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NUR 209 Medical-Surgical Nursing II
2025 – Complete Exam Guide with
Verified Answers
1. A patient with chronic renal failure is at risk for hyperkalemia. Which dietary
restriction should the nurse emphasize?
A. Low-sodium diet
B. Low-potassium diet
C. Low-protein diet
D. Low-fat diet
Correct Answer: B. Low-potassium diet
Rationale: Hyperkalemia is common in chronic renal failure due to impaired potassium
excretion. A low-potassium diet (avoiding bananas, oranges, tomatoes, etc.) helps
manage potassium levels. Sodium, protein, and fat restrictions may apply but are not the
priority for hyperkalemia.
2. Which IV fluid is most appropriate for a patient with dehydration from diarrhea
lasting 5 days?
A. 5% Dextrose in water
B. Lactated Ringer’s
C. 3% Sodium chloride
D. 0.45% Sodium chloride
Correct Answer: B. Lactated Ringer’s
Rationale: Lactated Ringer’s is an isotonic solution that replaces fluid and electrolytes
lost in diarrhea, restoring volume and correcting imbalances. Dextrose provides calories,
3% saline is for severe hyponatremia, and 0.45% saline is hypotonic, less effective for
volume replacement.
3. A patient with a potassium level of 3.0 mEq/L is receiving Lasix. What should the
nurse do?
A. Administer the Lasix as ordered
B. Hold the Lasix and notify the provider
C. Give potassium supplements without notifying
D. Increase the Lasix dose
Correct Answer: B. Hold the Lasix and notify the provider
Rationale: A potassium level of 3.0 mEq/L indicates hypokalemia, exacerbated by Lasix
(furosemide), a loop diuretic. Holding the dose and notifying the provider prevents
further potassium loss. Administering Lasix worsens hypokalemia, and supplements
require a prescription.
4. Which symptom indicates hypervolemia in a patient with heart failure?
A. Dry mucous membranes
B. Moist crackles in the lungs
, 2
C. Decreased blood pressure
D. Increased urine output
Correct Answer: B. Moist crackles in the lungs
Rationale: Hypervolemia in heart failure causes fluid overload, leading to pulmonary
edema and moist crackles. Dry mucous membranes and decreased blood pressure suggest
hypovolemia, while increased urine output is not typical in fluid overload.
5. What is the priority nursing action for a patient with suspected skin cancer?
A. Apply sunscreen to the lesion
B. Assess the lesion using the ABCDE criteria
C. Biopsy the lesion immediately
D. Teach the patient about UV protection
Correct Answer: B. Assess the lesion using the ABCDE criteria
Rationale: The ABCDE criteria (Asymmetry, Border, Color, Diameter, Evolving) help
identify malignant lesions. Assessment is the priority before interventions like biopsy
(provider-ordered) or teaching. Applying sunscreen does not address the current lesion.
6. A patient with actinic keratosis asks what it is. How should the nurse respond?
A. A benign skin growth
B. A thick, scaly patch that may become cancerous
C. A type of melanoma
D. A fungal skin infection
Correct Answer: B. A thick, scaly patch that may become cancerous
Rationale: Actinic keratosis is a precancerous lesion caused by UV exposure, presenting
as a scaly patch that may progress to squamous cell carcinoma. It is neither benign,
melanoma, nor fungal.
7. What is the normal range for arterial blood gas pH?
A. 7.25–7.35
B. 7.35–7.45
C. 7.45–7.55
D. 7.15–7.25
Correct Answer: B. 7.35–7.45
Rationale: The normal pH range for arterial blood gases is 7.35–7.45, indicating acid-
base balance. Values outside this range suggest acidosis or alkalosis.
8. A patient with renal failure has a potassium level of 6.5 mEq/L. Which medication
should the nurse expect to administer?
A. Furosemide
B. Sodium polystyrene sulfonate
C. Spironolactone
D. Mannitol
Correct Answer: B. Sodium polystyrene sulfonate
Rationale: Sodium polystyrene sulfonate (Kayexalate) removes excess potassium via the
GI tract in hyperkalemia. Furosemide and spironolactone are diuretics that may worsen
potassium imbalances, and mannitol is for cerebral edema.
9. What is the priority teaching for a patient with melanoma?
A. Avoid all sun exposure
B. Perform monthly self-skin exams
C. Use high-potency steroids
, 3
D. Increase dietary vitamin D
Correct Answer: B. Perform monthly self-skin exams
Rationale: Monthly self-skin exams help detect melanoma recurrence or new lesions
early. Avoiding sun exposure is important but less specific than regular monitoring.
Steroids are not standard, and vitamin D is unrelated to melanoma management.
10. A patient with a T2 spinal cord injury requires which nursing intervention?
A. Continuous cardiac monitoring
B. Urinary catheter care
C. Administer beta-blockers
D. Restrict fluid intake
Correct Answer: B. Urinary catheter care
Rationale: T2 spinal cord injuries cause neurogenic bladder, requiring catheter care to
prevent infections. Cardiac monitoring and beta-blockers are not routine, and fluid
restriction is inappropriate unless indicated.
11. What should the nurse do if clear cerebrospinal fluid (CSF) is observed leaking
from a patient’s nose?
A. Suction the nasal cavity
B. Test the fluid for glucose
C. Apply a nasal packing
D. Administer antibiotics
Correct Answer: B. Test the fluid for glucose
Rationale: Clear CSF leakage is confirmed by testing for glucose, indicating a possible
skull fracture. Suctioning or packing risks infection, and antibiotics are not given
preemptively.
12. A patient with a stroke is to receive oral medication. What should the nurse assess
first?
A. Blood pressure
B. Gag reflex
C. Bowel sounds
D. Pain level
Correct Answer: B. Gag reflex
Rationale: Assessing the gag reflex ensures safe swallowing to prevent aspiration in
stroke patients. Blood pressure, bowel sounds, and pain are important but secondary to
swallowing safety.
13. Which symptom is most concerning in a patient with a head injury?
A. Headache
B. Nausea
C. Unequal pupils
D. Dizziness
Correct Answer: C. Unequal pupils
Rationale: Unequal pupils indicate increased intracranial pressure or neurological
deterioration, requiring immediate intervention. Headache, nausea, and dizziness are
common but less urgent.
14. What is the priority nursing action for a patient with an epidural hematoma?
A. Administer pain medication
B. Prepare for emergency craniotomy
NUR 209 Medical-Surgical Nursing II
2025 – Complete Exam Guide with
Verified Answers
1. A patient with chronic renal failure is at risk for hyperkalemia. Which dietary
restriction should the nurse emphasize?
A. Low-sodium diet
B. Low-potassium diet
C. Low-protein diet
D. Low-fat diet
Correct Answer: B. Low-potassium diet
Rationale: Hyperkalemia is common in chronic renal failure due to impaired potassium
excretion. A low-potassium diet (avoiding bananas, oranges, tomatoes, etc.) helps
manage potassium levels. Sodium, protein, and fat restrictions may apply but are not the
priority for hyperkalemia.
2. Which IV fluid is most appropriate for a patient with dehydration from diarrhea
lasting 5 days?
A. 5% Dextrose in water
B. Lactated Ringer’s
C. 3% Sodium chloride
D. 0.45% Sodium chloride
Correct Answer: B. Lactated Ringer’s
Rationale: Lactated Ringer’s is an isotonic solution that replaces fluid and electrolytes
lost in diarrhea, restoring volume and correcting imbalances. Dextrose provides calories,
3% saline is for severe hyponatremia, and 0.45% saline is hypotonic, less effective for
volume replacement.
3. A patient with a potassium level of 3.0 mEq/L is receiving Lasix. What should the
nurse do?
A. Administer the Lasix as ordered
B. Hold the Lasix and notify the provider
C. Give potassium supplements without notifying
D. Increase the Lasix dose
Correct Answer: B. Hold the Lasix and notify the provider
Rationale: A potassium level of 3.0 mEq/L indicates hypokalemia, exacerbated by Lasix
(furosemide), a loop diuretic. Holding the dose and notifying the provider prevents
further potassium loss. Administering Lasix worsens hypokalemia, and supplements
require a prescription.
4. Which symptom indicates hypervolemia in a patient with heart failure?
A. Dry mucous membranes
B. Moist crackles in the lungs
, 2
C. Decreased blood pressure
D. Increased urine output
Correct Answer: B. Moist crackles in the lungs
Rationale: Hypervolemia in heart failure causes fluid overload, leading to pulmonary
edema and moist crackles. Dry mucous membranes and decreased blood pressure suggest
hypovolemia, while increased urine output is not typical in fluid overload.
5. What is the priority nursing action for a patient with suspected skin cancer?
A. Apply sunscreen to the lesion
B. Assess the lesion using the ABCDE criteria
C. Biopsy the lesion immediately
D. Teach the patient about UV protection
Correct Answer: B. Assess the lesion using the ABCDE criteria
Rationale: The ABCDE criteria (Asymmetry, Border, Color, Diameter, Evolving) help
identify malignant lesions. Assessment is the priority before interventions like biopsy
(provider-ordered) or teaching. Applying sunscreen does not address the current lesion.
6. A patient with actinic keratosis asks what it is. How should the nurse respond?
A. A benign skin growth
B. A thick, scaly patch that may become cancerous
C. A type of melanoma
D. A fungal skin infection
Correct Answer: B. A thick, scaly patch that may become cancerous
Rationale: Actinic keratosis is a precancerous lesion caused by UV exposure, presenting
as a scaly patch that may progress to squamous cell carcinoma. It is neither benign,
melanoma, nor fungal.
7. What is the normal range for arterial blood gas pH?
A. 7.25–7.35
B. 7.35–7.45
C. 7.45–7.55
D. 7.15–7.25
Correct Answer: B. 7.35–7.45
Rationale: The normal pH range for arterial blood gases is 7.35–7.45, indicating acid-
base balance. Values outside this range suggest acidosis or alkalosis.
8. A patient with renal failure has a potassium level of 6.5 mEq/L. Which medication
should the nurse expect to administer?
A. Furosemide
B. Sodium polystyrene sulfonate
C. Spironolactone
D. Mannitol
Correct Answer: B. Sodium polystyrene sulfonate
Rationale: Sodium polystyrene sulfonate (Kayexalate) removes excess potassium via the
GI tract in hyperkalemia. Furosemide and spironolactone are diuretics that may worsen
potassium imbalances, and mannitol is for cerebral edema.
9. What is the priority teaching for a patient with melanoma?
A. Avoid all sun exposure
B. Perform monthly self-skin exams
C. Use high-potency steroids
, 3
D. Increase dietary vitamin D
Correct Answer: B. Perform monthly self-skin exams
Rationale: Monthly self-skin exams help detect melanoma recurrence or new lesions
early. Avoiding sun exposure is important but less specific than regular monitoring.
Steroids are not standard, and vitamin D is unrelated to melanoma management.
10. A patient with a T2 spinal cord injury requires which nursing intervention?
A. Continuous cardiac monitoring
B. Urinary catheter care
C. Administer beta-blockers
D. Restrict fluid intake
Correct Answer: B. Urinary catheter care
Rationale: T2 spinal cord injuries cause neurogenic bladder, requiring catheter care to
prevent infections. Cardiac monitoring and beta-blockers are not routine, and fluid
restriction is inappropriate unless indicated.
11. What should the nurse do if clear cerebrospinal fluid (CSF) is observed leaking
from a patient’s nose?
A. Suction the nasal cavity
B. Test the fluid for glucose
C. Apply a nasal packing
D. Administer antibiotics
Correct Answer: B. Test the fluid for glucose
Rationale: Clear CSF leakage is confirmed by testing for glucose, indicating a possible
skull fracture. Suctioning or packing risks infection, and antibiotics are not given
preemptively.
12. A patient with a stroke is to receive oral medication. What should the nurse assess
first?
A. Blood pressure
B. Gag reflex
C. Bowel sounds
D. Pain level
Correct Answer: B. Gag reflex
Rationale: Assessing the gag reflex ensures safe swallowing to prevent aspiration in
stroke patients. Blood pressure, bowel sounds, and pain are important but secondary to
swallowing safety.
13. Which symptom is most concerning in a patient with a head injury?
A. Headache
B. Nausea
C. Unequal pupils
D. Dizziness
Correct Answer: C. Unequal pupils
Rationale: Unequal pupils indicate increased intracranial pressure or neurological
deterioration, requiring immediate intervention. Headache, nausea, and dizziness are
common but less urgent.
14. What is the priority nursing action for a patient with an epidural hematoma?
A. Administer pain medication
B. Prepare for emergency craniotomy
