NU 157 Final Exam V1 | NU 157 Medical-
Surgical Nursing I-A | NCLEX (NGN) Q&A
with Rationale (NU157 Final Exam) | Galen
1. A nurse is assessing a patient with a potassium level of 3.2 mEq/L. Which cardiac rhythm
changes should the nurse expect to see on the EKG monitor?
A. Tall, peaked T waves
B. Prolonged PR interval
C. Widened QRS complex
D. Presence of U waves
Correct Answer: D
Explanation: Hypokalemia, defined as a serum potassium level below 3.5 mEq/L, typically
manifests on an EKG as flat or inverted T waves and the appearance of U waves. Tall
peaked T waves and widened QRS complexes are associated with hyperkalemia, not
hypokalemia. The nurse must monitor these changes closely as they indicate increased
cardiac irritability and potential for lethal dysrhythmias.
2. The nurse is preparing a client for a total hip arthroplasty. Which actions should the nurse
include in the preoperative checklist? (Select All That Apply)
A. Verify that the informed consent is signed and witnessed.
B. Administer a large meal to ensure the patient has energy for surgery.
,C. Ensure the surgical site is marked by the surgeon.
D. Confirm the patient has been NPO for the prescribed timeframe.
E. Remove all jewelry, piercings, and nail polish.
F. Assess for any allergies to latex or medications.
Correct Answer: A, C, D, E, F
Explanation: Preoperative safety protocols require the verification of legal consent and
site marking to prevent wrong-site surgery. The NPO status is critical to minimize the risk
of aspiration under anesthesia, while removing jewelry and assessing allergies prevent
injury and adverse reactions. Administering a large meal is contraindicated as it increases
the risk of vomiting and aspiration during the procedure.
3. A patient with Gastroesophageal Reflux Disease (GERD) is being discharged. Which dietary
instruction should the nurse emphasize to the patient?
A. Drink a glass of orange juice with every breakfast.
B. Consume three large meals a day instead of snacks.
C. Avoid eating within 3 hours of going to bed.
D. Lie down immediately after eating to promote digestion.
Correct Answer: C
Explanation: Patients with GERD should avoid eating close to bedtime to prevent the
reflux of gastric contents while lying flat. Small, frequent meals are preferred over large
,meals to reduce gastric distention and pressure on the lower esophageal sphincter. Citrus
juices and lying down post-prandially are known triggers that exacerbate acid reflux
symptoms.
4. The nurse is providing education to a client newly diagnosed with Type 1 Diabetes Mellitus
regarding foot care. Which of the following statements by the client indicate an
understanding of the teaching? (Select All That Apply)
A. I will soak my feet in hot water daily to improve circulation.
B. I will inspect the bottoms of my feet every day using a mirror.
C. I will apply lotion between my toes to prevent cracking.
D. I will always wear well-fitting shoes and never go barefoot.
E. I will trim my toenails in a rounded shape close to the skin.
Correct Answer: B, D
Explanation: Daily inspection and wearing shoes are vital components of diabetic foot care
to prevent undetected injuries and infections. Soaking feet can lead to skin breakdown, and
applying lotion between the toes creates a moist environment that promotes fungal
growth. Toenails should be cut straight across rather than rounded to prevent ingrown
nails and potential trauma to the skin.
5. A nurse is caring for a patient who is 24 hours post-abdominal surgery. The patient reports
sudden shortness of breath and chest pain. What is the priority nursing action?
A. Administer the prescribed PRN pain medication.
, B. Perform a dressing change to check for surgical site infection.
C. Assist the patient to ambulate in the hallway to improve circulation.
D. Assess the patient’s oxygen saturation and apply supplemental oxygen.
Correct Answer: D
Explanation: Sudden onset of dyspnea and chest pain post-operatively are hallmark signs
of a pulmonary embolism, which is a medical emergency. The nurse must first stabilize the
patient by assessing respiratory status and providing oxygen to support gas exchange.
Ambulation or focusing on the surgical dressing would delay critical intervention for a life-
threatening condition.
6. A patient presents with a serum sodium level of 155 mEq/L. Which clinical manifestation
should the nurse monitor for most closely?
A. Altered mental status and agitation
B. Hyperactive bowel sounds and diarrhea
C. Muscle weakness and cardiac dysrhythmias
D. Increased intracranial pressure and bradycardia
Correct Answer: A
Explanation: Hypernatremia, a sodium level above 145 mEq/L, causes water to shift out of
the cells, leading to cellular dehydration, especially in the brain. This results in neurological
symptoms such as restlessness, agitation, confusion, and potentially seizures. While muscle
Surgical Nursing I-A | NCLEX (NGN) Q&A
with Rationale (NU157 Final Exam) | Galen
1. A nurse is assessing a patient with a potassium level of 3.2 mEq/L. Which cardiac rhythm
changes should the nurse expect to see on the EKG monitor?
A. Tall, peaked T waves
B. Prolonged PR interval
C. Widened QRS complex
D. Presence of U waves
Correct Answer: D
Explanation: Hypokalemia, defined as a serum potassium level below 3.5 mEq/L, typically
manifests on an EKG as flat or inverted T waves and the appearance of U waves. Tall
peaked T waves and widened QRS complexes are associated with hyperkalemia, not
hypokalemia. The nurse must monitor these changes closely as they indicate increased
cardiac irritability and potential for lethal dysrhythmias.
2. The nurse is preparing a client for a total hip arthroplasty. Which actions should the nurse
include in the preoperative checklist? (Select All That Apply)
A. Verify that the informed consent is signed and witnessed.
B. Administer a large meal to ensure the patient has energy for surgery.
,C. Ensure the surgical site is marked by the surgeon.
D. Confirm the patient has been NPO for the prescribed timeframe.
E. Remove all jewelry, piercings, and nail polish.
F. Assess for any allergies to latex or medications.
Correct Answer: A, C, D, E, F
Explanation: Preoperative safety protocols require the verification of legal consent and
site marking to prevent wrong-site surgery. The NPO status is critical to minimize the risk
of aspiration under anesthesia, while removing jewelry and assessing allergies prevent
injury and adverse reactions. Administering a large meal is contraindicated as it increases
the risk of vomiting and aspiration during the procedure.
3. A patient with Gastroesophageal Reflux Disease (GERD) is being discharged. Which dietary
instruction should the nurse emphasize to the patient?
A. Drink a glass of orange juice with every breakfast.
B. Consume three large meals a day instead of snacks.
C. Avoid eating within 3 hours of going to bed.
D. Lie down immediately after eating to promote digestion.
Correct Answer: C
Explanation: Patients with GERD should avoid eating close to bedtime to prevent the
reflux of gastric contents while lying flat. Small, frequent meals are preferred over large
,meals to reduce gastric distention and pressure on the lower esophageal sphincter. Citrus
juices and lying down post-prandially are known triggers that exacerbate acid reflux
symptoms.
4. The nurse is providing education to a client newly diagnosed with Type 1 Diabetes Mellitus
regarding foot care. Which of the following statements by the client indicate an
understanding of the teaching? (Select All That Apply)
A. I will soak my feet in hot water daily to improve circulation.
B. I will inspect the bottoms of my feet every day using a mirror.
C. I will apply lotion between my toes to prevent cracking.
D. I will always wear well-fitting shoes and never go barefoot.
E. I will trim my toenails in a rounded shape close to the skin.
Correct Answer: B, D
Explanation: Daily inspection and wearing shoes are vital components of diabetic foot care
to prevent undetected injuries and infections. Soaking feet can lead to skin breakdown, and
applying lotion between the toes creates a moist environment that promotes fungal
growth. Toenails should be cut straight across rather than rounded to prevent ingrown
nails and potential trauma to the skin.
5. A nurse is caring for a patient who is 24 hours post-abdominal surgery. The patient reports
sudden shortness of breath and chest pain. What is the priority nursing action?
A. Administer the prescribed PRN pain medication.
, B. Perform a dressing change to check for surgical site infection.
C. Assist the patient to ambulate in the hallway to improve circulation.
D. Assess the patient’s oxygen saturation and apply supplemental oxygen.
Correct Answer: D
Explanation: Sudden onset of dyspnea and chest pain post-operatively are hallmark signs
of a pulmonary embolism, which is a medical emergency. The nurse must first stabilize the
patient by assessing respiratory status and providing oxygen to support gas exchange.
Ambulation or focusing on the surgical dressing would delay critical intervention for a life-
threatening condition.
6. A patient presents with a serum sodium level of 155 mEq/L. Which clinical manifestation
should the nurse monitor for most closely?
A. Altered mental status and agitation
B. Hyperactive bowel sounds and diarrhea
C. Muscle weakness and cardiac dysrhythmias
D. Increased intracranial pressure and bradycardia
Correct Answer: A
Explanation: Hypernatremia, a sodium level above 145 mEq/L, causes water to shift out of
the cells, leading to cellular dehydration, especially in the brain. This results in neurological
symptoms such as restlessness, agitation, confusion, and potentially seizures. While muscle
