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NUR 242 Medical-Surgical Nursing – Exam 2 Study Guide | Cardiac Disorders, Pharmacology, Legal/Ethical Issues & Infection Control | Practice Questions with Verified Answers | 2026–2027 Updated Edition

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This comprehensive NUR 242 Exam 2 Study Guide contains practice questions with verified answers — fully updated for the 2026–2027 academic year. Perfect for nursing students (ADN, BSN, or pre‑licensure programs) preparing for their second medical‑surgical nursing examination. Content covers all major exam topics including: Cardiac Pharmacology – digoxin (therapeutic effects: increased contractility, decreased heart rate; toxicity signs: nausea, vomiting, yellow vision, cardiac dysrhythmias; hold for apical pulse 60 bpm in adults, 70 bpm in children; monitor potassium levels – hypokalemia increases toxicity), furosemide (monitor potassium, give with orange juice), nitroglycerin (sublingual onset 1–3 minutes; side effects: headache, hypotension; store in dark container; use prophylactically before activity; sustained‑release capsules swallowed whole), morphine (for MI pain, decreases cardiac workload), amiodarone, adenosine (have crash cart ready), metoprolol (monitor for bradycardia), antiarrhythmics, anticoagulants (heparin – aPTT twice control; warfarin – monitor INR, vitamin K antidote) Cardiac Disorders & Dysrhythmias – myocardial infarction (MI) pain described as severe, intense; troponin I/T elevation; ST elevation on ECG; pain relief with morphine; nitroglycerin patch decreases preload; thrombolytics (t‑PA) monitor IV site for bleeding; complications: dysrhythmias (ventricular tachycardia, PVCs – T wave phase most dangerous), heart failure, cardiogenic shock; women’s atypical symptoms (fatigue, indigestion, dyspnea); sexual activity after MI (stress test first; familiar settings; climbing two flights of stairs as indicator) Dysrhythmias – atrial fibrillation (rapid ventricular response; anticoagulate with warfarin; synchronized cardioversion; monitor apical pulse for full minute; sudden vision change or arm weakness report immediately), ventricular tachycardia (amiodarone; check pulse/BP first; if pulseless, defibrillation), ventricular fibrillation (priority: defibrillation, CPR, epinephrine), premature ventricular complexes (unifocal vs. multifocal; ask about caffeine/stimulants; treat with amiodarone), supraventricular tachycardia (diltiazem, adenosine; synchronized cardioversion if unstable), heart block (temporary pacemaker for third degree) Pacemakers & Post‑Procedure Care – demand pacemaker (spikes without QRS = failure to capture); avoid strong magnets, power plants; notify provider for pulse rate 40; discharge teaching (daily pulse, report swelling/drainage, airport security notification); coronary artery bypass graft (CABG) – vein graft leg elevation; chest tube drainage (fluid fluctuation loss may indicate obstruction); monitor temperature (102°F concerning) Cardiac Catheterization & Angiography – femoral angiogram (assess insertion site, pedal pulses q15 min); brachial artery approach (monitor bilateral radial pulses); post‑procedure priority: assess affected leg for hematoma Cardiac Risk Factors & Prevention – modifiable (weight, tobacco use, diet, exercise) vs. non‑modifiable (heredity, age); women’s symptoms (severe fatigue, unease, shortness of breath); aspirin therapy (take with food, report ringing in ears, bleeding, avoid OTC aspirin) Nurse Practice Act (NPA) & Board of Nursing (BON) – purpose: protect public; licensure requirements (application, graduation from approved program, NCLEX passage, background check); grounds for discipline (practice‑related, drug‑related, boundary violations, sexual misconduct, abuse, fraud, criminal background); alternative‑to‑discipline programs for substance use disorder; National Practitioner Data Bank (prevents state‑to‑state movement without disclosure); Nursys for license verification Health Care Law & Patient Rights – HIPAA (privacy rule), EMTALA (emergency care regardless of ability to pay), Patient Self‑Determination Act (advance directives), HITECH Act (electronic health records), ACA (insurance exchanges), Death with Dignity Law (end‑of‑life choices) Informed Consent – requires explanation of procedure, risks, benefits, alternatives; competent adult, legal guardian, emancipated minor, parent, court order; implied consent in emergencies; spouse/family cannot sign without power of attorney Negligence & Malpractice – professional negligence elements: duty, breach of duty, foreseeable harm, causation, injury; standard of care; Good Samaritan law (protects if within scope of practice); incident reports (confidential, not placed in patient chart) Infection Control & Chain of Infection – infectious agent, reservoir, portal of exit, mode of transmission (contact – direct/indirect; droplet; airborne; vehicle; vector), portal of entry, susceptible host; contact precautions (gown, gloves – C. diff, VRE, RSV); droplet precautions (mask – influenza, adenovirus, COVID, rhinovirus); airborne precautions (N95 mask, negative pressure room – TB, measles, chickenpox); protective isolation (transplant patients, no plants) Medical vs. Surgical Asepsis – medical asepsis (clean technique) for medications, enemas, hygiene; surgical asepsis (sterile technique) for dressing changes, catheterizations, surgery; sterilization (steam, ethylene oxide); hand hygiene (alcohol‑based rub or soap and water) Restraints & Safety – restraint types: physical, mechanical (least restrictive – hand mitts), chemical, barrier, seclusion; last resort, try alternatives first; tie to bed frame (not side rail) with quick‑release knot; risks: bruising, fractures, strangulation, death; fall precautions (non‑skid footwear, low bed, locked wheels, clutter‑free, adequate lighting, call light within reach) Mobility & Body Mechanics – effects of immobility (cardiac deconditioning, orthostatic hypotension, DVT, PE, atelectasis, pneumonia, constipation, urinary retention, renal calculi, pressure injuries); proper positioning (Fowler’s, semi‑Fowler’s, high‑Fowler’s, lateral, prone, supine, Trendelenburg); foot drop, joint contracture, muscle atrophy (sarcopenia) Sensory Alterations – vision (myopia, hyperopia, presbyopia, astigmatism, cataracts, diabetic retinopathy, glaucoma – loss of peripheral vision); hearing (conductive, sensorineural, mixed; otitis media, otosclerosis; tinnitus; deafness); aphasia types (expressive – Broca’s; comprehensive – Wernicke’s; global); tactile hypersensitivity/defensiveness; peripheral neuropathy (diabetic neuropathy); age‑related changes (vision, hearing most affected) Fire Safety – RACE (Rescue, Alarm, Confine, Extinguish); PASS (Pull, Aim, Squeeze, Sweep) All answers are verified and tested — ideal for exam 2 review, clinical rotation preparation, and NCLEX‑RN success.

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Instelling
NUR 242 – Medical‑Surgical Nursing II / Nursing Ca
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NUR 242 – Medical‑Surgical Nursing II / Nursing Ca

Voorbeeld van de inhoud

1|Page



NUR 242 Exam 2 FOR NURSING STUDENTS
2025/2026 LATEST UPDATE GRADED A+
PRACTICE QUESTIONS WITH ANSWERS
(VERIFIED SOLUTIONS)

A 2-month-old infant with the diagnosis of heart failure is discharged with a prescription for
oral digoxin 0.05 mg every 12 hours. The bottle of digoxin is labeled "0.05 mg/mL." Which
item would the nurse teach the mother to use when administering the medication? ----
ANSWER----Calibrated syringe



An infant with congenital heart disease is prescribed digoxin and furosemide upon discharge.
Which sign would the nurse instruct the parents to be alert for? ---- ANSWER --- Difficulty
feeding with vomiting



A client, who is currently taking digoxin 0.125 mg in the morning and alprazolam 0.5 mg
twice a day, is prescribed donepezil 5 mg daily for early dementia of the Alzheimer type.
Which instruction would the nurse include when teaching the client's spouse about
medication administration? ---- ANSWER --- Prefill a weekly medication box with the
medications for the client to self-administe



A client with congestive heart failure is receiving intravenous digoxin (Cardoxin) therapy.
The registered nurse identifies that which items on the client's care plan are appropriate for a
licensed practical nurse (LPN) to perform? Select all that apply. One, some, or all responses
may be correct. ---- ANSWER --- Help the client ambulate when required.

Monitor the client's vitals every 30 minutes.

Administer adequate oral fluids to the client.

,2|Page




The clinic nurse receives a call from the mother of an infant prescribed digoxin. The mother
reports she forgot whether she gave the morning dose of digoxin. Which response by the
nurse is most appropriate? ---- ANSWER --- Skip this dose and give it at the next prescribed
time



The nurse teaches the parents of a 4-year-old child about the administration of digoxin elixir
twice a day. Which statement indicates to the nurse the parents need further teaching? ----
ANSWER----"We should give the digoxin twice a day, at breakfast and dinner



Which lifestyle advice does the nurse give to a client when oral digoxin therapy is initiated?
Select all that apply. One, some, or all responses may be correct. ---- ANSWER ----Bran can
decrease digoxin absorption.

Digoxin should not be taken with hawthorn supplements.

Ginseng may cause a dangerous increase in digoxin levels in the blood.

Medications that lower serum potassium or magnesium can cause digoxin toxicity



The nurse is monitoring a 6-year-old child for toxicity precipitated by digoxin. Which sign of
digoxin toxicity would the nurse monitor for? ---- ANSWER -- Vomiting



A child is prescribed 1.2 mL of digoxin twice a day. The medication label reads "Digoxin
0.125 mg/mL." What is the total amount of medication, in milligrams, the child takes each
day? mg ---- ANSWER --- 0.3



According to developmental norms for a 5-year-old child, the nurse would hold digoxin if an
apical heart rate falls below which number? ---- ANSWER --- 70 beats/min

,3|Page


A health care provider prescribes digoxin for a client. The nurse teaches the client to be alert
for which common early indication of acute digoxin toxicity? ---- ANSWER --- Vomiting



When teaching a client about digoxin, which symptom will the nurse include as a reason to
withhold the digoxin? ---- ANSWER -- yellow vision



Which clinical finding indicates that a client taking digoxin may have developed digoxin
toxicity? ---- ANSWER --- Cardiac dysrhythmias



A client has been receiving digoxin. The client calls the clinic and complains of "yellow
vision." Which response would the nurse provide? ---- ANSWER --- "The medication may
need to be discontinued. Come to the clinic this afternoon."



Digoxin is prescribed for a client. Which therapeutic effect of digoxin would the nurse
expect? ---- ANSWER --- Increased contractile force of the myocardium



A client who has been diagnosed with a myocardial infarction receives digoxin, fluoxetine,
morphine, and docusate sodium. Which medication would the nurse identify as a risk factor
for straining due to constipation? ---- ANSWER ---Morphine



A client takes furosemide and digoxin for heart failure. Why would the nurse advise the client
to drink a glass of orange juice every day? ---- ANSWER ---Maintaining potassium levels



Which action by the nurse is most important when preparing for cardioversion of a client
with atrial fibrillation? ---- ANSWER -- Set synchronizer switch on defibrillator to the "on"
position

, 4|Page


Which assessment finding by the nurse caring for a client with new-onset atrial fibrillation
would be most important to communicate to the health care provider? ---- ANSWER----
Sudden vision change



A client who has atrial fibrillation with rapid ventricular response is started on a continuous
heparin infusion. Which clinical finding enables the nurse to conclude that the heparin
therapy is effective? ---- ANSWER ---An activated partial thromboplastin time (aPTT) is
twice the usual value.



When treating clients for osteoporosis, which medication has a side effect of atrial fibrillation
when infused too quickly? ---- ANSWER --- Zoledronic acid



After the home health nurse obtains a radial pulse rate of 136 beats/minute in a client with
chronic atrial fibrillation, which action would the nurse take next? ---- ANSWER -- Take the
client's apical pulse for a full minut



Which finding for a client who has a diagnosis of paroxysmal atrial fibrillation is most
important to report quickly to the health care provider? ---- ANSWER --- Right arm weakness



When teaching a client with atrial fibrillation about a new prescription for warfarin, the nurse
will include information about which vitamin? ---- ANSWER -- Vitamin K



Which action is essential for the nurse to include in the plan of care for a client with atrial
fibrillation? ---- ANSWER ---Take pulse apically for a full minute.



Which action would the nurse include in the plan of care for a client who had an ischemic
stroke caused by atrial fibrillation and has been placed on anticoagulation therapy to prevent

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NUR 242 – Medical‑Surgical Nursing II / Nursing Ca
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NUR 242 – Medical‑Surgical Nursing II / Nursing Ca

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