NU 192 Final Exam V1 | NU 192 Medical-
Surgical Nursing II-B | NCLEX (NGN) Q&A
with Rationale (NU192 Final Exam) | Galen
1. A nurse is caring for a patient who has been diagnosed with Multiple Sclerosis (MS). Which
clinical manifestation should the nurse expect the patient to report during the initial
assessment?
A. Diplopia and blurred vision
B. Symmetrical muscle wasting in the lower extremities
C. Resting tremors that disappear with movement
D. Ascending paralysis starting in the feet
Correct Answer: A
Explanation: Multiple Sclerosis often presents initially with visual disturbances such as
diplopia, blurred vision, or red-green color distortion due to demyelination of the optic
nerve. Symmetrical muscle wasting is more characteristic of Amyotrophic Lateral Sclerosis
(ALS). Resting tremors are a hallmark of Parkinson’s disease, and ascending paralysis is
typical of Guillain-Barre Syndrome.
,2. A patient with End-Stage Renal Disease (ESRD) is receiving hemodialysis. The nurse notes
the patient’s blood pressure has dropped from 140/90 mmHg to 90/60 mmHg, and the
patient reports dizziness. What is the priority nursing action?
A. Administer a 250 mL bolus of 0.9% Normal Saline
B. Decrease the rate of ultrafiltration and lower the head of the bed
C. Place the patient in the Trendelenburg position
D. Stop the dialysis treatment immediately
Correct Answer: B
Explanation: Hypotension during hemodialysis is often caused by rapid fluid removal; the
first response should be to reduce the ultrafiltration rate and position the patient to
improve cerebral perfusion. Administering a bolus is a secondary action if the rate
adjustment does not stabilize the patient. Stopping treatment is unnecessary unless the
patient remains unstable after initial interventions.
3. A nurse is providing discharge education to a patient who underwent a kidney transplant.
Which of the following instructions should the nurse include? (Select All That Apply)
A. Avoid large crowds and people with known infections
B. Expect to take immunosuppressant medications for at least six months
C. Report a weight gain of more than 2-3 pounds in one day to the provider
D. Notify the provider if you experience tenderness over the graft site
,E. Use NSAIDs for minor pain management instead of acetaminophen
F. Monitor for a decrease in urine output
Correct Answer: A, C, D, F
Explanation: Kidney transplant recipients must avoid infections due to lifelong
immunosuppression, not just for six months. Graft tenderness and sudden weight gain or
decreased urine output are signs of rejection that must be reported immediately. NSAIDs
should be avoided as they are nephrotoxic and can damage the new kidney.
4. A patient with a T4 spinal cord injury suddenly complains of a severe, pounding headache
and nasal congestion. The nurse notes the patient is flushed above the level of injury and has
a blood pressure of 210/110 mmHg. Which action should the nurse take first?
A. Administer prescribed hydralazine intravenously
B. Elevate the head of the bed to a 45-degree angle or higher
C. Check the patient for bladder distension or a kinked catheter
D. Assess the patient for a fecal impaction
Correct Answer: B
Explanation: The patient is experiencing Autonomic Dysreflexia, a medical emergency
characterized by severe hypertension. The immediate priority is to elevate the head of the
bed to help lower blood pressure via orthostatic effect. Once the patient is positioned
safely, the nurse should then identify and remove the triggering stimulus, such as a
distended bladder or bowel.
, 5. A nurse is assessing a patient with Cushing’s Syndrome. Which of the following findings are
consistent with this diagnosis? (Select All That Apply)
A. Truncal obesity with thin extremities
B. Hypoglycemia and hypotension
C. Purple striae on the abdomen
D. Buffalo hump and moon face
E. Hyperpigmentation of the skin
Correct Answer: A, C, D
Explanation: Cushing’s Syndrome results from excess cortisol, leading to abnormal fat
distribution (moon face, buffalo hump, truncal obesity) and skin thinning that causes
purple striae. Hypoglycemia and hypotension are associated with Addison’s disease
(adrenal insufficiency). Hyperpigmentation is also a classic sign of Addison’s due to
increased ACTH levels, not Cushing’s.
6. A patient is admitted to the ICU with a diagnosis of Myasthenic Crisis. Which assessment
finding requires immediate intervention by the nurse?
A. Inability to maintain a patent airway or clear secretions
B. Generalized weakness in the upper extremities
C. Increased ptosis and diplopia
D. Difficulty swallowing solid foods
Surgical Nursing II-B | NCLEX (NGN) Q&A
with Rationale (NU192 Final Exam) | Galen
1. A nurse is caring for a patient who has been diagnosed with Multiple Sclerosis (MS). Which
clinical manifestation should the nurse expect the patient to report during the initial
assessment?
A. Diplopia and blurred vision
B. Symmetrical muscle wasting in the lower extremities
C. Resting tremors that disappear with movement
D. Ascending paralysis starting in the feet
Correct Answer: A
Explanation: Multiple Sclerosis often presents initially with visual disturbances such as
diplopia, blurred vision, or red-green color distortion due to demyelination of the optic
nerve. Symmetrical muscle wasting is more characteristic of Amyotrophic Lateral Sclerosis
(ALS). Resting tremors are a hallmark of Parkinson’s disease, and ascending paralysis is
typical of Guillain-Barre Syndrome.
,2. A patient with End-Stage Renal Disease (ESRD) is receiving hemodialysis. The nurse notes
the patient’s blood pressure has dropped from 140/90 mmHg to 90/60 mmHg, and the
patient reports dizziness. What is the priority nursing action?
A. Administer a 250 mL bolus of 0.9% Normal Saline
B. Decrease the rate of ultrafiltration and lower the head of the bed
C. Place the patient in the Trendelenburg position
D. Stop the dialysis treatment immediately
Correct Answer: B
Explanation: Hypotension during hemodialysis is often caused by rapid fluid removal; the
first response should be to reduce the ultrafiltration rate and position the patient to
improve cerebral perfusion. Administering a bolus is a secondary action if the rate
adjustment does not stabilize the patient. Stopping treatment is unnecessary unless the
patient remains unstable after initial interventions.
3. A nurse is providing discharge education to a patient who underwent a kidney transplant.
Which of the following instructions should the nurse include? (Select All That Apply)
A. Avoid large crowds and people with known infections
B. Expect to take immunosuppressant medications for at least six months
C. Report a weight gain of more than 2-3 pounds in one day to the provider
D. Notify the provider if you experience tenderness over the graft site
,E. Use NSAIDs for minor pain management instead of acetaminophen
F. Monitor for a decrease in urine output
Correct Answer: A, C, D, F
Explanation: Kidney transplant recipients must avoid infections due to lifelong
immunosuppression, not just for six months. Graft tenderness and sudden weight gain or
decreased urine output are signs of rejection that must be reported immediately. NSAIDs
should be avoided as they are nephrotoxic and can damage the new kidney.
4. A patient with a T4 spinal cord injury suddenly complains of a severe, pounding headache
and nasal congestion. The nurse notes the patient is flushed above the level of injury and has
a blood pressure of 210/110 mmHg. Which action should the nurse take first?
A. Administer prescribed hydralazine intravenously
B. Elevate the head of the bed to a 45-degree angle or higher
C. Check the patient for bladder distension or a kinked catheter
D. Assess the patient for a fecal impaction
Correct Answer: B
Explanation: The patient is experiencing Autonomic Dysreflexia, a medical emergency
characterized by severe hypertension. The immediate priority is to elevate the head of the
bed to help lower blood pressure via orthostatic effect. Once the patient is positioned
safely, the nurse should then identify and remove the triggering stimulus, such as a
distended bladder or bowel.
, 5. A nurse is assessing a patient with Cushing’s Syndrome. Which of the following findings are
consistent with this diagnosis? (Select All That Apply)
A. Truncal obesity with thin extremities
B. Hypoglycemia and hypotension
C. Purple striae on the abdomen
D. Buffalo hump and moon face
E. Hyperpigmentation of the skin
Correct Answer: A, C, D
Explanation: Cushing’s Syndrome results from excess cortisol, leading to abnormal fat
distribution (moon face, buffalo hump, truncal obesity) and skin thinning that causes
purple striae. Hypoglycemia and hypotension are associated with Addison’s disease
(adrenal insufficiency). Hyperpigmentation is also a classic sign of Addison’s due to
increased ACTH levels, not Cushing’s.
6. A patient is admitted to the ICU with a diagnosis of Myasthenic Crisis. Which assessment
finding requires immediate intervention by the nurse?
A. Inability to maintain a patent airway or clear secretions
B. Generalized weakness in the upper extremities
C. Increased ptosis and diplopia
D. Difficulty swallowing solid foods
