NUR 210 & NUR 242 Nursing Fundamentals & Med-Surg Foundations
Exam 5 2026 |Galen College
1. A nurse is assessing a patient’s wound and notes a thick, yellow, stringy
substance. How should the nurse document this finding?
A. Granulation tissue
B. Slough
C. Eschar
D. Serosanguineous drainage
Answer: B
Rationale: Slough is yellow, tan, gray, green, or brown stringy tissue that must be removed
for a wound to heal. Granulation is beefy red; eschar is black/brown necrotic tissue.
2. A patient is admitted with a potassium level of 2.8 mEq/L. Which of the
following should the nurse expect to see on the ECG?
A. Peaked T waves
B. Widened QRS complex
C. Presence of U waves
D. Shortened PR interval
Answer: C
Rationale: Hypokalemia (low potassium) is characterized by the presence of U waves, ST-
segment depression, and flattened T waves. Peaked T waves are associated with
hyperkalemia.
,3. Which arterial blood gas (ABG) result is consistent with a patient experiencing
a panic attack and hyperventilating?
A. pH 7.32, PaCO2 50, HCO3 24
B. pH 7.48, PaCO2 30, HCO3 23
C. pH 7.30, PaCO2 35, HCO3 18
D. pH 7.50, PaCO2 45, HCO3 32
Answer: B
Rationale: Hyperventilation causes the excessive ‘blowing off’ of CO2, leading to
Respiratory Alkalosis (High pH, low CO2).
4. A patient has a pressure injury that involves full-thickness skin loss with
visible subcutaneous fat, but no bone or muscle is exposed. What stage is this?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
Answer: C
Rationale: Stage 3 involves full-thickness loss where adipose (fat) is visible, but fascia,
muscle, tendon, ligament, cartilage, and bone are not exposed.
5. The nurse is monitoring a patient receiving 0.9% Normal Saline at 150 mL/hr.
Which finding suggests fluid volume overload?
A. Flattened neck veins
B. Crackles in the lower lung bases
C. Tachycardia and hypotension
D. Dry mucous membranes
Answer: B
Rationale: Fluid volume overload often leads to pulmonary edema, manifested as crackles,
as well as jugular venous distention and peripheral edema.
, 6. When performing a sterile dressing change, which action by the nurse would
break the sterile field?
A. Opening the first flap away from the body
B. Keeping the sterile gloved hands above the waist
C. Turning the back to the sterile field to grab a trash can
D. Dropping a sterile item onto the center of the field
Answer: C
Rationale: A sterile field should never be left unattended or have the nurse’s back turned
to it, as it is then considered contaminated.
7. Which electrolyte imbalance is most likely to cause a positive Chvostek’s
sign?
A. Hyperkalemia
B. Hypermagnesemia
C. Hyponatremia
D. Hypocalcemia
Answer: D
Rationale: Chvostek’s sign (facial twitching when the facial nerve is tapped) and
Trousseau’s sign are classic indicators of hypocalcemia and hypomagnesemia.
8. A post-operative patient reports a ‘popping’ sensation at the abdominal
incision site after coughing. The nurse observes internal organs protruding.
What is the immediate priority?
A. Push the organs back into the abdominal cavity
B. Cover the area with sterile towels soaked in sterile saline
C. Apply a dry sterile dressing
D. Help the patient walk to the bathroom to relieve pressure
Answer: B
Exam 5 2026 |Galen College
1. A nurse is assessing a patient’s wound and notes a thick, yellow, stringy
substance. How should the nurse document this finding?
A. Granulation tissue
B. Slough
C. Eschar
D. Serosanguineous drainage
Answer: B
Rationale: Slough is yellow, tan, gray, green, or brown stringy tissue that must be removed
for a wound to heal. Granulation is beefy red; eschar is black/brown necrotic tissue.
2. A patient is admitted with a potassium level of 2.8 mEq/L. Which of the
following should the nurse expect to see on the ECG?
A. Peaked T waves
B. Widened QRS complex
C. Presence of U waves
D. Shortened PR interval
Answer: C
Rationale: Hypokalemia (low potassium) is characterized by the presence of U waves, ST-
segment depression, and flattened T waves. Peaked T waves are associated with
hyperkalemia.
,3. Which arterial blood gas (ABG) result is consistent with a patient experiencing
a panic attack and hyperventilating?
A. pH 7.32, PaCO2 50, HCO3 24
B. pH 7.48, PaCO2 30, HCO3 23
C. pH 7.30, PaCO2 35, HCO3 18
D. pH 7.50, PaCO2 45, HCO3 32
Answer: B
Rationale: Hyperventilation causes the excessive ‘blowing off’ of CO2, leading to
Respiratory Alkalosis (High pH, low CO2).
4. A patient has a pressure injury that involves full-thickness skin loss with
visible subcutaneous fat, but no bone or muscle is exposed. What stage is this?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
Answer: C
Rationale: Stage 3 involves full-thickness loss where adipose (fat) is visible, but fascia,
muscle, tendon, ligament, cartilage, and bone are not exposed.
5. The nurse is monitoring a patient receiving 0.9% Normal Saline at 150 mL/hr.
Which finding suggests fluid volume overload?
A. Flattened neck veins
B. Crackles in the lower lung bases
C. Tachycardia and hypotension
D. Dry mucous membranes
Answer: B
Rationale: Fluid volume overload often leads to pulmonary edema, manifested as crackles,
as well as jugular venous distention and peripheral edema.
, 6. When performing a sterile dressing change, which action by the nurse would
break the sterile field?
A. Opening the first flap away from the body
B. Keeping the sterile gloved hands above the waist
C. Turning the back to the sterile field to grab a trash can
D. Dropping a sterile item onto the center of the field
Answer: C
Rationale: A sterile field should never be left unattended or have the nurse’s back turned
to it, as it is then considered contaminated.
7. Which electrolyte imbalance is most likely to cause a positive Chvostek’s
sign?
A. Hyperkalemia
B. Hypermagnesemia
C. Hyponatremia
D. Hypocalcemia
Answer: D
Rationale: Chvostek’s sign (facial twitching when the facial nerve is tapped) and
Trousseau’s sign are classic indicators of hypocalcemia and hypomagnesemia.
8. A post-operative patient reports a ‘popping’ sensation at the abdominal
incision site after coughing. The nurse observes internal organs protruding.
What is the immediate priority?
A. Push the organs back into the abdominal cavity
B. Cover the area with sterile towels soaked in sterile saline
C. Apply a dry sterile dressing
D. Help the patient walk to the bathroom to relieve pressure
Answer: B
