,Galen College NUR 242 Exam 4 (pdf) | 2026/2027 | Med-Surg Q&A |
Medical-Surgical Nursing
**1. A nurse is preparing to administer a beta-blocker to a patient with a
history of heart failure. Which assessment finding would require the nurse to
hold the medication and notify the healthcare provider?**
A) Apical pulse of 58 beats per minute
B) Blood pressure of 118/76 mm Hg
C) Respiratory rate of 18 breaths per minute
D) Oxygen saturation of 94%
**Correct Answer: Apical pulse of 58 beats per minute**
**Rationale:** Beta-blockers decrease heart rate. A pulse <60 bpm is a
common contraindication because administering the drug could cause
symptomatic bradycardia or heart block. The nurse should always check the
apical pulse before giving a beta-blocker (see **I. Cardiovascular/Perfusion
Disorders: Heart Failure** in the **High-Yield Topics** section of the Exam
Study Guide).
**2. A patient is diagnosed with heart failure and has an ejection fraction of
35%. Which medication classification is considered first-line therapy to
improve survival and reduce hospitalizations?**
A) Angiotensin-converting enzyme (ACE) inhibitors
B) Loop diuretics
C) Digoxin
D) Calcium channel blockers
**Correct Answer: Angiotensin-converting enzyme (ACE) inhibitors**
,**Rationale:** ACE inhibitors are foundational in heart failure with reduced
ejection fraction (HFrEF). They decrease afterload, preload, and ventricular
remodeling, leading to reduced mortality and hospitalizations. Loop diuretics
control symptoms but do not improve survival.
**3. A patient reports sudden, severe chest pain that radiates to the jaw and
left arm, accompanied by diaphoresis and nausea. Vital signs are BP 160/95,
HR 110, RR 22, O2 sat 94%. What is the priority nursing action?**
A) Administer sublingual nitroglycerin
B) Obtain a 12-lead electrocardiogram (ECG)
C) Apply oxygen via nasal cannula
D) Place the patient in a supine position
**Correct Answer: Obtain a 12-lead electrocardiogram (ECG)**
**Rationale:** The symptoms are classic for an acute myocardial infarction
(MI). The priority is to obtain an ECG quickly to determine if ST-elevation MI
(STEMI) is present, as this will guide urgent reperfusion therapy (e.g.,
percutaneous coronary intervention). Obtaining the ECG is the first step after
initial assessment and oxygen administration.
**4. A patient is admitted with an acute exacerbation of heart failure. The
nurse notes crackles in the lung bases, 3+ pitting edema in the lower
extremities, and jugular vein distention. Which medication should the nurse
prepare to administer first?**
A) Furosemide (Lasix)
B) Metoprolol (Lopressor)
C) Spironolactone (Aldactone)
D) Lisinopril (Prinivil)
**Correct Answer: Furosemide (Lasix)**
, **Rationale:** Furosemide is a loop diuretic used to rapidly reduce fluid
overload in acute heart failure. It promotes diuresis, relieving pulmonary
congestion (crackles) and peripheral edema. The other medications are used
for chronic management.
**5. A client is 2 days post-coronary artery bypass graft (CABG) surgery. The
nurse notes new-onset confusion, a temperature of 101.2°F (38.4°C), and a
white blood cell count of 18,000/mm³. What is the nurse’s priority action?**
A) Administer acetaminophen as ordered
B) Notify the healthcare provider immediately
C) Increase the flow rate of supplemental oxygen
D) Continue to monitor vital signs every 4 hours
**Correct Answer: Notify the healthcare provider immediately**
**Rationale:** Post-operative fever, confusion, and leukocytosis are potential
signs of a serious infection or sepsis. The provider must be notified promptly
for further evaluation and intervention.
**6. A patient taking warfarin for atrial fibrillation has an international
normalized ratio (INR) of 4.5. The patient has no signs of active bleeding.
What intervention should the nurse anticipate?**
A) Administer vitamin K orally
B) Increase the warfarin dose
C) Administer protamine sulfate
D) Prepare for fresh frozen plasma transfusion
**Correct Answer: Administer vitamin K orally**
Medical-Surgical Nursing
**1. A nurse is preparing to administer a beta-blocker to a patient with a
history of heart failure. Which assessment finding would require the nurse to
hold the medication and notify the healthcare provider?**
A) Apical pulse of 58 beats per minute
B) Blood pressure of 118/76 mm Hg
C) Respiratory rate of 18 breaths per minute
D) Oxygen saturation of 94%
**Correct Answer: Apical pulse of 58 beats per minute**
**Rationale:** Beta-blockers decrease heart rate. A pulse <60 bpm is a
common contraindication because administering the drug could cause
symptomatic bradycardia or heart block. The nurse should always check the
apical pulse before giving a beta-blocker (see **I. Cardiovascular/Perfusion
Disorders: Heart Failure** in the **High-Yield Topics** section of the Exam
Study Guide).
**2. A patient is diagnosed with heart failure and has an ejection fraction of
35%. Which medication classification is considered first-line therapy to
improve survival and reduce hospitalizations?**
A) Angiotensin-converting enzyme (ACE) inhibitors
B) Loop diuretics
C) Digoxin
D) Calcium channel blockers
**Correct Answer: Angiotensin-converting enzyme (ACE) inhibitors**
,**Rationale:** ACE inhibitors are foundational in heart failure with reduced
ejection fraction (HFrEF). They decrease afterload, preload, and ventricular
remodeling, leading to reduced mortality and hospitalizations. Loop diuretics
control symptoms but do not improve survival.
**3. A patient reports sudden, severe chest pain that radiates to the jaw and
left arm, accompanied by diaphoresis and nausea. Vital signs are BP 160/95,
HR 110, RR 22, O2 sat 94%. What is the priority nursing action?**
A) Administer sublingual nitroglycerin
B) Obtain a 12-lead electrocardiogram (ECG)
C) Apply oxygen via nasal cannula
D) Place the patient in a supine position
**Correct Answer: Obtain a 12-lead electrocardiogram (ECG)**
**Rationale:** The symptoms are classic for an acute myocardial infarction
(MI). The priority is to obtain an ECG quickly to determine if ST-elevation MI
(STEMI) is present, as this will guide urgent reperfusion therapy (e.g.,
percutaneous coronary intervention). Obtaining the ECG is the first step after
initial assessment and oxygen administration.
**4. A patient is admitted with an acute exacerbation of heart failure. The
nurse notes crackles in the lung bases, 3+ pitting edema in the lower
extremities, and jugular vein distention. Which medication should the nurse
prepare to administer first?**
A) Furosemide (Lasix)
B) Metoprolol (Lopressor)
C) Spironolactone (Aldactone)
D) Lisinopril (Prinivil)
**Correct Answer: Furosemide (Lasix)**
, **Rationale:** Furosemide is a loop diuretic used to rapidly reduce fluid
overload in acute heart failure. It promotes diuresis, relieving pulmonary
congestion (crackles) and peripheral edema. The other medications are used
for chronic management.
**5. A client is 2 days post-coronary artery bypass graft (CABG) surgery. The
nurse notes new-onset confusion, a temperature of 101.2°F (38.4°C), and a
white blood cell count of 18,000/mm³. What is the nurse’s priority action?**
A) Administer acetaminophen as ordered
B) Notify the healthcare provider immediately
C) Increase the flow rate of supplemental oxygen
D) Continue to monitor vital signs every 4 hours
**Correct Answer: Notify the healthcare provider immediately**
**Rationale:** Post-operative fever, confusion, and leukocytosis are potential
signs of a serious infection or sepsis. The provider must be notified promptly
for further evaluation and intervention.
**6. A patient taking warfarin for atrial fibrillation has an international
normalized ratio (INR) of 4.5. The patient has no signs of active bleeding.
What intervention should the nurse anticipate?**
A) Administer vitamin K orally
B) Increase the warfarin dose
C) Administer protamine sulfate
D) Prepare for fresh frozen plasma transfusion
**Correct Answer: Administer vitamin K orally**
