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Galen NUR 242 Exam 2 Med Surg Nursing
Actual Exam 2026/2027 – Complete Exam-Style
Questions with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
[SECTION 1: Cardiovascular Disorders — Questions 1-18]
Q1: A patient with heart failure reports waking up at night gasping for air. The nurse documents
this as which of the following?
A. Orthopnea
B. Dyspnea on exertion
C. Paroxysmal nocturnal dyspnea (PND)
D. Cheyne-Stokes respiration
Correct Answer: C
Rationale: Paroxysmal nocturnal dyspnea (PND) is defined as sudden awakening from sleep with
shortness of breath, often requiring the patient to sit up or stand to relieve symptoms. This occurs
due to the reabsorption of peripheral edema fluid into the vascular compartment while lying
down, increasing cardiac preload. Orthopnea (A) is dyspnea that occurs when lying flat but is
relieved by sitting up; however, PND specifically refers to the nighttime awakening. Dyspnea on
exertion (B) occurs during activity, and Cheyne-Stokes respiration (D) is a pattern of periodic
breathing characterized by alternating hyperventilation and apnea.
Q2: The nurse is teaching a patient with heart failure about daily weight monitoring. Which
instruction is most important to include to prevent exacerbation?
A. Weigh yourself at different times throughout the day.
B. Wear different clothing each time you weigh yourself.
C. Report a weight gain of 2 pounds (0.9 kg) in one day or 5 pounds (2.3 kg) in one week.
D. Ignore small fluctuations in weight as they are likely dietary.
,2
Correct Answer: C
Rationale: The patient should be instructed to report a weight gain of 2 to 3 pounds in one day or
5 pounds in one week, as this indicates fluid retention and potential heart failure exacerbation.
Weighing should be done at the same time daily, usually in the morning after voiding and before
eating, wearing similar clothing, to ensure consistency (A and B are incorrect). Ignoring
fluctuations (D) is dangerous because rapid weight gain is a critical early sign of volume
overload requiring intervention, such as diuretic adjustment.
Q3: A patient with heart failure is prescribed furosemide (Lasix). The nurse should monitor for
which potential adverse effect of this loop diuretic?
A. Hypernatremia
B. Hyperkalemia
C. Hypokalemia
D. Ototoxicity with high doses
Correct Answer: C
Rationale: Loop diuretics like furosemide increase the excretion of sodium, chloride, potassium,
and water, placing the patient at high risk for hypokalemia. Hypokalemia can lead to cardiac
dysrhythmias, which is particularly dangerous in patients with heart failure. While ototoxicity
(D) is a risk with high intravenous doses, hypokalemia is the most common and ongoing
electrolyte imbalance requiring monitoring. Hypernatremia (A) and hyperkalemia (B) are
incorrect because the drug promotes sodium loss and potassium wasting.
Q4: Which assessment finding is the most specific indicator of left-sided heart failure?
A. Jugular vein distention (JVD)
B. Hepatomegaly
C. Dependent edema
D. Crackles in the lungs
Correct Answer: D
,3
Rationale: Crackles (rales) in the lungs are caused by fluid accumulation in the alveoli due to
increased pulmonary capillary hydrostatic pressure, which is a hallmark of left-sided heart
failure. Left-sided failure causes backup of blood into the left atrium and pulmonary veins. JVD
(A), hepatomegaly (B), and dependent edema (C) are signs of right-sided heart failure, resulting
from systemic venous congestion.
Q5: A patient with heart failure has a prescription for lisinopril, an ACE inhibitor. The nurse
monitors the patient for which common side effect of this medication class?
A. Dry, non-productive cough
B. Hyperglycemia
C. Hypocalcemia
D. Tremors
Correct Answer: A
Rationale: A dry, non-productive cough is a common side effect of ACE inhibitors, occurring in
up to 20% of patients due to the accumulation of bradykinin in the lungs. If the cough is
intolerable, the provider may switch the patient to an ARB (angiotensin II receptor blocker).
Hyperglycemia (B), hypocalcemia (C), and tremors (D) are not typical adverse effects associated
with ACE inhibitors; instead, they may cause hyperkalemia and angioedema.
Q6: The nurse is assessing a client with heart failure and hears an extra heart sound immediately
following the S2 heart sound. The nurse documents this as:
A. S1 heart sound
B. Split S2
C. S3 gallop
D. Pericardial friction rub
Correct Answer: C
Rationale: An S3 gallop is a low-pitched sound heard immediately after the S2 heart sound
(diastole) and is caused by rapid ventricular filling stretching a failing ventricle. It is a classic
sign of left-sided ventricular failure and volume overload. An S1 (A) is the "lub" caused by
, 4
mitral and tricuspid valve closure. A split S2 (B) is normally heard on inspiration but is not a sign
of failure. A pericardial friction rub (D) is a grating sound heard in pericarditis.
Q7: A patient is admitted with a diagnosis of STEMI (ST-Elevation Myocardial Infarction). The
nurse knows that the treatment of choice for this patient, if available within the designated
timeframe, is:
A. Fibrinolytic therapy
B. Medical management with morphine only
C. Percutaneous Coronary Intervention (PCI)
D. Immediate coronary artery bypass graft (CABG) surgery
Correct Answer: C
Rationale: Percutaneous Coronary Intervention (PCI) is the gold standard treatment for STEMI,
ideally performed within 90 minutes of first medical contact (door-to-balloon time). PCI involves
mechanically opening the blocked artery to restore blood flow. Fibrinolytic therapy (A) is
indicated if PCI is not available within 120 minutes. CABG (D) is generally reserved for
complex multivessel disease or failed PCI, not the immediate first-line intervention for standard
STEMI.
Q8: When administering nitroglycerin for chest pain, what parameter must the nurse assess
before giving the dose?
A. Respiratory rate
B. Oxygen saturation
C. Blood pressure
D. Heart rate
Correct Answer: C
Rationale: Nitroglycerin is a potent vasodilator that can cause severe hypotension. The nurse
must check the blood pressure and withhold the medication if the systolic blood pressure is less
than 90 mm Hg or if there is a significant drop from baseline. While heart rate (D) and oxygen
saturation (B) are important, the contraindication for administration is primarily based on blood
Galen NUR 242 Exam 2 Med Surg Nursing
Actual Exam 2026/2027 – Complete Exam-Style
Questions with Detailed Rationales | 100%
Verified | Pass Guaranteed – A+ Graded
[SECTION 1: Cardiovascular Disorders — Questions 1-18]
Q1: A patient with heart failure reports waking up at night gasping for air. The nurse documents
this as which of the following?
A. Orthopnea
B. Dyspnea on exertion
C. Paroxysmal nocturnal dyspnea (PND)
D. Cheyne-Stokes respiration
Correct Answer: C
Rationale: Paroxysmal nocturnal dyspnea (PND) is defined as sudden awakening from sleep with
shortness of breath, often requiring the patient to sit up or stand to relieve symptoms. This occurs
due to the reabsorption of peripheral edema fluid into the vascular compartment while lying
down, increasing cardiac preload. Orthopnea (A) is dyspnea that occurs when lying flat but is
relieved by sitting up; however, PND specifically refers to the nighttime awakening. Dyspnea on
exertion (B) occurs during activity, and Cheyne-Stokes respiration (D) is a pattern of periodic
breathing characterized by alternating hyperventilation and apnea.
Q2: The nurse is teaching a patient with heart failure about daily weight monitoring. Which
instruction is most important to include to prevent exacerbation?
A. Weigh yourself at different times throughout the day.
B. Wear different clothing each time you weigh yourself.
C. Report a weight gain of 2 pounds (0.9 kg) in one day or 5 pounds (2.3 kg) in one week.
D. Ignore small fluctuations in weight as they are likely dietary.
,2
Correct Answer: C
Rationale: The patient should be instructed to report a weight gain of 2 to 3 pounds in one day or
5 pounds in one week, as this indicates fluid retention and potential heart failure exacerbation.
Weighing should be done at the same time daily, usually in the morning after voiding and before
eating, wearing similar clothing, to ensure consistency (A and B are incorrect). Ignoring
fluctuations (D) is dangerous because rapid weight gain is a critical early sign of volume
overload requiring intervention, such as diuretic adjustment.
Q3: A patient with heart failure is prescribed furosemide (Lasix). The nurse should monitor for
which potential adverse effect of this loop diuretic?
A. Hypernatremia
B. Hyperkalemia
C. Hypokalemia
D. Ototoxicity with high doses
Correct Answer: C
Rationale: Loop diuretics like furosemide increase the excretion of sodium, chloride, potassium,
and water, placing the patient at high risk for hypokalemia. Hypokalemia can lead to cardiac
dysrhythmias, which is particularly dangerous in patients with heart failure. While ototoxicity
(D) is a risk with high intravenous doses, hypokalemia is the most common and ongoing
electrolyte imbalance requiring monitoring. Hypernatremia (A) and hyperkalemia (B) are
incorrect because the drug promotes sodium loss and potassium wasting.
Q4: Which assessment finding is the most specific indicator of left-sided heart failure?
A. Jugular vein distention (JVD)
B. Hepatomegaly
C. Dependent edema
D. Crackles in the lungs
Correct Answer: D
,3
Rationale: Crackles (rales) in the lungs are caused by fluid accumulation in the alveoli due to
increased pulmonary capillary hydrostatic pressure, which is a hallmark of left-sided heart
failure. Left-sided failure causes backup of blood into the left atrium and pulmonary veins. JVD
(A), hepatomegaly (B), and dependent edema (C) are signs of right-sided heart failure, resulting
from systemic venous congestion.
Q5: A patient with heart failure has a prescription for lisinopril, an ACE inhibitor. The nurse
monitors the patient for which common side effect of this medication class?
A. Dry, non-productive cough
B. Hyperglycemia
C. Hypocalcemia
D. Tremors
Correct Answer: A
Rationale: A dry, non-productive cough is a common side effect of ACE inhibitors, occurring in
up to 20% of patients due to the accumulation of bradykinin in the lungs. If the cough is
intolerable, the provider may switch the patient to an ARB (angiotensin II receptor blocker).
Hyperglycemia (B), hypocalcemia (C), and tremors (D) are not typical adverse effects associated
with ACE inhibitors; instead, they may cause hyperkalemia and angioedema.
Q6: The nurse is assessing a client with heart failure and hears an extra heart sound immediately
following the S2 heart sound. The nurse documents this as:
A. S1 heart sound
B. Split S2
C. S3 gallop
D. Pericardial friction rub
Correct Answer: C
Rationale: An S3 gallop is a low-pitched sound heard immediately after the S2 heart sound
(diastole) and is caused by rapid ventricular filling stretching a failing ventricle. It is a classic
sign of left-sided ventricular failure and volume overload. An S1 (A) is the "lub" caused by
, 4
mitral and tricuspid valve closure. A split S2 (B) is normally heard on inspiration but is not a sign
of failure. A pericardial friction rub (D) is a grating sound heard in pericarditis.
Q7: A patient is admitted with a diagnosis of STEMI (ST-Elevation Myocardial Infarction). The
nurse knows that the treatment of choice for this patient, if available within the designated
timeframe, is:
A. Fibrinolytic therapy
B. Medical management with morphine only
C. Percutaneous Coronary Intervention (PCI)
D. Immediate coronary artery bypass graft (CABG) surgery
Correct Answer: C
Rationale: Percutaneous Coronary Intervention (PCI) is the gold standard treatment for STEMI,
ideally performed within 90 minutes of first medical contact (door-to-balloon time). PCI involves
mechanically opening the blocked artery to restore blood flow. Fibrinolytic therapy (A) is
indicated if PCI is not available within 120 minutes. CABG (D) is generally reserved for
complex multivessel disease or failed PCI, not the immediate first-line intervention for standard
STEMI.
Q8: When administering nitroglycerin for chest pain, what parameter must the nurse assess
before giving the dose?
A. Respiratory rate
B. Oxygen saturation
C. Blood pressure
D. Heart rate
Correct Answer: C
Rationale: Nitroglycerin is a potent vasodilator that can cause severe hypotension. The nurse
must check the blood pressure and withhold the medication if the systolic blood pressure is less
than 90 mm Hg or if there is a significant drop from baseline. While heart rate (D) and oxygen
saturation (B) are important, the contraindication for administration is primarily based on blood
