NU 157 Exam 2 V2 | NU 157 Medical-
Surgical Nursing I-A | NCLEX (NGN) Q&A
with Rationale (NU157 Exam 2) | Galen
1. A nurse is reviewing the arterial blood gas (ABG) results for a client with chronic
obstructive pulmonary disease (COPD). The results are: pH 7.31, PaCO2 52 mmHg, and HCO3
28 mEq/L. Which acid-base imbalance is the client experiencing?
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Correct Answer: A
Explanation: The pH of 7.31 indicates acidosis, while the elevated PaCO2 of 52 mmHg
indicates a respiratory cause. The elevated bicarbonate level (HCO3 28) suggests that the
kidneys are attempting to compensate for the primary respiratory issue. Therefore, the
client is in a state of partially compensated respiratory acidosis.
2. A nurse is conducting a preoperative assessment for an older adult client scheduled for a
total hip arthroplasty. Which factors increase this client’s risk for surgical complications?
(Select All That Apply)
A. Decreased glomerular filtration rate
,B. Increased thoracic compliance
C. History of smoking for 20 years
D. Diminished sensory perception
E. Frequent use of over-the-counter herbal supplements
F. Body Mass Index (BMI) of 22
Correct Answer: A, C, D, E
Explanation: Decreased renal function (GFR) affects the excretion of anesthetics and
analgesics, increasing the risk of toxicity. Smoking impairs respiratory function and wound
healing, while sensory deficits can lead to postoperative confusion or falls. Herbal
supplements, such as Ginko or Garlic, can increase the risk of bleeding during and after
surgery.
3. A client is admitted with severe vomiting and diarrhea for three days. The nurse notes poor
skin turgor, flat neck veins, and a heart rate of 115 bpm. Which intravenous fluid should the
nurse anticipate the provider to order initially?
A. 0.45% Sodium Chloride (1/2 NS)
B. 3% Sodium Chloride
C. 0.9% Sodium Chloride (Normal Saline)
D. 5% Dextrose in Water (D5W)
Correct Answer: C
,Explanation: The client is exhibiting signs of hypovolemia, including tachycardia and poor
skin turgor. Isotonic solutions like 0.9% Normal Saline are used to expand the extracellular
fluid volume and improve blood pressure. These solutions stay within the intravascular
space longer than hypotonic solutions, which is critical for stabilizing a dehydrated client.
4. A nurse is caring for a client with a serum potassium level of 2.8 mEq/L. Which clinical
manifestation is most important for the nurse to monitor?
A. Hyperactive bowel sounds
B. Elevated ST segments on ECG
C. Positive Trousseau’s sign
D. Cardiac dysrhythmias
Correct Answer: D
Explanation: Hypokalemia significantly affects cardiac muscle excitability and can lead to
life-threatening arrhythmias or cardiac arrest. The nurse should anticipate findings such as
U-waves, flattened T-waves, or ST-segment depression. Because the heart is highly
sensitive to potassium fluctuations, monitoring the cardiac rhythm is the highest priority
for patient safety.
5. A postoperative client reports sudden shortness of breath and chest pain that worsens
with deep breathing. The nurse suspects a pulmonary embolism. Which action should the
nurse take first?
A. Auscultate the client’s lung sounds
, B. Obtain a 12-lead ECG
C. Apply oxygen via nasal cannula
D. Notify the Rapid Response Team
Correct Answer: C
Explanation: In an emergency situation involving respiratory distress, the nurse must
ensure adequate oxygenation to prevent hypoxia. While notifying the medical team is
essential, the immediate nursing intervention is to support the airway and breathing.
Providing supplemental oxygen helps maintain tissue perfusion while further diagnostic
tests are performed.
6. A client with lung cancer is scheduled for a lobectomy. During the preoperative phase, the
client expresses fear about the procedure and states, ‘I am not sure I want to do this
anymore.’ Which is the best response by the nurse?
A. Can you tell me more about what is making you feel this way?
B. You have the right to change your mind, but it might be fatal.
C. Don’t worry, the surgeon is one of the best in the state.
D. I will call the doctor so you can cancel the surgery right now.
Correct Answer: A
Explanation: This response uses therapeutic communication to explore the client’s
feelings and concerns. The nurse serves as an advocate and must assess the underlying
Surgical Nursing I-A | NCLEX (NGN) Q&A
with Rationale (NU157 Exam 2) | Galen
1. A nurse is reviewing the arterial blood gas (ABG) results for a client with chronic
obstructive pulmonary disease (COPD). The results are: pH 7.31, PaCO2 52 mmHg, and HCO3
28 mEq/L. Which acid-base imbalance is the client experiencing?
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Correct Answer: A
Explanation: The pH of 7.31 indicates acidosis, while the elevated PaCO2 of 52 mmHg
indicates a respiratory cause. The elevated bicarbonate level (HCO3 28) suggests that the
kidneys are attempting to compensate for the primary respiratory issue. Therefore, the
client is in a state of partially compensated respiratory acidosis.
2. A nurse is conducting a preoperative assessment for an older adult client scheduled for a
total hip arthroplasty. Which factors increase this client’s risk for surgical complications?
(Select All That Apply)
A. Decreased glomerular filtration rate
,B. Increased thoracic compliance
C. History of smoking for 20 years
D. Diminished sensory perception
E. Frequent use of over-the-counter herbal supplements
F. Body Mass Index (BMI) of 22
Correct Answer: A, C, D, E
Explanation: Decreased renal function (GFR) affects the excretion of anesthetics and
analgesics, increasing the risk of toxicity. Smoking impairs respiratory function and wound
healing, while sensory deficits can lead to postoperative confusion or falls. Herbal
supplements, such as Ginko or Garlic, can increase the risk of bleeding during and after
surgery.
3. A client is admitted with severe vomiting and diarrhea for three days. The nurse notes poor
skin turgor, flat neck veins, and a heart rate of 115 bpm. Which intravenous fluid should the
nurse anticipate the provider to order initially?
A. 0.45% Sodium Chloride (1/2 NS)
B. 3% Sodium Chloride
C. 0.9% Sodium Chloride (Normal Saline)
D. 5% Dextrose in Water (D5W)
Correct Answer: C
,Explanation: The client is exhibiting signs of hypovolemia, including tachycardia and poor
skin turgor. Isotonic solutions like 0.9% Normal Saline are used to expand the extracellular
fluid volume and improve blood pressure. These solutions stay within the intravascular
space longer than hypotonic solutions, which is critical for stabilizing a dehydrated client.
4. A nurse is caring for a client with a serum potassium level of 2.8 mEq/L. Which clinical
manifestation is most important for the nurse to monitor?
A. Hyperactive bowel sounds
B. Elevated ST segments on ECG
C. Positive Trousseau’s sign
D. Cardiac dysrhythmias
Correct Answer: D
Explanation: Hypokalemia significantly affects cardiac muscle excitability and can lead to
life-threatening arrhythmias or cardiac arrest. The nurse should anticipate findings such as
U-waves, flattened T-waves, or ST-segment depression. Because the heart is highly
sensitive to potassium fluctuations, monitoring the cardiac rhythm is the highest priority
for patient safety.
5. A postoperative client reports sudden shortness of breath and chest pain that worsens
with deep breathing. The nurse suspects a pulmonary embolism. Which action should the
nurse take first?
A. Auscultate the client’s lung sounds
, B. Obtain a 12-lead ECG
C. Apply oxygen via nasal cannula
D. Notify the Rapid Response Team
Correct Answer: C
Explanation: In an emergency situation involving respiratory distress, the nurse must
ensure adequate oxygenation to prevent hypoxia. While notifying the medical team is
essential, the immediate nursing intervention is to support the airway and breathing.
Providing supplemental oxygen helps maintain tissue perfusion while further diagnostic
tests are performed.
6. A client with lung cancer is scheduled for a lobectomy. During the preoperative phase, the
client expresses fear about the procedure and states, ‘I am not sure I want to do this
anymore.’ Which is the best response by the nurse?
A. Can you tell me more about what is making you feel this way?
B. You have the right to change your mind, but it might be fatal.
C. Don’t worry, the surgeon is one of the best in the state.
D. I will call the doctor so you can cancel the surgery right now.
Correct Answer: A
Explanation: This response uses therapeutic communication to explore the client’s
feelings and concerns. The nurse serves as an advocate and must assess the underlying
