NU 185 Exam 1 Medical-Surgical Nursing II 2026 Galen College
1. A patient presents with a pH of 7.30, PaCO2 of 55 mmHg, and HCO3 of 26
mEq/L. Which acid-base imbalance is occurring?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: The pH is low (acidosis) and the PaCO2 is high (respiratory component), while
the HCO3 is normal, indicating respiratory acidosis.
2. Which clinical manifestation is most characteristic of right-sided heart failure?
A. Jugular Venous Distention (JVD)
B. Crackles in the lungs
C. Dyspnea on exertion
D. Pulmonary edema
Answer: A
Rationale: Right-sided heart failure causes systemic congestion, leading to JVD, peripheral
edema, and hepatomegaly. Left-sided failure causes pulmonary symptoms.
,3. A patient is prescribed Digoxin for heart failure. Which lab value should the
nurse monitor most closely to prevent toxicity?
A. Serum Sodium
B. Serum Calcium
C. Serum Magnesium
D. Serum Potassium
Answer: D
Rationale: Hypokalemia (low potassium) significantly increases the risk of Digoxin
toxicity.
4. When teaching a patient about using a metered-dose inhaler (MDI) with a
spacer, which instruction is correct?
A. Exhale deeply after inhaling the medication.
B. Inhale as quickly and forcefully as possible.
C. Wait at least 1 minute between puffs of the same medication.
D. Rinse the mouth only if using a bronchodilator.
Answer: C
Rationale: Waiting 1 minute between puffs allows the lungs to expand and the second dose
to penetrate deeper into the airways.
5. A patient with a history of DVT reports sudden chest pain and shortness of
breath. What is the priority nursing action?
A. Apply oxygen and notify the Rapid Response Team.
B. Administer pain medication.
C. Obtain an EKG.
D. Start a new IV line.
Answer: A
Rationale: The symptoms suggest a Pulmonary Embolism (PE). Maintaining oxygenation
and seeking immediate medical intervention are the priorities.
, 6. Which of the following is a modifiable risk factor for Coronary Artery Disease
(CAD)?
A. Family history
B. Hyperlipidemia
C. Increasing age
D. Gender
Answer: B
Rationale: Hyperlipidemia can be managed through diet and medication; age, gender, and
genetics cannot be changed.
7. A nurse is assessing a chest tube drainage system and notes continuous
bubbling in the water seal chamber. What does this indicate?
A. Normal operation
B. The lung has fully re-expanded
C. An air leak in the system
D. The suction is turned up too high
Answer: C
Rationale: Continuous bubbling in the water seal chamber suggests a leak. Occasional
bubbling during coughing or expiration is normal.
8. Which assessment finding is a classic sign of Peripheral Artery Disease (PAD)?
A. Intermittent claudication
B. Brawny skin discoloration
C. Varicose veins
D. Painless ulcers on the medial malleolus
Answer: A
Rationale: Intermittent claudication (muscle pain during exercise that resolves with rest)
is the hallmark sign of PAD.
1. A patient presents with a pH of 7.30, PaCO2 of 55 mmHg, and HCO3 of 26
mEq/L. Which acid-base imbalance is occurring?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: The pH is low (acidosis) and the PaCO2 is high (respiratory component), while
the HCO3 is normal, indicating respiratory acidosis.
2. Which clinical manifestation is most characteristic of right-sided heart failure?
A. Jugular Venous Distention (JVD)
B. Crackles in the lungs
C. Dyspnea on exertion
D. Pulmonary edema
Answer: A
Rationale: Right-sided heart failure causes systemic congestion, leading to JVD, peripheral
edema, and hepatomegaly. Left-sided failure causes pulmonary symptoms.
,3. A patient is prescribed Digoxin for heart failure. Which lab value should the
nurse monitor most closely to prevent toxicity?
A. Serum Sodium
B. Serum Calcium
C. Serum Magnesium
D. Serum Potassium
Answer: D
Rationale: Hypokalemia (low potassium) significantly increases the risk of Digoxin
toxicity.
4. When teaching a patient about using a metered-dose inhaler (MDI) with a
spacer, which instruction is correct?
A. Exhale deeply after inhaling the medication.
B. Inhale as quickly and forcefully as possible.
C. Wait at least 1 minute between puffs of the same medication.
D. Rinse the mouth only if using a bronchodilator.
Answer: C
Rationale: Waiting 1 minute between puffs allows the lungs to expand and the second dose
to penetrate deeper into the airways.
5. A patient with a history of DVT reports sudden chest pain and shortness of
breath. What is the priority nursing action?
A. Apply oxygen and notify the Rapid Response Team.
B. Administer pain medication.
C. Obtain an EKG.
D. Start a new IV line.
Answer: A
Rationale: The symptoms suggest a Pulmonary Embolism (PE). Maintaining oxygenation
and seeking immediate medical intervention are the priorities.
, 6. Which of the following is a modifiable risk factor for Coronary Artery Disease
(CAD)?
A. Family history
B. Hyperlipidemia
C. Increasing age
D. Gender
Answer: B
Rationale: Hyperlipidemia can be managed through diet and medication; age, gender, and
genetics cannot be changed.
7. A nurse is assessing a chest tube drainage system and notes continuous
bubbling in the water seal chamber. What does this indicate?
A. Normal operation
B. The lung has fully re-expanded
C. An air leak in the system
D. The suction is turned up too high
Answer: C
Rationale: Continuous bubbling in the water seal chamber suggests a leak. Occasional
bubbling during coughing or expiration is normal.
8. Which assessment finding is a classic sign of Peripheral Artery Disease (PAD)?
A. Intermittent claudication
B. Brawny skin discoloration
C. Varicose veins
D. Painless ulcers on the medial malleolus
Answer: A
Rationale: Intermittent claudication (muscle pain during exercise that resolves with rest)
is the hallmark sign of PAD.
