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NUR 242 EXAM 3 MEDICAL-SURGICAL NURSING
GALEN COLLEGE OF NURSING 2026 PRACTICE
QUESTIONS | NEURO, MUSCULOSKELETAL &
SKIN NURSING REVIEW |INSTANT PDF
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Exam 3 – Neurological, Musculoskeletal & Integumentary Disorders Overview: Exam 3 covers neurological, musculoskeletal, and integumentary system disorders. Important topics include stroke, seizures, Parkinson’s disease, multiple sclerosis, fractures, osteoporosis, burns, and wound care. Questions focus on assessment findings, lab interpretation, imaging, and nursing management, emphasizing safety, mobility, pain management, and rehabilitation. Q1. A patient with heart failure presents with dyspnea, edema, and crackles. Which is the priority nursing intervention? A) Administer oxygen ✅ B) Encourage fluids C) Restrict activity D) Monitor sodium only Answer: A) Administer oxygen ✅ Rationale: Oxygen improves tissue perfusion and relieves hypoxia caused by pulmonary congestion. Q2. Which lab is most important to monitor in a patient with heart failure taking furosemide? A) Potassium ✅ B) Sodium only C) Calcium only D) Magnesium only
Answer: A) Potassium ✅ Rationale: Loop diuretics → potassium loss → risk of arrhythmias; monitor electrolytes closely. Q3. Which finding is characteristic of left-sided heart failure? A) Peripheral edema B) Pulmonary congestion, dyspnea ✅ C) Jugular vein distention D) Hepatomegaly Answer: B) Pulmonary congestion, dyspnea ✅ Rationale: Left-sided failure → blood backs up into lungs , causing pulmonary symptoms. Q4. A patient presents with chest pain and ST elevation on ECG. Which is priority? A) Administer nitroglycerin B) Call rapid response / activate STEMI protocol ✅ C) Restrict fluids D) Monitor potassium only Answer: B) Call rapid response / activate STEMI protocol ✅ Rationale: ST-elevation MI → emergent reperfusion is critical to prevent cardiac tissue death. Q5. Which electrolyte imbalance increases the risk of arrhythmias in heart failure? A) Hyperkalemia ✅ B) Hypercalcemia C) Hyponatremia only D) Hypomagnesemia only Answer: A) Hyperkalemia ✅ Rationale: Both hyper- and hypokalemia can precipitate arrhythmias, especially in patients on diuretics or ACE inhibitors.
C) ST elevation only D) Bradycardia only Answer: A) Peaked T waves ✅ Rationale: Early hyperkalemia → peaked T waves , progressing to widened QRS and arrhythmias if untreated. Q10. A patient with myocardial infarction is prescribed nitroglycerin. Which is the priority teaching? A) Take while lying down B) Monitor for headache and hypotension ✅ C) Avoid fluids D) Check potassium Answer: B) Monitor for headache and hypotension ✅ Rationale: Nitroglycerin → vasodilation , may cause hypotension and headache; monitor vital signs. Q11. Which lab is most important in a patient with heart failure and CKD? A) Potassium ✅ B) Sodium only C) Calcium only D) Magnesium only Answer: A) Potassium ✅ Rationale: CKD + diuretics → high risk of hyper- or hypokalemia , which affects cardiac rhythm. Q12. A patient with COPD is receiving oxygen therapy. Which is priority assessment? A) Respiratory rate, oxygen saturation ✅ B) Blood pressure only C) Potassium D) Glucose
Answer: A) Respiratory rate, oxygen saturation ✅ Rationale: Monitor for hypoxia, hypercapnia, and CO ₂ retention. Q13. Which sign indicates worsening left-sided heart failure? A) Peripheral edema B) Dyspnea, orthopnea, crackles ✅ C) Jugular vein distention D) Hepatomegaly Answer: B) Dyspnea, orthopnea, crackles ✅ Rationale: Left-sided failure → pulmonary congestion. Q14. A patient with atrial fibrillation is at increased risk for: A) Stroke ✅ B) Hypokalemia C) Hypernatremia D) Pulmonary edema only Answer: A) Stroke ✅ Rationale: Atrial fibrillation → blood stasis in atria → thrombus formation → embolic stroke risk. Q15. Which intervention is priority for a patient with angina? A) Administer nitroglycerin ✅ B) Restrict fluids C) Give potassium D) Encourage high-calorie diet Answer: A) Administer nitroglycerin ✅ Rationale: Relieves coronary artery spasm and reduces myocardial oxygen demand.
C) Dyspnea only D) Orthopnea Answer: A) Peripheral edema ✅ Rationale: Right-sided failure → systemic venous congestion. Q20. Which lab abnormality increases the risk of arrhythmias in cardiovascular patients? A) Hyperkalemia ✅ B) Hypernatremia only C) Hypocalcemia only D) Hypoglycemia Answer: A) Hyperkalemia ✅ Rationale: Hyperkalemia → affects cardiac conduction , leading to arrhythmias and potential cardiac arrest. Q21. Which assessment finding is most characteristic of left-sided heart failure? A) Pulmonary congestion, dyspnea, orthopnea ✅ B) Peripheral edema C) Jugular vein distention D) Hepatomegaly Answer: A) Pulmonary congestion, dyspnea, orthopnea ✅ Rationale: Left-sided heart failure → blood backs up into the lungs , causing respiratory symptoms. Q22. Which is a priority intervention for a patient with acute pulmonary edema? A) High-Fowler’s position and oxygen ✅ B) Restrict fluids only C) Administer potassium D) Encourage oral intake Answer: A) High-Fowler’s position and oxygen ✅ Rationale: Improves ventilation and oxygenation; reduces pulmonary venous pressure.
Q23. A patient with heart failure is prescribed furosemide. Which electrolyte imbalance should the nurse monitor? A) Hypokalemia ✅ B) Hypercalcemia C) Hyponatremia only D) Hypomagnesemia only Answer: A) Hypokalemia ✅ Rationale: Loop diuretics → potassium wasting ; risk of arrhythmias. Q24. Which lab is priority in a patient with CKD and heart failure? A) Serum potassium ✅ B) Sodium only C) Calcium only D) Magnesium only Answer: A) Serum potassium ✅ Rationale: CKD impairs potassium excretion; monitor closely for hyperkalemia or hypokalemia. Q25. A patient with myocardial infarction develops ST-elevation on ECG. What is the priority intervention? A) Call rapid response / STEMI protocol ✅ B) Give potassium C) Restrict fluids D) Administer antacids Answer: A) Call rapid response / STEMI protocol ✅ Rationale: Emergent reperfusion is critical to prevent myocardial tissue death. Q26. Which assessment finding indicates right-sided heart failure? A) Peripheral edema, jugular vein distention ✅
Answer: A) Administer oxygen carefully ✅ Rationale: Avoid over-oxygenation → risk of CO ₂ retention and respiratory acidosis. Q30. Which lab abnormality increases the risk of arrhythmias in cardiovascular patients? A) Hyperkalemia ✅ B) Hypocalcemia only C) Hyponatremia only D) Hypoglycemia Answer: A) Hyperkalemia ✅ Rationale: Potassium affects cardiac conduction → arrhythmias and potential cardiac arrest. Q31. Which symptom indicates worsening left-sided heart failure? A) Dyspnea, orthopnea, crackles ✅ B) Peripheral edema only C) Jugular vein distention D) Hepatomegaly Answer: A) Dyspnea, orthopnea, crackles ✅ Rationale: Blood backs up into lungs → pulmonary congestion. Q32. Which is the hallmark symptom of right-sided heart failure? A) Peripheral edema and JVD ✅ B) Pulmonary edema C) Dyspnea only D) Crackles Answer: A) Peripheral edema and JVD ✅ Rationale: Right-sided failure → systemic venous congestion.
Q33. A patient with atrial fibrillation is at increased risk for: A) Stroke ✅ B) Hypokalemia C) Pulmonary edema only D) Hyponatremia Answer: A) Stroke ✅ Rationale: Blood stasis in atria → thrombus formation → embolic stroke risk. Q34. Which intervention is priority for pulmonary embolism? A) Administer oxygen ✅ B) Restrict fluids only C) Encourage activity D) Give insulin Answer: A) Administer oxygen ✅ Rationale: Pulmonary embolism → hypoxemia ; oxygen improves tissue perfusion. Q35. Which position improves oxygenation in pulmonary edema? A) High-Fowler’s ✅ B) Supine C) Trendelenburg D) Lateral Answer: A) High-Fowler’s ✅ Rationale: Upright position → reduces pulmonary venous pressure and improves ventilation. Q36. Which electrolyte imbalance is most dangerous in CKD and heart failure? A) Hyperkalemia ✅ B) Hypocalcemia C) Hyponatremia D) Hypoglycemia
Q40. Which lab abnormality increases arrhythmia risk in cardiovascular patients? A) Hyperkalemia ✅ B) Hypocalcemia only C) Hyponatremia only D) Hypoglycemia Answer: A) Hyperkalemia ✅ Rationale: Elevated potassium → affects cardiac conduction , arrhythmia risk. Q41. A patient with myocardial infarction develops bradycardia and hypotension. Which intervention is priority? A) Administer atropine ✅ B) Give potassium C) Restrict fluids D) Encourage oral intake Answer: A) Administer atropine ✅ Rationale: Bradycardia with hypotension → impairs cardiac output ; atropine increases heart rate and perfusion. Q42. A patient with heart failure has dyspnea and pulmonary crackles. Which is priority intervention? A) Administer oxygen ✅ B) Encourage fluids C) Restrict activity D) Monitor potassium only Answer: A) Administer oxygen ✅ Rationale: Oxygen improves tissue perfusion and relieves hypoxia caused by pulmonary congestion. Q43. Which lab is most important to monitor in a patient with heart failure taking furosemide? A) Potassium ✅ B) Sodium only
C) Calcium only D) Magnesium only Answer: A) Potassium ✅ Rationale: Loop diuretics → potassium loss , increasing arrhythmia risk. Q44. Which assessment finding is characteristic of left-sided heart failure? A) Pulmonary congestion, dyspnea, orthopnea ✅ B) Peripheral edema C) Jugular vein distention D) Hepatomegaly Answer: A) Pulmonary congestion, dyspnea, orthopnea ✅ Rationale: Left-sided failure → blood backs up into lungs , causing respiratory symptoms. Q45. A patient presents with chest pain and ST-elevation MI. Which is the priority action? A) Call rapid response / STEMI protocol ✅ B) Administer potassium C) Restrict fluids D) Give antacids Answer: A) Call rapid response / STEMI protocol ✅ Rationale: ST-elevation MI → emergent reperfusion is critical to save myocardial tissue. Q46. Which symptom is hallmark of right-sided heart failure? A) Peripheral edema, jugular vein distention ✅ B) Pulmonary crackles C) Dyspnea only D) Orthopnea Answer: A) Peripheral edema, jugular vein distention ✅ Rationale: Right-sided failure → systemic venous congestion.
C) Hyponatremia only D) Hypoglycemia Answer: A) Hyperkalemia ✅ Rationale: Potassium affects cardiac conduction → arrhythmias and potential cardiac arrest. Q51. Which symptom indicates worsening left-sided heart failure? A) Dyspnea, orthopnea, crackles ✅ B) Peripheral edema only C) Jugular vein distention D) Hepatomegaly Answer: A) Dyspnea, orthopnea, crackles ✅ Rationale: Left-sided failure → pulmonary congestion. Q52. Which is the hallmark symptom of right-sided heart failure? A) Peripheral edema and JVD ✅ B) Pulmonary edema C) Dyspnea only D) Crackles Answer: A) Peripheral edema and JVD ✅ Rationale: Right-sided failure → systemic venous congestion. Q53. A patient with atrial fibrillation is at increased risk for: A) Stroke ✅ B) Hypokalemia C) Pulmonary edema only D) Hyponatremia Answer: A) Stroke ✅ Rationale: Blood stasis in atria → thrombus formation → embolic stroke risk.
Q54. Which intervention is priority for pulmonary embolism? A) Administer oxygen ✅ B) Restrict fluids only C) Encourage activity D) Give insulin Answer: A) Administer oxygen ✅ Rationale: Pulmonary embolism → hypoxemia ; oxygen improves tissue perfusion. Q55. Which position improves oxygenation in pulmonary edema? A) High-Fowler’s ✅ B) Supine C) Trendelenburg D) Lateral Answer: A) High-Fowler’s ✅ Rationale: Upright position → reduces pulmonary venous pressure and improves ventilation. Q56. Which electrolyte imbalance is most dangerous in CKD and heart failure? A) Hyperkalemia ✅ B) Hypocalcemia C) Hyponatremia D) Hypoglycemia Answer: A) Hyperkalemia ✅ Rationale: Hyperkalemia → cardiac conduction abnormalities → arrhythmias. Q57. A patient with COPD develops confusion. Which is priority assessment? A) ABGs ✅ B) Sodium only
Q61. Which assessment finding is priority in a patient with acute myocardial infarction? A) Chest pain severity ✅ B) Sodium level C) Temperature D) Urine output Answer: A) Chest pain severity ✅ Rationale: Severe chest pain indicates ongoing myocardial ischemia ; early intervention reduces myocardial damage. Q62. A patient with heart failure is prescribed digoxin. Which assessment is most important before administering? A) Apical pulse ✅ B) Respiratory rate only C) Blood pressure only D) Temperature Answer: A) Apical pulse ✅ Rationale: Digoxin → slows heart rate ; hold if pulse <60 bpm to prevent bradycardia. Q63. Which finding is characteristic of left-sided heart failure? A) Pulmonary congestion, dyspnea ✅ B) Peripheral edema only C) Jugular vein distention D) Hepatomegaly Answer: A) Pulmonary congestion, dyspnea ✅ Rationale: Left-sided failure → blood backs up into lungs → pulmonary symptoms. Q64. A patient with COPD develops PaCO ₂ of 65 mmHg. Which is priority? A) Assess oxygenation and respiratory status ✅ B) Restrict fluids
C) Administer potassium D) Encourage oral intake Answer: A) Assess oxygenation and respiratory status ✅ Rationale: Hypercapnia → respiratory acidosis , monitor closely and titrate oxygen carefully. Q65. A patient with atrial fibrillation is at highest risk for: A) Stroke ✅ B) Hypokalemia C) Hyponatremia D) Pulmonary edema Answer: A) Stroke ✅ Rationale: Atrial fibrillation → blood stasis → thrombus formation → embolic stroke. Q66. Which intervention is priority in pulmonary embolism? A) Administer oxygen ✅ B) Restrict fluids only C) Encourage activity D) Give insulin Answer: A) Administer oxygen ✅ Rationale: Pulmonary embolism → hypoxemia ; oxygen improves tissue perfusion. Q67. A patient with heart failure has crackles, dyspnea, and orthopnea. Which position is best? A) High-Fowler’s ✅ B) Supine C) Trendelenburg D) Lateral
