NUR 242 Medical-Surgical Nursing – Exam 1 Study Guide | Anemia, Coagulation Disorders, Peripheral Vascular Disease & Skin Integrity | Practice Questions with Correct Answers | 2026–2027 Updated Edition

This comprehensive NUR 242 Exam 1 Study Guide contains practice questions with verified correct answers and rationales — fully updated for the 2026–2027 academic year. Perfect for nursing students (ADN, BSN, or pre‑licensure programs) preparing for their first medical‑surgical nursing examination. Content covers all major exam topics including: Anemia & Hematologic Disorders – iron‑deficiency anemia (low MCV/MCH/MCHC, increased TIBC, koilonychia/spoon nails, causes: increased milk intake in toddlers, menorrhagia, poor diet; treatment with iron supplements, administer with orange juice for absorption, causes green‑black stools), sickle cell anemia (vaso‑occlusive crisis, pain management priority, hydration, oxygenation, avoid dehydration/hypoxia, 25% recurrence risk if both parents carriers), pernicious anemia (B12 deficiency, lack of intrinsic factor, lifelong IM B12 injections, beefy red tongue, glossitis), thalassemia (Cooley anemia, microcytic, frequent transfusions, iron overload → deferoxamine), aplastic anemia (pancytopenia), hemolytic anemia (methyldopa-induced), anemia of chronic disease (normocytic normochromic), polycythemia (elevated hemoglobin, COPD complication, high fluid intake) Transfusion Therapy – packed RBCs (consent, baseline vitals, two‑nurse verification, run slowly first 15–20 minutes, monitor for reaction within first 10 minutes), platelet transfusion (threshold 10,000), transfusion reaction (wheezing requires immediate treatment), iron overload from transfusions (deferoxamine for cardiac dysrhythmias) Anticoagulation & Coagulation Disorders – heparin (monitor aPTT – therapeutic = twice control; adverse effects: bleeding, osteoporosis with prolonged use; antidote: protamine sulfate; administer subcutaneously without massage), warfarin (monitor INR – therapeutic 2–3; antidote: vitamin K; avoid aspirin, NSAIDs, cranberry juice, green leafy vegetables (vitamin K); INR 4.6 → notify provider; INR 6 → hold dose), heparin + warfarin overlap until INR therapeutic, enoxaparin (subcutaneous for postpartum DVT) Thrombocytopenia & Bleeding Risks – causes (chemotherapy, MMR vaccine, mycophenolate, azathioprine), manifestations (petechiae, ecchymosis, melena, hematuria, epistaxis, blood clots in nasal passages), nursing care (avoid IM injections, use electric razor, apply ice to trauma, avoid NSAIDs, delegate positioning but not assessment) Deep Vein Thrombosis (DVT) & Venous Insufficiency – risk factors (inactivity, pelvic surgery, leg trauma, obesity), manifestations (calf pain, edema, redness, warmth, Homans sign – dorsiflexion pain), complications (pulmonary embolism), prevention (early ambulation, leg exercises, compression stockings, heparin), treatment (elevate legs above heart, Doppler for pulse verification, brownish discoloration from RBC leakage) Peripheral Arterial Disease (PAD) – manifestations (intermittent claudication, pain with exercise relieved by rest, absent hair on toes, thickened toenails, pallor of feet, delayed capillary refill, ulcers on toes/great toe), teaching (avoid crossing legs, inspect feet daily, do NOT elevate legs, do NOT use heating pad, supervised exercise program, walking program – stop and rest if leg cramps occur), femoral angiogram post‑procedure (check pedal pulses q15 min, assess affected leg first) Pulmonary Embolism (PE) – risk factors (DVT, atrial fibrillation, knee replacement, obesity), manifestations (sudden chest pain, abrupt dyspnea, hemoptysis, pink sputum, decreased O2 saturation, feeling of impending doom), nursing priorities (elevate HOB, high‑flow oxygen, cardiac monitor, notify rapid response team), diagnostic test (spiral CT – assess for shellfish allergy before), anticoagulation (heparin then warfarin) Skin Integrity & Pressure Injuries – pressure injury staging (stage 1 – intact nonblanchable redness; stage 2 – partial thickness, blister; stage 3 – full thickness with visible fat; stage 4 – exposed muscle/bone; unstageable – covered with slough/eschar; deep tissue injury – purple/maroon intact skin), risk factors (immobility, incontinence, poor nutrition, decreased cognition, serum albumin 3.5), prevention (Braden scale, turning, support surfaces) Wound Healing – primary intention (approximated edges), secondary intention (granulation, larger scar), tertiary intention (contaminated wound left open), dehiscence (wound separation – risk factors: obesity, diabetes, corticosteroids, malnutrition, immune deficiency), evisceration (protrusion of organs – cover with sterile saline‑soaked gauze, supine with hips/knees flexed, HOB 15–20°, do not reinsert) Inflammation & Healing – three stages (vasodilation/warmth/redness, neutrophil exudate/pus, tissue repair) IV Therapy & Central Lines – midline catheters (short‑term ≤4 weeks, no X‑ray needed), PICC line (long‑term up to 1 year, flush with 10 mL syringe, removal with Valsalva), implantable port (Huber needle at 90°), complications (infiltration, phlebitis, CLABSI, air embolism – left side Trendelenburg, pneumothorax – verify with chest X‑ray) TPN (Total Parenteral Nutrition) – two‑nurse verification, if unavailable give D10W or D20W, never increase rate, change tubing every 24 hours, dressing change q48–72h, monitor albumin/prealbumin Pre‑Op & Post‑Op Care – informed consent (surgeon’s responsibility, nurse clarifies, emergency consent not imperative but preferred), pre‑op medications (sedatives, hypnotics, anxiolytics, opioids), SCIP measures (antibiotic within 1 hour, discontinued within 24 hours, glucose control for cardiac surgery, appropriate hair removal with clippers, urinary catheter removal POD 1–2, beta‑blocker continuation), post‑op DVT prevention (leg exercises, early ambulation, SCDs, hydration) Pain Management – pain as 5th vital sign, self‑report most reliable, PCA (morphine/fentanyl/hydromorphone, lockout interval 5–15 min, not for cognitively impaired), TENS unit Geriatric & Older Adult Considerations – dementia (slow progression, chronic, Alzheimer’s most common, multi‑infarct dementia second), delirium (acute onset, fluctuating, inattentiveness, disorganized thinking, altered LOC, often from unfamiliar environment), Geriatric Failure to Thrive (GFTT – undernutrition, impaired mobility, depression, cognitive impairment), depression most common mental health problem in older adults, Geriatric Depression Scale, health promotion (yearly flu, pneumococcal, shingles vaccines, tetanus q10 years, fall prevention – waxed floors/scattered rugs reduce) Safety & Professional Practice – restraints (last resort, least restrictive – hand mitts, tie to bed frame not side rail, quick‑release knot), fall prevention (non‑skid footwear, low bed, locked wheels, clutter‑free, call light within reach), incident reports (not placed in chart), Good Samaritan law (protects if within scope), delegation (UAP can position client with thrombocytopenia), LGBTQQ client safety (avoid exclusive waiting rooms, integrate care) Infection Control – standard precautions (all patients), contact precautions (C. diff, scabies, RSV, impetigo – gown, gloves, soap and water for C. diff), droplet precautions (mask within 3 feet – sepsis, pneumonia, pertussis, influenza, diphtheria, epiglottitis, rubella, mumps, meningitis, adenovirus), airborne precautions (negative pressure, N95 – measles, TB, varicella) Skin Lesions & Assessment – ABCDE (asymmetry, border irregularity, color variation, diameter 6mm, evolving), primary vs. secondary lesions, cyanosis in dark skin (lips/tongue gray, nail beds/palms blue tinge, conjunctiva pallor), jaundice (check hard palate, sclera near iris) All answers are verified and tested with rationales — ideal for exam 1 review, clinical rotation preparation, and NCLEX‑RN success.