NU 185 Medical-Surgical Nursing II Exam 2 Prep Document |
2026/2027 Edition | 250 Verified Questions
NU 185 Exam 2 (GALEN) 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED A+. 100% Verified
Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive exam preparation document contains 250 actual exam questions from the NU 185
Medical-Surgical Nursing II Exam 2 at Galen College of Nursing. Each question is accompanied by a
verified correct answer and detailed rationale, ensuring thorough understanding of key concepts.
Designed for the 2026/2027 academic year, this resource reflects the most recent exam patterns and
clinical guidelines. Ideal for students aiming for a top score, this document has been graded A+ by
previous users.
Abstract:
This exam preparation document is meticulously compiled from the NU 185 Medical-Surgical Nursing II Exam 2 at
Galen College of Nursing, covering the 2026/2027 academic year. It includes 250 real exam questions with verified
correct answers and comprehensive rationales, designed to facilitate deep learning and retention. The content
spans critical areas such as perioperative care, fluid and electrolyte management, cardiovascular and respiratory
disorders, renal and urinary conditions, and endocrine imbalances. Each question is aligned with current nursing
standards and clinical guidelines, ensuring relevance and accuracy. The document is organized to mirror the exam
structure, allowing students to practice under realistic conditions. With a focus on high-yield topics and common
pitfalls, this resource is an essential tool for achieving a top grade. The answers are graded A+ by previous users,
attesting to the quality and reliability of the content.
Content Area Overview:
Content Area Questions Key Topics Weight
Perioperative Nursing Care 1-50 Preoperative assessment, intraoperative 20%
nursing, postoperative complications, pain
management, wound care
Fluid and Electrolyte Balance 51-90 Fluid volume imbalances, electrolyte 16%
disturbances, acid-base balance, IV therapy,
blood transfusions
Cardiovascular Disorders 91-140 Hypertension, heart failure, coronary artery 20%
disease, dysrhythmias, cardiac medications
Respiratory Disorders 141-180 COPD, asthma, pneumonia, pulmonary 16%
embolism, oxygen therapy, ventilator
management
Renal and Urinary Disorders 181-215 Acute kidney injury, chronic kidney disease, 14%
urinary tract infections, dialysis, fluid
management
Endocrine Disorders 216-250 Diabetes mellitus, thyroid disorders, adrenal 14%
insufficiency, insulin therapy, glucose
monitoring
Page 1
,Q1. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled ventilation.
Plateau pressure is 30 cmH2O and PEEP is 5 cmH2O. Which intervention most directly reduces
ventilator-induced lung injury?
A. Increase PEEP to 15 cmH2O
B. Switch to pressure-controlled ventilation
C. Reduce tidal volume to 6 mL/kg predicted body weight
D. Administer neuromuscular blockade
Correct Answer: C. Reduce tidal volume to 6 mL/kg predicted body weight
Rationale: Low tidal volume ventilation (6 mL/kg PBW) is the cornerstone of lung-protective ventilation
in ARDS, reducing volutrauma and barotrauma. Increasing PEEP may improve oxygenation but does not
directly reduce lung injury from overdistension. Pressure-controlled ventilation and neuromuscular
blockade are adjunctive but not primary for injury prevention.
Why Wrong:
A - Increasing PEEP may improve oxygenation but does not directly address overdistension-induced
injury.
B - Switching modes does not guarantee reduced tidal volume; the key is limiting tidal volume
regardless of mode.
D - Neuromuscular blockade may reduce oxygen consumption but does not directly prevent
ventilator-induced lung injury.
Reference: The ARDS Network. (2000). Ventilation with lower tidal volumes. NEJM, 342(18), 1301-1308.
Q2. Which acid-base disturbance is most consistent with a patient who has a pH of 7.50, PaCO2 of
48 mm Hg, and HCO3- of 36 mEq/L?
A. Respiratory alkalosis with metabolic compensation
B. Metabolic alkalosis with respiratory compensation
C. Respiratory acidosis with metabolic compensation
D. Mixed respiratory acidosis and metabolic alkalosis
Correct Answer: B. Metabolic alkalosis with respiratory compensation
Rationale: The pH is alkaline (7.50), HCO3- is elevated (36 mEq/L) indicating metabolic alkalosis, and
PaCO2 is elevated (48 mm Hg) as a compensatory respiratory response (hypoventilation). In metabolic
alkalosis, the expected PaCO2 = 0.7 × HCO3- + 20 ± 5 (range 45-55), so 48 is within compensation
range, not a second primary disorder.
Why Wrong:
A - Respiratory alkalosis would have low PaCO2, not elevated.
C - Respiratory acidosis would have low pH and elevated PaCO2, opposite findings.
D - The PaCO2 is appropriately elevated for compensation, not excessive enough for a second
primary acidosis.
Reference: Rose, B. D., & Post, T. W. (2001). Clinical Physiology of Acid-Base and Electrolyte Disorders,
5th Ed., Ch. 14.
Page 2
,Q3. A patient with heart failure with reduced ejection fraction (HFrEF) is on lisinopril, carvedilol,
and furosemide. Which laboratory finding most warrants withholding the next dose of carvedilol?
A. Serum potassium 5.0 mEq/L
B. Heart rate 56 beats per minute
C. Blood pressure 90/60 mm Hg
D. Serum creatinine 1.3 mg/dL
Correct Answer: C. Blood pressure 90/60 mm Hg
Rationale: Carvedilol is a beta-blocker that can cause hypotension, especially in combination with ACE
inhibitors and diuretics. A systolic BP <90 mm Hg or symptomatic hypotension is a common reason to
hold beta-blockers. While bradycardia (HR 56) is a beta-blocker effect, it is not as immediately
concerning unless symptomatic. Potassium 5.0 and creatinine 1.3 are within acceptable ranges.
Why Wrong:
A - Potassium 5.0 is high-normal but not an indication to hold carvedilol; lisinopril may cause
hyperkalemia but carvedilol does not significantly affect potassium.
B - Heart rate 56 is expected with beta-blockade; holding is typically considered if HR <50 or
symptomatic.
D - Creatinine 1.3 is mildly elevated but not a contraindication to carvedilol; carvedilol is not
nephrotoxic.
Reference: Yancy, C. W., et al. (2017). ACC/AHA/HFSA Focused Update on Heart Failure. Circulation,
136(6), e137-e161.
Q4. A patient with end-stage renal disease on hemodialysis presents with muscle weakness and an
ECG showing peaked T waves. Which intervention should the nurse prioritize?
A. Administer sodium polystyrene sulfonate
B. Prepare for emergency hemodialysis
C. Administer intravenous calcium gluconate
D. Administer albuterol nebulizer
Correct Answer: C. Administer intravenous calcium gluconate
Rationale: Peaked T waves indicate hyperkalemia. The priority is to stabilize the cardiac membrane with
intravenous calcium gluconate to prevent arrhythmias. This is a temporizing measure while preparing for
definitive treatment (dialysis). Sodium polystyrene sulfonate works slowly and is not first-line in
emergencies. Albuterol shifts potassium intracellularly but is slower than calcium.
Why Wrong:
A - Sodium polystyrene sulfonate is slow-acting and not appropriate for life-threatening
hyperkalemia.
B - Dialysis is definitive but requires time to initiate; calcium gluconate should be given first for
cardiac protection.
D - Albuterol is an adjunct, but calcium gluconate is the priority for membrane stabilization.
Reference: Palmer, B. F., & Clegg, D. J. (2017). Diagnosis and treatment of hyperkalemia. Kidney
International, 91(2), 287-298.
Page 3
, Q5. Which finding is most indicative of a patient experiencing a transient ischemic attack (TIA)
rather than a stroke?
A. Symptoms lasting 30 minutes with complete resolution
B. Small area of infarction on diffusion-weighted MRI
C. Presence of atrial fibrillation on telemetry
D. Focal neurological deficit that fluctuates over hours
Correct Answer: A. Symptoms lasting 30 minutes with complete resolution
Rationale: TIA is defined as a transient episode of neurological dysfunction caused by focal brain
ischemia without acute infarction. Symptoms typically resolve within 1 hour, and complete resolution
within 24 hours is classic. While some TIAs show infarction on MRI, the absence of infarction is more
typical. Atrial fibrillation is a risk factor for both, not diagnostic. Fluctuating deficits suggest stroke or
other pathology.
Why Wrong:
B - If infarction is present, it is a stroke, not TIA, by definition (tissue-based diagnosis).
C - Atrial fibrillation is a risk factor for both TIA and stroke; it does not differentiate.
D - Fluctuating deficits are more characteristic of stroke or carotid artery disease, not TIA.
Reference: Easton, J. D., et al. (2009). Definition and evaluation of TIA. Stroke, 40(6), 2276-2293.
Q6. A patient with cirrhosis and ascites develops altered mental status, asterixis, and a serum
ammonia level of 120 mcg/dL. Which intervention is most appropriate to reduce ammonia
production?
A. Administer lactulose orally
B. Administer intravenous albumin
C. Insert a nasogastric tube for bowel decompression
D. Administer spironolactone
Correct Answer: A. Administer lactulose orally
Rationale: Lactulose works by acidifying the colon, converting NH3 to NH4+ which is trapped and
excreted, thereby reducing serum ammonia. It is first-line for hepatic encephalopathy. Albumin is used for
volume expansion in SBP or hepatorenal syndrome, not for ammonia reduction. Bowel decompression is
not indicated. Spironolactone is a diuretic for ascites but does not lower ammonia.
Why Wrong:
B - Albumin does not directly affect ammonia levels; it is used for other complications of cirrhosis.
C - Nasogastric decompression is not indicated; lactulose is given orally or via NG if needed.
D - Spironolactone treats ascites but does not reduce ammonia production.
Reference: Vilstrup, H., et al. (2014). Hepatic encephalopathy in chronic liver disease: 2014 Practice
Guideline by AASLD. Hepatology, 60(2), 715-735.
Page 4
2026/2027 Edition | 250 Verified Questions
NU 185 Exam 2 (GALEN) 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED A+. 100% Verified
Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive exam preparation document contains 250 actual exam questions from the NU 185
Medical-Surgical Nursing II Exam 2 at Galen College of Nursing. Each question is accompanied by a
verified correct answer and detailed rationale, ensuring thorough understanding of key concepts.
Designed for the 2026/2027 academic year, this resource reflects the most recent exam patterns and
clinical guidelines. Ideal for students aiming for a top score, this document has been graded A+ by
previous users.
Abstract:
This exam preparation document is meticulously compiled from the NU 185 Medical-Surgical Nursing II Exam 2 at
Galen College of Nursing, covering the 2026/2027 academic year. It includes 250 real exam questions with verified
correct answers and comprehensive rationales, designed to facilitate deep learning and retention. The content
spans critical areas such as perioperative care, fluid and electrolyte management, cardiovascular and respiratory
disorders, renal and urinary conditions, and endocrine imbalances. Each question is aligned with current nursing
standards and clinical guidelines, ensuring relevance and accuracy. The document is organized to mirror the exam
structure, allowing students to practice under realistic conditions. With a focus on high-yield topics and common
pitfalls, this resource is an essential tool for achieving a top grade. The answers are graded A+ by previous users,
attesting to the quality and reliability of the content.
Content Area Overview:
Content Area Questions Key Topics Weight
Perioperative Nursing Care 1-50 Preoperative assessment, intraoperative 20%
nursing, postoperative complications, pain
management, wound care
Fluid and Electrolyte Balance 51-90 Fluid volume imbalances, electrolyte 16%
disturbances, acid-base balance, IV therapy,
blood transfusions
Cardiovascular Disorders 91-140 Hypertension, heart failure, coronary artery 20%
disease, dysrhythmias, cardiac medications
Respiratory Disorders 141-180 COPD, asthma, pneumonia, pulmonary 16%
embolism, oxygen therapy, ventilator
management
Renal and Urinary Disorders 181-215 Acute kidney injury, chronic kidney disease, 14%
urinary tract infections, dialysis, fluid
management
Endocrine Disorders 216-250 Diabetes mellitus, thyroid disorders, adrenal 14%
insufficiency, insulin therapy, glucose
monitoring
Page 1
,Q1. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled ventilation.
Plateau pressure is 30 cmH2O and PEEP is 5 cmH2O. Which intervention most directly reduces
ventilator-induced lung injury?
A. Increase PEEP to 15 cmH2O
B. Switch to pressure-controlled ventilation
C. Reduce tidal volume to 6 mL/kg predicted body weight
D. Administer neuromuscular blockade
Correct Answer: C. Reduce tidal volume to 6 mL/kg predicted body weight
Rationale: Low tidal volume ventilation (6 mL/kg PBW) is the cornerstone of lung-protective ventilation
in ARDS, reducing volutrauma and barotrauma. Increasing PEEP may improve oxygenation but does not
directly reduce lung injury from overdistension. Pressure-controlled ventilation and neuromuscular
blockade are adjunctive but not primary for injury prevention.
Why Wrong:
A - Increasing PEEP may improve oxygenation but does not directly address overdistension-induced
injury.
B - Switching modes does not guarantee reduced tidal volume; the key is limiting tidal volume
regardless of mode.
D - Neuromuscular blockade may reduce oxygen consumption but does not directly prevent
ventilator-induced lung injury.
Reference: The ARDS Network. (2000). Ventilation with lower tidal volumes. NEJM, 342(18), 1301-1308.
Q2. Which acid-base disturbance is most consistent with a patient who has a pH of 7.50, PaCO2 of
48 mm Hg, and HCO3- of 36 mEq/L?
A. Respiratory alkalosis with metabolic compensation
B. Metabolic alkalosis with respiratory compensation
C. Respiratory acidosis with metabolic compensation
D. Mixed respiratory acidosis and metabolic alkalosis
Correct Answer: B. Metabolic alkalosis with respiratory compensation
Rationale: The pH is alkaline (7.50), HCO3- is elevated (36 mEq/L) indicating metabolic alkalosis, and
PaCO2 is elevated (48 mm Hg) as a compensatory respiratory response (hypoventilation). In metabolic
alkalosis, the expected PaCO2 = 0.7 × HCO3- + 20 ± 5 (range 45-55), so 48 is within compensation
range, not a second primary disorder.
Why Wrong:
A - Respiratory alkalosis would have low PaCO2, not elevated.
C - Respiratory acidosis would have low pH and elevated PaCO2, opposite findings.
D - The PaCO2 is appropriately elevated for compensation, not excessive enough for a second
primary acidosis.
Reference: Rose, B. D., & Post, T. W. (2001). Clinical Physiology of Acid-Base and Electrolyte Disorders,
5th Ed., Ch. 14.
Page 2
,Q3. A patient with heart failure with reduced ejection fraction (HFrEF) is on lisinopril, carvedilol,
and furosemide. Which laboratory finding most warrants withholding the next dose of carvedilol?
A. Serum potassium 5.0 mEq/L
B. Heart rate 56 beats per minute
C. Blood pressure 90/60 mm Hg
D. Serum creatinine 1.3 mg/dL
Correct Answer: C. Blood pressure 90/60 mm Hg
Rationale: Carvedilol is a beta-blocker that can cause hypotension, especially in combination with ACE
inhibitors and diuretics. A systolic BP <90 mm Hg or symptomatic hypotension is a common reason to
hold beta-blockers. While bradycardia (HR 56) is a beta-blocker effect, it is not as immediately
concerning unless symptomatic. Potassium 5.0 and creatinine 1.3 are within acceptable ranges.
Why Wrong:
A - Potassium 5.0 is high-normal but not an indication to hold carvedilol; lisinopril may cause
hyperkalemia but carvedilol does not significantly affect potassium.
B - Heart rate 56 is expected with beta-blockade; holding is typically considered if HR <50 or
symptomatic.
D - Creatinine 1.3 is mildly elevated but not a contraindication to carvedilol; carvedilol is not
nephrotoxic.
Reference: Yancy, C. W., et al. (2017). ACC/AHA/HFSA Focused Update on Heart Failure. Circulation,
136(6), e137-e161.
Q4. A patient with end-stage renal disease on hemodialysis presents with muscle weakness and an
ECG showing peaked T waves. Which intervention should the nurse prioritize?
A. Administer sodium polystyrene sulfonate
B. Prepare for emergency hemodialysis
C. Administer intravenous calcium gluconate
D. Administer albuterol nebulizer
Correct Answer: C. Administer intravenous calcium gluconate
Rationale: Peaked T waves indicate hyperkalemia. The priority is to stabilize the cardiac membrane with
intravenous calcium gluconate to prevent arrhythmias. This is a temporizing measure while preparing for
definitive treatment (dialysis). Sodium polystyrene sulfonate works slowly and is not first-line in
emergencies. Albuterol shifts potassium intracellularly but is slower than calcium.
Why Wrong:
A - Sodium polystyrene sulfonate is slow-acting and not appropriate for life-threatening
hyperkalemia.
B - Dialysis is definitive but requires time to initiate; calcium gluconate should be given first for
cardiac protection.
D - Albuterol is an adjunct, but calcium gluconate is the priority for membrane stabilization.
Reference: Palmer, B. F., & Clegg, D. J. (2017). Diagnosis and treatment of hyperkalemia. Kidney
International, 91(2), 287-298.
Page 3
, Q5. Which finding is most indicative of a patient experiencing a transient ischemic attack (TIA)
rather than a stroke?
A. Symptoms lasting 30 minutes with complete resolution
B. Small area of infarction on diffusion-weighted MRI
C. Presence of atrial fibrillation on telemetry
D. Focal neurological deficit that fluctuates over hours
Correct Answer: A. Symptoms lasting 30 minutes with complete resolution
Rationale: TIA is defined as a transient episode of neurological dysfunction caused by focal brain
ischemia without acute infarction. Symptoms typically resolve within 1 hour, and complete resolution
within 24 hours is classic. While some TIAs show infarction on MRI, the absence of infarction is more
typical. Atrial fibrillation is a risk factor for both, not diagnostic. Fluctuating deficits suggest stroke or
other pathology.
Why Wrong:
B - If infarction is present, it is a stroke, not TIA, by definition (tissue-based diagnosis).
C - Atrial fibrillation is a risk factor for both TIA and stroke; it does not differentiate.
D - Fluctuating deficits are more characteristic of stroke or carotid artery disease, not TIA.
Reference: Easton, J. D., et al. (2009). Definition and evaluation of TIA. Stroke, 40(6), 2276-2293.
Q6. A patient with cirrhosis and ascites develops altered mental status, asterixis, and a serum
ammonia level of 120 mcg/dL. Which intervention is most appropriate to reduce ammonia
production?
A. Administer lactulose orally
B. Administer intravenous albumin
C. Insert a nasogastric tube for bowel decompression
D. Administer spironolactone
Correct Answer: A. Administer lactulose orally
Rationale: Lactulose works by acidifying the colon, converting NH3 to NH4+ which is trapped and
excreted, thereby reducing serum ammonia. It is first-line for hepatic encephalopathy. Albumin is used for
volume expansion in SBP or hepatorenal syndrome, not for ammonia reduction. Bowel decompression is
not indicated. Spironolactone is a diuretic for ascites but does not lower ammonia.
Why Wrong:
B - Albumin does not directly affect ammonia levels; it is used for other complications of cirrhosis.
C - Nasogastric decompression is not indicated; lactulose is given orally or via NG if needed.
D - Spironolactone treats ascites but does not reduce ammonia production.
Reference: Vilstrup, H., et al. (2014). Hepatic encephalopathy in chronic liver disease: 2014 Practice
Guideline by AASLD. Hepatology, 60(2), 715-735.
Page 4
