NU 185 Exam 1–4 Megabank –
Med-Surg II (2026) Actual
Q&As with Rationales – Galen
College (100% Pass Guarantee)
Ace your nursing exams with this definitive, 400-question
2026 blueprint study bundle explicitly tailored for Galen
College of Nursing’s NU 185 (Medical-Surgical
Nursing II) curriculum covering Exams 1 through 4.
Every single NCLEX-style question is paired with a direct
answer and an exhaustive clinical rationale meticulously
formatted in bold-italic styling to allow for immediate
highlighting and seamless document processing. Boost
your study efficiency and secure your 100% pass
guarantee with this ready-to-use, high-yield exam
preparation resource.
,1. A nurse is evaluating a patient in the emergency department who presents with
a suspected ischemic stroke. Symptoms started 2 hours ago. Which diagnostic
test must be completed and interpreted first before initiating any thrombolytic
therapy?
A) Magnetic Resonance Imaging (MRI) of the brain
B) Non-contrast Computed Tomography (CT) scan of the head
C) Carotid duplex ultrasound
D) Lumbar puncture for cerebrospinal fluid analysis
Answer: B
Rationale: A non-contrast head CT scan must be performed and interpreted
immediately to rule out a hemorrhagic stroke. Thrombolytic therapy (such as
alteplase) is strictly contraindicated in hemorrhagic strokes and can cause fatal
bleeding if administered to these patients.
2. A nurse is caring for a patient who has just returned to the unit after an
esophagogastroduodenoscopy (EGD). Which nursing action is the absolute
priority before allowing the patient to consume oral fluids or food?
A) Assessing for the return of the gag reflex
B) Monitoring the patient's blood pressure and heart rate
C) Checking the patient's stool for occult blood
D) Administering ordered analgesic medication for throat soreness
Answer: A
Rationale: During an EGD, the local airway and throat are anesthetized to prevent
gagging and coughing. The nurse must verify that the gag reflex has fully
returned to prevent aspiration, airway obstruction, and subsequent aspiration
pneumonia before any oral intake is permitted.
3. A patient with a history of liver cirrhosis is admitted with severe hepatic
encephalopathy. The nurse notes extreme asterixis, confusion, and fetor
hepaticus. Which laboratory value should the nurse monitor closely to track the
therapeutic efficacy of prescribed lactulose?
A) Serum bilirubin
B) Alanine aminotransferase (ALT)
C) Serum ammonia
D) Prothrombin time (PT/INR)
Answer: C
Rationale: Hepatic encephalopathy is primarily driven by elevated blood ammonia
levels that cross the blood-brain barrier, causing neurotoxicity. Lactulose works
,by trapping ammonia in the gut and expelling it through the stool. A reduction in
serum ammonia and an improvement in neurological status indicate therapeutic
success.
4. A nurse is caring for a patient in acute renal failure who presents with a serum
potassium level of 6.8 mEq/L. The healthcare provider orders an immediate
intravenous infusion of 10% calcium gluconate. What is the primary therapeutic
rationale for administering calcium gluconate to this patient?
A) To lower the serum potassium level by driving potassium back into the intracellular
space.
B) To protect the myocardium and stabilize the cardiac cell membrane against
hyperkalemia-induced arrhythmias.
C) To increase the excretion of potassium through the renal tubules.
D) To bind with potassium in the gastrointestinal tract for elimination.
Answer: B
Rationale: Calcium gluconate does not lower serum potassium levels. Instead, it
directly antagonizes the neuromuscular effects of hyperkalemia on the
myocardium, stabilizing the cardiac cell membrane to prevent lethal arrhythmias
like ventricular fibrillation while other treatments work to lower the actual
potassium level.
5. A patient with type 1 diabetes mellitus is admitted to the intensive care unit in
Diabetic Ketoacidosis (DKA). An intravenous insulin infusion has been running
for several hours. The patient’s blood glucose has decreased from 580 mg/dL to
250 mg/dL. Which prescription should the nurse anticipate next?
A) Increase the rate of the intravenous regular insulin infusion.
B) Administer a bolus of subcutaneous long-acting insulin.
C) Change the intravenous fluid infusion to include 5% dextrose.
D) Discontinue all intravenous fluids and initiate an oral diet.
Answer: C
Rationale: When blood glucose drops to approximately 250–300 mg/dL during
DKA treatment, dextrose (such as 5% dextrose in 0.45% normal saline) is added
to the IV fluids. This prevents a rapid drop in blood glucose that could cause
hypoglycemia and severe cerebral edema, while allowing the insulin infusion to
continue clearing ketones.
6. A patient is admitted to the medical-surgical unit with an acute exacerbation of
Crohn's disease. The patient reports frequent, loose, non-bloody stools, severe
abdominal cramping, and significant weight loss. Which dietary instruction
should the nurse include in the care plan during this acute phase?
A) Maintain a strict high-fiber, high-fat diet to maximize caloric intake.
B) Consume a low-residue, high-protein, high-calorie diet.
C) Limit fluid intake to 1 liter per day to reduce diarrhea frequency.
D) Increase intake of fresh green leafy vegetables and whole grains.
Answer: B
, Rationale: During an acute flare-up of Crohn's disease, a low-residue (low-fiber)
diet is essential to minimize mechanical irritation to the inflamed bowel, reduce
peristalsis, and alleviate abdominal pain. High protein and high calories are
necessary to promote tissue healing and reverse malnutrition.
7. A nurse is monitoring a patient who underwent a thyroidectomy 12 hours ago.
The patient complains of a tingling sensation around the mouth and fingertips,
and the nurse observes a positive Chvostek's sign. Which medication should the
nurse ensure is readily available for immediate administration?
A) Potassium chloride
B) Calcium gluconate
C) Magnesium sulfate
D) Sodium bicarbonate
Answer: B
Rationale: Accidental removal or injury to the parathyroid glands during a
thyroidectomy can cause acute hypoparathyroidism, leading to severe
hypocalcemia. Perioral tingling and a positive Chvostek's sign (facial twitching)
are signs of neuromuscular irritability that require immediate treatment with IV
calcium gluconate to prevent laryngospasm.
8. A patient with a sustained high-level spinal cord injury at T2 is resting in bed
when they suddenly report a severe, pounding headache and blurred vision. The
nurse notes the patient is heavily sweating above the level of injury and has a
blood pressure of 190/100 mmHg. What is the nurse's immediate priority action?
A) Administer an ordered PRN dose of intravenous hydralazine.
B) Elevate the head of the bed to a high-Fowler's position.
C) Check the patient's urinary catheter for kinks or obstruction.
D) Perform a digital rectal exam to assess for fecal impaction.
Answer: B
Rationale: The patient is experiencing autonomic dysreflexia, a life-threatening
emergency. The immediate priority action is to sit the patient upright (high-
Fowler's position) to induce orthostatic hypotension and help lower the
dangerously elevated blood pressure, before investigating the noxious trigger
(e.g., distended bladder, fecal impaction).
9. A patient is prescribed a continuous intravenous heparin infusion for the
treatment of a deep vein thrombosis (DVT). Which laboratory parameter must the
nurse monitor closely to safely adjust the heparin dosage according to the
facility's protocol?
A) Prothrombin Time (PT)
B) International Normalized Ratio (INR)
C) Activated Partial Thromboplastin Time (aPTT)
D) Platelet count
Answer: C
Med-Surg II (2026) Actual
Q&As with Rationales – Galen
College (100% Pass Guarantee)
Ace your nursing exams with this definitive, 400-question
2026 blueprint study bundle explicitly tailored for Galen
College of Nursing’s NU 185 (Medical-Surgical
Nursing II) curriculum covering Exams 1 through 4.
Every single NCLEX-style question is paired with a direct
answer and an exhaustive clinical rationale meticulously
formatted in bold-italic styling to allow for immediate
highlighting and seamless document processing. Boost
your study efficiency and secure your 100% pass
guarantee with this ready-to-use, high-yield exam
preparation resource.
,1. A nurse is evaluating a patient in the emergency department who presents with
a suspected ischemic stroke. Symptoms started 2 hours ago. Which diagnostic
test must be completed and interpreted first before initiating any thrombolytic
therapy?
A) Magnetic Resonance Imaging (MRI) of the brain
B) Non-contrast Computed Tomography (CT) scan of the head
C) Carotid duplex ultrasound
D) Lumbar puncture for cerebrospinal fluid analysis
Answer: B
Rationale: A non-contrast head CT scan must be performed and interpreted
immediately to rule out a hemorrhagic stroke. Thrombolytic therapy (such as
alteplase) is strictly contraindicated in hemorrhagic strokes and can cause fatal
bleeding if administered to these patients.
2. A nurse is caring for a patient who has just returned to the unit after an
esophagogastroduodenoscopy (EGD). Which nursing action is the absolute
priority before allowing the patient to consume oral fluids or food?
A) Assessing for the return of the gag reflex
B) Monitoring the patient's blood pressure and heart rate
C) Checking the patient's stool for occult blood
D) Administering ordered analgesic medication for throat soreness
Answer: A
Rationale: During an EGD, the local airway and throat are anesthetized to prevent
gagging and coughing. The nurse must verify that the gag reflex has fully
returned to prevent aspiration, airway obstruction, and subsequent aspiration
pneumonia before any oral intake is permitted.
3. A patient with a history of liver cirrhosis is admitted with severe hepatic
encephalopathy. The nurse notes extreme asterixis, confusion, and fetor
hepaticus. Which laboratory value should the nurse monitor closely to track the
therapeutic efficacy of prescribed lactulose?
A) Serum bilirubin
B) Alanine aminotransferase (ALT)
C) Serum ammonia
D) Prothrombin time (PT/INR)
Answer: C
Rationale: Hepatic encephalopathy is primarily driven by elevated blood ammonia
levels that cross the blood-brain barrier, causing neurotoxicity. Lactulose works
,by trapping ammonia in the gut and expelling it through the stool. A reduction in
serum ammonia and an improvement in neurological status indicate therapeutic
success.
4. A nurse is caring for a patient in acute renal failure who presents with a serum
potassium level of 6.8 mEq/L. The healthcare provider orders an immediate
intravenous infusion of 10% calcium gluconate. What is the primary therapeutic
rationale for administering calcium gluconate to this patient?
A) To lower the serum potassium level by driving potassium back into the intracellular
space.
B) To protect the myocardium and stabilize the cardiac cell membrane against
hyperkalemia-induced arrhythmias.
C) To increase the excretion of potassium through the renal tubules.
D) To bind with potassium in the gastrointestinal tract for elimination.
Answer: B
Rationale: Calcium gluconate does not lower serum potassium levels. Instead, it
directly antagonizes the neuromuscular effects of hyperkalemia on the
myocardium, stabilizing the cardiac cell membrane to prevent lethal arrhythmias
like ventricular fibrillation while other treatments work to lower the actual
potassium level.
5. A patient with type 1 diabetes mellitus is admitted to the intensive care unit in
Diabetic Ketoacidosis (DKA). An intravenous insulin infusion has been running
for several hours. The patient’s blood glucose has decreased from 580 mg/dL to
250 mg/dL. Which prescription should the nurse anticipate next?
A) Increase the rate of the intravenous regular insulin infusion.
B) Administer a bolus of subcutaneous long-acting insulin.
C) Change the intravenous fluid infusion to include 5% dextrose.
D) Discontinue all intravenous fluids and initiate an oral diet.
Answer: C
Rationale: When blood glucose drops to approximately 250–300 mg/dL during
DKA treatment, dextrose (such as 5% dextrose in 0.45% normal saline) is added
to the IV fluids. This prevents a rapid drop in blood glucose that could cause
hypoglycemia and severe cerebral edema, while allowing the insulin infusion to
continue clearing ketones.
6. A patient is admitted to the medical-surgical unit with an acute exacerbation of
Crohn's disease. The patient reports frequent, loose, non-bloody stools, severe
abdominal cramping, and significant weight loss. Which dietary instruction
should the nurse include in the care plan during this acute phase?
A) Maintain a strict high-fiber, high-fat diet to maximize caloric intake.
B) Consume a low-residue, high-protein, high-calorie diet.
C) Limit fluid intake to 1 liter per day to reduce diarrhea frequency.
D) Increase intake of fresh green leafy vegetables and whole grains.
Answer: B
, Rationale: During an acute flare-up of Crohn's disease, a low-residue (low-fiber)
diet is essential to minimize mechanical irritation to the inflamed bowel, reduce
peristalsis, and alleviate abdominal pain. High protein and high calories are
necessary to promote tissue healing and reverse malnutrition.
7. A nurse is monitoring a patient who underwent a thyroidectomy 12 hours ago.
The patient complains of a tingling sensation around the mouth and fingertips,
and the nurse observes a positive Chvostek's sign. Which medication should the
nurse ensure is readily available for immediate administration?
A) Potassium chloride
B) Calcium gluconate
C) Magnesium sulfate
D) Sodium bicarbonate
Answer: B
Rationale: Accidental removal or injury to the parathyroid glands during a
thyroidectomy can cause acute hypoparathyroidism, leading to severe
hypocalcemia. Perioral tingling and a positive Chvostek's sign (facial twitching)
are signs of neuromuscular irritability that require immediate treatment with IV
calcium gluconate to prevent laryngospasm.
8. A patient with a sustained high-level spinal cord injury at T2 is resting in bed
when they suddenly report a severe, pounding headache and blurred vision. The
nurse notes the patient is heavily sweating above the level of injury and has a
blood pressure of 190/100 mmHg. What is the nurse's immediate priority action?
A) Administer an ordered PRN dose of intravenous hydralazine.
B) Elevate the head of the bed to a high-Fowler's position.
C) Check the patient's urinary catheter for kinks or obstruction.
D) Perform a digital rectal exam to assess for fecal impaction.
Answer: B
Rationale: The patient is experiencing autonomic dysreflexia, a life-threatening
emergency. The immediate priority action is to sit the patient upright (high-
Fowler's position) to induce orthostatic hypotension and help lower the
dangerously elevated blood pressure, before investigating the noxious trigger
(e.g., distended bladder, fecal impaction).
9. A patient is prescribed a continuous intravenous heparin infusion for the
treatment of a deep vein thrombosis (DVT). Which laboratory parameter must the
nurse monitor closely to safely adjust the heparin dosage according to the
facility's protocol?
A) Prothrombin Time (PT)
B) International Normalized Ratio (INR)
C) Activated Partial Thromboplastin Time (aPTT)
D) Platelet count
Answer: C
