,Galen College NUR 242 Final Exam (pdf) | 2026/2027 | Med-Surg Q&A
| Medical-Surgical Nursing
**1. A nurse is assessing a patient with chronic heart failure. Which finding is
most indicative of worsening fluid overload?**
A) Weight loss of 1 kg in 24 hours
B) Crackles in the lung bases
C) Thready peripheral pulses
D) Decreased jugular venous pressure
**Correct Answer: B) Crackles in the lung bases**
**Rationale:** Crackles (rales) in the lung bases indicate pulmonary
congestion from increased left ventricular filling pressures, a hallmark of
worsening heart failure. Weight loss and decreased jugular venous pressure
suggest improvement, while thready pulses may be seen in low cardiac
output states but are less specific for fluid overload.
---
**2. Which medication is the first-line treatment for ST-segment elevation
myocardial infarction (STEMI) when a patient presents within 90 minutes of
symptom onset?**
A) Fibrinolytic therapy
B) Percutaneous coronary intervention (PCI)
C) Aspirin and nitroglycerin
D) Beta-blocker therapy
**Correct Answer: B) Percutaneous coronary intervention (PCI)**
,**Rationale:** PCI is the preferred reperfusion strategy for STEMI if it can be
performed within 90 minutes of presentation. It has higher success rates and
lower complication rates than fibrinolytic therapy. Aspirin and nitroglycerin
are early interventions, but they do not reopen the occluded artery.
Beta-blockers are initiated early but are not reperfusion therapy.
---
**3. A patient is prescribed warfarin for atrial fibrillation. The nurse should
instruct the patient to avoid foods high in which vitamin due to drug
interaction?**
A) Vitamin A
B) Vitamin C
C) Vitamin D
D) Vitamin K
**Correct Answer: D) Vitamin K**
**Rationale:** Vitamin K antagonises the action of warfarin. Sudden changes
in vitamin K intake can alter the INR, increasing the risk of thrombosis or
bleeding. Patients should be advised to maintain a consistent intake of
vitamin K-rich foods such as leafy green vegetables.
---
**4. The nurse is preparing to administer intravenous alteplase (tPA) to a
patient with an acute ischemic stroke. Which finding requires immediate
action?**
A) Blood pressure 150/90 mm Hg
B) Headache and neurologic deterioration
, C) Heart rate 90 beats/minute
D) Oxygen saturation 95%
**Correct Answer: B) Headache and neurologic deterioration**
**Rationale:** Headache and neurologic deterioration after tPA
administration may indicate intracranial hemorrhage, a life-threatening
complication. The infusion should be stopped immediately, and emergency
interventions initiated.
---
**5. Which assessment finding is most consistent with right-sided heart
failure?**
A) Crackles in the lung bases
B) Jugular venous distention
C) Paroxysmal nocturnal dyspnea
D) S3 gallop
**Correct Answer: B) Jugular venous distention**
**Rationale:** Jugular venous distention (JVD) is a classic sign of increased
systemic venous pressure from right-sided heart failure. Crackles,
paroxysmal nocturnal dyspnea, and S3 gallop are associated with left-sided
heart failure.
---
| Medical-Surgical Nursing
**1. A nurse is assessing a patient with chronic heart failure. Which finding is
most indicative of worsening fluid overload?**
A) Weight loss of 1 kg in 24 hours
B) Crackles in the lung bases
C) Thready peripheral pulses
D) Decreased jugular venous pressure
**Correct Answer: B) Crackles in the lung bases**
**Rationale:** Crackles (rales) in the lung bases indicate pulmonary
congestion from increased left ventricular filling pressures, a hallmark of
worsening heart failure. Weight loss and decreased jugular venous pressure
suggest improvement, while thready pulses may be seen in low cardiac
output states but are less specific for fluid overload.
---
**2. Which medication is the first-line treatment for ST-segment elevation
myocardial infarction (STEMI) when a patient presents within 90 minutes of
symptom onset?**
A) Fibrinolytic therapy
B) Percutaneous coronary intervention (PCI)
C) Aspirin and nitroglycerin
D) Beta-blocker therapy
**Correct Answer: B) Percutaneous coronary intervention (PCI)**
,**Rationale:** PCI is the preferred reperfusion strategy for STEMI if it can be
performed within 90 minutes of presentation. It has higher success rates and
lower complication rates than fibrinolytic therapy. Aspirin and nitroglycerin
are early interventions, but they do not reopen the occluded artery.
Beta-blockers are initiated early but are not reperfusion therapy.
---
**3. A patient is prescribed warfarin for atrial fibrillation. The nurse should
instruct the patient to avoid foods high in which vitamin due to drug
interaction?**
A) Vitamin A
B) Vitamin C
C) Vitamin D
D) Vitamin K
**Correct Answer: D) Vitamin K**
**Rationale:** Vitamin K antagonises the action of warfarin. Sudden changes
in vitamin K intake can alter the INR, increasing the risk of thrombosis or
bleeding. Patients should be advised to maintain a consistent intake of
vitamin K-rich foods such as leafy green vegetables.
---
**4. The nurse is preparing to administer intravenous alteplase (tPA) to a
patient with an acute ischemic stroke. Which finding requires immediate
action?**
A) Blood pressure 150/90 mm Hg
B) Headache and neurologic deterioration
, C) Heart rate 90 beats/minute
D) Oxygen saturation 95%
**Correct Answer: B) Headache and neurologic deterioration**
**Rationale:** Headache and neurologic deterioration after tPA
administration may indicate intracranial hemorrhage, a life-threatening
complication. The infusion should be stopped immediately, and emergency
interventions initiated.
---
**5. Which assessment finding is most consistent with right-sided heart
failure?**
A) Crackles in the lung bases
B) Jugular venous distention
C) Paroxysmal nocturnal dyspnea
D) S3 gallop
**Correct Answer: B) Jugular venous distention**
**Rationale:** Jugular venous distention (JVD) is a classic sign of increased
systemic venous pressure from right-sided heart failure. Crackles,
paroxysmal nocturnal dyspnea, and S3 gallop are associated with left-sided
heart failure.
---
