NUR 170 Exams 1–4 Study Guide – Medical-
Surgical Nursing (Galen) (Updated) EXAM with
Questions and Answers/Plus a Rationale
Updated 2026 A+/Instant Download PDF
EXAM COVERAGE
1. Fluid and Electrolyte Imbalances and Acid-Base Disturbances
2. Perioperative Nursing Care and Management
3. Management of Patients with Pain and Inflammatory Responses
4. Cardiovascular Disorders: Hypertension, Heart Failure, and Dysrhythmias
5. Respiratory Disorders: COPD, Asthma, and Pneumonia
6. Endocrine Disorders: Diabetes Mellitus and Thyroid Dysfunction
7. Gastrointestinal Disorders: GERD, Peptic Ulcer Disease, and Bowel Obstruction
8. Renal and Urinary System Disorders: CKD and UTI Management
9. Hematologic and Immunologic Disorders
10. Musculoskeletal Disorders and Fracture Management
1. A patient with a history of heart failure is admitted with a serum potassium level of 2.8 mEq/L.
The nurse notes flattened T waves and a U wave on the ECG. Which intervention is the priority?
A. Administer 40 mEq of potassium chloride IV push over 15 minutes.
B. Initiate continuous cardiac monitoring and verify potassium replacement protocol.
, C. Increase dietary intake of bananas and oranges immediately.
D. Administer intravenous normal saline at 150 mL/hr.
CORRECT ANSWER : B
Rationale: Hypokalemia poses a significant risk for life-threatening arrhythmias, requiring
continuous cardiac monitoring to assess for further ECG changes. Option A is incorrect because
rapid IV push of potassium is fatal and contraindicated. Option C is insufficient for acute,
symptomatic hypokalemia. Option D does not address the underlying electrolyte deficit.
2. A post-operative patient on the second day following an abdominal resection reports sudden
shortness of breath and sharp chest pain. Assessment reveals tachycardia and decreased oxygen
saturation. Which complication is the most likely cause?
A. Atelectasis
B. Pulmonary embolism
C. Pneumothorax
D. Myocardial infarction
CORRECT ANSWER : B
Rationale: The clinical triad of sudden dyspnea, chest pain, and tachycardia in a post-operative
patient is highly suggestive of a pulmonary embolism. Atelectasis (A) usually presents gradually
with diminished breath sounds. Pneumothorax (C) would present with absent breath sounds on
the affected side. Myocardial infarction (D) is possible but less likely given the surgical context.
3. A patient with type 1 diabetes mellitus presents with Kussmaul respirations, fruity breath odor,
and a blood glucose level of 450 mg/dL. Which action should the nurse take first?
A. Administer a sliding scale dose of subcutaneous insulin.
B. Initiate an IV bolus of 0.9% normal saline.
C. Obtain a serum potassium level.
D. Administer 50% dextrose IV push.
CORRECT ANSWER : B
Rationale: The patient is exhibiting signs of Diabetic Ketoacidosis (DKA). Fluid resuscitation
with normal saline is the priority to restore intravascular volume and improve renal clearance of
, glucose. Subcutaneous insulin (A) is ineffective in acute DKA. Serum potassium (C) is important
but secondary to fluid resuscitation. Dextrose (D) is contraindicated in hyperglycemia.
4. A patient is prescribed warfarin for chronic atrial fibrillation. Which laboratory value should the
nurse prioritize when evaluating the effectiveness of the medication?
A. Partial thromboplastin time (PTT)
B. International normalized ratio (INR)
C. Platelet count
D. Prothrombin time (PT)
CORRECT ANSWER : B
Rationale: The INR is the standard measurement used to monitor the effectiveness of warfarin
therapy. PTT (A) is used for heparin monitoring. Platelet count (C) monitors for
thrombocytopenia. PT (D) is used to calculate the INR but is not the clinical standard for
reporting warfarin therapeutic levels.
5. A patient with chronic obstructive pulmonary disease (COPD) is being discharged. Which
statement by the patient indicates an understanding of self-management?
A. "I will increase my oxygen flow to 6 L/min if I feel short of breath."
B. "I will practice pursed-lip breathing to help keep my airways open longer."
C. "I should avoid all physical exercise to prevent exacerbations."
D. "I will take my rescue inhaler every 2 hours to prevent coughing."
CORRECT ANSWER : B
Rationale: Pursed-lip breathing helps maintain positive airway pressure and prevent premature
airway collapse in COPD patients. Increasing oxygen (A) can depress the respiratory drive in
CO2 retainers. Exercise (C) is encouraged to maintain conditioning. Overuse of rescue inhalers
(D) indicates poor disease control and medication side effects.
6. A patient with severe hypertension is prescribed lisinopril. Which side effect requires immediate
nursing assessment?
A. Dry cough
B. Angioedema
, C. Headache
D. Hyperkalemia
CORRECT ANSWER : B
Rationale: Angioedema is a rare but life-threatening adverse effect of ACE inhibitors like
lisinopril that involves facial/airway swelling. Dry cough (A) is a common but not life-
threatening side effect. Headache (C) is common during titration. Hyperkalemia (D) is a risk,
but airway obstruction (angioedema) takes priority.
7. A nurse is caring for a patient with a bowel obstruction. Which clinical finding should be
reported to the provider immediately?
A. High-pitched bowel sounds
B. Abdominal rigidity and guarding
C. Passing of small amounts of liquid stool
D. Distended abdomen
CORRECT ANSWER : B
Rationale: Abdominal rigidity and guarding are signs of peritonitis or bowel perforation, which
are surgical emergencies. High-pitched sounds (A), liquid stools (C), and distension (D) are
classic findings of an obstruction but do not immediately indicate the presence of peritonitis.
8. A patient recovering from a thyroidectomy experiences tingling in the fingers and circumoral
numbness. Which action should the nurse take?
A. Administer oral calcium supplements immediately.
B. Check for Trousseau’s sign and notify the surgeon.
C. Elevate the head of the bed to decrease laryngeal edema.
D. Reassure the patient that this is a normal post-operative finding.
CORRECT ANSWER : B
Rationale: Tingling and numbness are signs of hypocalcemia, a potential complication of
accidental parathyroid gland removal. Trousseau’s sign is a clinical assessment for
hypocalcemia. Oral supplements (A) should only be given per order. Laryngeal edema (C) is a
concern but not the cause of tingling. It is not a normal finding (D).
Surgical Nursing (Galen) (Updated) EXAM with
Questions and Answers/Plus a Rationale
Updated 2026 A+/Instant Download PDF
EXAM COVERAGE
1. Fluid and Electrolyte Imbalances and Acid-Base Disturbances
2. Perioperative Nursing Care and Management
3. Management of Patients with Pain and Inflammatory Responses
4. Cardiovascular Disorders: Hypertension, Heart Failure, and Dysrhythmias
5. Respiratory Disorders: COPD, Asthma, and Pneumonia
6. Endocrine Disorders: Diabetes Mellitus and Thyroid Dysfunction
7. Gastrointestinal Disorders: GERD, Peptic Ulcer Disease, and Bowel Obstruction
8. Renal and Urinary System Disorders: CKD and UTI Management
9. Hematologic and Immunologic Disorders
10. Musculoskeletal Disorders and Fracture Management
1. A patient with a history of heart failure is admitted with a serum potassium level of 2.8 mEq/L.
The nurse notes flattened T waves and a U wave on the ECG. Which intervention is the priority?
A. Administer 40 mEq of potassium chloride IV push over 15 minutes.
B. Initiate continuous cardiac monitoring and verify potassium replacement protocol.
, C. Increase dietary intake of bananas and oranges immediately.
D. Administer intravenous normal saline at 150 mL/hr.
CORRECT ANSWER : B
Rationale: Hypokalemia poses a significant risk for life-threatening arrhythmias, requiring
continuous cardiac monitoring to assess for further ECG changes. Option A is incorrect because
rapid IV push of potassium is fatal and contraindicated. Option C is insufficient for acute,
symptomatic hypokalemia. Option D does not address the underlying electrolyte deficit.
2. A post-operative patient on the second day following an abdominal resection reports sudden
shortness of breath and sharp chest pain. Assessment reveals tachycardia and decreased oxygen
saturation. Which complication is the most likely cause?
A. Atelectasis
B. Pulmonary embolism
C. Pneumothorax
D. Myocardial infarction
CORRECT ANSWER : B
Rationale: The clinical triad of sudden dyspnea, chest pain, and tachycardia in a post-operative
patient is highly suggestive of a pulmonary embolism. Atelectasis (A) usually presents gradually
with diminished breath sounds. Pneumothorax (C) would present with absent breath sounds on
the affected side. Myocardial infarction (D) is possible but less likely given the surgical context.
3. A patient with type 1 diabetes mellitus presents with Kussmaul respirations, fruity breath odor,
and a blood glucose level of 450 mg/dL. Which action should the nurse take first?
A. Administer a sliding scale dose of subcutaneous insulin.
B. Initiate an IV bolus of 0.9% normal saline.
C. Obtain a serum potassium level.
D. Administer 50% dextrose IV push.
CORRECT ANSWER : B
Rationale: The patient is exhibiting signs of Diabetic Ketoacidosis (DKA). Fluid resuscitation
with normal saline is the priority to restore intravascular volume and improve renal clearance of
, glucose. Subcutaneous insulin (A) is ineffective in acute DKA. Serum potassium (C) is important
but secondary to fluid resuscitation. Dextrose (D) is contraindicated in hyperglycemia.
4. A patient is prescribed warfarin for chronic atrial fibrillation. Which laboratory value should the
nurse prioritize when evaluating the effectiveness of the medication?
A. Partial thromboplastin time (PTT)
B. International normalized ratio (INR)
C. Platelet count
D. Prothrombin time (PT)
CORRECT ANSWER : B
Rationale: The INR is the standard measurement used to monitor the effectiveness of warfarin
therapy. PTT (A) is used for heparin monitoring. Platelet count (C) monitors for
thrombocytopenia. PT (D) is used to calculate the INR but is not the clinical standard for
reporting warfarin therapeutic levels.
5. A patient with chronic obstructive pulmonary disease (COPD) is being discharged. Which
statement by the patient indicates an understanding of self-management?
A. "I will increase my oxygen flow to 6 L/min if I feel short of breath."
B. "I will practice pursed-lip breathing to help keep my airways open longer."
C. "I should avoid all physical exercise to prevent exacerbations."
D. "I will take my rescue inhaler every 2 hours to prevent coughing."
CORRECT ANSWER : B
Rationale: Pursed-lip breathing helps maintain positive airway pressure and prevent premature
airway collapse in COPD patients. Increasing oxygen (A) can depress the respiratory drive in
CO2 retainers. Exercise (C) is encouraged to maintain conditioning. Overuse of rescue inhalers
(D) indicates poor disease control and medication side effects.
6. A patient with severe hypertension is prescribed lisinopril. Which side effect requires immediate
nursing assessment?
A. Dry cough
B. Angioedema
, C. Headache
D. Hyperkalemia
CORRECT ANSWER : B
Rationale: Angioedema is a rare but life-threatening adverse effect of ACE inhibitors like
lisinopril that involves facial/airway swelling. Dry cough (A) is a common but not life-
threatening side effect. Headache (C) is common during titration. Hyperkalemia (D) is a risk,
but airway obstruction (angioedema) takes priority.
7. A nurse is caring for a patient with a bowel obstruction. Which clinical finding should be
reported to the provider immediately?
A. High-pitched bowel sounds
B. Abdominal rigidity and guarding
C. Passing of small amounts of liquid stool
D. Distended abdomen
CORRECT ANSWER : B
Rationale: Abdominal rigidity and guarding are signs of peritonitis or bowel perforation, which
are surgical emergencies. High-pitched sounds (A), liquid stools (C), and distension (D) are
classic findings of an obstruction but do not immediately indicate the presence of peritonitis.
8. A patient recovering from a thyroidectomy experiences tingling in the fingers and circumoral
numbness. Which action should the nurse take?
A. Administer oral calcium supplements immediately.
B. Check for Trousseau’s sign and notify the surgeon.
C. Elevate the head of the bed to decrease laryngeal edema.
D. Reassure the patient that this is a normal post-operative finding.
CORRECT ANSWER : B
Rationale: Tingling and numbness are signs of hypocalcemia, a potential complication of
accidental parathyroid gland removal. Trousseau’s sign is a clinical assessment for
hypocalcemia. Oral supplements (A) should only be given per order. Laryngeal edema (C) is a
concern but not the cause of tingling. It is not a normal finding (D).
