NUR 242 | Galen
OBJECTIVE ASSESSMENT - EXAM
Med-Surg Nursing
Exam 2
NUR 242 | Galen College
75 100% 2026/2027
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Cardiovascular Disorders & Management Renal & Urinary System Disorders
Respiratory Conditions & Oxygen Therapy Endocrine & Metabolic Conditions
Gastrointestinal & Hepatic Disorders
COVER PAGE - 1
,SECTION 1 | Cardiovascular Disorders & Management | Q1-Q20 | NUR 242 Med-Surg Nursing Exam 2 2026/2027
Q1 Question 1 of 75
Q1. A 68-year-old man presents to the emergency department with crushing substernal chest pain
that began 45 minutes ago while shoveling snow. The pain radiates to his left jaw and is
accompanied by diaphoresis and nausea. His ECG shows ST-segment elevation in leads II, III, and
aVF. What is the priority nursing intervention for this patient?
A. Establish IV access, administer oxygen, and prepare for immediate reperfusion therapy
B. Obtain a complete cardiac enzyme panel before initiating treatment
C. Administer sublingual nitroglycerin and obtain a 12-lead ECG
D. Place the patient on bed rest and monitor vital signs every four hours
Correct Answer: A
Rationale:
This patient presents with an ST-elevation myocardial infarction (STEMI) requiring immediate
reperfusion therapy, either percutaneous coronary intervention or thrombolytics, to minimize myocardial
damage. Establishing IV access, administering oxygen, and preparing for reperfusion are the priority
interventions. Obtaining cardiac enzymes before treatment causes life-threatening delays, and
monitoring every four hours is grossly insufficient for an acute MI.
NUR 242 Med-Surg Nursing Exam 2 -- 2026/2027 | Passing Score: 80% | Page 2 of 41
,Q2 Question 2 of 75
Q2. A 55-year-old woman with a history of hypertension and type 2 diabetes mellitus is admitted
with acute decompensated heart failure. She has bilateral crackles throughout her lung fields,
jugular venous distension of 10 cm, and 3+ pitting edema in both lower extremities. Her BNP level
is 1,200 pg/mL. Which pathophysiological process best explains her peripheral edema?
A. Enhanced lymphatic drainage overwhelming the interstitial space
B. Decreased right ventricular output leading to increased hydrostatic pressure in the
venous system
C. Reduced renal blood flow stimulating aldosterone suppression
D. Increased left ventricular ejection fraction causing excessive tissue perfusion
Correct Answer: B
Rationale:
In right-sided heart failure, decreased right ventricular output leads to venous congestion and increased
hydrostatic pressure, forcing fluid into the interstitial spaces and causing peripheral edema. Increased
ejection fraction does not cause edema, aldosterone is activated rather than suppressed in heart failure,
and enhanced lymphatic drainage does not contribute to edema formation.
Q3 Question 3 of 75
Q3. A 72-year-old man with chronic atrial fibrillation is admitted with an ischemic stroke. He has
been taking warfarin 5 mg daily, and his current INR is 1.4. The nurse understands that his
subtherapeutic INR likely contributed to his stroke. What is the target INR range for a patient with
atrial fibrillation on warfarin therapy?
A. 3.0 to 4.0
B. 4.0 to 5.0
C. 2.0 to 3.0
D. 1.0 to 1.5
Correct Answer: C
Rationale:
The target INR for patients with atrial fibrillation on warfarin is 2.0 to 3.0, which provides adequate
anticoagulation to prevent thromboembolic events while minimizing bleeding risk. This patient's INR of
1.4 is subtherapeutic, indicating insufficient anticoagulation. An INR of 3.0 to 4.0 or higher increases
bleeding risk without providing additional therapeutic benefit.
NUR 242 Med-Surg Nursing Exam 2 -- 2026/2027 | Passing Score: 80% | Page 3 of 41
, Q4 Question 4 of 75
Q4. A 60-year-old woman is admitted with a diagnosis of deep vein thrombosis in her left leg. She
is started on a continuous heparin infusion. Six hours after the infusion begins, her aPTT is 45
seconds. The protocol calls for a therapeutic aPTT of 60 to 80 seconds. What is the most
appropriate nursing action?
A. Continue the current infusion rate and recheck aPTT in 24 hours
B. Switch to oral warfarin immediately and discontinue heparin
C. Stop the heparin infusion immediately
D. Increase the heparin infusion rate per protocol and recheck aPTT in six hours
Correct Answer: D
Rationale:
An aPTT of 45 seconds is below the therapeutic range of 60 to 80 seconds, indicating the patient is
under-anticoagulated and at risk for thrombus extension. The appropriate action is to increase the
heparin infusion rate per protocol and recheck the aPTT in six hours. Stopping the infusion would
eliminate anticoagulation, waiting 24 hours is too long, and switching to warfarin alone requires overlap
with heparin for at least five days.
Q5 Question 5 of 75
Q5. A 45-year-old man with hypertension is prescribed lisinopril 10 mg daily. At his two-week
follow-up, he reports a persistent dry cough that began shortly after starting the medication. His
blood pressure is well-controlled at 128/78 mmHg. What is the most likely cause of his cough, and
what is the appropriate action?
A. ACE inhibitor-induced cough due to bradykinin accumulation; switch to an angiotensin II
receptor blocker
B. Respiratory infection requiring antibiotic therapy
C. Pulmonary embolism requiring immediate hospitalization
D. Heart failure exacerbation requiring diuretic therapy
Correct Answer: A
Rationale:
ACE inhibitors like lisinopril block the degradation of bradykinin, leading to its accumulation in the
respiratory tract, which causes a persistent dry cough in approximately 10 to 20 percent of patients.
Switching to an ARB provides similar blood pressure control without the cough side effect because ARBs
do not affect bradykinin metabolism. The other options do not explain the temporal association with
medication initiation.
NUR 242 Med-Surg Nursing Exam 2 -- 2026/2027 | Passing Score: 80% | Page 4 of 41
OBJECTIVE ASSESSMENT - EXAM
Med-Surg Nursing
Exam 2
NUR 242 | Galen College
75 100% 2026/2027
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Cardiovascular Disorders & Management Renal & Urinary System Disorders
Respiratory Conditions & Oxygen Therapy Endocrine & Metabolic Conditions
Gastrointestinal & Hepatic Disorders
COVER PAGE - 1
,SECTION 1 | Cardiovascular Disorders & Management | Q1-Q20 | NUR 242 Med-Surg Nursing Exam 2 2026/2027
Q1 Question 1 of 75
Q1. A 68-year-old man presents to the emergency department with crushing substernal chest pain
that began 45 minutes ago while shoveling snow. The pain radiates to his left jaw and is
accompanied by diaphoresis and nausea. His ECG shows ST-segment elevation in leads II, III, and
aVF. What is the priority nursing intervention for this patient?
A. Establish IV access, administer oxygen, and prepare for immediate reperfusion therapy
B. Obtain a complete cardiac enzyme panel before initiating treatment
C. Administer sublingual nitroglycerin and obtain a 12-lead ECG
D. Place the patient on bed rest and monitor vital signs every four hours
Correct Answer: A
Rationale:
This patient presents with an ST-elevation myocardial infarction (STEMI) requiring immediate
reperfusion therapy, either percutaneous coronary intervention or thrombolytics, to minimize myocardial
damage. Establishing IV access, administering oxygen, and preparing for reperfusion are the priority
interventions. Obtaining cardiac enzymes before treatment causes life-threatening delays, and
monitoring every four hours is grossly insufficient for an acute MI.
NUR 242 Med-Surg Nursing Exam 2 -- 2026/2027 | Passing Score: 80% | Page 2 of 41
,Q2 Question 2 of 75
Q2. A 55-year-old woman with a history of hypertension and type 2 diabetes mellitus is admitted
with acute decompensated heart failure. She has bilateral crackles throughout her lung fields,
jugular venous distension of 10 cm, and 3+ pitting edema in both lower extremities. Her BNP level
is 1,200 pg/mL. Which pathophysiological process best explains her peripheral edema?
A. Enhanced lymphatic drainage overwhelming the interstitial space
B. Decreased right ventricular output leading to increased hydrostatic pressure in the
venous system
C. Reduced renal blood flow stimulating aldosterone suppression
D. Increased left ventricular ejection fraction causing excessive tissue perfusion
Correct Answer: B
Rationale:
In right-sided heart failure, decreased right ventricular output leads to venous congestion and increased
hydrostatic pressure, forcing fluid into the interstitial spaces and causing peripheral edema. Increased
ejection fraction does not cause edema, aldosterone is activated rather than suppressed in heart failure,
and enhanced lymphatic drainage does not contribute to edema formation.
Q3 Question 3 of 75
Q3. A 72-year-old man with chronic atrial fibrillation is admitted with an ischemic stroke. He has
been taking warfarin 5 mg daily, and his current INR is 1.4. The nurse understands that his
subtherapeutic INR likely contributed to his stroke. What is the target INR range for a patient with
atrial fibrillation on warfarin therapy?
A. 3.0 to 4.0
B. 4.0 to 5.0
C. 2.0 to 3.0
D. 1.0 to 1.5
Correct Answer: C
Rationale:
The target INR for patients with atrial fibrillation on warfarin is 2.0 to 3.0, which provides adequate
anticoagulation to prevent thromboembolic events while minimizing bleeding risk. This patient's INR of
1.4 is subtherapeutic, indicating insufficient anticoagulation. An INR of 3.0 to 4.0 or higher increases
bleeding risk without providing additional therapeutic benefit.
NUR 242 Med-Surg Nursing Exam 2 -- 2026/2027 | Passing Score: 80% | Page 3 of 41
, Q4 Question 4 of 75
Q4. A 60-year-old woman is admitted with a diagnosis of deep vein thrombosis in her left leg. She
is started on a continuous heparin infusion. Six hours after the infusion begins, her aPTT is 45
seconds. The protocol calls for a therapeutic aPTT of 60 to 80 seconds. What is the most
appropriate nursing action?
A. Continue the current infusion rate and recheck aPTT in 24 hours
B. Switch to oral warfarin immediately and discontinue heparin
C. Stop the heparin infusion immediately
D. Increase the heparin infusion rate per protocol and recheck aPTT in six hours
Correct Answer: D
Rationale:
An aPTT of 45 seconds is below the therapeutic range of 60 to 80 seconds, indicating the patient is
under-anticoagulated and at risk for thrombus extension. The appropriate action is to increase the
heparin infusion rate per protocol and recheck the aPTT in six hours. Stopping the infusion would
eliminate anticoagulation, waiting 24 hours is too long, and switching to warfarin alone requires overlap
with heparin for at least five days.
Q5 Question 5 of 75
Q5. A 45-year-old man with hypertension is prescribed lisinopril 10 mg daily. At his two-week
follow-up, he reports a persistent dry cough that began shortly after starting the medication. His
blood pressure is well-controlled at 128/78 mmHg. What is the most likely cause of his cough, and
what is the appropriate action?
A. ACE inhibitor-induced cough due to bradykinin accumulation; switch to an angiotensin II
receptor blocker
B. Respiratory infection requiring antibiotic therapy
C. Pulmonary embolism requiring immediate hospitalization
D. Heart failure exacerbation requiring diuretic therapy
Correct Answer: A
Rationale:
ACE inhibitors like lisinopril block the degradation of bradykinin, leading to its accumulation in the
respiratory tract, which causes a persistent dry cough in approximately 10 to 20 percent of patients.
Switching to an ARB provides similar blood pressure control without the cough side effect because ARBs
do not affect bradykinin metabolism. The other options do not explain the temporal association with
medication initiation.
NUR 242 Med-Surg Nursing Exam 2 -- 2026/2027 | Passing Score: 80% | Page 4 of 41
