NU 185 Exam 1–4 Ultimate
Megabank – Med-Surg II
(2026) 400 Actual Q&As –
Galen College (100% Pass
Guarantee)
Elevate your test preparation with this definitive 400-
question master study bank explicitly engineered for
Galen College of Nursing's NU 185 (Medical-
Surgical Nursing II) Exams 1 through 4. This
premium resource features high-yield, NCLEX-style
questions mapped directly to the latest course
competencies, with every correct answer and deep-
dive rationale structured on separate lines in
unmerged bold-italic text for hassle-free copying
and individual highlighting. Eliminate exam anxiety,
master complex med-surg concepts, and secure
your Grade A pass with this 100% verified, upload-
ready Stuvia package.
,1. A patient is admitted to the emergency department with an acute ischemic
stroke. The symptoms began exactly 90 minutes ago. Which diagnostic study
must the nurse ensure is completed and read within 45 minutes of the patient's
arrival to determine eligibility for thrombolytic therapy?
A) 12-Lead Electrocardiogram (ECG)
B) Non-contrast Computed Tomography (CT) scan of the head
C) Magnetic Resonance Imaging (MRI) of the brain
D) Carotid duplex ultrasound imaging
Answer: B
Rationale: A non-contrast head CT scan must be performed immediately to
differentiate between an ischemic and a hemorrhagic stroke. Thrombolytic
therapy (such as alteplase) is strictly contraindicated in a hemorrhagic stroke. To
meet stroke center guidelines, the CT must be completed and interpreted rapidly
to ensure safe administration within the narrow therapeutic window.
2. A nurse is caring for a patient who has just returned to the medical-surgical
unit after a scheduled esophagogastroduodenoscopy (EGD). Which assessment
is the absolute nursing priority before the patient can be allowed to consume ice
chips or fluids?
A) Assessing for the return of a functional gag reflex
B) Monitoring the blood pressure for orthostatic hypotension
C) Checking the stool for the presence of occult blood
D) Auscultating for the presence of hyperactive bowel sounds
Answer: A
Rationale: During an EGD, the patient's throat and upper airway are sprayed with a
local anesthetic to suppress the gag reflex and allow passage of the endoscope.
The nurse must verify the full return of the gag reflex before giving any oral fluids
or food to prevent dangerous aspiration, airway compromise, or secondary
aspiration pneumonia.
3. A patient with an extensive history of liver cirrhosis is admitted in a state of
severe hepatic encephalopathy. The nurse notes extreme confusion, slurred
speech, and a distinct "flapping" tremor of the hands (asterixis). Which laboratory
marker will the nurse monitor to directly track the therapeutic efficacy of
prescribed lactulose?
A) Alanine aminotransferase (ALT)
B) Serum albumin level
C) Serum ammonia level
D) Prothrombin time (PT/INR)
Answer: C
Rationale: Hepatic encephalopathy is driven by the liver's inability to convert
neurotoxic ammonia into urea, allowing ammonia to cross the blood-brain barrier.
Lactulose works by acidifying the colon, trapping ammonia in the gut as
,ammonium, and expelling it via the stool. Monitoring falling serum ammonia
levels directly tracks the medication's therapeutic efficacy.
4. A nurse is reviewing lab values for a patient with acute kidney injury and notes
a critically high serum potassium level of 6.6 mEq/L. The healthcare provider
prescribes an immediate intravenous injection of 10% calcium gluconate. What is
the primary therapeutic rationale for this specific intervention?
A) To rapidly drive potassium ions out of the serum and back into the intracellular
space.
B) To protect the myocardium by stabilizing the cardiac cell membrane against
hyperkalemia-induced lethal arrhythmias.
C) To stimulate the renal tubules to accelerate the excretion of excess potassium.
D) To bind with potassium within the gastrointestinal tract for elimination via the feces.
Answer: B
Rationale: Calcium gluconate does not lower the actual serum potassium level.
Instead, it directly counteracts the adverse neuromuscular effects of
hyperkalemia on the heart by stabilizing the myocardial cell membrane. This
temporary measure prevents lethal cardiac rhythms (such as ventricular
fibrillation) while other treatments actively reduce the potassium.
5. A patient with Type 1 diabetes mellitus is being treated in the intensive care
unit for Diabetic Ketoacidosis (DKA). A regular insulin infusion has been running
continuously, and the patient's blood glucose has decreased from 520 mg/dL to
250 mg/dL. Which intravenous fluid modification should the nurse anticipate
next?
A) Increasing the rate of the continuous regular insulin infusion.
B) Administering a large bolus of subcutaneous long-acting glargine insulin.
C) Changing the primary IV fluids to a dextrose-containing solution (e.g., 5% dextrose in
0.45% normal saline).
D) Discontinuing all intravenous fluids and transitioning the patient to an oral fluid diet.
Answer: C
Rationale: When blood glucose falls to approximately 250–300 mg/dL during the
management of DKA, dextrose is added to the IV fluids. This prevents a rapid
drop in blood glucose that could trigger severe hypoglycemia and life-threatening
cerebral edema, while allowing the insulin infusion to continue running to safely
clear remaining blood ketones.
6. A patient is admitted to the medical unit during an acute, severe flare-up of
Crohn's disease. The patient reports experiencing 10 to 12 loose, non-bloody
stools daily, intense abdominal cramping, and rapid weight loss. Which dietary
prescription should the nurse expect to implement during this acute phase?
A) A high-fiber, high-fat diet to maximize caloric density and slow down transit.
B) A low-residue, high-protein, high-calorie diet with vitamin supplementation.
C) Restricting total oral and intravenous fluid intake to less than 1,000 mL per day.
D) An unrestricted regular diet high in raw green leafy vegetables and whole grains.
, Answer: B
Rationale: During an acute flare-up of Crohn's disease, a low-residue (low-fiber)
diet is mandatory to reduce mechanical irritation to the highly inflamed intestinal
mucosa, minimize peristalsis, and decrease abdominal pain. High protein and
high calories are required to promote tissue healing and counteract severe
malnutrition and protein-losing enteropathy.
7. A nurse is assessing a patient who returns to the surgical unit 12 hours
following a subtotal thyroidectomy. The patient complains of a progressive
tingling sensation around the mouth and fingertips, and the nurse elicits a
positive Chvostek's sign. Which medication must the nurse ensure is immediately
available?
A) Potassium chloride injection
B) Calcium gluconate injection
C) Magnesium sulfate injection
D) Sodium bicarbonate injection
Answer: B
Rationale: Accidental removal of or trauma to the parathyroid glands during a
thyroidectomy can trigger acute hypoparathyroidism, leading to a sudden drop in
serum calcium. Perioral tingling and a positive Chvostek's sign (facial muscle
twitching when the facial nerve is tapped) indicate severe neuromuscular
irritability requiring immediate IV calcium gluconate to prevent lethal
laryngospasm.
8. A patient with a sustained high-level spinal cord injury at T2 is resting in bed
when they suddenly report a severe, pounding headache and blurred vision. The
nurse notes heavy sweating above the level of injury and a blood pressure of
190/105 mmHg. What is the nurse's immediate priority action?
A) Administer an ordered PRN dose of intravenous hydralazine to lower blood pressure.
B) Elevate the head of the bed immediately to a high-Fowler's position.
C) Check the patient's indwelling urinary catheter for kinks or physical obstructions.
D) Perform a gentle digital rectal examination to assess for potential fecal impaction.
Answer: B
Rationale: The patient is experiencing autonomic dysreflexia, an acute, life-
threatening clinical emergency. The absolute first nursing intervention is to sit
the patient upright (high-Fowler's position). This utilizes gravity to induce
orthostatic hypotension, helping safely lower the dangerously elevated blood
pressure before the nurse investigates and eliminates the noxious trigger (e.g.,
bladder distention, impaction).
9. A patient is prescribed a continuous intravenous unfractionated heparin
infusion for the treatment of an acute deep vein thrombosis (DVT). Which
laboratory parameter must the nurse monitor closely to safely adjust the heparin
infusion rate according to the facility's titration protocol?
A) Prothrombin Time (PT)
Megabank – Med-Surg II
(2026) 400 Actual Q&As –
Galen College (100% Pass
Guarantee)
Elevate your test preparation with this definitive 400-
question master study bank explicitly engineered for
Galen College of Nursing's NU 185 (Medical-
Surgical Nursing II) Exams 1 through 4. This
premium resource features high-yield, NCLEX-style
questions mapped directly to the latest course
competencies, with every correct answer and deep-
dive rationale structured on separate lines in
unmerged bold-italic text for hassle-free copying
and individual highlighting. Eliminate exam anxiety,
master complex med-surg concepts, and secure
your Grade A pass with this 100% verified, upload-
ready Stuvia package.
,1. A patient is admitted to the emergency department with an acute ischemic
stroke. The symptoms began exactly 90 minutes ago. Which diagnostic study
must the nurse ensure is completed and read within 45 minutes of the patient's
arrival to determine eligibility for thrombolytic therapy?
A) 12-Lead Electrocardiogram (ECG)
B) Non-contrast Computed Tomography (CT) scan of the head
C) Magnetic Resonance Imaging (MRI) of the brain
D) Carotid duplex ultrasound imaging
Answer: B
Rationale: A non-contrast head CT scan must be performed immediately to
differentiate between an ischemic and a hemorrhagic stroke. Thrombolytic
therapy (such as alteplase) is strictly contraindicated in a hemorrhagic stroke. To
meet stroke center guidelines, the CT must be completed and interpreted rapidly
to ensure safe administration within the narrow therapeutic window.
2. A nurse is caring for a patient who has just returned to the medical-surgical
unit after a scheduled esophagogastroduodenoscopy (EGD). Which assessment
is the absolute nursing priority before the patient can be allowed to consume ice
chips or fluids?
A) Assessing for the return of a functional gag reflex
B) Monitoring the blood pressure for orthostatic hypotension
C) Checking the stool for the presence of occult blood
D) Auscultating for the presence of hyperactive bowel sounds
Answer: A
Rationale: During an EGD, the patient's throat and upper airway are sprayed with a
local anesthetic to suppress the gag reflex and allow passage of the endoscope.
The nurse must verify the full return of the gag reflex before giving any oral fluids
or food to prevent dangerous aspiration, airway compromise, or secondary
aspiration pneumonia.
3. A patient with an extensive history of liver cirrhosis is admitted in a state of
severe hepatic encephalopathy. The nurse notes extreme confusion, slurred
speech, and a distinct "flapping" tremor of the hands (asterixis). Which laboratory
marker will the nurse monitor to directly track the therapeutic efficacy of
prescribed lactulose?
A) Alanine aminotransferase (ALT)
B) Serum albumin level
C) Serum ammonia level
D) Prothrombin time (PT/INR)
Answer: C
Rationale: Hepatic encephalopathy is driven by the liver's inability to convert
neurotoxic ammonia into urea, allowing ammonia to cross the blood-brain barrier.
Lactulose works by acidifying the colon, trapping ammonia in the gut as
,ammonium, and expelling it via the stool. Monitoring falling serum ammonia
levels directly tracks the medication's therapeutic efficacy.
4. A nurse is reviewing lab values for a patient with acute kidney injury and notes
a critically high serum potassium level of 6.6 mEq/L. The healthcare provider
prescribes an immediate intravenous injection of 10% calcium gluconate. What is
the primary therapeutic rationale for this specific intervention?
A) To rapidly drive potassium ions out of the serum and back into the intracellular
space.
B) To protect the myocardium by stabilizing the cardiac cell membrane against
hyperkalemia-induced lethal arrhythmias.
C) To stimulate the renal tubules to accelerate the excretion of excess potassium.
D) To bind with potassium within the gastrointestinal tract for elimination via the feces.
Answer: B
Rationale: Calcium gluconate does not lower the actual serum potassium level.
Instead, it directly counteracts the adverse neuromuscular effects of
hyperkalemia on the heart by stabilizing the myocardial cell membrane. This
temporary measure prevents lethal cardiac rhythms (such as ventricular
fibrillation) while other treatments actively reduce the potassium.
5. A patient with Type 1 diabetes mellitus is being treated in the intensive care
unit for Diabetic Ketoacidosis (DKA). A regular insulin infusion has been running
continuously, and the patient's blood glucose has decreased from 520 mg/dL to
250 mg/dL. Which intravenous fluid modification should the nurse anticipate
next?
A) Increasing the rate of the continuous regular insulin infusion.
B) Administering a large bolus of subcutaneous long-acting glargine insulin.
C) Changing the primary IV fluids to a dextrose-containing solution (e.g., 5% dextrose in
0.45% normal saline).
D) Discontinuing all intravenous fluids and transitioning the patient to an oral fluid diet.
Answer: C
Rationale: When blood glucose falls to approximately 250–300 mg/dL during the
management of DKA, dextrose is added to the IV fluids. This prevents a rapid
drop in blood glucose that could trigger severe hypoglycemia and life-threatening
cerebral edema, while allowing the insulin infusion to continue running to safely
clear remaining blood ketones.
6. A patient is admitted to the medical unit during an acute, severe flare-up of
Crohn's disease. The patient reports experiencing 10 to 12 loose, non-bloody
stools daily, intense abdominal cramping, and rapid weight loss. Which dietary
prescription should the nurse expect to implement during this acute phase?
A) A high-fiber, high-fat diet to maximize caloric density and slow down transit.
B) A low-residue, high-protein, high-calorie diet with vitamin supplementation.
C) Restricting total oral and intravenous fluid intake to less than 1,000 mL per day.
D) An unrestricted regular diet high in raw green leafy vegetables and whole grains.
, Answer: B
Rationale: During an acute flare-up of Crohn's disease, a low-residue (low-fiber)
diet is mandatory to reduce mechanical irritation to the highly inflamed intestinal
mucosa, minimize peristalsis, and decrease abdominal pain. High protein and
high calories are required to promote tissue healing and counteract severe
malnutrition and protein-losing enteropathy.
7. A nurse is assessing a patient who returns to the surgical unit 12 hours
following a subtotal thyroidectomy. The patient complains of a progressive
tingling sensation around the mouth and fingertips, and the nurse elicits a
positive Chvostek's sign. Which medication must the nurse ensure is immediately
available?
A) Potassium chloride injection
B) Calcium gluconate injection
C) Magnesium sulfate injection
D) Sodium bicarbonate injection
Answer: B
Rationale: Accidental removal of or trauma to the parathyroid glands during a
thyroidectomy can trigger acute hypoparathyroidism, leading to a sudden drop in
serum calcium. Perioral tingling and a positive Chvostek's sign (facial muscle
twitching when the facial nerve is tapped) indicate severe neuromuscular
irritability requiring immediate IV calcium gluconate to prevent lethal
laryngospasm.
8. A patient with a sustained high-level spinal cord injury at T2 is resting in bed
when they suddenly report a severe, pounding headache and blurred vision. The
nurse notes heavy sweating above the level of injury and a blood pressure of
190/105 mmHg. What is the nurse's immediate priority action?
A) Administer an ordered PRN dose of intravenous hydralazine to lower blood pressure.
B) Elevate the head of the bed immediately to a high-Fowler's position.
C) Check the patient's indwelling urinary catheter for kinks or physical obstructions.
D) Perform a gentle digital rectal examination to assess for potential fecal impaction.
Answer: B
Rationale: The patient is experiencing autonomic dysreflexia, an acute, life-
threatening clinical emergency. The absolute first nursing intervention is to sit
the patient upright (high-Fowler's position). This utilizes gravity to induce
orthostatic hypotension, helping safely lower the dangerously elevated blood
pressure before the nurse investigates and eliminates the noxious trigger (e.g.,
bladder distention, impaction).
9. A patient is prescribed a continuous intravenous unfractionated heparin
infusion for the treatment of an acute deep vein thrombosis (DVT). Which
laboratory parameter must the nurse monitor closely to safely adjust the heparin
infusion rate according to the facility's titration protocol?
A) Prothrombin Time (PT)
