NU 155 EXAM 3 MEDICAL-SURGICAL NURSING EXAM PRACTICE | COMPREHENSIVE
STUDY GUIDE | TESTBANK | PRACTICE QUESTIONS & ANSWERS | LATEST UPDATE
2026/2027 | ADVANCED REVIEW
TABLE OF CONTENTS
i. Cardiovascular Disorders and Hemodynamic Management
ii. Respiratory Disorders and Acute Pulmonary Complications
iii. Neurologic Disorders and Increased Intracranial Pressure
iv. Renal and Urinary Disorders
v. Endocrine and Metabolic Emergencies
vi. Gastrointestinal and Hepatobiliary Disorders
vii. Hematologic Disorders and Transfusion Management
viii. Complex Clinical Prioritization and Patient Safety
INTRODUCTION
This comprehensive NU 155 Exam 3 Medical-Surgical Nursing practice examination is
designed to evaluate advanced clinical judgment, prioritization, pathophysiologic
reasoning, nursing assessment, intervention selection, and evaluation of patient
outcomes. Questions emphasize application rather than simple memorization and
require the learner to distinguish expected findings from clinical deterioration,
recognize emergencies, interpret assessment data, and select the safest evidence-
based nursing action. The examination integrates cardiovascular, respiratory,
neurologic, renal, endocrine, gastrointestinal, hematologic, and multisystem conditions.
Expect progressively challenging scenarios involving competing priorities,
complications, medication effects, diagnostic findings, and changes in patient status.
The questions are appropriate for advanced nursing examination preparation and
emphasize the clinical reasoning expected of a medical-surgical nursing student.
Question 1
A patient with acute decompensated heart failure is receiving IV furosemide. Two hours
after administration, the patient reports generalized weakness and new palpitations.
The cardiac monitor shows frequent premature ventricular contractions. Which
assessment finding is most important for the nurse to obtain immediately?
A. Daily weight
B. Serum potassium level
,C. Peripheral oxygen saturation
D. Jugular venous pressure
🔴 Correct Answer: B. Serum potassium level.
🔵 Explanation: Loop diuretics such as furosemide can cause significant potassium loss.
Hypokalemia increases myocardial irritability and can precipitate ventricular
dysrhythmias. New PVCs accompanied by weakness and palpitations require immediate
evaluation of serum potassium and other electrolytes.
Question 2
A patient with an acute myocardial infarction suddenly develops severe dyspnea,
bilateral crackles, diaphoresis, and an oxygen saturation of 82%. Which intervention
should the nurse prioritize?
A. Place the patient in high-Fowler position and administer oxygen as prescribed
B. Encourage oral fluids to improve circulating volume
C. Place the patient supine to increase cerebral perfusion
D. Obtain a routine 12-lead ECG before initiating treatment
🔴 Correct Answer: A. Place the patient in high-Fowler position and administer
oxygen as prescribed.
🔵 Explanation: The findings strongly suggest acute pulmonary edema associated with
left ventricular failure. Positioning upright improves lung expansion and decreases venous
return, while oxygen therapy addresses severe hypoxemia. Stabilization of airway and
breathing takes priority.
Question 3
A patient with chronic obstructive pulmonary disease becomes increasingly somnolent
after receiving supplemental oxygen. The respiratory rate decreases from 20/min to
10/min. Which action should the nurse take first?
A. Discontinue oxygen completely
B. Assess the patient's respiratory effort and obtain an arterial blood gas as indicated
C. Encourage the patient to ambulate
D. Administer a sedative to decrease anxiety
🔴 Correct Answer: B. Assess the patient's respiratory effort and obtain an arterial
blood gas as indicated.
🔵 Explanation: Increasing somnolence and declining respiratory rate may indicate
worsening hypercapnia and respiratory failure. Oxygen should not simply be discontinued
,because hypoxemia may persist. The nurse should immediately reassess ventilation and
oxygenation and obtain further respiratory evaluation.
Question 4
A patient with severe asthma has received repeated nebulized bronchodilator
treatments. Initially, wheezing was prominent; the patient now has markedly diminished
breath sounds and increasing fatigue. Which finding is most concerning?
A. Mild tachycardia
B. Anxiety
C. Decreased wheezing with worsening respiratory effort
D. Productive cough
🔴 Correct Answer: C. Decreased wheezing with worsening respiratory effort.
🔵 Explanation: A sudden reduction in wheezing in a severely compromised patient does
not necessarily indicate improvement. It may reflect critically reduced airflow, sometimes
described as a "silent chest," and can precede respiratory arrest. Increasing fatigue is an
additional sign of impending respiratory failure.
Question 5
A patient with a traumatic brain injury develops a worsening headache, repeated
vomiting, confusion, and a change from a normal pupillary response to a sluggish
unilateral pupil. Which nursing action has the highest priority?
A. Place the patient flat and encourage oral fluids
B. Perform frequent neurologic assessments and notify the provider immediately
C. Administer an opioid analgesic and reassess in four hours
D. Encourage coughing to mobilize respiratory secretions
🔴 Correct Answer: B. Perform frequent neurologic assessments and notify the
provider immediately.
🔵 Explanation: Worsening headache, vomiting, altered consciousness, and an
asymmetric pupil are concerning for increased intracranial pressure and possible
herniation. Rapid neurologic deterioration requires immediate escalation. Nursing care
should also avoid interventions that unnecessarily increase intracranial pressure.
Question 6
A patient with a recent ischemic stroke has dysphagia and begins coughing repeatedly
while attempting to drink water. Which action should the nurse take?
, A. Encourage the patient to drink through a straw
B. Continue oral intake but provide smaller sips
C. Stop oral intake and request a swallowing evaluation
D. Place the patient supine after drinking
🔴 Correct Answer: C. Stop oral intake and request a swallowing evaluation.
🔵 Explanation: Coughing during swallowing indicates possible aspiration. The patient
should remain NPO until swallowing safety has been evaluated. A straw does not
eliminate aspiration risk and may increase the speed or volume of fluid entering the
pharynx.
Question 7
A patient with acute kidney injury has a urine output of 250 mL over the past 24 hours.
The patient's potassium is 6.7 mEq/L, and the ECG demonstrates peaked T waves.
Which intervention should the nurse anticipate as the priority?
A. Administration of IV calcium as prescribed
B. Administration of oral potassium supplementation
C. Increasing dietary potassium intake
D. Encouraging unrestricted oral fluids
🔴 Correct Answer: A. Administration of IV calcium as prescribed.
🔵 Explanation: Severe hyperkalemia accompanied by ECG changes is a life-threatening
emergency. IV calcium stabilizes the cardiac membrane and reduces the immediate risk
of fatal dysrhythmia. Additional therapies are required to shift or remove potassium, but
cardiac stabilization is an immediate priority.
Question 8
A patient receiving hemodialysis develops headache, nausea, restlessness, and
confusion during the first treatment following severe azotemia. Which complication
should the nurse suspect?
A. Disequilibrium syndrome
B. Peritonitis
C. Hypoglycemia
D. Renal calculi
🔴 Correct Answer: A. Disequilibrium syndrome.
🔵 Explanation: Dialysis disequilibrium syndrome can occur when rapid removal of urea
produces osmotic shifts that promote cerebral edema. Neurologic manifestations include
STUDY GUIDE | TESTBANK | PRACTICE QUESTIONS & ANSWERS | LATEST UPDATE
2026/2027 | ADVANCED REVIEW
TABLE OF CONTENTS
i. Cardiovascular Disorders and Hemodynamic Management
ii. Respiratory Disorders and Acute Pulmonary Complications
iii. Neurologic Disorders and Increased Intracranial Pressure
iv. Renal and Urinary Disorders
v. Endocrine and Metabolic Emergencies
vi. Gastrointestinal and Hepatobiliary Disorders
vii. Hematologic Disorders and Transfusion Management
viii. Complex Clinical Prioritization and Patient Safety
INTRODUCTION
This comprehensive NU 155 Exam 3 Medical-Surgical Nursing practice examination is
designed to evaluate advanced clinical judgment, prioritization, pathophysiologic
reasoning, nursing assessment, intervention selection, and evaluation of patient
outcomes. Questions emphasize application rather than simple memorization and
require the learner to distinguish expected findings from clinical deterioration,
recognize emergencies, interpret assessment data, and select the safest evidence-
based nursing action. The examination integrates cardiovascular, respiratory,
neurologic, renal, endocrine, gastrointestinal, hematologic, and multisystem conditions.
Expect progressively challenging scenarios involving competing priorities,
complications, medication effects, diagnostic findings, and changes in patient status.
The questions are appropriate for advanced nursing examination preparation and
emphasize the clinical reasoning expected of a medical-surgical nursing student.
Question 1
A patient with acute decompensated heart failure is receiving IV furosemide. Two hours
after administration, the patient reports generalized weakness and new palpitations.
The cardiac monitor shows frequent premature ventricular contractions. Which
assessment finding is most important for the nurse to obtain immediately?
A. Daily weight
B. Serum potassium level
,C. Peripheral oxygen saturation
D. Jugular venous pressure
🔴 Correct Answer: B. Serum potassium level.
🔵 Explanation: Loop diuretics such as furosemide can cause significant potassium loss.
Hypokalemia increases myocardial irritability and can precipitate ventricular
dysrhythmias. New PVCs accompanied by weakness and palpitations require immediate
evaluation of serum potassium and other electrolytes.
Question 2
A patient with an acute myocardial infarction suddenly develops severe dyspnea,
bilateral crackles, diaphoresis, and an oxygen saturation of 82%. Which intervention
should the nurse prioritize?
A. Place the patient in high-Fowler position and administer oxygen as prescribed
B. Encourage oral fluids to improve circulating volume
C. Place the patient supine to increase cerebral perfusion
D. Obtain a routine 12-lead ECG before initiating treatment
🔴 Correct Answer: A. Place the patient in high-Fowler position and administer
oxygen as prescribed.
🔵 Explanation: The findings strongly suggest acute pulmonary edema associated with
left ventricular failure. Positioning upright improves lung expansion and decreases venous
return, while oxygen therapy addresses severe hypoxemia. Stabilization of airway and
breathing takes priority.
Question 3
A patient with chronic obstructive pulmonary disease becomes increasingly somnolent
after receiving supplemental oxygen. The respiratory rate decreases from 20/min to
10/min. Which action should the nurse take first?
A. Discontinue oxygen completely
B. Assess the patient's respiratory effort and obtain an arterial blood gas as indicated
C. Encourage the patient to ambulate
D. Administer a sedative to decrease anxiety
🔴 Correct Answer: B. Assess the patient's respiratory effort and obtain an arterial
blood gas as indicated.
🔵 Explanation: Increasing somnolence and declining respiratory rate may indicate
worsening hypercapnia and respiratory failure. Oxygen should not simply be discontinued
,because hypoxemia may persist. The nurse should immediately reassess ventilation and
oxygenation and obtain further respiratory evaluation.
Question 4
A patient with severe asthma has received repeated nebulized bronchodilator
treatments. Initially, wheezing was prominent; the patient now has markedly diminished
breath sounds and increasing fatigue. Which finding is most concerning?
A. Mild tachycardia
B. Anxiety
C. Decreased wheezing with worsening respiratory effort
D. Productive cough
🔴 Correct Answer: C. Decreased wheezing with worsening respiratory effort.
🔵 Explanation: A sudden reduction in wheezing in a severely compromised patient does
not necessarily indicate improvement. It may reflect critically reduced airflow, sometimes
described as a "silent chest," and can precede respiratory arrest. Increasing fatigue is an
additional sign of impending respiratory failure.
Question 5
A patient with a traumatic brain injury develops a worsening headache, repeated
vomiting, confusion, and a change from a normal pupillary response to a sluggish
unilateral pupil. Which nursing action has the highest priority?
A. Place the patient flat and encourage oral fluids
B. Perform frequent neurologic assessments and notify the provider immediately
C. Administer an opioid analgesic and reassess in four hours
D. Encourage coughing to mobilize respiratory secretions
🔴 Correct Answer: B. Perform frequent neurologic assessments and notify the
provider immediately.
🔵 Explanation: Worsening headache, vomiting, altered consciousness, and an
asymmetric pupil are concerning for increased intracranial pressure and possible
herniation. Rapid neurologic deterioration requires immediate escalation. Nursing care
should also avoid interventions that unnecessarily increase intracranial pressure.
Question 6
A patient with a recent ischemic stroke has dysphagia and begins coughing repeatedly
while attempting to drink water. Which action should the nurse take?
, A. Encourage the patient to drink through a straw
B. Continue oral intake but provide smaller sips
C. Stop oral intake and request a swallowing evaluation
D. Place the patient supine after drinking
🔴 Correct Answer: C. Stop oral intake and request a swallowing evaluation.
🔵 Explanation: Coughing during swallowing indicates possible aspiration. The patient
should remain NPO until swallowing safety has been evaluated. A straw does not
eliminate aspiration risk and may increase the speed or volume of fluid entering the
pharynx.
Question 7
A patient with acute kidney injury has a urine output of 250 mL over the past 24 hours.
The patient's potassium is 6.7 mEq/L, and the ECG demonstrates peaked T waves.
Which intervention should the nurse anticipate as the priority?
A. Administration of IV calcium as prescribed
B. Administration of oral potassium supplementation
C. Increasing dietary potassium intake
D. Encouraging unrestricted oral fluids
🔴 Correct Answer: A. Administration of IV calcium as prescribed.
🔵 Explanation: Severe hyperkalemia accompanied by ECG changes is a life-threatening
emergency. IV calcium stabilizes the cardiac membrane and reduces the immediate risk
of fatal dysrhythmia. Additional therapies are required to shift or remove potassium, but
cardiac stabilization is an immediate priority.
Question 8
A patient receiving hemodialysis develops headache, nausea, restlessness, and
confusion during the first treatment following severe azotemia. Which complication
should the nurse suspect?
A. Disequilibrium syndrome
B. Peritonitis
C. Hypoglycemia
D. Renal calculi
🔴 Correct Answer: A. Disequilibrium syndrome.
🔵 Explanation: Dialysis disequilibrium syndrome can occur when rapid removal of urea
produces osmotic shifts that promote cerebral edema. Neurologic manifestations include
