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NUR 170 Exam 3 Concepts of Medical-Surgical
Nursing ACTUAL EXAM 2026/2027 | Galen
College | Complete Verified Questions and
Answers | Pass Guaranteed - A+ Graded
SECTION A: FLUID, ELECTROLYTE, AND ACID-BASE BALANCE (Questions 1-15)
1. A 68-year-old post-operative client has been receiving 0.9% NS at 125 mL/h for 36
hours. The student nurse notes bibasilar crackles, +2 pedal edema, and a 2 kg weight
gain. Which concept best explains these findings?
A. Active transport overload
B. Osmotic diuresis
C. Isotonic fluid overload
D. Third-spacing redistribution
Correct Answer: C
Rationale: Isotonic saline in excess expands the ECF compartment, leading to circulatory
overload—manifested by weight gain, edema, and crackles.
Concept Link: Isotonic solutions stay in the vascular space; students must connect cumulative
intake/output to compartment expansion.
2. An elderly client with heart failure is prescribed furosemide 40 mg IV push BID. Which
assessment finding best demonstrates the intended therapeutic effect?
A. Urine output 850 mL in 4 hours
B. Serum potassium 3.0 mEq/L
C. Blood pressure 88/56 mm Hg
D. Serum creatinine rising from 1.0 to 1.8 mg/dL
Correct Answer: A
Rationale: Loop diuretics mobilize excess fluid; a brisk diuresis indicates desired effect.
Safety Note: Monitor for hypokalemia and hypotension, but output increase is the primary goal.
3. A client’s ABG results are pH 7.48, PaCO₂ 46 mmHg, HCO₃⁻ 34 mEq/L. Which
condition does the student nurse suspect?
A. Compensated respiratory acidosis
,2
B. Uncompensated metabolic alkalosis
C. Partially compensated metabolic acidosis
D. Respiratory alkalosis with renal compensation
Correct Answer: B
Rationale: Alkalotic pH with elevated HCO₃ and normal PaCO₂ indicates primary metabolic
alkalosis; kidneys have not yet hypoventilated to compensate.
Concept Link: Students match ABG components to the acid-base map.
4. The student nurse reviews morning labs: Na 128 mEq/L, K 3.4 mEq/L, Cl 98 mEq/L.
Which clinical manifestation should the student report immediately?
A. Orthostatic hypotension
B. Diminished bowel sounds
C. Muscle cramps
D. Confusion and lethargy
Correct Answer: D
Rationale: Hyponatremia (<135) causes cerebral edema; acute confusion can progress to
seizures.
Priority Rule: Neuro signs trump musculoskeletal or GI in hyponatremia.
5. A client with DKA has serum K⁺ 5.8 mEq/L on admission. An insulin infusion is started.
Which concept explains why the student nurse must monitor for hypokalemia within the
first hour?
A. Insulin drives K⁺ into the intracellular compartment
B. Bicarbonate correction causes renal K⁺ wasting
C. Fluid resuscitation dilutes plasma potassium
D. Acetaminophen potentiates diuresis
Correct Answer: A
Rationale: Insulin stimulates Na⁺/K⁺ pump, shifting K⁺ intracellularly; plasma level can
plummet.
Concept Link: Treat the patient, not the number—expect rapid changes.
6. The student nurse is selecting an IV solution for a client with diabetic ketoacidosis who is
hypotensive. Which fluid choice best supports circulating volume while aligning with
DKA protocol?
A. 0.45% saline
B. Lactated Ringer’s
C. 0.9% saline
D. Dextrose 5% in water
, 3
Correct Answer: C
Rationale: Isotonic saline restores intravascular volume without dropping osmolality too quickly.
Guideline Recall: AHA & ADA recommend 0.9% NS as initial resuscitation fluid in DKA.
7. A client post-thyroidectomy develops tingling in fingers and perioral numbness. Which
electrolyte imbalance is most likely?
A. Hypomagnesemia
B. Hypocalcemia
C. Hypernatremia
D. Hyperphosphatemia
Correct Answer: B
Rationale: Parathyroid trauma → ↓PTH → ↓ionized Ca²⁺ → neuromuscular irritability.
Assessment Tip: Trousseau’s or Chvostek’s sign may be positive.
8. The student nurse reviews ABGs: pH 7.30, PaCO₂ 55 mmHg, HCO₃⁻ 26 mEq/L. Which
intervention is most appropriate for the student to perform within scope?
A. Administer sodium bicarbonate IV
B. Encourage slow deep-breathing exercises
C. Increase IV fluid rate
D. Assist with intubation
Correct Answer: B
Rationale: Respiratory acidosis—first action is to improve ventilation; deep breathing reduces
CO₂.
Scope Reminder: Students do not push bicarb or intubate.
9. A client receiving total parenteral nutrition (TPN) via central line develops sudden
tachypnea and chest pain. Which concept supports suspecting catheter-related air
embolism?
A. Negative intrathoracic pressure draws air into open system
B. Hyperosmolar solution causes pulmonary edema
C. Rapid glucose load triggers micro-emboli
D. Lipid emulsion precipitates allergic reaction
Correct Answer: A
Rationale: An open central line allows air entry during inspiration; immediate clamping/left
lateral Trendelenburg is critical.
Safety Drill: Always clamp central lines during tubing changes.
10. Which client is at greatest risk for developing third-spacing losses post-operatively?
A. 25-year-old laparoscopic appendectomy
B. 55-year-old undergoing open bowel resection with peritonitis
NUR 170 Exam 3 Concepts of Medical-Surgical
Nursing ACTUAL EXAM 2026/2027 | Galen
College | Complete Verified Questions and
Answers | Pass Guaranteed - A+ Graded
SECTION A: FLUID, ELECTROLYTE, AND ACID-BASE BALANCE (Questions 1-15)
1. A 68-year-old post-operative client has been receiving 0.9% NS at 125 mL/h for 36
hours. The student nurse notes bibasilar crackles, +2 pedal edema, and a 2 kg weight
gain. Which concept best explains these findings?
A. Active transport overload
B. Osmotic diuresis
C. Isotonic fluid overload
D. Third-spacing redistribution
Correct Answer: C
Rationale: Isotonic saline in excess expands the ECF compartment, leading to circulatory
overload—manifested by weight gain, edema, and crackles.
Concept Link: Isotonic solutions stay in the vascular space; students must connect cumulative
intake/output to compartment expansion.
2. An elderly client with heart failure is prescribed furosemide 40 mg IV push BID. Which
assessment finding best demonstrates the intended therapeutic effect?
A. Urine output 850 mL in 4 hours
B. Serum potassium 3.0 mEq/L
C. Blood pressure 88/56 mm Hg
D. Serum creatinine rising from 1.0 to 1.8 mg/dL
Correct Answer: A
Rationale: Loop diuretics mobilize excess fluid; a brisk diuresis indicates desired effect.
Safety Note: Monitor for hypokalemia and hypotension, but output increase is the primary goal.
3. A client’s ABG results are pH 7.48, PaCO₂ 46 mmHg, HCO₃⁻ 34 mEq/L. Which
condition does the student nurse suspect?
A. Compensated respiratory acidosis
,2
B. Uncompensated metabolic alkalosis
C. Partially compensated metabolic acidosis
D. Respiratory alkalosis with renal compensation
Correct Answer: B
Rationale: Alkalotic pH with elevated HCO₃ and normal PaCO₂ indicates primary metabolic
alkalosis; kidneys have not yet hypoventilated to compensate.
Concept Link: Students match ABG components to the acid-base map.
4. The student nurse reviews morning labs: Na 128 mEq/L, K 3.4 mEq/L, Cl 98 mEq/L.
Which clinical manifestation should the student report immediately?
A. Orthostatic hypotension
B. Diminished bowel sounds
C. Muscle cramps
D. Confusion and lethargy
Correct Answer: D
Rationale: Hyponatremia (<135) causes cerebral edema; acute confusion can progress to
seizures.
Priority Rule: Neuro signs trump musculoskeletal or GI in hyponatremia.
5. A client with DKA has serum K⁺ 5.8 mEq/L on admission. An insulin infusion is started.
Which concept explains why the student nurse must monitor for hypokalemia within the
first hour?
A. Insulin drives K⁺ into the intracellular compartment
B. Bicarbonate correction causes renal K⁺ wasting
C. Fluid resuscitation dilutes plasma potassium
D. Acetaminophen potentiates diuresis
Correct Answer: A
Rationale: Insulin stimulates Na⁺/K⁺ pump, shifting K⁺ intracellularly; plasma level can
plummet.
Concept Link: Treat the patient, not the number—expect rapid changes.
6. The student nurse is selecting an IV solution for a client with diabetic ketoacidosis who is
hypotensive. Which fluid choice best supports circulating volume while aligning with
DKA protocol?
A. 0.45% saline
B. Lactated Ringer’s
C. 0.9% saline
D. Dextrose 5% in water
, 3
Correct Answer: C
Rationale: Isotonic saline restores intravascular volume without dropping osmolality too quickly.
Guideline Recall: AHA & ADA recommend 0.9% NS as initial resuscitation fluid in DKA.
7. A client post-thyroidectomy develops tingling in fingers and perioral numbness. Which
electrolyte imbalance is most likely?
A. Hypomagnesemia
B. Hypocalcemia
C. Hypernatremia
D. Hyperphosphatemia
Correct Answer: B
Rationale: Parathyroid trauma → ↓PTH → ↓ionized Ca²⁺ → neuromuscular irritability.
Assessment Tip: Trousseau’s or Chvostek’s sign may be positive.
8. The student nurse reviews ABGs: pH 7.30, PaCO₂ 55 mmHg, HCO₃⁻ 26 mEq/L. Which
intervention is most appropriate for the student to perform within scope?
A. Administer sodium bicarbonate IV
B. Encourage slow deep-breathing exercises
C. Increase IV fluid rate
D. Assist with intubation
Correct Answer: B
Rationale: Respiratory acidosis—first action is to improve ventilation; deep breathing reduces
CO₂.
Scope Reminder: Students do not push bicarb or intubate.
9. A client receiving total parenteral nutrition (TPN) via central line develops sudden
tachypnea and chest pain. Which concept supports suspecting catheter-related air
embolism?
A. Negative intrathoracic pressure draws air into open system
B. Hyperosmolar solution causes pulmonary edema
C. Rapid glucose load triggers micro-emboli
D. Lipid emulsion precipitates allergic reaction
Correct Answer: A
Rationale: An open central line allows air entry during inspiration; immediate clamping/left
lateral Trendelenburg is critical.
Safety Drill: Always clamp central lines during tubing changes.
10. Which client is at greatest risk for developing third-spacing losses post-operatively?
A. 25-year-old laparoscopic appendectomy
B. 55-year-old undergoing open bowel resection with peritonitis
