cramps and perioral tingling are early neuromuscular signs.
7. A client who has been taking antacids containing calcium carbonate multiple times daily for several weeks
presents with nausea, vomiting, polyuria, and flank pain. Serum calcium is 13.2 mg/dL. Which nursing
intervention is the priority?
A. Encourage increased fluid intake and ambulation
B. Administer calcitonin as prescribed
C. Begin continuous cardiac monitoring
D. Monitor intake and output strictly
Answer: C. The client has hypercalcemia (normal 8.5-10.5 mg/dL) caused by excessive calcium intake from antacids.
Hypercalcemia directly affects cardiac conduction, shortening the QT interval and predisposing to lethal dysrhythmias.
Although all interventions may be appropriate, continuous cardiac monitoring is the priority to detect and respond to
cardiac complications. Calcitonin lowers serum calcium but monitoring takes precedence.
8. A nurse is interpreting the following ABG results: pH 7.50, PaCO2 30 mmHg, HCO3- 24 mEq/L. Which
condition does this represent?
A. Metabolic alkalosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Respiratory acidosis
Answer: B. The pH is above 7.45 (alkalosis), and the PaCO2 is below 35 mmHg, indicating the respiratory system is
the cause of the alkalosis. The HCO3- is within the normal range, indicating this is an uncompensated respiratory
alkalosis. This pattern is commonly seen with hyperventilation, anxiety, pain, or early respiratory stimulant use.
9. A client is receiving intravenous potassium replacement at 10 mEq/hr. Which assessment finding requires the
nurse to immediately stop the infusion and notify the provider?
A. The client reports pain at the IV site
B. Serum potassium increases from 3.0 to 3.4 mEq/L
C. The client develops peaked T waves on the cardiac monitor
D. Urine output is 20 mL/hr
Answer: C. Peaked T waves are an early sign of hyperkalemia and indicate that the potassium infusion may be causing
dangerously elevated serum potassium levels, placing the client at risk for lethal cardiac dysrhythmias. The infusion
must be stopped immediately. Although pain at the IV site, oliguria, and rising potassium require attention, peaked T
waves signal a life-threatening complication.
10. A client with severe burns is experiencing massive fluid loss. The nurse understands that which type of fluid
shift is occurring during the emergent phase of burn injury?
A. Fluid moves from the intracellular space to the interstitial space
3
, Galen NUR 242 – MedSurg Nursing Exam Bank (2026/2027)
B. Fluid shifts from the vascular space into the interstitial and intracellular spaces
C. Fluid moves from the interstitial space into the vascular space
D. Fluid shifts from the vascular space into the intracellular space only
Answer: B. During the emergent (resuscitation) phase of burn injury, increased capillary permeability allows plasma
proteins and fluid to escape from the vascular compartment into the interstitial and intracellular spaces, causing
massive edema and hypovolemia. This fluid shift is the primary cause of burn shock and is addressed by aggressive
fluid resuscitation.
11. A client with hypomagnesemia has a serum magnesium level of 1.0 mg/dL. Which finding should the nurse
most closely monitor for?
A. Hyperactive deep tendon reflexes and tetany
B. Hypoactive bowel sounds and constipation
C. Decreased respiratory rate and bradypnea
D. Elevated blood pressure and tachycardia
Answer: A. Hypomagnesemia (normal 1.7-2.2 mg/dL) causes increased neuromuscular excitability, leading to
hyperactive reflexes, muscle tremors, tetany, and even seizures. Because magnesium normally inhibits neuromuscular
transmission, low levels remove this inhibition. Hypomagnesemia is also frequently associated with hypocalcemia and
hypokalemia, which further contribute to these neuromuscular symptoms.
12. A client receiving total parenteral nutrition (TPN) develops sudden onset of confusion, lethargy, and a seizure.
Laboratory results reveal a serum sodium of 125 mEq/L. The nurse recognizes that the client likely developed
which condition?
A. Hyperosmolar hyperglycemic state
B. Rapid correction of hypernatremia
C. Fluid overload from TPN
D. Osmotic demyelination syndrome
Answer: D. Osmotic demyelination syndrome (central pontine myelinolysis) can occur when hyponatremia is corrected
too rapidly, typically exceeding 10-12 mEq/L in 24 hours. This causes demyelination of neurons in the pons and other
brain regions, producing neurologic symptoms including confusion, lethargy, seizures, and potentially locked-in
syndrome. Sodium correction must occur gradually.
13. The nurse is caring for a client who is vomiting frequently. Which ABG result would the nurse expect to find?
A. pH 7.48, PaCO2 48 mmHg, HCO3- 38 mEq/L
B. pH 7.30, PaCO2 35 mmHg, HCO3- 18 mEq/L
C. pH 7.48, PaCO2 30 mmHg, HCO3- 24 mEq/L
D. pH 7.32, PaCO2 50 mmHg, HCO3- 26 mEq/L
Answer: A. Frequent vomiting causes loss of gastric hydrochloric acid, leading to metabolic alkalosis with an elevated
pH and elevated bicarbonate. The PaCO2 is also elevated because the respiratory system compensates by
hypoventilating to retain CO2. This represents metabolic alkalosis with partial respiratory compensation, commonly
seen with prolonged vomiting or nasogastric suction.
4
Galen NUR 242 Exams 1–4 – MedSurg Nursing (2026/2027)
Medical-Surgical Nursing Comprehensive Exam Bank
Complete Course Exam Bank Format | Expert-Aligned Structure
Total: 260 Questions Across 4 Unit Exams
This structured Galen NUR 242 Exams 1–4 Complete Exam Bank for 2026/2027 provides comprehensive
question sets for all four unit exams with correct answers and rationales. It encompasses the full spectrum of
medical-surgical nursing, from foundational concepts of fluid/electrolyte balance and perioperative care through
complex cardiovascular, respiratory, endocrine, renal, gastrointestinal, musculoskeletal, neurological, and
oncologic disorders, preparing students for course assessments, HESI/ATI specialty exams, and NCLEX-RN
licensure. Each question is presented in NCLEX-style format with clinical scenarios that test application and
analysis-level thinking. Correct answers are highlighted in bold cyan blue, accompanied by concise rationales
explaining the pathophysiological basis, priority nursing assessments, pharmacological interventions, diagnostic
data interpretation, and patient teaching points.
Answer Format: All correct answers appear in bold and cyan blue, accompanied by concise rationales
explaining the pathophysiological basis of the disorder, the priority nursing assessment for a given scenario, the
appropriate pharmacological intervention, the correct interpretation of diagnostic data, key patient teaching points,
and why alternative options are incorrect, contraindicated, or represent a lower priority in comprehensive medical-
surgical nursing care.
Exam 1: Foundations, Fluid/Electrolyte, Perioperative, Inflammation,
Pain Management & Integumentary
Domains: Fluid/Electrolyte/Acid-Base Imbalances, Perioperative Nursing, Inflammation & Infection, Pain
Management, Integumentary Disorders
Total Questions: 65 | Select the BEST answer for each question. Correct answers are indicated in bold cyan.
1. A client with heart failure is receiving furosemide (Lasix) intravenously. Which finding should the nurse
identify as the priority to report to the health care provider?
A. Blood pressure decrease from 130/80 to 118/74 mmHg
B. Serum potassium level of 2.8 mEq/L
C. Urine output of 400 mL over the past 4 hours
D. Serum sodium level of 138 mEq/L
Answer: B. Furosemide is a loop diuretic that causes potassium wasting, placing the client at risk for hypokalemia. A
potassium level of 2.8 mEq/L is critically low and increases the risk for lethal cardiac dysrhythmias, making it the
priority finding to report. The other findings are expected or within normal limits.
2. A nurse is reviewing the arterial blood gas (ABG) results of a client with chronic obstructive pulmonary disease
(COPD): pH 7.32, PaCO2 58 mmHg, HCO3- 32 mEq/L. Which interpretation of these results is correct?
A. Respiratory acidosis with partial compensation
B. Metabolic alkalosis with respiratory compensation
C. Respiratory alkalosis with metabolic compensation
D. Uncompensated respiratory acidosis
1
, Galen NUR 242 – MedSurg Nursing Exam Bank (2026/2027)
Answer: A. The pH is below 7.35 (acidosis), the PaCO2 is elevated (respiratory cause), and the HCO3- is elevated
(renal compensation). In COPD, the kidneys retain bicarbonate to compensate for chronic CO2 retention. Since the pH
is not yet normalized, this represents partial compensation.
3. A client presents with muscle weakness, paresthesias, and abdominal cramping. The nurse notes a serum
sodium level of 120 mEq/L. Which intervention should the nurse anticipate?
A. Administering 3% hypertonic saline intravenously
B. Infusing 0.9% normal saline at a rapid rate
C. Restricting all oral and IV fluid intake
D. Administering regular insulin with dextrose
Answer: A. The client has severe hyponatremia (normal 136-145 mEq/L) with neurologic and neuromuscular
manifestations. Hypertonic saline (3% NaCl) is indicated for symptomatic hyponatremia to safely raise serum sodium
levels. The sodium must be corrected slowly to avoid osmotic demyelination syndrome. Insulin with dextrose is used for
hyperkalemia, not hyponatremia.
4. A client with hypernatremia has a serum sodium level of 158 mEq/L. Which clinical manifestation is most
consistent with this electrolyte imbalance?
A. Diminished deep tendon reflexes
B. Lethargy and confusion
C. Bounding pulse and flushed skin
D. Bradycardia and hypotension
Answer: B. Hypernatremia causes water to shift out of cells by osmosis, leading to cellular dehydration. Cerebral cells
are most sensitive, producing neurologic symptoms such as lethargy, confusion, restlessness, and in severe cases
seizures or coma. Bounding pulse and flushed skin are associated with hyperkalemia, and diminished reflexes are seen
with hypokalemia.
5. The nurse is caring for a client with a serum potassium level of 6.8 mEq/L. Which action should the nurse take
first?
A. Administer oral potassium binders as prescribed
B. Place the client on a cardiac monitor immediately
C. Prepare to administer intravenous calcium gluconate
D. Restrict potassium intake in the diet
Answer: B. A potassium level of 6.8 mEq/L is critically high and can cause life-threatening cardiac dysrhythmias,
including peaked T waves, widened QRS complexes, and ventricular fibrillation. The first priority is continuous cardiac
monitoring to detect lethal arrhythmias. Calcium gluconate may then be administered to stabilize the cardiac
membrane, but monitoring must be established first.
6. A client with chronic kidney disease reports muscle cramps and tingling around the mouth. The nurse observes
positive Chvostek's and Trousseau's signs. Which electrolyte imbalance should the nurse suspect?
A. Hypercalcemia
B. Hypocalcemia
C. Hypermagnesemia
2
, Galen NUR 242 – MedSurg Nursing Exam Bank (2026/2027)
D. Hypomagnesemia
Answer: B. Positive Chvostek's sign (facial muscle twitching when the facial nerve is tapped) and Trousseau's sign
(carpal spasm when a blood pressure cuff is inflated) are classic indicators of hypocalcemia. In chronic kidney disease,
the kidneys cannot activate vitamin D or excrete phosphate adequately, leading to decreased serum calcium. Muscle
cramps and perioral tingling are early neuromuscular signs.
7. A client who has been taking antacids containing calcium carbonate multiple times daily for several weeks
presents with nausea, vomiting, polyuria, and flank pain. Serum calcium is 13.2 mg/dL. Which nursing
intervention is the priority?
A. Encourage increased fluid intake and ambulation
B. Administer calcitonin as prescribed
C. Begin continuous cardiac monitoring
D. Monitor intake and output strictly
Answer: C. The client has hypercalcemia (normal 8.5-10.5 mg/dL) caused by excessive calcium intake from antacids.
Hypercalcemia directly affects cardiac conduction, shortening the QT interval and predisposing to lethal dysrhythmias.
Although all interventions may be appropriate, continuous cardiac monitoring is the priority to detect and respond to
cardiac complications. Calcitonin lowers serum calcium but monitoring takes precedence.
8. A nurse is interpreting the following ABG results: pH 7.50, PaCO2 30 mmHg, HCO3- 24 mEq/L. Which
condition does this represent?
A. Metabolic alkalosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Respiratory acidosis
Answer: B. The pH is above 7.45 (alkalosis), and the PaCO2 is below 35 mmHg, indicating the respiratory system is
the cause of the alkalosis. The HCO3- is within the normal range, indicating this is an uncompensated respiratory
alkalosis. This pattern is commonly seen with hyperventilation, anxiety, pain, or early respiratory stimulant use.
9. A client is receiving intravenous potassium replacement at 10 mEq/hr. Which assessment finding requires the
nurse to immediately stop the infusion and notify the provider?
A. The client reports pain at the IV site
B. Serum potassium increases from 3.0 to 3.4 mEq/L
C. The client develops peaked T waves on the cardiac monitor
D. Urine output is 20 mL/hr
Answer: C. Peaked T waves are an early sign of hyperkalemia and indicate that the potassium infusion may be causing
dangerously elevated serum potassium levels, placing the client at risk for lethal cardiac dysrhythmias. The infusion
must be stopped immediately. Although pain at the IV site, oliguria, and rising potassium require attention, peaked T
waves signal a life-threatening complication.
10. A client with severe burns is experiencing massive fluid loss. The nurse understands that which type of fluid
shift is occurring during the emergent phase of burn injury?
A. Fluid moves from the intracellular space to the interstitial space
3
, Galen NUR 242 – MedSurg Nursing Exam Bank (2026/2027)
B. Fluid shifts from the vascular space into the interstitial and intracellular spaces
C. Fluid moves from the interstitial space into the vascular space
D. Fluid shifts from the vascular space into the intracellular space only
Answer: B. During the emergent (resuscitation) phase of burn injury, increased capillary permeability allows plasma
proteins and fluid to escape from the vascular compartment into the interstitial and intracellular spaces, causing
massive edema and hypovolemia. This fluid shift is the primary cause of burn shock and is addressed by aggressive
fluid resuscitation.
11. A client with hypomagnesemia has a serum magnesium level of 1.0 mg/dL. Which finding should the nurse
most closely monitor for?
A. Hyperactive deep tendon reflexes and tetany
B. Hypoactive bowel sounds and constipation
C. Decreased respiratory rate and bradypnea
D. Elevated blood pressure and tachycardia
Answer: A. Hypomagnesemia (normal 1.7-2.2 mg/dL) causes increased neuromuscular excitability, leading to
hyperactive reflexes, muscle tremors, tetany, and even seizures. Because magnesium normally inhibits neuromuscular
transmission, low levels remove this inhibition. Hypomagnesemia is also frequently associated with hypocalcemia and
hypokalemia, which further contribute to these neuromuscular symptoms.
12. A client receiving total parenteral nutrition (TPN) develops sudden onset of confusion, lethargy, and a seizure.
Laboratory results reveal a serum sodium of 125 mEq/L. The nurse recognizes that the client likely developed
which condition?
A. Hyperosmolar hyperglycemic state
B. Rapid correction of hypernatremia
C. Fluid overload from TPN
D. Osmotic demyelination syndrome
Answer: D. Osmotic demyelination syndrome (central pontine myelinolysis) can occur when hyponatremia is corrected
too rapidly, typically exceeding 10-12 mEq/L in 24 hours. This causes demyelination of neurons in the pons and other
brain regions, producing neurologic symptoms including confusion, lethargy, seizures, and potentially locked-in
syndrome. Sodium correction must occur gradually.
13. The nurse is caring for a client who is vomiting frequently. Which ABG result would the nurse expect to find?
A. pH 7.48, PaCO2 48 mmHg, HCO3- 38 mEq/L
B. pH 7.30, PaCO2 35 mmHg, HCO3- 18 mEq/L
C. pH 7.48, PaCO2 30 mmHg, HCO3- 24 mEq/L
D. pH 7.32, PaCO2 50 mmHg, HCO3- 26 mEq/L
Answer: A. Frequent vomiting causes loss of gastric hydrochloric acid, leading to metabolic alkalosis with an elevated
pH and elevated bicarbonate. The PaCO2 is also elevated because the respiratory system compensates by
hypoventilating to retain CO2. This represents metabolic alkalosis with partial respiratory compensation, commonly
seen with prolonged vomiting or nasogastric suction.
4
