NU 185 Medical-Surgical Nursing II Exam 3 Prep Document |
2026/2027 Edition | 250 Verified Questions
NU185 Exam 3 (GALEN) 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED A+. 100% Verified
Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive review document contains 250 verified questions for the NU 185
Medical-Surgical Nursing II Exam 3 at Galen College of Nursing. It covers critical content areas
including perioperative care, fluid and electrolyte balance, and management of patients with
respiratory, cardiovascular, and renal disorders. Each question is accompanied by detailed rationales
and distractors to enhance understanding and retention. Designed for the 2026/2027 academic year,
this resource aligns with current NCLEX-RN test plan standards.
Abstract:
This exam preparation document for NU 185 Medical-Surgical Nursing II Exam 3 at Galen College of Nursing
comprises 250 verified questions meticulously curated to reflect the 2026/2027 curriculum. The content spans
perioperative care, fluid and electrolyte management, respiratory and cardiovascular disorders, renal dysfunction,
and shock states. Each question is designed to test clinical judgment and application of nursing interventions, with
comprehensive rationales explaining correct and incorrect options. The document adheres to the latest NCLEX-RN
test plan and incorporates updates from professional organizations. It serves as a definitive study tool for students
seeking to achieve a high level of proficiency in medical-surgical nursing. The questions are organized by content
area with weighted distribution to mirror the actual exam blueprint. This resource is essential for mastering
complex concepts and ensuring exam readiness.
Content Area Overview:
Content Area Questions Key Topics Weight
Perioperative Nursing 1-50 Preoperative assessment, intraoperative care, 20%
postoperative complications, pain
management
Fluid, Electrolyte, and 51-90 Fluid volume deficits/excess, electrolyte 16%
Acid-Base Balance imbalances (Na, K, Ca, Mg), ABG
interpretation
Respiratory Disorders 91-140 Pneumonia, COPD, asthma, ARDS, 20%
pulmonary embolism, chest tube
management
Cardiovascular Disorders 141-190 Heart failure, myocardial infarction, 20%
dysrhythmias, hypertension, cardiac surgery
Renal and Urinary Disorders 191-220 Acute kidney injury, chronic kidney disease, 12%
urinary tract infections, dialysis
Shock and Sepsis 221-250 Hypovolemic, cardiogenic, septic shock; 12%
SIRS, MODS, fluid resuscitation
Page 1
,Q1. In a patient with acute respiratory distress syndrome (ARDS) who is on volume-controlled
ventilation, the plateau pressure is 32 cm H2O and PEEP is 12 cm H2O. Which intervention is most
appropriate to reduce ventilator-induced lung injury?
A. Increase PEEP to 18 cm H2O
B. Decrease tidal volume to 4 mL/kg predicted body weight
C. Switch to pressure-controlled ventilation
D. Administer neuromuscular blockade
Correct Answer: B. Decrease tidal volume to 4 mL/kg predicted body weight
Rationale: Lung-protective ventilation with low tidal volumes (6 mL/kg or less) is standard for ARDS to
minimize volutrauma. Plateau pressure above 30 cm H2O indicates excessive stretch; decreasing tidal
volume to 4 mL/kg reduces plateau pressure and lung injury. Increasing PEEP may improve oxygenation
but does not directly address volutrauma. Pressure-controlled ventilation and neuromuscular blockade
may be adjuncts but are not the primary intervention for reducing lung injury.
Why Wrong:
A - Increasing PEEP may worsen hyperinflation and does not reduce plateau pressure.
C - Switching to pressure-controlled ventilation does not guarantee lower tidal volumes or plateau
pressures.
D - Neuromuscular blockade is not indicated solely for elevated plateau pressure; it is used for
severe dyssynchrony.
Reference: The Acute Respiratory Distress Syndrome Network. (2000). Ventilation with lower tidal
volumes as compared with traditional tidal volumes for acute lung injury and the acute
respiratory distress syndrome. New England Journal of Medicine, 342(18), 1301-1308.
Q2. A patient with decompensated heart failure (HFrEF, ejection fraction 30%) presents with
dyspnea, JVD, and bilateral pedal edema. Current medications: lisinopril 20 mg daily, metoprolol
succinate 50 mg daily, furosemide 40 mg BID. Which intervention should be prioritized to improve
hemodynamics?
A. Add spironolactone 25 mg daily
B. Increase furosemide to 80 mg IV push now
C. Initiate dobutamine continuous infusion
D. Hold metoprolol succinate for 24 hours
Correct Answer: B. Increase furosemide to 80 mg IV push now
Rationale: The patient has acute decompensated HF with volume overload. IV loop diuretics (e.g.,
furosemide) are first-line to reduce preload and relieve congestion. Oral furosemide may be insufficient;
IV administration ensures bioavailability and rapid effect. Spironolactone is for chronic management.
Dobutamine is reserved for cardiogenic shock with low output, not primary congestion. Holding
beta-blockade may worsen long-term outcomes.
Why Wrong:
A - Spironolactone is a weak diuretic and takes days to act; not for acute decompensation.
C - Dobutamine is indicated for low cardiac output state, not primarily for volume overload.
D - Holding beta-blocker can cause rebound tachycardia and is not recommended in acute HF unless
severe bradycardia or shock.
Reference: Yancy, C. W., et al. (2013). 2013 ACCF/AHA guideline for the management of heart failure.
Journal of the American College of Cardiology, 62(16), e147-e239.
Page 2
,Q3. A patient with septic shock (MAP 60 mmHg despite 30 mL/kg crystalloid) has been started on
norepinephrine. After 2 hours, the MAP is 72 mmHg but the patient develops cold, mottled
extremities and urine output drops to 0.3 mL/kg/hr. Which intervention is most appropriate?
A. Add vasopressin 0.03 units/min
B. Increase norepinephrine to achieve MAP >75 mmHg
C. Start dobutamine 5 mcg/kg/min
D. Administer additional 500 mL crystalloid bolus
Correct Answer: C. Start dobutamine 5 mcg/kg/min
Rationale: The patient shows signs of tissue hypoperfusion (cold extremities, oliguria) despite adequate
MAP, suggesting low cardiac output with high systemic vascular resistance. Dobutamine, an inotrope,
can improve cardiac output and tissue perfusion. Vasopressin is a second-line vasopressor for refractory
shock. Increasing norepinephrine may worsen vasoconstriction. Fluid responsiveness is unlikely after
initial resuscitation.
Why Wrong:
A - Vasopressin is used to reduce norepinephrine dose, not to improve cardiac output.
B - Higher MAP may not improve perfusion if vasoconstriction is severe; target MAP 65-70 mmHg
is adequate.
D - Additional fluids may cause volume overload without improving perfusion in a vasodilated state.
Reference: Rhodes, A., et al. (2017). Surviving Sepsis Campaign: International Guidelines for
Management of Sepsis and Septic Shock: 2016. Intensive Care Medicine, 43(3), 304-377.
Q4. A patient with cirrhosis and ascites develops acute kidney injury (AKI) with serum creatinine
rising from 0.8 to 2.4 mg/dL over 72 hours, urine sodium <10 mEq/L, and no improvement after
albumin 25 g IV daily for 2 days. Which condition is most likely?
A. Acute tubular necrosis (ATN)
B. Prerenal azotemia due to diuretic overuse
C. Hepatorenal syndrome (HRS) type 1
D. Acute interstitial nephritis (AIN)
Correct Answer: C. Hepatorenal syndrome (HRS) type 1
Rationale: HRS type 1 is characterized by rapid rise in creatinine (>2.5 mg/dL in <2 weeks) in cirrhosis
with ascites, low urine sodium, and failure to respond to volume expansion. Urine sodium <10 mEq/L
distinguishes HRS from ATN (where urine sodium >20). Diuretic-induced prerenal azotemia usually
improves with volume. AIN often has fever, rash, and eosinophilia.
Why Wrong:
A - ATN typically presents with high urine sodium (>20 mEq/L) and muddy brown casts.
B - Prerenal azotemia due to diuretics would show some improvement after albumin/volume.
D - AIN usually has a history of drug exposure and signs of hypersensitivity.
Reference: Angeli, P., et al. (2015). Diagnosis and management of acute kidney injury in patients with
cirrhosis: revised consensus recommendations of the International Club of Ascites. Gut,
64(4), 531-537.
Page 3
, Q5. A patient with type 2 diabetes on metformin and insulin glargine is scheduled for a coronary
artery bypass graft (CABG) surgery. Which perioperative glucose management strategy is most
appropriate?
A. Continue metformin and glargine; hold glargine on morning of surgery
B. Hold metformin 24 hours before surgery; continue glargine at 50% dose
C. Discontinue metformin 48 hours before surgery; start insulin drip
D. Hold both metformin and glargine; start regular insulin sliding scale
Correct Answer: C. Discontinue metformin 48 hours before surgery; start insulin drip
Rationale: Metformin is held 48 hours before major surgery due to risk of lactic acidosis with renal
impairment and contrast. An insulin drip provides tight glycemic control during CABG, reducing
infection and mortality. Continuing glargine alone risks hypoglycemia during fasting. Sliding scale alone
is inadequate for tight control.
Why Wrong:
A - Metformin should be held; continuing glargine at full dose risks hypoglycemia.
B - Holding metformin only 24 hours may not be sufficient; glargine at 50% may still cause
hypoglycemia.
D - Sliding scale insulin is reactive and does not provide stable control; insulin drip is preferred.
Reference: American Diabetes Association. (2026). Standards of Medical Care in Diabetes-2026.
Diabetes Care, 49(Suppl 1), S1-S304.
Q6. A patient with a traumatic subarachnoid hemorrhage (SAH) develops acute hyponatremia (Na
125 mEq/L) on day 5. The patient is euvolemic with urine osmolality 600 mOsm/kg and urine
sodium 80 mEq/L. Which intervention is most appropriate?
A. Administer 3% hypertonic saline infusion
B. Restrict free water to 500 mL daily
C. Start fludrocortisone 0.1 mg daily
D. Give 0.9% normal saline at 150 mL/hr
Correct Answer: A. Administer 3% hypertonic saline infusion
Rationale: This presentation is consistent with syndrome of inappropriate antidiuretic hormone (SIADH)
secondary to SAH. Severe hyponatremia (Na <130) with symptoms requires hypertonic saline to correct
slowly. Water restriction is first-line for mild SIADH but too slow for severe hyponatremia.
Fludrocortisone is used in cerebral salt wasting (CSW), which presents with hypovolemia and high urine
sodium. Normal saline may worsen hyponatremia in SIADH.
Why Wrong:
B - Water restriction is too slow for severe symptomatic hyponatremia.
C - Fludrocortisone is for CSW, which presents with hypovolemia and high urine sodium.
D - Normal saline may not correct hyponatremia in SIADH and can cause fluid overload.
Reference: Spasovski, G., et al. (2014). Clinical practice guideline on diagnosis and treatment of
hyponatraemia. European Journal of Endocrinology, 170(3), G1-G47.
Page 4
2026/2027 Edition | 250 Verified Questions
NU185 Exam 3 (GALEN) 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED A+. 100% Verified
Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive review document contains 250 verified questions for the NU 185
Medical-Surgical Nursing II Exam 3 at Galen College of Nursing. It covers critical content areas
including perioperative care, fluid and electrolyte balance, and management of patients with
respiratory, cardiovascular, and renal disorders. Each question is accompanied by detailed rationales
and distractors to enhance understanding and retention. Designed for the 2026/2027 academic year,
this resource aligns with current NCLEX-RN test plan standards.
Abstract:
This exam preparation document for NU 185 Medical-Surgical Nursing II Exam 3 at Galen College of Nursing
comprises 250 verified questions meticulously curated to reflect the 2026/2027 curriculum. The content spans
perioperative care, fluid and electrolyte management, respiratory and cardiovascular disorders, renal dysfunction,
and shock states. Each question is designed to test clinical judgment and application of nursing interventions, with
comprehensive rationales explaining correct and incorrect options. The document adheres to the latest NCLEX-RN
test plan and incorporates updates from professional organizations. It serves as a definitive study tool for students
seeking to achieve a high level of proficiency in medical-surgical nursing. The questions are organized by content
area with weighted distribution to mirror the actual exam blueprint. This resource is essential for mastering
complex concepts and ensuring exam readiness.
Content Area Overview:
Content Area Questions Key Topics Weight
Perioperative Nursing 1-50 Preoperative assessment, intraoperative care, 20%
postoperative complications, pain
management
Fluid, Electrolyte, and 51-90 Fluid volume deficits/excess, electrolyte 16%
Acid-Base Balance imbalances (Na, K, Ca, Mg), ABG
interpretation
Respiratory Disorders 91-140 Pneumonia, COPD, asthma, ARDS, 20%
pulmonary embolism, chest tube
management
Cardiovascular Disorders 141-190 Heart failure, myocardial infarction, 20%
dysrhythmias, hypertension, cardiac surgery
Renal and Urinary Disorders 191-220 Acute kidney injury, chronic kidney disease, 12%
urinary tract infections, dialysis
Shock and Sepsis 221-250 Hypovolemic, cardiogenic, septic shock; 12%
SIRS, MODS, fluid resuscitation
Page 1
,Q1. In a patient with acute respiratory distress syndrome (ARDS) who is on volume-controlled
ventilation, the plateau pressure is 32 cm H2O and PEEP is 12 cm H2O. Which intervention is most
appropriate to reduce ventilator-induced lung injury?
A. Increase PEEP to 18 cm H2O
B. Decrease tidal volume to 4 mL/kg predicted body weight
C. Switch to pressure-controlled ventilation
D. Administer neuromuscular blockade
Correct Answer: B. Decrease tidal volume to 4 mL/kg predicted body weight
Rationale: Lung-protective ventilation with low tidal volumes (6 mL/kg or less) is standard for ARDS to
minimize volutrauma. Plateau pressure above 30 cm H2O indicates excessive stretch; decreasing tidal
volume to 4 mL/kg reduces plateau pressure and lung injury. Increasing PEEP may improve oxygenation
but does not directly address volutrauma. Pressure-controlled ventilation and neuromuscular blockade
may be adjuncts but are not the primary intervention for reducing lung injury.
Why Wrong:
A - Increasing PEEP may worsen hyperinflation and does not reduce plateau pressure.
C - Switching to pressure-controlled ventilation does not guarantee lower tidal volumes or plateau
pressures.
D - Neuromuscular blockade is not indicated solely for elevated plateau pressure; it is used for
severe dyssynchrony.
Reference: The Acute Respiratory Distress Syndrome Network. (2000). Ventilation with lower tidal
volumes as compared with traditional tidal volumes for acute lung injury and the acute
respiratory distress syndrome. New England Journal of Medicine, 342(18), 1301-1308.
Q2. A patient with decompensated heart failure (HFrEF, ejection fraction 30%) presents with
dyspnea, JVD, and bilateral pedal edema. Current medications: lisinopril 20 mg daily, metoprolol
succinate 50 mg daily, furosemide 40 mg BID. Which intervention should be prioritized to improve
hemodynamics?
A. Add spironolactone 25 mg daily
B. Increase furosemide to 80 mg IV push now
C. Initiate dobutamine continuous infusion
D. Hold metoprolol succinate for 24 hours
Correct Answer: B. Increase furosemide to 80 mg IV push now
Rationale: The patient has acute decompensated HF with volume overload. IV loop diuretics (e.g.,
furosemide) are first-line to reduce preload and relieve congestion. Oral furosemide may be insufficient;
IV administration ensures bioavailability and rapid effect. Spironolactone is for chronic management.
Dobutamine is reserved for cardiogenic shock with low output, not primary congestion. Holding
beta-blockade may worsen long-term outcomes.
Why Wrong:
A - Spironolactone is a weak diuretic and takes days to act; not for acute decompensation.
C - Dobutamine is indicated for low cardiac output state, not primarily for volume overload.
D - Holding beta-blocker can cause rebound tachycardia and is not recommended in acute HF unless
severe bradycardia or shock.
Reference: Yancy, C. W., et al. (2013). 2013 ACCF/AHA guideline for the management of heart failure.
Journal of the American College of Cardiology, 62(16), e147-e239.
Page 2
,Q3. A patient with septic shock (MAP 60 mmHg despite 30 mL/kg crystalloid) has been started on
norepinephrine. After 2 hours, the MAP is 72 mmHg but the patient develops cold, mottled
extremities and urine output drops to 0.3 mL/kg/hr. Which intervention is most appropriate?
A. Add vasopressin 0.03 units/min
B. Increase norepinephrine to achieve MAP >75 mmHg
C. Start dobutamine 5 mcg/kg/min
D. Administer additional 500 mL crystalloid bolus
Correct Answer: C. Start dobutamine 5 mcg/kg/min
Rationale: The patient shows signs of tissue hypoperfusion (cold extremities, oliguria) despite adequate
MAP, suggesting low cardiac output with high systemic vascular resistance. Dobutamine, an inotrope,
can improve cardiac output and tissue perfusion. Vasopressin is a second-line vasopressor for refractory
shock. Increasing norepinephrine may worsen vasoconstriction. Fluid responsiveness is unlikely after
initial resuscitation.
Why Wrong:
A - Vasopressin is used to reduce norepinephrine dose, not to improve cardiac output.
B - Higher MAP may not improve perfusion if vasoconstriction is severe; target MAP 65-70 mmHg
is adequate.
D - Additional fluids may cause volume overload without improving perfusion in a vasodilated state.
Reference: Rhodes, A., et al. (2017). Surviving Sepsis Campaign: International Guidelines for
Management of Sepsis and Septic Shock: 2016. Intensive Care Medicine, 43(3), 304-377.
Q4. A patient with cirrhosis and ascites develops acute kidney injury (AKI) with serum creatinine
rising from 0.8 to 2.4 mg/dL over 72 hours, urine sodium <10 mEq/L, and no improvement after
albumin 25 g IV daily for 2 days. Which condition is most likely?
A. Acute tubular necrosis (ATN)
B. Prerenal azotemia due to diuretic overuse
C. Hepatorenal syndrome (HRS) type 1
D. Acute interstitial nephritis (AIN)
Correct Answer: C. Hepatorenal syndrome (HRS) type 1
Rationale: HRS type 1 is characterized by rapid rise in creatinine (>2.5 mg/dL in <2 weeks) in cirrhosis
with ascites, low urine sodium, and failure to respond to volume expansion. Urine sodium <10 mEq/L
distinguishes HRS from ATN (where urine sodium >20). Diuretic-induced prerenal azotemia usually
improves with volume. AIN often has fever, rash, and eosinophilia.
Why Wrong:
A - ATN typically presents with high urine sodium (>20 mEq/L) and muddy brown casts.
B - Prerenal azotemia due to diuretics would show some improvement after albumin/volume.
D - AIN usually has a history of drug exposure and signs of hypersensitivity.
Reference: Angeli, P., et al. (2015). Diagnosis and management of acute kidney injury in patients with
cirrhosis: revised consensus recommendations of the International Club of Ascites. Gut,
64(4), 531-537.
Page 3
, Q5. A patient with type 2 diabetes on metformin and insulin glargine is scheduled for a coronary
artery bypass graft (CABG) surgery. Which perioperative glucose management strategy is most
appropriate?
A. Continue metformin and glargine; hold glargine on morning of surgery
B. Hold metformin 24 hours before surgery; continue glargine at 50% dose
C. Discontinue metformin 48 hours before surgery; start insulin drip
D. Hold both metformin and glargine; start regular insulin sliding scale
Correct Answer: C. Discontinue metformin 48 hours before surgery; start insulin drip
Rationale: Metformin is held 48 hours before major surgery due to risk of lactic acidosis with renal
impairment and contrast. An insulin drip provides tight glycemic control during CABG, reducing
infection and mortality. Continuing glargine alone risks hypoglycemia during fasting. Sliding scale alone
is inadequate for tight control.
Why Wrong:
A - Metformin should be held; continuing glargine at full dose risks hypoglycemia.
B - Holding metformin only 24 hours may not be sufficient; glargine at 50% may still cause
hypoglycemia.
D - Sliding scale insulin is reactive and does not provide stable control; insulin drip is preferred.
Reference: American Diabetes Association. (2026). Standards of Medical Care in Diabetes-2026.
Diabetes Care, 49(Suppl 1), S1-S304.
Q6. A patient with a traumatic subarachnoid hemorrhage (SAH) develops acute hyponatremia (Na
125 mEq/L) on day 5. The patient is euvolemic with urine osmolality 600 mOsm/kg and urine
sodium 80 mEq/L. Which intervention is most appropriate?
A. Administer 3% hypertonic saline infusion
B. Restrict free water to 500 mL daily
C. Start fludrocortisone 0.1 mg daily
D. Give 0.9% normal saline at 150 mL/hr
Correct Answer: A. Administer 3% hypertonic saline infusion
Rationale: This presentation is consistent with syndrome of inappropriate antidiuretic hormone (SIADH)
secondary to SAH. Severe hyponatremia (Na <130) with symptoms requires hypertonic saline to correct
slowly. Water restriction is first-line for mild SIADH but too slow for severe hyponatremia.
Fludrocortisone is used in cerebral salt wasting (CSW), which presents with hypovolemia and high urine
sodium. Normal saline may worsen hyponatremia in SIADH.
Why Wrong:
B - Water restriction is too slow for severe symptomatic hyponatremia.
C - Fludrocortisone is for CSW, which presents with hypovolemia and high urine sodium.
D - Normal saline may not correct hyponatremia in SIADH and can cause fluid overload.
Reference: Spasovski, G., et al. (2014). Clinical practice guideline on diagnosis and treatment of
hyponatraemia. European Journal of Endocrinology, 170(3), G1-G47.
Page 4
