NUR 242 Exam 4 Medical-Surgical Nursing
Concepts (2026/2027) PDF | Nursing | Galen
College
1. A patient with acute decompensated heart failure has
crackles in all lung fields, S3 gallop, and oxygen
saturation of 88% on room air. Which intervention does
the nurse perform first?
A. Administer furosemide IV
B. Place the patient in high-Fowler’s position
C. Give morphine sulfate IV
D. Start a dopamine infusion
Answer: B
Rationale: High-Fowler’s position reduces preload and
improves ventilation; this is immediate and non-invasive
before medications.
2. A patient with chronic heart failure is prescribed
carvedilol. Which statement indicates the patient needs
1
,further teaching?
A. “I will take my pulse every morning.”
B. “I can stop this drug if I feel dizzy.”
C. “This medication helps my heart work better over time.”
D. “I will report weight gain of 3 pounds in a week.”
Answer: B
Rationale: Abrupt withdrawal of beta-blockers can cause
rebound tachycardia and worsening heart failure; patient
must consult provider.
3. A patient with ST-elevation myocardial infarction
(STEMI) is being transferred for percutaneous coronary
intervention (PCI). Which medication does the nurse
administer en route?
A. Aspirin, clopidogrel, and heparin
B. Warfarin and digoxin
C. Furosemide and spironolactone
D. Nitroprusside and dobutamine
Answer: A
2
,Rationale: Dual antiplatelet therapy (aspirin +
clopidogrel) plus anticoagulation (heparin) prevents
reocclusion before PCI.
4. A patient with a new diagnosis of atrial fibrillation has
a CHA₂ DS₂ -VASc score of 4. Which intervention is
most important?
A. Rate control with metoprolol
B. Rhythm control with amiodarone
C. Anticoagulation with warfarin or DOAC
D. Electrical cardioversion
Answer: C
*Rationale: CHA₂ DS₂ -VASc ≥2 in men or ≥3 in women
indicates high stroke risk; anticoagulation is mandatory
regardless of rate/rhythm strategy.*
5. The nurse assesses a patient with infective endocarditis.
Which finding suggests an embolic event to the brain?
A. Splinter hemorrhages
B. Sudden-onset aphasia
3
, C. Osler nodes on fingers
D. Roth spots on retina
Answer: B
Rationale: Sudden aphasia indicates embolic stroke;
peripheral signs (Osler nodes, Roth spots, splinter
hemorrhages) are important but not acute brain events.
6. A patient with aortic stenosis is scheduled for valve
replacement. The patient asks why surgery is needed now.
Which symptom is the strongest indication?
A. Mild dyspnea on exertion
B. Syncope during exercise
C. Asymptomatic murmur
D. Occasional palpitations
Answer: B
Rationale: Exertional syncope indicates severe obstruction
with high risk of sudden death; surgery is indicated even
if ejection fraction is normal.
4
Concepts (2026/2027) PDF | Nursing | Galen
College
1. A patient with acute decompensated heart failure has
crackles in all lung fields, S3 gallop, and oxygen
saturation of 88% on room air. Which intervention does
the nurse perform first?
A. Administer furosemide IV
B. Place the patient in high-Fowler’s position
C. Give morphine sulfate IV
D. Start a dopamine infusion
Answer: B
Rationale: High-Fowler’s position reduces preload and
improves ventilation; this is immediate and non-invasive
before medications.
2. A patient with chronic heart failure is prescribed
carvedilol. Which statement indicates the patient needs
1
,further teaching?
A. “I will take my pulse every morning.”
B. “I can stop this drug if I feel dizzy.”
C. “This medication helps my heart work better over time.”
D. “I will report weight gain of 3 pounds in a week.”
Answer: B
Rationale: Abrupt withdrawal of beta-blockers can cause
rebound tachycardia and worsening heart failure; patient
must consult provider.
3. A patient with ST-elevation myocardial infarction
(STEMI) is being transferred for percutaneous coronary
intervention (PCI). Which medication does the nurse
administer en route?
A. Aspirin, clopidogrel, and heparin
B. Warfarin and digoxin
C. Furosemide and spironolactone
D. Nitroprusside and dobutamine
Answer: A
2
,Rationale: Dual antiplatelet therapy (aspirin +
clopidogrel) plus anticoagulation (heparin) prevents
reocclusion before PCI.
4. A patient with a new diagnosis of atrial fibrillation has
a CHA₂ DS₂ -VASc score of 4. Which intervention is
most important?
A. Rate control with metoprolol
B. Rhythm control with amiodarone
C. Anticoagulation with warfarin or DOAC
D. Electrical cardioversion
Answer: C
*Rationale: CHA₂ DS₂ -VASc ≥2 in men or ≥3 in women
indicates high stroke risk; anticoagulation is mandatory
regardless of rate/rhythm strategy.*
5. The nurse assesses a patient with infective endocarditis.
Which finding suggests an embolic event to the brain?
A. Splinter hemorrhages
B. Sudden-onset aphasia
3
, C. Osler nodes on fingers
D. Roth spots on retina
Answer: B
Rationale: Sudden aphasia indicates embolic stroke;
peripheral signs (Osler nodes, Roth spots, splinter
hemorrhages) are important but not acute brain events.
6. A patient with aortic stenosis is scheduled for valve
replacement. The patient asks why surgery is needed now.
Which symptom is the strongest indication?
A. Mild dyspnea on exertion
B. Syncope during exercise
C. Asymptomatic murmur
D. Occasional palpitations
Answer: B
Rationale: Exertional syncope indicates severe obstruction
with high risk of sudden death; surgery is indicated even
if ejection fraction is normal.
4
