NU 185 Medical Surgical Nursing II Comprehensive
Prep Comprehensive Study Guide 2026 20, Exams of
Nursing
1. A patient with acute decompensated heart failure has been started on IV furosemide.
Which assessment finding best indicates a therapeutic response?
A. Serum potassium of 3.2 mEq/L
B. Urine output of 50 mL/hr with decreased JVD
C. Weight gain of 1 kg over 24 hours
D. Bibasilar crackles that remain unchanged
Answer: B
Rationale: Loop diuretics reduce preload, so adequate diuresis with falling jugular venous
distention signals effective decongestion. Hypokalemia, weight gain, and persistent crackles
indicate inadequate response or an adverse effect rather than therapeutic benefit.
2. Which arterial blood gas pattern is most consistent with an acute exacerbation of COPD
with CO2 retention?
A. pH 7.48, PaCO2 30, HCO3 24
B. pH 7.30, PaCO2 58, HCO3 26
C. pH 7.50, PaCO2 40, HCO3 30
D. pH 7.36, PaCO2 40, HCO3 24
Answer: B
Rationale: Acute respiratory acidosis from CO2 retention shows low pH with elevated PaCO2
and near-normal bicarbonate before renal compensation. The other options reflect respiratory
alkalosis, metabolic alkalosis, or normal values.
3. A patient with chronic kidney disease has a potassium of 6.4 mEq/L and peaked T waves.
Which prescription should the nurse anticipate first?
A. Oral sodium polystyrene sulfonate
B. IV calcium gluconate
C. Subcutaneous insulin with dextrose
D. IV furosemide
Answer: B
Rationale: IV calcium stabilizes the myocardium immediately in hyperkalemia with ECG
changes, making it the priority. Insulin/dextrose, furosemide, and cation exchange resins shift or
remove potassium but do not provide immediate cardiac protection.
Page 1
,4. Which finding most strongly suggests impending thyroid storm in a patient admitted
with Graves disease?
A. Heart rate 92 with mild fatigue
B. Temperature 104.2°F with agitation and tachycardia
C. Weight gain with bradycardia
D. Dry skin with cold intolerance
Answer: B
Rationale: Thyroid storm presents with hyperthermia, severe tachycardia, agitation, and altered
mental status. The other options describe milder hyperthyroidism or hypothyroid features
inconsistent with storm.
5. A patient recovering from an acute ischemic stroke develops sudden severe headache and
a drop in level of consciousness. Which complication should the nurse suspect?
A. Hemorrhagic transformation
B. Urinary tract infection
C. Aspiration pneumonia
D. Deep vein thrombosis
Answer: A
Rationale: Sudden headache with neurologic deterioration after ischemic stroke suggests
hemorrhagic conversion, especially post-thrombolysis. Infection, aspiration, and DVT do not
produce abrupt focal deterioration with severe headache.
6. Which instruction is most important for a patient beginning chemotherapy with
oxaliplatin?
A. Avoid cold drinks and cold objects
B. Increase sun exposure for vitamin D
C. Take aspirin daily for clot prevention
D. Limit oral fluids to 1 L per day
Answer: A
Rationale: Oxaliplatin causes cold-induced peripheral paresthesias and dysesthesias, so cold
avoidance is essential. Sun exposure, aspirin, and fluid restriction are unrelated or unsafe for
this patient.
7. Which assessment finding is most concerning in a patient two hours after total hip
arthroplasty?
A. Serosanguineous drainage on the dressing
B. Complaint of incisional pain rated 4/10
C. Shortness of breath with unilateral calf swelling
D. Temperature of 99.8°F
Answer: C
Page 2
, Rationale: Unilateral calf swelling with dyspnea suggests DVT with possible pulmonary embolism, a life-threatening
postoperative complication. Minor drainage, moderate pain, and low-grade fever are expected after arthroplasty.
8. A patient with cirrhosis has increasing abdominal girth, confusion, and asterixis. Which
intervention should the nurse prioritize?
A. Administer lactulose as prescribed
B. Restrict oral protein completely
C. Encourage a high-sodium diet
D. Apply warm compresses to the abdomen
Answer: A
Rationale: Asterixis and confusion indicate hepatic encephalopathy; lactulose reduces ammonia
by promoting excretion. Protein restriction is outdated and not routinely complete, sodium
worsens ascites, and warm compresses do not treat encephalopathy.
9. Which laboratory value should the nurse monitor most closely in a patient receiving
vancomycin IV?
A. Serum creatinine
B. Serum amylase
C. Serum calcium
D. Serum magnesium
Answer: A
Rationale: Vancomycin is nephrotoxic, so renal function must be tracked with serum creatinine
and trough levels. Amylase, calcium, and magnesium are not primary markers for vancomycin
toxicity.
10. A patient with a new colostomy has liquid stool and skin breakdown around the stoma.
Which action should the nurse take first?
A. Apply a larger skin barrier
B. Measure and refit the pouching system
C. Administer a bulk-forming laxative
D. Restrict oral fluids
Answer: B
Rationale: A properly sized pouching system prevents leakage and protects skin, which is the
priority. A larger barrier worsens leakage, laxatives are contraindicated with liquid stool, and
fluid restriction does not address the skin issue.
11. A patient with acute decompensated heart failure is receiving IV furosemide. Which
assessment finding best indicates the medication is achieving its intended therapeutic
effect?
A. Serum potassium rises from 3.2 to 4.0 mEq/L
Page 3
Prep Comprehensive Study Guide 2026 20, Exams of
Nursing
1. A patient with acute decompensated heart failure has been started on IV furosemide.
Which assessment finding best indicates a therapeutic response?
A. Serum potassium of 3.2 mEq/L
B. Urine output of 50 mL/hr with decreased JVD
C. Weight gain of 1 kg over 24 hours
D. Bibasilar crackles that remain unchanged
Answer: B
Rationale: Loop diuretics reduce preload, so adequate diuresis with falling jugular venous
distention signals effective decongestion. Hypokalemia, weight gain, and persistent crackles
indicate inadequate response or an adverse effect rather than therapeutic benefit.
2. Which arterial blood gas pattern is most consistent with an acute exacerbation of COPD
with CO2 retention?
A. pH 7.48, PaCO2 30, HCO3 24
B. pH 7.30, PaCO2 58, HCO3 26
C. pH 7.50, PaCO2 40, HCO3 30
D. pH 7.36, PaCO2 40, HCO3 24
Answer: B
Rationale: Acute respiratory acidosis from CO2 retention shows low pH with elevated PaCO2
and near-normal bicarbonate before renal compensation. The other options reflect respiratory
alkalosis, metabolic alkalosis, or normal values.
3. A patient with chronic kidney disease has a potassium of 6.4 mEq/L and peaked T waves.
Which prescription should the nurse anticipate first?
A. Oral sodium polystyrene sulfonate
B. IV calcium gluconate
C. Subcutaneous insulin with dextrose
D. IV furosemide
Answer: B
Rationale: IV calcium stabilizes the myocardium immediately in hyperkalemia with ECG
changes, making it the priority. Insulin/dextrose, furosemide, and cation exchange resins shift or
remove potassium but do not provide immediate cardiac protection.
Page 1
,4. Which finding most strongly suggests impending thyroid storm in a patient admitted
with Graves disease?
A. Heart rate 92 with mild fatigue
B. Temperature 104.2°F with agitation and tachycardia
C. Weight gain with bradycardia
D. Dry skin with cold intolerance
Answer: B
Rationale: Thyroid storm presents with hyperthermia, severe tachycardia, agitation, and altered
mental status. The other options describe milder hyperthyroidism or hypothyroid features
inconsistent with storm.
5. A patient recovering from an acute ischemic stroke develops sudden severe headache and
a drop in level of consciousness. Which complication should the nurse suspect?
A. Hemorrhagic transformation
B. Urinary tract infection
C. Aspiration pneumonia
D. Deep vein thrombosis
Answer: A
Rationale: Sudden headache with neurologic deterioration after ischemic stroke suggests
hemorrhagic conversion, especially post-thrombolysis. Infection, aspiration, and DVT do not
produce abrupt focal deterioration with severe headache.
6. Which instruction is most important for a patient beginning chemotherapy with
oxaliplatin?
A. Avoid cold drinks and cold objects
B. Increase sun exposure for vitamin D
C. Take aspirin daily for clot prevention
D. Limit oral fluids to 1 L per day
Answer: A
Rationale: Oxaliplatin causes cold-induced peripheral paresthesias and dysesthesias, so cold
avoidance is essential. Sun exposure, aspirin, and fluid restriction are unrelated or unsafe for
this patient.
7. Which assessment finding is most concerning in a patient two hours after total hip
arthroplasty?
A. Serosanguineous drainage on the dressing
B. Complaint of incisional pain rated 4/10
C. Shortness of breath with unilateral calf swelling
D. Temperature of 99.8°F
Answer: C
Page 2
, Rationale: Unilateral calf swelling with dyspnea suggests DVT with possible pulmonary embolism, a life-threatening
postoperative complication. Minor drainage, moderate pain, and low-grade fever are expected after arthroplasty.
8. A patient with cirrhosis has increasing abdominal girth, confusion, and asterixis. Which
intervention should the nurse prioritize?
A. Administer lactulose as prescribed
B. Restrict oral protein completely
C. Encourage a high-sodium diet
D. Apply warm compresses to the abdomen
Answer: A
Rationale: Asterixis and confusion indicate hepatic encephalopathy; lactulose reduces ammonia
by promoting excretion. Protein restriction is outdated and not routinely complete, sodium
worsens ascites, and warm compresses do not treat encephalopathy.
9. Which laboratory value should the nurse monitor most closely in a patient receiving
vancomycin IV?
A. Serum creatinine
B. Serum amylase
C. Serum calcium
D. Serum magnesium
Answer: A
Rationale: Vancomycin is nephrotoxic, so renal function must be tracked with serum creatinine
and trough levels. Amylase, calcium, and magnesium are not primary markers for vancomycin
toxicity.
10. A patient with a new colostomy has liquid stool and skin breakdown around the stoma.
Which action should the nurse take first?
A. Apply a larger skin barrier
B. Measure and refit the pouching system
C. Administer a bulk-forming laxative
D. Restrict oral fluids
Answer: B
Rationale: A properly sized pouching system prevents leakage and protects skin, which is the
priority. A larger barrier worsens leakage, laxatives are contraindicated with liquid stool, and
fluid restriction does not address the skin issue.
11. A patient with acute decompensated heart failure is receiving IV furosemide. Which
assessment finding best indicates the medication is achieving its intended therapeutic
effect?
A. Serum potassium rises from 3.2 to 4.0 mEq/L
Page 3
