,NU 185 – Medical-Surgical II – Exam 2 | Questions &
Verified Answers | 2026 Edition | Galen College
1. Which of the following best describes the pathophysiology of acute respiratory distress syndrome
(ARDS)?
A) Bronchoconstriction and mucus plugging of airways
B) Diffuse alveolar-capillary damage with increased permeability and noncardiogenic pulmonary edema
C) Progressive destruction of alveolar walls and loss of elastic recoil
D) Accumulation of purulent secretions in the bronchi
Correct Answer: Diffuse alveolar-capillary damage with increased permeability and noncardiogenic
pulmonary edema
Rationale: ARDS is characterized by an acute inflammatory injury to the alveolar-capillary membrane,
leading to increased permeability, protein-rich pulmonary edema, and severe hypoxemia. It is not
primarily caused by bronchoconstriction, emphysematous destruction, or purulent secretions.
2. The nurse is caring for a patient with acute heart failure who develops severe dyspnea, pink frothy
sputum, and crackles throughout both lung fields. Which intervention should the nurse implement first?
A) Administer IV furosemide as ordered
B) Place the patient in high Fowler's position and administer oxygen
C) Insert an indwelling urinary catheter
D) Obtain a 12-lead electrocardiogram
Correct Answer: Place the patient in high Fowler's position and administer oxygen
Rationale: The patient is experiencing acute pulmonary edema. Immediate priorities are to improve
oxygenation and reduce venous return by positioning the patient upright. Oxygen is given to relieve
hypoxemia. Diuretics follow after initial positioning and oxygen.
,3. A patient with chronic obstructive pulmonary disease is receiving oxygen via nasal cannula at 2 L/min.
The nurse notes the patient is somnolent and has a respiratory rate of 8 breaths per minute. What is the
priority nursing action?
A) Increase the oxygen flow rate to 4 L/min
B) Administer a bronchodilator nebulizer treatment
C) Assess the patient's level of consciousness and arterial blood gas results
D) Discontinue oxygen therapy
Correct Answer: Assess the patient's level of consciousness and arterial blood gas results
Rationale: Somnolence and decreased respiratory rate may indicate carbon dioxide narcosis in a COPD
patient. The nurse must first assess the patient thoroughly, including neurological status and ABG
results, before adjusting oxygen or administering other treatments. Abruptly discontinuing oxygen can
be dangerous.
4. The nurse is teaching a patient with heart failure about daily weight monitoring. Which statement
indicates a need for further teaching?
A) "I will weigh myself at the same time every morning after voiding."
B) "I will report a weight gain of 2 to 3 pounds in one day or 5 pounds in a week."
C) "I will wear the same type of clothing each time I weigh."
D) "I will skip weighing if I feel well that day."
Correct Answer: "I will skip weighing if I feel well that day."
Rationale: Daily weights are essential to detect fluid retention early, even when the patient feels well.
Weight gain is often the first sign of decompensation. The other statements reflect correct weight
monitoring practices.
5. A patient is admitted with chest pain and ST-segment elevation in leads V1 through V4. The nurse
anticipates an infarction in which area of the heart?
A) Inferior wall
B) Lateral wall
, C) Posterior wall
D) Anterior wall
Correct Answer: Anterior wall
Rationale: Leads V1-V4 reflect the anterior wall of the left ventricle, supplied by the left anterior
descending artery. Anterior MIs are associated with higher mortality and risk of heart failure. Inferior MI
shows changes in II, III, aVF; lateral in I, aVL, V5-V6.
6. The nurse is monitoring a patient receiving IV unfractionated heparin. Which laboratory value
indicates a therapeutic effect?
A) Prothrombin time of 15 seconds
B) International normalized ratio of 2.5
C) Activated partial thromboplastin time 2 times the control value
D) Platelet count of 150,000/mm³
Correct Answer: Activated partial thromboplastin time 2 times the control value
Rationale: Unfractionated heparin is monitored by aPTT, with a therapeutic range of 1.5 to 2.5 times the
control. Warfarin is monitored by PT/INR. Platelet count is monitored for heparin-induced
thrombocytopenia but does not indicate therapeutic anticoagulation.
7. A patient with a chest tube to water-seal drainage develops continuous bubbling in the water-seal
chamber. What is the priority nursing action?
A) Clamp the chest tube immediately
B) Notify the health care provider
C) Check all connections and the insertion site for an air leak
D) Add more sterile water to the chamber
Correct Answer: Check all connections and the insertion site for an air leak
Verified Answers | 2026 Edition | Galen College
1. Which of the following best describes the pathophysiology of acute respiratory distress syndrome
(ARDS)?
A) Bronchoconstriction and mucus plugging of airways
B) Diffuse alveolar-capillary damage with increased permeability and noncardiogenic pulmonary edema
C) Progressive destruction of alveolar walls and loss of elastic recoil
D) Accumulation of purulent secretions in the bronchi
Correct Answer: Diffuse alveolar-capillary damage with increased permeability and noncardiogenic
pulmonary edema
Rationale: ARDS is characterized by an acute inflammatory injury to the alveolar-capillary membrane,
leading to increased permeability, protein-rich pulmonary edema, and severe hypoxemia. It is not
primarily caused by bronchoconstriction, emphysematous destruction, or purulent secretions.
2. The nurse is caring for a patient with acute heart failure who develops severe dyspnea, pink frothy
sputum, and crackles throughout both lung fields. Which intervention should the nurse implement first?
A) Administer IV furosemide as ordered
B) Place the patient in high Fowler's position and administer oxygen
C) Insert an indwelling urinary catheter
D) Obtain a 12-lead electrocardiogram
Correct Answer: Place the patient in high Fowler's position and administer oxygen
Rationale: The patient is experiencing acute pulmonary edema. Immediate priorities are to improve
oxygenation and reduce venous return by positioning the patient upright. Oxygen is given to relieve
hypoxemia. Diuretics follow after initial positioning and oxygen.
,3. A patient with chronic obstructive pulmonary disease is receiving oxygen via nasal cannula at 2 L/min.
The nurse notes the patient is somnolent and has a respiratory rate of 8 breaths per minute. What is the
priority nursing action?
A) Increase the oxygen flow rate to 4 L/min
B) Administer a bronchodilator nebulizer treatment
C) Assess the patient's level of consciousness and arterial blood gas results
D) Discontinue oxygen therapy
Correct Answer: Assess the patient's level of consciousness and arterial blood gas results
Rationale: Somnolence and decreased respiratory rate may indicate carbon dioxide narcosis in a COPD
patient. The nurse must first assess the patient thoroughly, including neurological status and ABG
results, before adjusting oxygen or administering other treatments. Abruptly discontinuing oxygen can
be dangerous.
4. The nurse is teaching a patient with heart failure about daily weight monitoring. Which statement
indicates a need for further teaching?
A) "I will weigh myself at the same time every morning after voiding."
B) "I will report a weight gain of 2 to 3 pounds in one day or 5 pounds in a week."
C) "I will wear the same type of clothing each time I weigh."
D) "I will skip weighing if I feel well that day."
Correct Answer: "I will skip weighing if I feel well that day."
Rationale: Daily weights are essential to detect fluid retention early, even when the patient feels well.
Weight gain is often the first sign of decompensation. The other statements reflect correct weight
monitoring practices.
5. A patient is admitted with chest pain and ST-segment elevation in leads V1 through V4. The nurse
anticipates an infarction in which area of the heart?
A) Inferior wall
B) Lateral wall
, C) Posterior wall
D) Anterior wall
Correct Answer: Anterior wall
Rationale: Leads V1-V4 reflect the anterior wall of the left ventricle, supplied by the left anterior
descending artery. Anterior MIs are associated with higher mortality and risk of heart failure. Inferior MI
shows changes in II, III, aVF; lateral in I, aVL, V5-V6.
6. The nurse is monitoring a patient receiving IV unfractionated heparin. Which laboratory value
indicates a therapeutic effect?
A) Prothrombin time of 15 seconds
B) International normalized ratio of 2.5
C) Activated partial thromboplastin time 2 times the control value
D) Platelet count of 150,000/mm³
Correct Answer: Activated partial thromboplastin time 2 times the control value
Rationale: Unfractionated heparin is monitored by aPTT, with a therapeutic range of 1.5 to 2.5 times the
control. Warfarin is monitored by PT/INR. Platelet count is monitored for heparin-induced
thrombocytopenia but does not indicate therapeutic anticoagulation.
7. A patient with a chest tube to water-seal drainage develops continuous bubbling in the water-seal
chamber. What is the priority nursing action?
A) Clamp the chest tube immediately
B) Notify the health care provider
C) Check all connections and the insertion site for an air leak
D) Add more sterile water to the chamber
Correct Answer: Check all connections and the insertion site for an air leak
