NU 155 Medical-Surgical Nursing I Exam 3 Actual
Exam 2026/2027 – Galen College of Nursing –
Verified Q&A with Detailed Rationales – Pass
Guaranteed – A+ Graded
======================================================
========== SECTION 1: FLUID, ELECTROLYTE, & ACID-BASE
BALANCE (12 Questions)
Q1. A nurse is caring for a 68-year-old patient with heart failure who gained 3 kg in 2
days. Assessment reveals JVD at 45 degrees, lung crackles bilaterally, and 2+ pitting
edema in lower extremities. Which intervention should the nurse implement first?
A. Increase oral fluid intake to prevent dehydration
B. Administer prescribed loop diuretic and monitor urine output [CORRECT]
C. Elevate legs to reduce peripheral edema
D. Obtain a chest x-ray to confirm pulmonary edema
Correct Answer: B
Rationale:
,Step 1 – Key assessment: 3 kg weight gain in 2 days with JVD, crackles, and peripheral
edema indicates acute fluid volume excess (hypervolemia) compromising cardiac and
pulmonary function.
Step 2 – Correct answer reasoning: Loop diuretics are first-line treatment to reduce
preload and eliminate excess fluid; monitoring intake/output assesses effectiveness
and prevents hypovolemia.
Step 3 – Distractor analysis: A is wrong (Trap 1): Increasing fluids worsens heart failure
and pulmonary edema; weight gain indicates retention, not dehydration. C is wrong: Leg
elevation does not address life-threatening pulmonary congestion and is
contraindicated without addressing cardiac preload. D is wrong: While chest x-ray
confirms diagnosis, the patient requires immediate intervention to reduce fluid overload;
diagnostic testing should not delay treatment.
Q2. A patient with diabetic ketoacidosis has the following arterial blood gas results: pH
7.25, PaCO₂ 28 mmHg, HCO₃⁻ 14 mEq/L. Which acid-base disorder does the patient
have?
A. Respiratory acidosis with partial compensation
B. Metabolic acidosis with respiratory compensation [CORRECT]
C. Metabolic alkalosis with respiratory compensation
D. Respiratory alkalosis with metabolic compensation
Correct Answer: B
Rationale:
,Step 1 – Key assessment: pH 7.25 (acidemia), HCO₃⁻ 14 (low = metabolic component),
PaCO₂ 28 (low = respiratory compensation via hyperventilation).
Step 2 – Correct answer reasoning: Low pH with low bicarbonate indicates metabolic
acidosis; the low PaCO₂ represents compensatory hyperventilation (Kussmaul
respirations) attempting to raise pH by blowing off CO₂.
Step 3 – Distractor analysis: A is wrong (Trap 3): PaCO₂ is low, not high; respiratory
acidosis requires elevated PaCO₂. C is wrong: pH is acidic, not alkaline; metabolic
alkalosis requires high HCO₃⁻. D is wrong: Primary disorder is metabolic (low HCO₃⁻),
not respiratory; the direction of pH and bicarbonate both indicate acidosis.
Q3. A nurse is reviewing morning laboratory results. Which patient should the nurse
assess first?
A. Patient with sodium 138 mEq/L
B. Patient with potassium 2.8 mEq/L [CORRECT]
C. Patient with calcium 9.2 mg/dL
D. Patient with magnesium 1.8 mg/dL
Correct Answer: B
Rationale:
Step 1 – Key assessment: Potassium 2.8 mEq/L represents severe hypokalemia
(normal 3.5-5.0); risk of life-threatening cardiac dysrhythmias.
, Step 2 – Correct answer reasoning: Hypokalemia increases risk of ventricular fibrillation
and cardiac arrest; requires immediate ECG monitoring and physician notification for IV
replacement.
Step 3 – Distractor analysis: A is wrong: Sodium 138 is within normal range (135-145). C
is wrong: Calcium 9.2 is normal (8.5-10.5); no immediate action needed. D is wrong:
Magnesium 1.8 is low-normal (1.7-2.2) but not immediately life-threatening compared to
severe hypokalemia.
Q4. The nurse is preparing to administer 1000 mL of 0.9% NaCl over 8 hours via gravity
infusion. The drip factor is 20 gtt/mL. How many drops per minute should the nurse set
the flow rate? (Round to the nearest whole number)
A. 28 gtt/min
B. 42 gtt/min [CORRECT]
C. 83 gtt/min
D. 125 gtt/min
Correct Answer: B
Rationale:
Step 1 – Key data: 1000 mL over 8 hours, drip factor 20 gtt/mL.
Step 2 – Correct calculation: (1000 mL ÷ 480 minutes) × 20 gtt/mL = 41.67 gtt/min
rounded to 42 gtt/min.
Exam 2026/2027 – Galen College of Nursing –
Verified Q&A with Detailed Rationales – Pass
Guaranteed – A+ Graded
======================================================
========== SECTION 1: FLUID, ELECTROLYTE, & ACID-BASE
BALANCE (12 Questions)
Q1. A nurse is caring for a 68-year-old patient with heart failure who gained 3 kg in 2
days. Assessment reveals JVD at 45 degrees, lung crackles bilaterally, and 2+ pitting
edema in lower extremities. Which intervention should the nurse implement first?
A. Increase oral fluid intake to prevent dehydration
B. Administer prescribed loop diuretic and monitor urine output [CORRECT]
C. Elevate legs to reduce peripheral edema
D. Obtain a chest x-ray to confirm pulmonary edema
Correct Answer: B
Rationale:
,Step 1 – Key assessment: 3 kg weight gain in 2 days with JVD, crackles, and peripheral
edema indicates acute fluid volume excess (hypervolemia) compromising cardiac and
pulmonary function.
Step 2 – Correct answer reasoning: Loop diuretics are first-line treatment to reduce
preload and eliminate excess fluid; monitoring intake/output assesses effectiveness
and prevents hypovolemia.
Step 3 – Distractor analysis: A is wrong (Trap 1): Increasing fluids worsens heart failure
and pulmonary edema; weight gain indicates retention, not dehydration. C is wrong: Leg
elevation does not address life-threatening pulmonary congestion and is
contraindicated without addressing cardiac preload. D is wrong: While chest x-ray
confirms diagnosis, the patient requires immediate intervention to reduce fluid overload;
diagnostic testing should not delay treatment.
Q2. A patient with diabetic ketoacidosis has the following arterial blood gas results: pH
7.25, PaCO₂ 28 mmHg, HCO₃⁻ 14 mEq/L. Which acid-base disorder does the patient
have?
A. Respiratory acidosis with partial compensation
B. Metabolic acidosis with respiratory compensation [CORRECT]
C. Metabolic alkalosis with respiratory compensation
D. Respiratory alkalosis with metabolic compensation
Correct Answer: B
Rationale:
,Step 1 – Key assessment: pH 7.25 (acidemia), HCO₃⁻ 14 (low = metabolic component),
PaCO₂ 28 (low = respiratory compensation via hyperventilation).
Step 2 – Correct answer reasoning: Low pH with low bicarbonate indicates metabolic
acidosis; the low PaCO₂ represents compensatory hyperventilation (Kussmaul
respirations) attempting to raise pH by blowing off CO₂.
Step 3 – Distractor analysis: A is wrong (Trap 3): PaCO₂ is low, not high; respiratory
acidosis requires elevated PaCO₂. C is wrong: pH is acidic, not alkaline; metabolic
alkalosis requires high HCO₃⁻. D is wrong: Primary disorder is metabolic (low HCO₃⁻),
not respiratory; the direction of pH and bicarbonate both indicate acidosis.
Q3. A nurse is reviewing morning laboratory results. Which patient should the nurse
assess first?
A. Patient with sodium 138 mEq/L
B. Patient with potassium 2.8 mEq/L [CORRECT]
C. Patient with calcium 9.2 mg/dL
D. Patient with magnesium 1.8 mg/dL
Correct Answer: B
Rationale:
Step 1 – Key assessment: Potassium 2.8 mEq/L represents severe hypokalemia
(normal 3.5-5.0); risk of life-threatening cardiac dysrhythmias.
, Step 2 – Correct answer reasoning: Hypokalemia increases risk of ventricular fibrillation
and cardiac arrest; requires immediate ECG monitoring and physician notification for IV
replacement.
Step 3 – Distractor analysis: A is wrong: Sodium 138 is within normal range (135-145). C
is wrong: Calcium 9.2 is normal (8.5-10.5); no immediate action needed. D is wrong:
Magnesium 1.8 is low-normal (1.7-2.2) but not immediately life-threatening compared to
severe hypokalemia.
Q4. The nurse is preparing to administer 1000 mL of 0.9% NaCl over 8 hours via gravity
infusion. The drip factor is 20 gtt/mL. How many drops per minute should the nurse set
the flow rate? (Round to the nearest whole number)
A. 28 gtt/min
B. 42 gtt/min [CORRECT]
C. 83 gtt/min
D. 125 gtt/min
Correct Answer: B
Rationale:
Step 1 – Key data: 1000 mL over 8 hours, drip factor 20 gtt/mL.
Step 2 – Correct calculation: (1000 mL ÷ 480 minutes) × 20 gtt/mL = 41.67 gtt/min
rounded to 42 gtt/min.
