1
NUR 265 Exam 1 Medical Surgical Nursing
Galen College Actual Exam 2026/2027 –
Complete Exam-Style Questions with Detailed
Rationales | Pass Guaranteed – A+ Graded
[SECTION 1: Cardiovascular Disorders — Questions 1-20]
Q1: A patient with heart failure reports a weight gain of 2 kg (4.4 lbs) over the last two days. The
patient notes shortness of breath when lying flat (orthopnea). Based on these findings, which
physiological change is the primary cause of the weight gain and symptoms?
A. Increased appetite and caloric intake
B. Fluid retention and increased preload
C. Muscle wasting due to cardiac cachexia
D. Increased metabolic rate due to fever
Correct Answer: B
Rationale: In heart failure, the heart's reduced pumping efficiency triggers compensatory
mechanisms like the renin-angiotensin-aldosterone system (RAAS), leading to sodium and water
retention. This fluid retention increases intravascular volume and preload, resulting in rapid
weight gain (fluid accumulation) and pulmonary congestion, which manifests as orthopnea.
Options A, C, and D are incorrect because weight gain in HF is specifically fluid overload, not
fat gain, muscle loss, or metabolic changes.
Q2: The nurse is teaching a patient prescribed Furosemide (Lasix) for heart failure. Which
instruction is most critical for the nurse to include regarding potential side effects?
A. "Drink at least 3 liters of water daily to prevent dehydration."
B. "Report any ringing in the ears or hearing changes immediately."
C. "Take this medication at bedtime to maximize its diuretic effect."
D. "Expect a significant increase in your blood sugar levels."
,2
Correct Answer: B
Rationale: Furosemide is a loop diuretic associated with ototoxicity, particularly when
administered in high doses or rapidly IV. Patients must be instructed to report tinnitus (ringing in
the ears) or hearing loss immediately so the medication can be adjusted or discontinued to
prevent permanent damage. Option A is incorrect because while hydration is important,
excessive fluid intake contradicts fluid restriction often needed in HF; Option C is incorrect
because diuretics should be taken in the morning to prevent nocturia; Option D is incorrect
because while it may cause hyperglycemia, ototoxicity is the more immediate and critical safety
alert.
Q3: A patient with Heart Failure with Reduced Ejection Fraction (HFrEF) is prescribed
Lisinopril. The nurse monitors the patient for which common adverse effect of this medication?
A. Persistent dry, non-productive cough
B. Reflex tachycardia
C. Hyperkalemia
D. First-degree atrioventricular block
Correct Answer: A
Rationale: Lisinopril is an ACE inhibitor, which inhibits the breakdown of bradykinin, leading to
a persistent dry cough in a significant percentage of patients. This is a classic side effect
distinguishing ACEi from ARBs. While hyperkalemia (Option C) is also a potential side effect of
ACE inhibitors, the cough is the most distinctive and common adverse effect requiring
monitoring for medication adherence. Options B and D are less commonly associated directly
with ACE inhibitors compared to beta-blockers or calcium channel blockers.
Q4: During assessment of a patient with heart failure, the nurse auscultates a third heart sound
(S3 gallop). What does this finding indicate?
A. Increased contractility of the left ventricle
B. Normal physiologic finding in healthy adults
C. Rapid ventricular filling into a stiff, non-compliant ventricle
D. Aortic stenosis causing turbulent flow
,3
Correct Answer: C
Rationale: An S3 gallop is caused by blood rushing into a distended, non-compliant ventricle
during rapid filling (diastole). It is a classic sign of heart failure and volume overload. Option A
is incorrect because contractility is typically decreased in HF. Option B is incorrect because an
S3 is pathological in adults (though normal in children/athletes). Option D describes murmurs
associated with valvular disorders like aortic stenosis, not an S3.
Q5: The nurse is administering Digoxin to a patient with atrial fibrillation and heart failure.
Which finding indicates the medication is therapeutic rather than toxic?
A. Serum digoxin level of 2.5 ng/mL
B. Heart rate of 68 beats per minute
C. Complaints of nausea and vomiting
D. Visual disturbances of yellow halos
Correct Answer: B
Rationale: The therapeutic range for digoxin is narrow (0.5–0.8 ng/mL or up to 1.0-2.0 ng/mL in
some texts, but lower for HF). Therapeutic effects in atrial fibrillation include controlling
ventricular rate (negative chronotropic effect). A heart rate of 68 bpm indicates rate control.
Options A, C, and D are incorrect because a serum level >2.0 ng/mL, nausea/vomiting, and
visual halos are all classic signs of digoxin toxicity.
Q6: A patient is admitted with Acute Coronary Syndrome (ACS) and reports chest pain. The
nurse administers sublingual nitroglycerin. What is the primary mechanism of action of
nitroglycerin?
A. Increases myocardial contractility
B. Dilates veins and arteries to reduce preload and afterload
C. Prevents platelet aggregation
D. Dissolves the coronary thrombus
Correct Answer: B
, 4
Rationale: Nitroglycerin is a vasodilator that primarily dilates veins (reducing preload) and
arteries (reducing afterload). This decreases myocardial oxygen demand and relieves ischemic
chest pain. Option A is incorrect because it does not increase contractility; it may actually lower
reflexively. Option C describes antiplatelets (e.g., aspirin/clopidogrel). Option D describes
fibrinolytics (e.g., tPA).
Q7: A patient presents to the Emergency Department with chest pain. The 12-lead ECG shows
ST-segment elevation in leads V3 and V4. The nurse recognizes this indicates which type of
myocardial infarction (MI) and prepares for which immediate intervention?
A. Non-ST-elevation MI (NSTEMI); administration of heparin drip
B. ST-elevation MI (STEMI); preparation for immediate percutaneous coronary intervention
(PCI)
C. Unstable angina; administration of troponin levels only
D. Stable angina; administration of oral nitroglycerin
Correct Answer: B
Rationale: ST-segment elevation in two contiguous leads (V3, V4 indicate anterior wall)
confirms a STEMI. The standard of care is immediate reperfusion therapy, preferably
Percutaneous Coronary Intervention (PCI) within 90 minutes of first medical contact (door-to-
balloon time). Option A and C involve NSTEMI/Unstable angina which are managed medically
or with urgent PCI later, not emergently. Option D is incorrect for acute MI presentation.
Q8: The nurse is caring for a patient with hypertension. Which instruction is consistent with the
Dietary Approaches to Stop Hypertension (DASH) diet?
A. Limit sodium intake to less than 2,300 mg/day (or 1,500 mg if possible)
B. Increase intake of red meats and full-fat dairy products
C. Restrict all fruits and vegetables due to potassium content
D. Consume a high-protein, low-carbohydrate diet only
Correct Answer: A
NUR 265 Exam 1 Medical Surgical Nursing
Galen College Actual Exam 2026/2027 –
Complete Exam-Style Questions with Detailed
Rationales | Pass Guaranteed – A+ Graded
[SECTION 1: Cardiovascular Disorders — Questions 1-20]
Q1: A patient with heart failure reports a weight gain of 2 kg (4.4 lbs) over the last two days. The
patient notes shortness of breath when lying flat (orthopnea). Based on these findings, which
physiological change is the primary cause of the weight gain and symptoms?
A. Increased appetite and caloric intake
B. Fluid retention and increased preload
C. Muscle wasting due to cardiac cachexia
D. Increased metabolic rate due to fever
Correct Answer: B
Rationale: In heart failure, the heart's reduced pumping efficiency triggers compensatory
mechanisms like the renin-angiotensin-aldosterone system (RAAS), leading to sodium and water
retention. This fluid retention increases intravascular volume and preload, resulting in rapid
weight gain (fluid accumulation) and pulmonary congestion, which manifests as orthopnea.
Options A, C, and D are incorrect because weight gain in HF is specifically fluid overload, not
fat gain, muscle loss, or metabolic changes.
Q2: The nurse is teaching a patient prescribed Furosemide (Lasix) for heart failure. Which
instruction is most critical for the nurse to include regarding potential side effects?
A. "Drink at least 3 liters of water daily to prevent dehydration."
B. "Report any ringing in the ears or hearing changes immediately."
C. "Take this medication at bedtime to maximize its diuretic effect."
D. "Expect a significant increase in your blood sugar levels."
,2
Correct Answer: B
Rationale: Furosemide is a loop diuretic associated with ototoxicity, particularly when
administered in high doses or rapidly IV. Patients must be instructed to report tinnitus (ringing in
the ears) or hearing loss immediately so the medication can be adjusted or discontinued to
prevent permanent damage. Option A is incorrect because while hydration is important,
excessive fluid intake contradicts fluid restriction often needed in HF; Option C is incorrect
because diuretics should be taken in the morning to prevent nocturia; Option D is incorrect
because while it may cause hyperglycemia, ototoxicity is the more immediate and critical safety
alert.
Q3: A patient with Heart Failure with Reduced Ejection Fraction (HFrEF) is prescribed
Lisinopril. The nurse monitors the patient for which common adverse effect of this medication?
A. Persistent dry, non-productive cough
B. Reflex tachycardia
C. Hyperkalemia
D. First-degree atrioventricular block
Correct Answer: A
Rationale: Lisinopril is an ACE inhibitor, which inhibits the breakdown of bradykinin, leading to
a persistent dry cough in a significant percentage of patients. This is a classic side effect
distinguishing ACEi from ARBs. While hyperkalemia (Option C) is also a potential side effect of
ACE inhibitors, the cough is the most distinctive and common adverse effect requiring
monitoring for medication adherence. Options B and D are less commonly associated directly
with ACE inhibitors compared to beta-blockers or calcium channel blockers.
Q4: During assessment of a patient with heart failure, the nurse auscultates a third heart sound
(S3 gallop). What does this finding indicate?
A. Increased contractility of the left ventricle
B. Normal physiologic finding in healthy adults
C. Rapid ventricular filling into a stiff, non-compliant ventricle
D. Aortic stenosis causing turbulent flow
,3
Correct Answer: C
Rationale: An S3 gallop is caused by blood rushing into a distended, non-compliant ventricle
during rapid filling (diastole). It is a classic sign of heart failure and volume overload. Option A
is incorrect because contractility is typically decreased in HF. Option B is incorrect because an
S3 is pathological in adults (though normal in children/athletes). Option D describes murmurs
associated with valvular disorders like aortic stenosis, not an S3.
Q5: The nurse is administering Digoxin to a patient with atrial fibrillation and heart failure.
Which finding indicates the medication is therapeutic rather than toxic?
A. Serum digoxin level of 2.5 ng/mL
B. Heart rate of 68 beats per minute
C. Complaints of nausea and vomiting
D. Visual disturbances of yellow halos
Correct Answer: B
Rationale: The therapeutic range for digoxin is narrow (0.5–0.8 ng/mL or up to 1.0-2.0 ng/mL in
some texts, but lower for HF). Therapeutic effects in atrial fibrillation include controlling
ventricular rate (negative chronotropic effect). A heart rate of 68 bpm indicates rate control.
Options A, C, and D are incorrect because a serum level >2.0 ng/mL, nausea/vomiting, and
visual halos are all classic signs of digoxin toxicity.
Q6: A patient is admitted with Acute Coronary Syndrome (ACS) and reports chest pain. The
nurse administers sublingual nitroglycerin. What is the primary mechanism of action of
nitroglycerin?
A. Increases myocardial contractility
B. Dilates veins and arteries to reduce preload and afterload
C. Prevents platelet aggregation
D. Dissolves the coronary thrombus
Correct Answer: B
, 4
Rationale: Nitroglycerin is a vasodilator that primarily dilates veins (reducing preload) and
arteries (reducing afterload). This decreases myocardial oxygen demand and relieves ischemic
chest pain. Option A is incorrect because it does not increase contractility; it may actually lower
reflexively. Option C describes antiplatelets (e.g., aspirin/clopidogrel). Option D describes
fibrinolytics (e.g., tPA).
Q7: A patient presents to the Emergency Department with chest pain. The 12-lead ECG shows
ST-segment elevation in leads V3 and V4. The nurse recognizes this indicates which type of
myocardial infarction (MI) and prepares for which immediate intervention?
A. Non-ST-elevation MI (NSTEMI); administration of heparin drip
B. ST-elevation MI (STEMI); preparation for immediate percutaneous coronary intervention
(PCI)
C. Unstable angina; administration of troponin levels only
D. Stable angina; administration of oral nitroglycerin
Correct Answer: B
Rationale: ST-segment elevation in two contiguous leads (V3, V4 indicate anterior wall)
confirms a STEMI. The standard of care is immediate reperfusion therapy, preferably
Percutaneous Coronary Intervention (PCI) within 90 minutes of first medical contact (door-to-
balloon time). Option A and C involve NSTEMI/Unstable angina which are managed medically
or with urgent PCI later, not emergently. Option D is incorrect for acute MI presentation.
Q8: The nurse is caring for a patient with hypertension. Which instruction is consistent with the
Dietary Approaches to Stop Hypertension (DASH) diet?
A. Limit sodium intake to less than 2,300 mg/day (or 1,500 mg if possible)
B. Increase intake of red meats and full-fat dairy products
C. Restrict all fruits and vegetables due to potassium content
D. Consume a high-protein, low-carbohydrate diet only
Correct Answer: A
