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NUR 242 Exam 2 Medical Surgical Nursing Concepts
Study Guide Galen Actual Exam 2026/2027 –
Complete Exam-Style Questions with Detailed
Rationales | Pass Guaranteed – A+ Graded
[SECTION 1: Cardiovascular Disorders — Questions 1-18]
Q1: A nurse is assessing a client with heart failure. Which of the following clinical
manifestations is most specific to left-sided heart failure?
A. Hepatomegaly
B. Jugular vein distention
C. Pulmonary crackles [CORRECT]
D. Dependent sacral edema
Correct Answer: C
Rationale: Left-sided heart failure causes blood to back up into the left atrium and pulmonary
system, resulting in pulmonary congestion, which manifests as crackles (rales) and dyspnea.
Hepatomegaly (A), JVD (B), and dependent edema (D) are classic signs of right-sided heart
failure due to systemic venous congestion. Recognizing the distinction between left and right
failure is critical for targeted nursing interventions.
Q2: A client with heart failure (HF) is prescribed Furosemide (Lasix). Which of the following
laboratory results should the nurse monitor closely as a potential side effect of this medication?
A. Hypernatremia
C. Hypokalemia [CORRECT]
D. Hypermagnesemia
Correct Answer: C
Rationale: Furosemide is a loop diuretic that increases the excretion of sodium, water, and
potassium, leading to hypokalemia. Low potassium levels can precipitate dysrhythmias,
especially in clients with heart failure. Hyponatremia (A) is more likely with SIADH or thiazide
,2
diuretics; hypercalcemia (B) is associated with cancer; and hypermagnesemia (D) is not a typical
effect of loop diuretics.
Q3: A nurse is teaching a client with heart failure about lifestyle modifications to manage fluid
overload. Which of the following client statements indicates a need for further teaching?
A. "I will weigh myself every morning after urinating."
B. "I can drink as much fluid as I want because I take water pills." [CORRECT]
C. "I will limit my sodium intake to 2-3 grams per day."
D. "I will report a weight gain of more than 2 pounds in one day."
Correct Answer: B
Rationale: Fluid restriction is a standard part of managing heart failure, typically limited to 1.5 to
2 liters per day depending on the provider's order. Stating that fluid intake is unlimited because
diuretics are taken indicates a misunderstanding of the balance between fluid intake and output.
Weighing daily (A), limiting sodium (C), and reporting weight gain (D) are correct self-
management strategies.
Q4: A client is admitted with chest pain and is diagnosed with Myocardial Infarction (MI). The
nurse should prepare to administer which medication as part of the MONA (Morphine, Oxygen,
Nitroglycerin, Aspirin) protocol?
A. Clopidogrel (Plavix)
C. Aspirin (chewable) [CORRECT]
D. Warfarin (Coumadin)
Correct Answer: C
Rationale: Aspirin is the primary antiplatelet agent administered immediately for a suspected MI
to inhibit platelet aggregation and reduce mortality; chewing the tablet ensures rapid absorption.
Clopidogrel (A) may be added later but is not the immediate MONA priority. Warfarin (D) is an
anticoagulant used for conditions like atrial fibrillation, not acute MI management. Atorvastatin
(B) is for lipid management but not part of the acute MONA protocol.
,3
Q5: A nurse is caring for a client receiving Digoxin (Lanoxin) for heart failure. Which of the
following findings should the nurse report immediately as a sign of toxicity?
A. Heart rate of 68/min
C. Visual disturbances (yellow halos) [CORRECT]
D. Urinary output of 60 mL/hr
Correct Answer: C
Rationale: Visual disturbances, such as seeing yellow or green halos around lights, are a classic
early sign of Digoxin toxicity and require immediate medical evaluation. A heart rate of 68 (A) is
within the normal therapeutic range (60-100), and urinary output of 60 mL/hr (D) is adequate.
Nausea and vomiting (B) are also signs of toxicity but often occur later or concurrently with
visual changes.
Q6: A client is diagnosed with hypertension. Which of the following classifications applies if the
client's blood pressure is consistently measured at 135/85 mm Hg?
A. Normal
C. Stage 1 Hypertension [CORRECT]
D. Hypertensive crisis
Correct Answer: C
Rationale: According to ACC/AHA guidelines, blood pressure of 130--89 is classified as
Stage 1 Hypertension. Normal BP is <120/<80. Elevated BP is Systolic 120-129 and Diastolic
<80. Hypertensive crisis (D) involves a systolic >180 or diastolic >120.
Q7: A client is being discharged after a Myocardial Infarction. Which of the following statements
by the client indicates the need for further teaching?
A. "I will change position slowly to prevent dizziness."
B. "I will do my heavy lifting exercises at home to regain strength." [CORRECT]
C. "I will take my nitroglycerin whenever I experience chest pain."
D. "I will join a support group for heart patients."
, 4
Correct Answer: B
Rationale: Heavy lifting is discouraged for 4-6 weeks post-MI (often longer if sternotomy) to
prevent strain on the heart and injury to the incision site. Changing positions slowly (A) is
important for clients on antihypertensives or beta-blockers. Taking nitroglycerin (C) and support
(D) are appropriate interventions.
Q8: A client is prescribed Lisinopril, an ACE inhibitor. Which of the following side effects
should the nurse instruct the client to report?
A. Constipation
C. Dry, non-productive cough [CORRECT]
D. Drowsiness
Correct Answer: C
Rationale: A persistent, dry, non-productive cough is a common side effect of ACE inhibitors
caused by the accumulation of bradykinin in the lungs. While not harmful, it is bothersome and
may require switching to an ARB. Constipation (A) is common with calcium channel blockers,
and drowsiness (D) is more common with beta-blockers.
Q9: A nurse is providing discharge teaching to a client with hypertension. Which of the
following dietary modifications is most appropriate?
A. DASH diet (Dietary Approaches to Stop Hypertension) [CORRECT]
B. High protein, low carbohydrate diet
C. Gluten-free diet
D. High fat, low protein diet
Correct Answer: A
Rationale: The DASH diet is specifically designed to lower blood pressure by emphasizing
fruits, vegetables, whole grains, and low-fat dairy while reducing red meat, sugar, and saturated
fats. It is the first-line dietary recommendation for hypertension. High protein/low carb (B) is for
NUR 242 Exam 2 Medical Surgical Nursing Concepts
Study Guide Galen Actual Exam 2026/2027 –
Complete Exam-Style Questions with Detailed
Rationales | Pass Guaranteed – A+ Graded
[SECTION 1: Cardiovascular Disorders — Questions 1-18]
Q1: A nurse is assessing a client with heart failure. Which of the following clinical
manifestations is most specific to left-sided heart failure?
A. Hepatomegaly
B. Jugular vein distention
C. Pulmonary crackles [CORRECT]
D. Dependent sacral edema
Correct Answer: C
Rationale: Left-sided heart failure causes blood to back up into the left atrium and pulmonary
system, resulting in pulmonary congestion, which manifests as crackles (rales) and dyspnea.
Hepatomegaly (A), JVD (B), and dependent edema (D) are classic signs of right-sided heart
failure due to systemic venous congestion. Recognizing the distinction between left and right
failure is critical for targeted nursing interventions.
Q2: A client with heart failure (HF) is prescribed Furosemide (Lasix). Which of the following
laboratory results should the nurse monitor closely as a potential side effect of this medication?
A. Hypernatremia
C. Hypokalemia [CORRECT]
D. Hypermagnesemia
Correct Answer: C
Rationale: Furosemide is a loop diuretic that increases the excretion of sodium, water, and
potassium, leading to hypokalemia. Low potassium levels can precipitate dysrhythmias,
especially in clients with heart failure. Hyponatremia (A) is more likely with SIADH or thiazide
,2
diuretics; hypercalcemia (B) is associated with cancer; and hypermagnesemia (D) is not a typical
effect of loop diuretics.
Q3: A nurse is teaching a client with heart failure about lifestyle modifications to manage fluid
overload. Which of the following client statements indicates a need for further teaching?
A. "I will weigh myself every morning after urinating."
B. "I can drink as much fluid as I want because I take water pills." [CORRECT]
C. "I will limit my sodium intake to 2-3 grams per day."
D. "I will report a weight gain of more than 2 pounds in one day."
Correct Answer: B
Rationale: Fluid restriction is a standard part of managing heart failure, typically limited to 1.5 to
2 liters per day depending on the provider's order. Stating that fluid intake is unlimited because
diuretics are taken indicates a misunderstanding of the balance between fluid intake and output.
Weighing daily (A), limiting sodium (C), and reporting weight gain (D) are correct self-
management strategies.
Q4: A client is admitted with chest pain and is diagnosed with Myocardial Infarction (MI). The
nurse should prepare to administer which medication as part of the MONA (Morphine, Oxygen,
Nitroglycerin, Aspirin) protocol?
A. Clopidogrel (Plavix)
C. Aspirin (chewable) [CORRECT]
D. Warfarin (Coumadin)
Correct Answer: C
Rationale: Aspirin is the primary antiplatelet agent administered immediately for a suspected MI
to inhibit platelet aggregation and reduce mortality; chewing the tablet ensures rapid absorption.
Clopidogrel (A) may be added later but is not the immediate MONA priority. Warfarin (D) is an
anticoagulant used for conditions like atrial fibrillation, not acute MI management. Atorvastatin
(B) is for lipid management but not part of the acute MONA protocol.
,3
Q5: A nurse is caring for a client receiving Digoxin (Lanoxin) for heart failure. Which of the
following findings should the nurse report immediately as a sign of toxicity?
A. Heart rate of 68/min
C. Visual disturbances (yellow halos) [CORRECT]
D. Urinary output of 60 mL/hr
Correct Answer: C
Rationale: Visual disturbances, such as seeing yellow or green halos around lights, are a classic
early sign of Digoxin toxicity and require immediate medical evaluation. A heart rate of 68 (A) is
within the normal therapeutic range (60-100), and urinary output of 60 mL/hr (D) is adequate.
Nausea and vomiting (B) are also signs of toxicity but often occur later or concurrently with
visual changes.
Q6: A client is diagnosed with hypertension. Which of the following classifications applies if the
client's blood pressure is consistently measured at 135/85 mm Hg?
A. Normal
C. Stage 1 Hypertension [CORRECT]
D. Hypertensive crisis
Correct Answer: C
Rationale: According to ACC/AHA guidelines, blood pressure of 130--89 is classified as
Stage 1 Hypertension. Normal BP is <120/<80. Elevated BP is Systolic 120-129 and Diastolic
<80. Hypertensive crisis (D) involves a systolic >180 or diastolic >120.
Q7: A client is being discharged after a Myocardial Infarction. Which of the following statements
by the client indicates the need for further teaching?
A. "I will change position slowly to prevent dizziness."
B. "I will do my heavy lifting exercises at home to regain strength." [CORRECT]
C. "I will take my nitroglycerin whenever I experience chest pain."
D. "I will join a support group for heart patients."
, 4
Correct Answer: B
Rationale: Heavy lifting is discouraged for 4-6 weeks post-MI (often longer if sternotomy) to
prevent strain on the heart and injury to the incision site. Changing positions slowly (A) is
important for clients on antihypertensives or beta-blockers. Taking nitroglycerin (C) and support
(D) are appropriate interventions.
Q8: A client is prescribed Lisinopril, an ACE inhibitor. Which of the following side effects
should the nurse instruct the client to report?
A. Constipation
C. Dry, non-productive cough [CORRECT]
D. Drowsiness
Correct Answer: C
Rationale: A persistent, dry, non-productive cough is a common side effect of ACE inhibitors
caused by the accumulation of bradykinin in the lungs. While not harmful, it is bothersome and
may require switching to an ARB. Constipation (A) is common with calcium channel blockers,
and drowsiness (D) is more common with beta-blockers.
Q9: A nurse is providing discharge teaching to a client with hypertension. Which of the
following dietary modifications is most appropriate?
A. DASH diet (Dietary Approaches to Stop Hypertension) [CORRECT]
B. High protein, low carbohydrate diet
C. Gluten-free diet
D. High fat, low protein diet
Correct Answer: A
Rationale: The DASH diet is specifically designed to lower blood pressure by emphasizing
fruits, vegetables, whole grains, and low-fat dairy while reducing red meat, sugar, and saturated
fats. It is the first-line dietary recommendation for hypertension. High protein/low carb (B) is for
