NU 192 Final Exam V2 | NU 192 Medical-
Surgical Nursing II-B | NCLEX (NGN) Q&A
with Rationale (NU192 Final Exam) | Galen
1. A client is admitted to the emergency department with a heart rate of 190 beats/minute
and a rhythm identified as supraventricular tachycardia (SVT). After vagal maneuvers are
unsuccessful, the nurse prepares to administer adenosine. Which action by the nurse is the
most appropriate?
A. Administer the medication via a slow IV push over 2 minutes.
B. Dilute the medication in 100 mL of 0.9% normal saline.
C. Instruct the client to perform a Valsalva maneuver during the injection.
D. Administer the medication as a rapid IV bolus over 1 to 2 seconds.
Correct Answer: D
Explanation: Adenosine has an extremely short half-life of less than 10 seconds and must
be administered as a rapid IV push to be effective. The nurse should use an IV site as close
to the heart as possible, typically the antecubital fossa, followed immediately by a rapid
saline flush. It is expected to see a brief period of asystole on the monitor, so the nurse
must ensure the crash cart is nearby and the client is informed of the sensation of chest
pressure.
,2. The nurse is providing discharge education to a client who had an arteriovenous (AV)
fistula created in the left forearm for hemodialysis. Which instructions should the nurse
include in the teaching? Select all that apply.
A. Palpate the site daily to feel for a thrill or vibration.
B. Avoid wearing a watch or tight clothing on the left arm.
C. Allow blood draws from the left arm only if using a small needle.
D. Sleep with the left arm elevated on pillows to reduce swelling.
E. Report any numbness, tingling, or coldness in the left hand.
F. Do not carry heavy objects or bags using the left arm.
Correct Answer: A, B, E, F
Explanation: Maintenance of AV fistula patency is essential for long-term hemodialysis
access. Clients must be taught to avoid any restrictive clothing or procedures, such as blood
pressure checks or venipuncture, on the affected limb to prevent thrombosis. The presence
of a thrill and bruit indicates adequate blood flow, and any signs of distal ischemia or ‘steal
syndrome’ must be reported immediately to the provider.
3. A client in the intensive care unit is being treated for Acute Respiratory Distress Syndrome
(ARDS) and is receiving mechanical ventilation with High-Level Positive End-Expiratory
Pressure (PEEP). Which assessment finding most concerns the nurse?
A. Slight abdominal distention and diminished bowel sounds.
B. A PaO2 of 82 mmHg on an FiO2 of 60%.
,C. Presence of coarse crackles in the lung bases.
D. A decrease in blood pressure from 120/80 to 90/60 mmHg.
Correct Answer: D
Explanation: High levels of PEEP increase intrathoracic pressure, which can lead to
decreased venous return to the heart and a subsequent drop in cardiac output and blood
pressure. The nurse must monitor hemodynamic stability closely in patients receiving high
PEEP settings. While crackles and PaO2 levels are important in ARDS, the acute drop in
blood pressure suggests a complication of the ventilator settings themselves.
4. A nurse is caring for a client with Diabetic Ketoacidosis (DKA) who is receiving a continuous
insulin infusion. The most recent laboratory results show a blood glucose of 240 mg/dL and a
potassium level of 3.2 mEq/L. Which action should the nurse take first?
A. Increase the insulin infusion rate to further lower the blood glucose.
B. Switch the IV fluid to 5% dextrose in 0.45% normal saline.
C. Notify the healthcare provider and prepare to administer potassium.
D. Document the findings as an expected response to insulin therapy.
Correct Answer: C
Explanation: Insulin causes potassium to shift from the extracellular fluid into the cells,
which can lead to life-threatening hypokalemia. If the potassium level is low, it must be
replaced before or during insulin therapy to prevent cardiac dysrhythmias. Once blood
, glucose reaches 250 mg/dL, dextrose is typically added to the IV fluids, but the priority
here is addressing the low potassium level.
5. A client arrives at the emergency department with symptoms of an acute ischemic stroke
that began 2 hours ago. Which diagnostic test is the priority for the nurse to facilitate?
A. Non-contrast Computed Tomography (CT) scan of the head.
B. Magnetic Resonance Imaging (MRI) of the brain.
C. Carotid duplex ultrasound.
D. Electroencephalogram (EEG).
Correct Answer: A
Explanation: A non-contrast CT scan is the priority diagnostic tool to differentiate between
an ischemic stroke and a hemorrhagic stroke. This distinction is critical because
thrombolytic therapy (tPA) is contraindicated in hemorrhagic strokes. The CT scan must be
performed and interpreted quickly to ensure the client remains within the narrow time
window for tPA administration if eligible.
6. The nurse is evaluating a client’s electrocardiogram (ECG) and notes a rhythm with no
identifiable P waves and a wavy baseline with an irregular ventricular rate. Which medication
does the nurse anticipate the healthcare provider will prescribe?
A. Atropine
B. Epinephrine
C. Lidocaine
Surgical Nursing II-B | NCLEX (NGN) Q&A
with Rationale (NU192 Final Exam) | Galen
1. A client is admitted to the emergency department with a heart rate of 190 beats/minute
and a rhythm identified as supraventricular tachycardia (SVT). After vagal maneuvers are
unsuccessful, the nurse prepares to administer adenosine. Which action by the nurse is the
most appropriate?
A. Administer the medication via a slow IV push over 2 minutes.
B. Dilute the medication in 100 mL of 0.9% normal saline.
C. Instruct the client to perform a Valsalva maneuver during the injection.
D. Administer the medication as a rapid IV bolus over 1 to 2 seconds.
Correct Answer: D
Explanation: Adenosine has an extremely short half-life of less than 10 seconds and must
be administered as a rapid IV push to be effective. The nurse should use an IV site as close
to the heart as possible, typically the antecubital fossa, followed immediately by a rapid
saline flush. It is expected to see a brief period of asystole on the monitor, so the nurse
must ensure the crash cart is nearby and the client is informed of the sensation of chest
pressure.
,2. The nurse is providing discharge education to a client who had an arteriovenous (AV)
fistula created in the left forearm for hemodialysis. Which instructions should the nurse
include in the teaching? Select all that apply.
A. Palpate the site daily to feel for a thrill or vibration.
B. Avoid wearing a watch or tight clothing on the left arm.
C. Allow blood draws from the left arm only if using a small needle.
D. Sleep with the left arm elevated on pillows to reduce swelling.
E. Report any numbness, tingling, or coldness in the left hand.
F. Do not carry heavy objects or bags using the left arm.
Correct Answer: A, B, E, F
Explanation: Maintenance of AV fistula patency is essential for long-term hemodialysis
access. Clients must be taught to avoid any restrictive clothing or procedures, such as blood
pressure checks or venipuncture, on the affected limb to prevent thrombosis. The presence
of a thrill and bruit indicates adequate blood flow, and any signs of distal ischemia or ‘steal
syndrome’ must be reported immediately to the provider.
3. A client in the intensive care unit is being treated for Acute Respiratory Distress Syndrome
(ARDS) and is receiving mechanical ventilation with High-Level Positive End-Expiratory
Pressure (PEEP). Which assessment finding most concerns the nurse?
A. Slight abdominal distention and diminished bowel sounds.
B. A PaO2 of 82 mmHg on an FiO2 of 60%.
,C. Presence of coarse crackles in the lung bases.
D. A decrease in blood pressure from 120/80 to 90/60 mmHg.
Correct Answer: D
Explanation: High levels of PEEP increase intrathoracic pressure, which can lead to
decreased venous return to the heart and a subsequent drop in cardiac output and blood
pressure. The nurse must monitor hemodynamic stability closely in patients receiving high
PEEP settings. While crackles and PaO2 levels are important in ARDS, the acute drop in
blood pressure suggests a complication of the ventilator settings themselves.
4. A nurse is caring for a client with Diabetic Ketoacidosis (DKA) who is receiving a continuous
insulin infusion. The most recent laboratory results show a blood glucose of 240 mg/dL and a
potassium level of 3.2 mEq/L. Which action should the nurse take first?
A. Increase the insulin infusion rate to further lower the blood glucose.
B. Switch the IV fluid to 5% dextrose in 0.45% normal saline.
C. Notify the healthcare provider and prepare to administer potassium.
D. Document the findings as an expected response to insulin therapy.
Correct Answer: C
Explanation: Insulin causes potassium to shift from the extracellular fluid into the cells,
which can lead to life-threatening hypokalemia. If the potassium level is low, it must be
replaced before or during insulin therapy to prevent cardiac dysrhythmias. Once blood
, glucose reaches 250 mg/dL, dextrose is typically added to the IV fluids, but the priority
here is addressing the low potassium level.
5. A client arrives at the emergency department with symptoms of an acute ischemic stroke
that began 2 hours ago. Which diagnostic test is the priority for the nurse to facilitate?
A. Non-contrast Computed Tomography (CT) scan of the head.
B. Magnetic Resonance Imaging (MRI) of the brain.
C. Carotid duplex ultrasound.
D. Electroencephalogram (EEG).
Correct Answer: A
Explanation: A non-contrast CT scan is the priority diagnostic tool to differentiate between
an ischemic stroke and a hemorrhagic stroke. This distinction is critical because
thrombolytic therapy (tPA) is contraindicated in hemorrhagic strokes. The CT scan must be
performed and interpreted quickly to ensure the client remains within the narrow time
window for tPA administration if eligible.
6. The nurse is evaluating a client’s electrocardiogram (ECG) and notes a rhythm with no
identifiable P waves and a wavy baseline with an irregular ventricular rate. Which medication
does the nurse anticipate the healthcare provider will prescribe?
A. Atropine
B. Epinephrine
C. Lidocaine
