NU 155 EXAM 3 2026 | MEDICAL-SURGICAL
NURSING I QUESTIONS, ANSWERS &
RATIONALES – GALEN COLLEGE
NU 155 EXAM 3 2026 | MEDICAL-SURGICAL NURSING I
QUESTIONS, ANSWERS & RATIONALES – GALEN COLLEGE
• This comprehensive 200-question study guide is designed to reinforce critical
medical-surgical nursing content and prepare you for clinical application in diverse
patient care scenarios across acute care settings.
• Active review with attention to rationales will strengthen your understanding of
pathophysiology, nursing interventions, and evidence-based practice standards
essential for NCLEX and clinical competency.
1. A 65-year-old patient with chronic obstructive pulmonary disease (COPD) is
admitted to the medical-surgical unit. Which assessment finding would be
most concerning and require immediate intervention?
A) Oxygen saturation of 88% on room air
B) Pink, frothy sputum production
C) Mild dyspnea with activity
D) Barrel-shaped chest configuration
E) Pursed-lip breathing pattern
Correct Answer: B) Pink, frothy sputum production indicates acute pulmonary
edema, requiring immediate intervention.
Rationale: Pink, frothy sputum is a classic sign of acute pulmonary edema,
signifying fluid accumulation in the lungs. This represents a medical emergency
requiring immediate notification of the healthcare provider and interventions such
as oxygen therapy, positioning, diuretics, and potentially intubation. While an
oxygen saturation of 88% is low and concerning, pink frothy sputum indicates acute
decompensation. Barrel chest, pursed-lip breathing, and mild dyspnea with activity
,are chronic COPD manifestations that, while important to monitor, are not acute
emergencies.
2. A patient undergoes abdominal surgery and is prescribed ketorolac
(Toradol) for postoperative pain management. Which nursing consideration is
most critical?
A) Administer the medication with food to prevent gastric upset
B) Monitor for signs of bleeding and renal function
C) Expect peak pain relief within 30 minutes of administration
D) Combine with an opioid to enhance pain relief
E) Administer for longer than 5 days if pain persists
Correct Answer: B) Monitor for signs of bleeding and renal function, as NSAIDs
carry significant risks in the postoperative period.
Rationale: Ketorolac is a potent NSAID used for short-term postoperative pain
management. Critical nursing considerations include monitoring for bleeding
complications, gastrointestinal perforation, and renal impairment. Ketorolac should
not be administered for more than 5 days due to increased risk of adverse effects.
NSAIDs should be used cautiously in patients with renal compromise or those at
risk for bleeding. While combining with opioids may be appropriate, monitoring for
complications is the priority. Ketorolac has a rapid onset (within 30 minutes) but
this does not override the need for vigilant monitoring.
3. A patient with type 2 diabetes mellitus presents with signs of diabetic
ketoacidosis (DKA). Which arterial blood gas (ABG) finding would you expect?
A) pH 7.45, HCO3- 28 mEq/L, PaCO2 45 mmHg
B) pH 7.30, HCO3- 15 mEq/L, PaCO2 30 mmHg
C) pH 7.50, HCO3- 30 mEq/L, PaCO2 50 mmHg
D) pH 7.40, HCO3- 22 mEq/L, PaCO2 40 mmHg
,E) pH 7.25, HCO3- 24 mEq/L, PaCO2 45 mmHg
Correct Answer: B) pH 7.30, HCO3- 15 mEq/L, PaCO2 30 mmHg represents
metabolic acidosis with respiratory compensation.
Rationale: DKA presents as metabolic acidosis due to accumulation of ketone
bodies and depletion of bicarbonate. The ABG will show a pH less than 7.35, low
bicarbonate (less than 15 mEq/L), and low PaCO2 (the respiratory system is
compensating by hyperventilating to blow off CO2). This pattern demonstrates the
body's attempt to restore pH through respiratory compensation. Option A shows
alkalosis, Option C shows alkalosis with respiratory changes, Option D is normal,
and Option E shows metabolic acidosis without appropriate respiratory
compensation.
4. A 72-year-old patient with congestive heart failure is receiving furosemide
(Lasix) therapy. Which electrolyte imbalance poses the greatest risk for
cardiac arrhythmias?
A) Hyperkalemia
B) Hypercalcemia
C) Hypokalemia
D) Hypernatremia
E) Hypomagnesemia
Correct Answer: C) Hypokalemia is the most dangerous electrolyte imbalance
causing cardiac arrhythmias with loop diuretics.
Rationale: Loop diuretics like furosemide promote potassium excretion in the urine,
leading to hypokalemia. Low serum potassium dramatically increases the risk of
cardiac arrhythmias, particularly in patients with heart failure who may already
have electrical instability. Potassium is essential for proper cardiac conduction and
muscle contractility. Hyperkalemia, while serious, is less common with diuretic use.
Calcium and magnesium imbalances can affect the cardiac action potential, but
potassium is the primary concern with loop diuretics. Nursing interventions include
, monitoring potassium levels, encouraging potassium-rich foods, and potentially
administering potassium supplements.
5. A patient diagnosed with acute myocardial infarction (MI) is administered
alteplase (tPA) in the emergency department. Within what time window is
this thrombolytic most effective?
A) Within 24 hours of symptom onset
B) Within 12 hours of symptom onset
C) Within 6 hours of symptom onset
D) Within 3 hours of symptom onset
E) Within 1 hour of symptom onset
Correct Answer: D) Within 3 hours of symptom onset is the optimal window
for thrombolytic therapy effectiveness.
Rationale: The efficacy of thrombolytic agents like alteplase decreases significantly
as time passes from the onset of myocardial infarction. The window of maximum
benefit is within 3 hours of symptom onset, though it may be used up to 12 hours
in select cases. The concept of "time is muscle" emphasizes the urgency of restoring
coronary blood flow to minimize myocardial necrosis. Primary percutaneous
coronary intervention (PCI) is now the preferred reperfusion strategy when
available. Early administration of tPA can reduce mortality and limit the extent of
myocardial damage. This is why rapid assessment, diagnosis, and treatment are
critical in acute MI management.
6. A patient with severe burns covering 40% of body surface area is admitted
to the intensive care unit. Which intravenous fluid is recommended for initial
resuscitation according to the Parkland Formula?
A) Dextrose 5% in water (D5W)
B) Normal saline (0.9% sodium chloride)
NURSING I QUESTIONS, ANSWERS &
RATIONALES – GALEN COLLEGE
NU 155 EXAM 3 2026 | MEDICAL-SURGICAL NURSING I
QUESTIONS, ANSWERS & RATIONALES – GALEN COLLEGE
• This comprehensive 200-question study guide is designed to reinforce critical
medical-surgical nursing content and prepare you for clinical application in diverse
patient care scenarios across acute care settings.
• Active review with attention to rationales will strengthen your understanding of
pathophysiology, nursing interventions, and evidence-based practice standards
essential for NCLEX and clinical competency.
1. A 65-year-old patient with chronic obstructive pulmonary disease (COPD) is
admitted to the medical-surgical unit. Which assessment finding would be
most concerning and require immediate intervention?
A) Oxygen saturation of 88% on room air
B) Pink, frothy sputum production
C) Mild dyspnea with activity
D) Barrel-shaped chest configuration
E) Pursed-lip breathing pattern
Correct Answer: B) Pink, frothy sputum production indicates acute pulmonary
edema, requiring immediate intervention.
Rationale: Pink, frothy sputum is a classic sign of acute pulmonary edema,
signifying fluid accumulation in the lungs. This represents a medical emergency
requiring immediate notification of the healthcare provider and interventions such
as oxygen therapy, positioning, diuretics, and potentially intubation. While an
oxygen saturation of 88% is low and concerning, pink frothy sputum indicates acute
decompensation. Barrel chest, pursed-lip breathing, and mild dyspnea with activity
,are chronic COPD manifestations that, while important to monitor, are not acute
emergencies.
2. A patient undergoes abdominal surgery and is prescribed ketorolac
(Toradol) for postoperative pain management. Which nursing consideration is
most critical?
A) Administer the medication with food to prevent gastric upset
B) Monitor for signs of bleeding and renal function
C) Expect peak pain relief within 30 minutes of administration
D) Combine with an opioid to enhance pain relief
E) Administer for longer than 5 days if pain persists
Correct Answer: B) Monitor for signs of bleeding and renal function, as NSAIDs
carry significant risks in the postoperative period.
Rationale: Ketorolac is a potent NSAID used for short-term postoperative pain
management. Critical nursing considerations include monitoring for bleeding
complications, gastrointestinal perforation, and renal impairment. Ketorolac should
not be administered for more than 5 days due to increased risk of adverse effects.
NSAIDs should be used cautiously in patients with renal compromise or those at
risk for bleeding. While combining with opioids may be appropriate, monitoring for
complications is the priority. Ketorolac has a rapid onset (within 30 minutes) but
this does not override the need for vigilant monitoring.
3. A patient with type 2 diabetes mellitus presents with signs of diabetic
ketoacidosis (DKA). Which arterial blood gas (ABG) finding would you expect?
A) pH 7.45, HCO3- 28 mEq/L, PaCO2 45 mmHg
B) pH 7.30, HCO3- 15 mEq/L, PaCO2 30 mmHg
C) pH 7.50, HCO3- 30 mEq/L, PaCO2 50 mmHg
D) pH 7.40, HCO3- 22 mEq/L, PaCO2 40 mmHg
,E) pH 7.25, HCO3- 24 mEq/L, PaCO2 45 mmHg
Correct Answer: B) pH 7.30, HCO3- 15 mEq/L, PaCO2 30 mmHg represents
metabolic acidosis with respiratory compensation.
Rationale: DKA presents as metabolic acidosis due to accumulation of ketone
bodies and depletion of bicarbonate. The ABG will show a pH less than 7.35, low
bicarbonate (less than 15 mEq/L), and low PaCO2 (the respiratory system is
compensating by hyperventilating to blow off CO2). This pattern demonstrates the
body's attempt to restore pH through respiratory compensation. Option A shows
alkalosis, Option C shows alkalosis with respiratory changes, Option D is normal,
and Option E shows metabolic acidosis without appropriate respiratory
compensation.
4. A 72-year-old patient with congestive heart failure is receiving furosemide
(Lasix) therapy. Which electrolyte imbalance poses the greatest risk for
cardiac arrhythmias?
A) Hyperkalemia
B) Hypercalcemia
C) Hypokalemia
D) Hypernatremia
E) Hypomagnesemia
Correct Answer: C) Hypokalemia is the most dangerous electrolyte imbalance
causing cardiac arrhythmias with loop diuretics.
Rationale: Loop diuretics like furosemide promote potassium excretion in the urine,
leading to hypokalemia. Low serum potassium dramatically increases the risk of
cardiac arrhythmias, particularly in patients with heart failure who may already
have electrical instability. Potassium is essential for proper cardiac conduction and
muscle contractility. Hyperkalemia, while serious, is less common with diuretic use.
Calcium and magnesium imbalances can affect the cardiac action potential, but
potassium is the primary concern with loop diuretics. Nursing interventions include
, monitoring potassium levels, encouraging potassium-rich foods, and potentially
administering potassium supplements.
5. A patient diagnosed with acute myocardial infarction (MI) is administered
alteplase (tPA) in the emergency department. Within what time window is
this thrombolytic most effective?
A) Within 24 hours of symptom onset
B) Within 12 hours of symptom onset
C) Within 6 hours of symptom onset
D) Within 3 hours of symptom onset
E) Within 1 hour of symptom onset
Correct Answer: D) Within 3 hours of symptom onset is the optimal window
for thrombolytic therapy effectiveness.
Rationale: The efficacy of thrombolytic agents like alteplase decreases significantly
as time passes from the onset of myocardial infarction. The window of maximum
benefit is within 3 hours of symptom onset, though it may be used up to 12 hours
in select cases. The concept of "time is muscle" emphasizes the urgency of restoring
coronary blood flow to minimize myocardial necrosis. Primary percutaneous
coronary intervention (PCI) is now the preferred reperfusion strategy when
available. Early administration of tPA can reduce mortality and limit the extent of
myocardial damage. This is why rapid assessment, diagnosis, and treatment are
critical in acute MI management.
6. A patient with severe burns covering 40% of body surface area is admitted
to the intensive care unit. Which intravenous fluid is recommended for initial
resuscitation according to the Parkland Formula?
A) Dextrose 5% in water (D5W)
B) Normal saline (0.9% sodium chloride)
