Concepts of Medical Surgical Nursing- NUR170: Exams 1,2,3 & 4 (all
in 1 pdf) | Answered 100% Updated A+ Guide.
Galen- NUR 170: Concepts of Medical Surgical Nursing – Exam 1
Review Questions/Answers/Rationales – Summer26.
Section 1: ABGs & Acid-Base Balance
1. A patient’s ABG results are pH 7.28, PaCO₂ 50 mm Hg, and HCO₃⁻ 24 mEq/L. How
should the nurse interpret these results?
A. Metabolic acidosis B. Respiratory acidosis C. Respiratory alkalosis D. Metabolic alkalosis
• Rationale: The pH is < 7.35 (acidosis) and the PaCO₂ is > 45 mm Hg, which matches the acidic
direction. This indicates a respiratory cause.
2. Which of the following is a common cause of respiratory alkalosis?
A. COPD B. Hyperventilation C. DKA D. Diarrhea
• Rationale: Respiratory alkalosis is caused by hyperventilation, often due to anxiety, pain, or
fever.
3. A patient with Diabetic Ketoacidosis (DKA) is most likely to exhibit which acid-base
imbalance?
A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis
• Rationale: DKA and renal failure are common causes of metabolic acidosis.
4. What is the normal range for bicarbonate (HCO₃⁻)?
A. 35 – 45 mEq/L B. 22 – 28 mEq/L C. 135 – 145 mEq/L D. 80 – 100 mEq/L
• Rationale: The normal range for HCO₃⁻ is 22 – 28 mEq/L.
5. Which ABG component represents the respiratory control of acid-base balance?
A. pH B. HCO₃⁻ C. PaCO₂ D. PaO₂
• Rationale: PaCO₂ reflects the respiratory control of acid-base balance.
6. A patient has been vomiting for two days. Which imbalance should the nurse anticipate?
A. Respiratory acidosis B. Metabolic acidosis C. Metabolic alkalosis D. Respiratory alkalosis
• Rationale: Metabolic alkalosis can be caused by vomiting, NG suctioning, or antacid overuse.
Section 2: Fluid & Electrolyte Balance
7. Which finding is consistent with fluid volume overload (hypervolemia)?
A. Poor skin turgor B. Bounding pulse and JVD C. Hypotension D. Dry mucous membranes
• Rationale: Hypervolemia findings include a bounding pulse, increased BP, crackles, and Jugular
Venous Distension (JVD).
,8. What is the priority intervention for a patient with hypovolemia? A. Restrict fluids B.
Give loop diuretics C. Administer isotonic IV fluids (0.9% NS or LR) D. Provide a sodium-
restricted diet
• Rationale: Interventions for hypovolemia include isotonic IV fluids and encouraging PO fluids.
9. A patient with hyponatremia is at risk for which of the following?
A. Seizures and confusion B. Peaked T waves C. Constipation D. Thirst and elevated
temperature
• Rationale: Hyponatremia can cause confusion, seizures, weakness, and muscle cramping.
10. When administering 3% Normal Saline (hypertonic) for hyponatremia, why must the
nurse proceed cautiously?
A. It causes hypotension B. Raising sodium too fast can cause cerebral edema/seizures C. It
leads to hypokalemia D. It causes metabolic alkalosis
• Rationale: Hypertonic saline must be given cautiously to prevent rapid shifts that lead to
cerebral edema or seizures.
11. Which electrolyte imbalance is associated with flattened T waves and a weak, irregular
pulse?
A. Hyperkalemia B. Hypokalemia C. Hypocalcemia D. Hypercalcemia
• Rationale: Hypokalemia manifests as muscle weakness, flattened T waves, and dysrhythmias.
12. A nurse is caring for a patient with a potassium level of 6.2 mEq/L. Which intervention
is appropriate?
A. Give oral potassium supplements B. Administer insulin + glucose C. Encourage intake of
bananas and potatoes D. Administer a loop diuretic
• Rationale: Interventions for hyperkalemia include insulin + glucose, Kayexalate, or calcium
gluconate.
13. A positive Trousseau’s sign is an indication of which imbalances?
A. Hypernatremia and Hypercalcemia B. Hypocalcemia and Hypomagnesemia C.
Hypokalemia and Hyponatremia D. Hypermagnesemia and Hypocalcemia
• Rationale: Both hypocalcemia and hypomagnesemia can present with positive Trousseau’s and
Chvostek’s signs.
14. What is the priority assessment for a patient with hypomagnesemia before they eat?
A. Inspect for skin mottling B. Check deep tendon reflexes C. Assess swallowing (dysphagia)
D. Measure abdominal girth
• Rationale: Hypomagnesemia can cause dysphagia, so swallowing must be assessed before food
or fluids are given.
,15. A patient has a magnesium level of 3.0 mEq/L. Which finding should the nurse expect?
A. Tachycardia B. Hypotension and decreased Deep Tendon Reflexes (DTRs) C.
Hyperreflexia D. Diarrhea
• Rationale: Hypermagnesemia (Mg > 2.1) causes hypotension, bradycardia, and decreased DTRs.
16. Which medication is the antidote for magnesium toxicity (hypermagnesemia)?
A. Naloxone B. Dantrolene sodium C. Calcium gluconate D. Kayexalate
• Rationale: IV calcium gluconate is used to treat hypermagnesemia.
17. A patient with hypercalcemia should be encouraged to do which of the following?
A. Increase mobility and active ROM B. Restrict all fluid intake C. Avoid all weight-bearing
exercises D. Eat more leafy greens
• Rationale: Interventions for hypercalcemia include increased mobility/active ROM and isotonic
IV fluids.
18. What is the normal range for Potassium (K⁺)?
A. 135–145 mEq/L B. 9–10.5 mg/dL C. 3.5–5.0 mEq/L D. 1.3–2.1 mEq/L
• Rationale: The normal range for serum potassium is 3.5–5.0 mEq/L.
Section 3: IV Care & Perioperative Nursing
19. When removing a PICC line, what should the nurse ask the patient to do?
A. Take deep, rapid breaths B. Cough forcefully C. Perform the Valsalva maneuver D. Hold
their breath and bear down (Trendelenburg)
• Rationale: The Valsalva maneuver is performed during PICC removal to increase intrathoracic
pressure and prevent an air embolus.
20. Which of the following is a preferred site for a peripheral IV?
A. Soft, non-tender distal veins B. Veins in the wrist or antecubital area C. A site distal to an
active infection D. The arm on the side of a previous mastectomy
• Rationale: Good IV sites are distal, soft, and non-tender. Areas of flexion (wrist/AC) and sites
distal to mastectomy or AV fistulas should be avoided.
21. Who is responsible for obtaining informed consent for surgery?
A. The nurse B. The surgeon C. The anesthesiologist D. The hospital administrator
• Rationale: The nurse must confirm the consent is signed, but if the patient is inadequately
informed, the nurse must contact the surgeon to see the patient for clarification.
22. A patient is NPO before surgery. This restriction includes:
, A. Water only B. Smoking and water C. Water, smoking, and oral medications D. Only solid
foods
• Rationale: NPO status before surgery includes water, smoking, and oral meds.
23. Why is a patient asked to void before surgery? A. To prevent skin breakdown B. To
prevent bladder injury and improve comfort C. To obtain a sterile specimen D. To assess for
renal failure
• Rationale: Patients should void before surgery. (Note: While the source simply states "Void
before surgery," it is a standard safety measure for comfort and to prevent bladder injury during
the procedure).
24. Which electrolyte imbalance increases the risk for dysrhythmias under anesthesia? A.
Hyponatremia B. Hyperkalemia C. Hypocalcemia D. Hypomagnesemia
• Rationale: Hyperkalemia increases the risk for dysrhythmias under anesthesia.
25. A patient in the PACU has a sudden temperature of 111.2°F and muscle rigidity. What
is the priority intervention? A. Apply a cooling blanket B. Administer IV fluids C. Administer
Dantrolene sodium D. Give acetaminophen
• Rationale: These are late signs of Malignant Hyperthermia (MH), which is treated with
Dantrolene sodium.
26. A post-operative wound has partially separated. What is the nurse's first action? A. Put
the organs back inside B. Apply a moist sterile dressing C. Notify the MD and leave the room
to get supplies D. Document the finding and check back in one hour
• Rationale: For dehiscence, the nurse should apply a moist sterile dressing, notify the MD, and
stay with the patient for safety.
27. What is the difference between dehiscence and evisceration? A. Dehiscence is an
emergency; evisceration is not. B. Evisceration involves organs protruding; dehiscence is just
wound separation. C. Dehiscence requires the surgeon; evisceration can be handled by the
nurse. D. There is no difference.
• Rationale: Dehiscence is partial wound separation; evisceration is an emergency where organs
protrude.
Section 4: Pain Management & Epidurals
28. A patient is using a PCA pump. What is the most important teaching point? A. The
family should press the button when the patient sleeps. B. Only the patient should press the
dosing button. C. The nurse will press the button every hour. D. The pump will prevent all pain.
• Rationale: Teach the patient that only they should control the dosing.
in 1 pdf) | Answered 100% Updated A+ Guide.
Galen- NUR 170: Concepts of Medical Surgical Nursing – Exam 1
Review Questions/Answers/Rationales – Summer26.
Section 1: ABGs & Acid-Base Balance
1. A patient’s ABG results are pH 7.28, PaCO₂ 50 mm Hg, and HCO₃⁻ 24 mEq/L. How
should the nurse interpret these results?
A. Metabolic acidosis B. Respiratory acidosis C. Respiratory alkalosis D. Metabolic alkalosis
• Rationale: The pH is < 7.35 (acidosis) and the PaCO₂ is > 45 mm Hg, which matches the acidic
direction. This indicates a respiratory cause.
2. Which of the following is a common cause of respiratory alkalosis?
A. COPD B. Hyperventilation C. DKA D. Diarrhea
• Rationale: Respiratory alkalosis is caused by hyperventilation, often due to anxiety, pain, or
fever.
3. A patient with Diabetic Ketoacidosis (DKA) is most likely to exhibit which acid-base
imbalance?
A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis
• Rationale: DKA and renal failure are common causes of metabolic acidosis.
4. What is the normal range for bicarbonate (HCO₃⁻)?
A. 35 – 45 mEq/L B. 22 – 28 mEq/L C. 135 – 145 mEq/L D. 80 – 100 mEq/L
• Rationale: The normal range for HCO₃⁻ is 22 – 28 mEq/L.
5. Which ABG component represents the respiratory control of acid-base balance?
A. pH B. HCO₃⁻ C. PaCO₂ D. PaO₂
• Rationale: PaCO₂ reflects the respiratory control of acid-base balance.
6. A patient has been vomiting for two days. Which imbalance should the nurse anticipate?
A. Respiratory acidosis B. Metabolic acidosis C. Metabolic alkalosis D. Respiratory alkalosis
• Rationale: Metabolic alkalosis can be caused by vomiting, NG suctioning, or antacid overuse.
Section 2: Fluid & Electrolyte Balance
7. Which finding is consistent with fluid volume overload (hypervolemia)?
A. Poor skin turgor B. Bounding pulse and JVD C. Hypotension D. Dry mucous membranes
• Rationale: Hypervolemia findings include a bounding pulse, increased BP, crackles, and Jugular
Venous Distension (JVD).
,8. What is the priority intervention for a patient with hypovolemia? A. Restrict fluids B.
Give loop diuretics C. Administer isotonic IV fluids (0.9% NS or LR) D. Provide a sodium-
restricted diet
• Rationale: Interventions for hypovolemia include isotonic IV fluids and encouraging PO fluids.
9. A patient with hyponatremia is at risk for which of the following?
A. Seizures and confusion B. Peaked T waves C. Constipation D. Thirst and elevated
temperature
• Rationale: Hyponatremia can cause confusion, seizures, weakness, and muscle cramping.
10. When administering 3% Normal Saline (hypertonic) for hyponatremia, why must the
nurse proceed cautiously?
A. It causes hypotension B. Raising sodium too fast can cause cerebral edema/seizures C. It
leads to hypokalemia D. It causes metabolic alkalosis
• Rationale: Hypertonic saline must be given cautiously to prevent rapid shifts that lead to
cerebral edema or seizures.
11. Which electrolyte imbalance is associated with flattened T waves and a weak, irregular
pulse?
A. Hyperkalemia B. Hypokalemia C. Hypocalcemia D. Hypercalcemia
• Rationale: Hypokalemia manifests as muscle weakness, flattened T waves, and dysrhythmias.
12. A nurse is caring for a patient with a potassium level of 6.2 mEq/L. Which intervention
is appropriate?
A. Give oral potassium supplements B. Administer insulin + glucose C. Encourage intake of
bananas and potatoes D. Administer a loop diuretic
• Rationale: Interventions for hyperkalemia include insulin + glucose, Kayexalate, or calcium
gluconate.
13. A positive Trousseau’s sign is an indication of which imbalances?
A. Hypernatremia and Hypercalcemia B. Hypocalcemia and Hypomagnesemia C.
Hypokalemia and Hyponatremia D. Hypermagnesemia and Hypocalcemia
• Rationale: Both hypocalcemia and hypomagnesemia can present with positive Trousseau’s and
Chvostek’s signs.
14. What is the priority assessment for a patient with hypomagnesemia before they eat?
A. Inspect for skin mottling B. Check deep tendon reflexes C. Assess swallowing (dysphagia)
D. Measure abdominal girth
• Rationale: Hypomagnesemia can cause dysphagia, so swallowing must be assessed before food
or fluids are given.
,15. A patient has a magnesium level of 3.0 mEq/L. Which finding should the nurse expect?
A. Tachycardia B. Hypotension and decreased Deep Tendon Reflexes (DTRs) C.
Hyperreflexia D. Diarrhea
• Rationale: Hypermagnesemia (Mg > 2.1) causes hypotension, bradycardia, and decreased DTRs.
16. Which medication is the antidote for magnesium toxicity (hypermagnesemia)?
A. Naloxone B. Dantrolene sodium C. Calcium gluconate D. Kayexalate
• Rationale: IV calcium gluconate is used to treat hypermagnesemia.
17. A patient with hypercalcemia should be encouraged to do which of the following?
A. Increase mobility and active ROM B. Restrict all fluid intake C. Avoid all weight-bearing
exercises D. Eat more leafy greens
• Rationale: Interventions for hypercalcemia include increased mobility/active ROM and isotonic
IV fluids.
18. What is the normal range for Potassium (K⁺)?
A. 135–145 mEq/L B. 9–10.5 mg/dL C. 3.5–5.0 mEq/L D. 1.3–2.1 mEq/L
• Rationale: The normal range for serum potassium is 3.5–5.0 mEq/L.
Section 3: IV Care & Perioperative Nursing
19. When removing a PICC line, what should the nurse ask the patient to do?
A. Take deep, rapid breaths B. Cough forcefully C. Perform the Valsalva maneuver D. Hold
their breath and bear down (Trendelenburg)
• Rationale: The Valsalva maneuver is performed during PICC removal to increase intrathoracic
pressure and prevent an air embolus.
20. Which of the following is a preferred site for a peripheral IV?
A. Soft, non-tender distal veins B. Veins in the wrist or antecubital area C. A site distal to an
active infection D. The arm on the side of a previous mastectomy
• Rationale: Good IV sites are distal, soft, and non-tender. Areas of flexion (wrist/AC) and sites
distal to mastectomy or AV fistulas should be avoided.
21. Who is responsible for obtaining informed consent for surgery?
A. The nurse B. The surgeon C. The anesthesiologist D. The hospital administrator
• Rationale: The nurse must confirm the consent is signed, but if the patient is inadequately
informed, the nurse must contact the surgeon to see the patient for clarification.
22. A patient is NPO before surgery. This restriction includes:
, A. Water only B. Smoking and water C. Water, smoking, and oral medications D. Only solid
foods
• Rationale: NPO status before surgery includes water, smoking, and oral meds.
23. Why is a patient asked to void before surgery? A. To prevent skin breakdown B. To
prevent bladder injury and improve comfort C. To obtain a sterile specimen D. To assess for
renal failure
• Rationale: Patients should void before surgery. (Note: While the source simply states "Void
before surgery," it is a standard safety measure for comfort and to prevent bladder injury during
the procedure).
24. Which electrolyte imbalance increases the risk for dysrhythmias under anesthesia? A.
Hyponatremia B. Hyperkalemia C. Hypocalcemia D. Hypomagnesemia
• Rationale: Hyperkalemia increases the risk for dysrhythmias under anesthesia.
25. A patient in the PACU has a sudden temperature of 111.2°F and muscle rigidity. What
is the priority intervention? A. Apply a cooling blanket B. Administer IV fluids C. Administer
Dantrolene sodium D. Give acetaminophen
• Rationale: These are late signs of Malignant Hyperthermia (MH), which is treated with
Dantrolene sodium.
26. A post-operative wound has partially separated. What is the nurse's first action? A. Put
the organs back inside B. Apply a moist sterile dressing C. Notify the MD and leave the room
to get supplies D. Document the finding and check back in one hour
• Rationale: For dehiscence, the nurse should apply a moist sterile dressing, notify the MD, and
stay with the patient for safety.
27. What is the difference between dehiscence and evisceration? A. Dehiscence is an
emergency; evisceration is not. B. Evisceration involves organs protruding; dehiscence is just
wound separation. C. Dehiscence requires the surgeon; evisceration can be handled by the
nurse. D. There is no difference.
• Rationale: Dehiscence is partial wound separation; evisceration is an emergency where organs
protrude.
Section 4: Pain Management & Epidurals
28. A patient is using a PCA pump. What is the most important teaching point? A. The
family should press the button when the patient sleeps. B. Only the patient should press the
dosing button. C. The nurse will press the button every hour. D. The pump will prevent all pain.
• Rationale: Teach the patient that only they should control the dosing.
