GALEN COLLEGE OF NURSING
NUR 254 Exam 2
Medical-Surgical Nursing II
Official Practice Exam · 2026/2027 Edition
Questions: 50 Minutes: 60 Passing Score: 80% Format: MCQ
TABLE OF CONTENTS
Section 1: Cardiovascular Disorders (Q1-Q14)
Section 2: Respiratory Disorders (Q15-Q28)
Section 3: Hematologic & Lymphatic Disorders (Q29-Q39)
Section 4: Immune & Infectious Disorders (Q40-Q50)
INSTRUCTIONS
Read each question carefully. Select the one best answer from the four options provided. This exam covers
cardiovascular, respiratory, hematologic/lymphatic, and immune/infectious disorders from the NUR 254
Medical-Surgical Nursing II curriculum. Each question includes a rationale explaining the correct answer and why the
most commonly chosen incorrect answer is wrong. A passing score of 80% or higher is required. You have 60 minutes
to complete all 50 questions.
NUR 254 Exam 2 — 2026/2027 | Passing Score: 80% | Page 1 of 27
, Section 1: Cardiovascular Disorders - 2026/2027
Q1 Question 1 of 50
A 68-year-old male with a history of hypertension and hyperlipidemia presents to the
emergency department with crushing substernal chest pain radiating to the left arm,
diaphoresis, and nausea that began 30 minutes ago. His ECG shows ST-segment elevation
in leads V2 through V4. The nurse should recognize these findings as indicative of which
type of myocardial infarction?
A. Non-ST elevation myocardial infarction requiring conservative medical management
B. Unstable angina requiring observation and serial cardiac enzyme monitoring
C. Anterior wall ST-elevation myocardial infarction requiring emergent reperfusion
therapy
D. Pericarditis presenting with diffuse ST-segment elevation and positional chest pain
Correct Answer: C
Rationale:
ST-segment elevation in leads V2-V4 indicates an anterior wall STEMI, which is a life-threatening
emergency requiring immediate reperfusion therapy (PCI or thrombolytics). NSTEMI shows ST depression
or T-wave inversion, unstable angina shows no enzyme elevation, and pericarditis shows diffuse ST
elevation and pain that changes with position.
Q2 Question 2 of 50
A 55-year-old female with a mechanical mitral valve replacement is taking warfarin with a
target INR of 2.5-3.5. Her current INR is 5.8, and she has no active bleeding. The nurse
anticipates the physician will order which intervention?
A. Administer fresh frozen plasma immediately to reverse the anticoagulant effect
B. Increase the warfarin dose to maintain therapeutic anticoagulation
C. Hold the warfarin dose and administer oral vitamin K (phytonadione)
D. Discontinue warfarin permanently and transition to aspirin therapy
Correct Answer: C
Rationale:
An INR of 5.8 is significantly above the therapeutic range without active bleeding. The standard approach is
to hold warfarin and administer oral vitamin K to gradually reverse the excessive anticoagulation. Fresh
frozen plasma is reserved for active, life-threatening bleeding. Increasing the dose would worsen the
situation, and permanent discontinuation is not indicated.
NUR 254 Exam 2 — 2026/2027 | Passing Score: 80% | Page 2 of 27
, Q3 Question 3 of 50
A 72-year-old male with systolic heart failure has an ejection fraction of 25% and takes
carvedilol, lisinopril, and furosemide. The nurse notes bilateral crackles, 3+ pitting edema,
and a weight gain of 5 pounds over 3 days. The patient's BNP is 1,200 pg/mL. The nurse
should identify the priority nursing diagnosis as:
A. Decreased cardiac output related to impaired ventricular pumping ability
B. Activity intolerance related to imbalance between oxygen supply and demand
C. Fluid volume excess related to compromised regulatory mechanisms secondary to
heart failure
D. Impaired gas exchange related to alveolar-capillary membrane changes
Correct Answer: C
Rationale:
The weight gain, bilateral crackles, pitting edema, and elevated BNP all indicate fluid volume excess as the
most immediate and observable problem. While decreased cardiac output is the underlying cause, fluid
volume excess is the priority nursing diagnosis because it represents the acute, life-threatening
manifestation requiring immediate intervention with diuretics and fluid restriction.
Q4 Question 4 of 50
A 60-year-old male presents with sudden onset of severe tearing chest pain that radiates to
his back between the scapulae. His blood pressure is 180/110 mmHg in the right arm and
140/80 mmHg in the left arm. A chest X-ray shows a widened mediastinum. The nurse
should suspect which life-threatening condition?
A. Acute myocardial infarction with cardiogenic shock
B. Pulmonary embolism with hemodynamic compromise
C. Aortic dissection requiring immediate blood pressure control and surgical evaluation
D. Tension pneumothorax causing mediastinal shift and unequal pulses
Correct Answer: C
Rationale:
Tearing chest pain radiating to the back, blood pressure discrepancy between arms (greater than 20
mmHg), and widened mediastinum are the classic triad of aortic dissection. This is a surgical emergency
requiring immediate IV beta-blocker therapy to reduce blood pressure and shear stress on the aortic wall.
MI pain is typically crushing and does not radiate to the back, and PE and pneumothorax present differently.
NUR 254 Exam 2 — 2026/2027 | Passing Score: 80% | Page 3 of 27
NUR 254 Exam 2
Medical-Surgical Nursing II
Official Practice Exam · 2026/2027 Edition
Questions: 50 Minutes: 60 Passing Score: 80% Format: MCQ
TABLE OF CONTENTS
Section 1: Cardiovascular Disorders (Q1-Q14)
Section 2: Respiratory Disorders (Q15-Q28)
Section 3: Hematologic & Lymphatic Disorders (Q29-Q39)
Section 4: Immune & Infectious Disorders (Q40-Q50)
INSTRUCTIONS
Read each question carefully. Select the one best answer from the four options provided. This exam covers
cardiovascular, respiratory, hematologic/lymphatic, and immune/infectious disorders from the NUR 254
Medical-Surgical Nursing II curriculum. Each question includes a rationale explaining the correct answer and why the
most commonly chosen incorrect answer is wrong. A passing score of 80% or higher is required. You have 60 minutes
to complete all 50 questions.
NUR 254 Exam 2 — 2026/2027 | Passing Score: 80% | Page 1 of 27
, Section 1: Cardiovascular Disorders - 2026/2027
Q1 Question 1 of 50
A 68-year-old male with a history of hypertension and hyperlipidemia presents to the
emergency department with crushing substernal chest pain radiating to the left arm,
diaphoresis, and nausea that began 30 minutes ago. His ECG shows ST-segment elevation
in leads V2 through V4. The nurse should recognize these findings as indicative of which
type of myocardial infarction?
A. Non-ST elevation myocardial infarction requiring conservative medical management
B. Unstable angina requiring observation and serial cardiac enzyme monitoring
C. Anterior wall ST-elevation myocardial infarction requiring emergent reperfusion
therapy
D. Pericarditis presenting with diffuse ST-segment elevation and positional chest pain
Correct Answer: C
Rationale:
ST-segment elevation in leads V2-V4 indicates an anterior wall STEMI, which is a life-threatening
emergency requiring immediate reperfusion therapy (PCI or thrombolytics). NSTEMI shows ST depression
or T-wave inversion, unstable angina shows no enzyme elevation, and pericarditis shows diffuse ST
elevation and pain that changes with position.
Q2 Question 2 of 50
A 55-year-old female with a mechanical mitral valve replacement is taking warfarin with a
target INR of 2.5-3.5. Her current INR is 5.8, and she has no active bleeding. The nurse
anticipates the physician will order which intervention?
A. Administer fresh frozen plasma immediately to reverse the anticoagulant effect
B. Increase the warfarin dose to maintain therapeutic anticoagulation
C. Hold the warfarin dose and administer oral vitamin K (phytonadione)
D. Discontinue warfarin permanently and transition to aspirin therapy
Correct Answer: C
Rationale:
An INR of 5.8 is significantly above the therapeutic range without active bleeding. The standard approach is
to hold warfarin and administer oral vitamin K to gradually reverse the excessive anticoagulation. Fresh
frozen plasma is reserved for active, life-threatening bleeding. Increasing the dose would worsen the
situation, and permanent discontinuation is not indicated.
NUR 254 Exam 2 — 2026/2027 | Passing Score: 80% | Page 2 of 27
, Q3 Question 3 of 50
A 72-year-old male with systolic heart failure has an ejection fraction of 25% and takes
carvedilol, lisinopril, and furosemide. The nurse notes bilateral crackles, 3+ pitting edema,
and a weight gain of 5 pounds over 3 days. The patient's BNP is 1,200 pg/mL. The nurse
should identify the priority nursing diagnosis as:
A. Decreased cardiac output related to impaired ventricular pumping ability
B. Activity intolerance related to imbalance between oxygen supply and demand
C. Fluid volume excess related to compromised regulatory mechanisms secondary to
heart failure
D. Impaired gas exchange related to alveolar-capillary membrane changes
Correct Answer: C
Rationale:
The weight gain, bilateral crackles, pitting edema, and elevated BNP all indicate fluid volume excess as the
most immediate and observable problem. While decreased cardiac output is the underlying cause, fluid
volume excess is the priority nursing diagnosis because it represents the acute, life-threatening
manifestation requiring immediate intervention with diuretics and fluid restriction.
Q4 Question 4 of 50
A 60-year-old male presents with sudden onset of severe tearing chest pain that radiates to
his back between the scapulae. His blood pressure is 180/110 mmHg in the right arm and
140/80 mmHg in the left arm. A chest X-ray shows a widened mediastinum. The nurse
should suspect which life-threatening condition?
A. Acute myocardial infarction with cardiogenic shock
B. Pulmonary embolism with hemodynamic compromise
C. Aortic dissection requiring immediate blood pressure control and surgical evaluation
D. Tension pneumothorax causing mediastinal shift and unequal pulses
Correct Answer: C
Rationale:
Tearing chest pain radiating to the back, blood pressure discrepancy between arms (greater than 20
mmHg), and widened mediastinum are the classic triad of aortic dissection. This is a surgical emergency
requiring immediate IV beta-blocker therapy to reduce blood pressure and shear stress on the aortic wall.
MI pain is typically crushing and does not radiate to the back, and PE and pneumothorax present differently.
NUR 254 Exam 2 — 2026/2027 | Passing Score: 80% | Page 3 of 27
