NU 189 Medical-Surgical Nursing II Exam Prep Document |
2026/2027 Edition | 250 Verified Questions
NU 189 Med-Surg II Exam 1-4 & Final QUESTIONS AND ANSWERS ALREADY GRADED A+. 100% Verified
Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive exam preparation resource for Galen College of Nursing's NU 189
Medical-Surgical Nursing II covers all major exams including Exam 1, 2, 3, 4, and the Final. With 250
verified questions and detailed answers, students can master key concepts in perioperative care, fluid
and electrolyte balance, cardiovascular disorders, respiratory management, and more. Designed to
mirror the actual exam format, this guide ensures thorough understanding and high performance. Ideal
for the 2026-2027 academic year.
Abstract:
This document provides a rigorous review of Medical-Surgical Nursing II as taught at Galen College of Nursing,
covering the entire course from Exam 1 through the Final Examination. Comprising 250 carefully selected
questions with verified answers, it addresses the core competencies required for safe and effective nursing care of
adult patients with complex health conditions. Topics include perioperative nursing, fluid and electrolyte
imbalances, cardiovascular disorders such as heart failure and myocardial infarction, respiratory conditions like
pneumonia and COPD, renal and endocrine emergencies, and neurological crises. Each question is accompanied
by a comprehensive rationale that explains not only the correct answer but also the underlying pathophysiology,
nursing interventions, and clinical reasoning. The content has been meticulously updated to align with the
2026-2027 academic year, integrating the latest evidence-based practice guidelines and NCLEX-RN test plan. This
resource serves as an indispensable tool for students aiming to achieve a top grade and excel in their clinical
practice.
Content Area Overview:
Content Area Questions Key Topics Weight
Perioperative Nursing 1-40 pre-operative assessment, intra-operative 16%
roles, post-operative complications, pain
management
Fluid & Electrolyte Imbalances 41-70 fluid volume deficits/excess, sodium and 12%
potassium imbalances, calcium and
magnesium disorders, IV therapy
Cardiovascular Disorders 71-110 hypertension, coronary artery disease, heart 16%
failure, arrhythmias, myocardial infarction
Respiratory Disorders 111-150 pneumonia, COPD, asthma, respiratory 16%
failure, chest tubes
Renal & Endocrine Disorders 151-190 acute kidney injury, chronic kidney disease, 16%
diabetes mellitus, thyroid disorders
Neurologic & Complex 191-250 stroke, seizures, increased intracranial 24%
Conditions pressure, shock, sepsis, burns
Page 1
,Q1. A patient with septic shock has received 30 mL/kg of crystalloid. Repeat assessment shows
central venous pressure 8 mm Hg, mean arterial pressure 62 mm Hg, and lactate 3.5 mmol/L.
Which intervention is most appropriate?
A. Continue IV fluid bolus at 20 mL/kg
B. Start norepinephrine infusion
C. Administer dobutamine
D. Obtain a focused cardiac ultrasound
Correct Answer: B. Start norepinephrine infusion
Rationale: The patient remains hypotensive despite adequate fluid resuscitation (CVP 8 mm Hg suggests
euvolemia). Per surviving sepsis guidelines, vasopressors (norepinephrine) are indicated after initial fluid
bolus when MAP remains below 65 mm Hg. Continuing fluids risks overload, dobutamine is for low
cardiac output, and ultrasound may be helpful but would delay necessary vasopressor initiation.
Why Wrong:
A - CVP is adequate; further fluid bolus increases risk of pulmonary edema without improving
perfusion.
C - Dobutamine is indicated for low cardiac output, not primarily for hypotension without signs of
myocardial dysfunction.
D - Focused cardiac ultrasound is a temporizing measure; vasopressor should be initiated
simultaneously if not already started.
Reference: Lewis, S.M. et al. (2023). Medical-Surgical Nursing, 11th ed., Ch. 14 (Shock) & Surviving
Sepsis Campaign Guidelines 2021.
Q2. A patient with a history of COPD and chronic hypercapnia presents with acute dyspnea.
Arterial blood gas: pH 7.30, PaCO 60 mm Hg, HCO 30 mEq/L, PaO 55 mm Hg on room air. What
is the interpretation?
A. Acute respiratory acidosis with metabolic compensation
B. Chronic respiratory acidosis with acute exacerbation
C. Mixed metabolic alkalosis and respiratory acidosis
D. Acute respiratory acidosis with no compensation
Correct Answer: B. Chronic respiratory acidosis with acute exacerbation
Rationale: The elevated HCO ƒ { (30 mEq/L) indicates chronic compensation for baseline hypercapnia.
The pH is acidic (7.30) and PaCO is high (60 mm Hg), reflecting an acute on chronic process. In chronic
respiratory acidosis, the expected HCO increases by 3-5 mEq/L per 10 mm Hg increase in PaCO. This
patient's HCO matches chronic compensation with an additional acute rise in PaCO.
Why Wrong:
A - Metabolic compensation would not be present in an acute-only acidosis; the elevated HCO
suggests chronicity.
C - Metabolic alkalosis would show pH >7.45 and HCO >30; here pH is low and PaCO high,
consistent with acidosis.
D - The HCO elevation indicates compensation, so it is not uncompensated.
Reference: Porth, C.M. (2023). Pathophysiology, 10th ed., Ch. 23 (Acid-Base Disorders).
Page 2
,Q3. A patient with 40% total body surface area burns arrives 2 hours after injury weighing 80 kg.
Using the Parkland formula, what is the total crystalloid volume to be infused in the first 24 hours?
A. 6,400 mL
B. 12,800 mL
C. 10,000 mL
D. 7,200 mL
Correct Answer: B. 12,800 mL
Rationale: The Parkland formula: 4 mL × weight (kg) × %TBSA. Here, 4 × 80 × 40 = 12,800 mL. Half is
given in the first 8 hours from the time of injury, and the remaining half over the next 16 hours. Since
arrival is at 2 hours, the first half (6,400 mL) must be infused over 6 hours (8 - 2 = 6).
Why Wrong:
A - 6,400 mL is only half of the calculated 24-hour volume.
C - 10,000 mL does not correspond to any standard calculation (4 × 80 × 40 = 12,800).
D - 7,200 mL would result from an incorrect formula, e.g., 2 mL/kg/%TBSA.
Reference: Lewis, S.M. et al. (2023). Medical-Surgical Nursing, 11th ed., Ch. 57 (Burn Care).
Q4. A patient with an inferior ST-elevation myocardial infarction develops hypotension, muffled
heart sounds, and jugular venous distention. The nurse suspects cardiac tamponade. Which
intervention is priority?
A. Administer IV fluid bolus 500 mL
B. Prepare for pericardiocentesis
C. Administer morphine for pain
D. Activate the cardiac catheterization lab
Correct Answer: B. Prepare for pericardiocentesis
Rationale: Cardiac tamponade requires immediate decompression via pericardiocentesis. While fluids
may temporarily support preload, definitive treatment is drainage of pericardial fluid. The triad of
hypotension, muffled heart sounds, and JVD (Beck's triad) is classic for tamponade. Morphine can
worsen hypotension; activation of cath lab is appropriate for STEMI but not tamponade.
Why Wrong:
A - IV fluids are a temporizing measure but do not relieve tamponade; pericardiocentesis is
definitive.
C - Morphine may reduce preload and exacerbate hypotension in tamponade.
D - Cardiac catheterization would be for revascularization of STEMI, but tamponade requires
immediate pericardiocentesis.
Reference: Lewis, S.M. et al. (2023). Medical-Surgical Nursing, 11th ed., Ch. 33 (Cardiovascular
Disorders).
Page 3
, Q5. A patient with acute ischemic stroke has an INR of 2.8. Which factor most contraindicates
administration of alteplase?
A. Onset of symptoms 3 hours ago
B. Blood pressure 185/110 mm Hg
C. INR 2.8
D. Platelet count 120,000/mm³
Correct Answer: C. INR 2.8
Rationale: Alteplase is contraindicated if INR >1.7 in patients on warfarin. An INR of 2.8 indicates high
bleeding risk. Onset within 3 hours is within the window, BP >185/110 is a contraindication if not
controlled, but options only list the BP value without stating if it is sustained. Platelet count >100,000 is
acceptable. However, INR is an absolute contraindication.
Why Wrong:
A - Onset within 3 hours is within the standard 4.5-hour window for alteplase, so not
contraindicated.
B - BP >185/110 is a contraindication only if it does not respond to treatment; the question does not
indicate failed control, so it is less absolute than INR.
D - Platelet count 120,000/mm³ is above the minimum of 100,000, so not a contraindication.
Reference: American Heart Association. (2023). Guidelines for the Early Management of Patients With
Acute Ischemic Stroke.
Q6. A patient with sepsis develops petechiae, prolonged PT/PTT, elevated D-dimer, and fibrinogen
80 mg/dL. Which condition is most likely?
A. Thrombotic thrombocytopenic purpura
B. Heparin-induced thrombocytopenia
C. Disseminated intravascular coagulation
D. Immune thrombocytopenia
Correct Answer: C. Disseminated intravascular coagulation
Rationale: The combination of microvascular bleeding (petechiae), prolonged coagulation times, elevated
D-dimer (fibrin degradation), and low fibrinogen is classic for disseminated intravascular coagulation
(DIC). DIC often complicates sepsis. TTP shows microangiopathic hemolytic anemia and low platelets
but normal PT/PTT; HIT is related to heparin; ITP has low platelets only.
Why Wrong:
A - TTP features thrombocytopenia, microangiopathic hemolytic anemia, fever, neurological
changes, and renal dysfunction, not prolonged PT/PTT.
B - HIT occurs after heparin exposure and presents with thrombocytopenia and thrombosis, not
prolonged PT/PTT and low fibrinogen.
D - ITP is isolated thrombocytopenia without coagulation factor depletion.
Reference: Levi, M. (2022). Management of Disseminated Intravascular Coagulation. New England
Journal of Medicine, 386(23), 2200-2211.
Page 4
2026/2027 Edition | 250 Verified Questions
NU 189 Med-Surg II Exam 1-4 & Final QUESTIONS AND ANSWERS ALREADY GRADED A+. 100% Verified
Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive exam preparation resource for Galen College of Nursing's NU 189
Medical-Surgical Nursing II covers all major exams including Exam 1, 2, 3, 4, and the Final. With 250
verified questions and detailed answers, students can master key concepts in perioperative care, fluid
and electrolyte balance, cardiovascular disorders, respiratory management, and more. Designed to
mirror the actual exam format, this guide ensures thorough understanding and high performance. Ideal
for the 2026-2027 academic year.
Abstract:
This document provides a rigorous review of Medical-Surgical Nursing II as taught at Galen College of Nursing,
covering the entire course from Exam 1 through the Final Examination. Comprising 250 carefully selected
questions with verified answers, it addresses the core competencies required for safe and effective nursing care of
adult patients with complex health conditions. Topics include perioperative nursing, fluid and electrolyte
imbalances, cardiovascular disorders such as heart failure and myocardial infarction, respiratory conditions like
pneumonia and COPD, renal and endocrine emergencies, and neurological crises. Each question is accompanied
by a comprehensive rationale that explains not only the correct answer but also the underlying pathophysiology,
nursing interventions, and clinical reasoning. The content has been meticulously updated to align with the
2026-2027 academic year, integrating the latest evidence-based practice guidelines and NCLEX-RN test plan. This
resource serves as an indispensable tool for students aiming to achieve a top grade and excel in their clinical
practice.
Content Area Overview:
Content Area Questions Key Topics Weight
Perioperative Nursing 1-40 pre-operative assessment, intra-operative 16%
roles, post-operative complications, pain
management
Fluid & Electrolyte Imbalances 41-70 fluid volume deficits/excess, sodium and 12%
potassium imbalances, calcium and
magnesium disorders, IV therapy
Cardiovascular Disorders 71-110 hypertension, coronary artery disease, heart 16%
failure, arrhythmias, myocardial infarction
Respiratory Disorders 111-150 pneumonia, COPD, asthma, respiratory 16%
failure, chest tubes
Renal & Endocrine Disorders 151-190 acute kidney injury, chronic kidney disease, 16%
diabetes mellitus, thyroid disorders
Neurologic & Complex 191-250 stroke, seizures, increased intracranial 24%
Conditions pressure, shock, sepsis, burns
Page 1
,Q1. A patient with septic shock has received 30 mL/kg of crystalloid. Repeat assessment shows
central venous pressure 8 mm Hg, mean arterial pressure 62 mm Hg, and lactate 3.5 mmol/L.
Which intervention is most appropriate?
A. Continue IV fluid bolus at 20 mL/kg
B. Start norepinephrine infusion
C. Administer dobutamine
D. Obtain a focused cardiac ultrasound
Correct Answer: B. Start norepinephrine infusion
Rationale: The patient remains hypotensive despite adequate fluid resuscitation (CVP 8 mm Hg suggests
euvolemia). Per surviving sepsis guidelines, vasopressors (norepinephrine) are indicated after initial fluid
bolus when MAP remains below 65 mm Hg. Continuing fluids risks overload, dobutamine is for low
cardiac output, and ultrasound may be helpful but would delay necessary vasopressor initiation.
Why Wrong:
A - CVP is adequate; further fluid bolus increases risk of pulmonary edema without improving
perfusion.
C - Dobutamine is indicated for low cardiac output, not primarily for hypotension without signs of
myocardial dysfunction.
D - Focused cardiac ultrasound is a temporizing measure; vasopressor should be initiated
simultaneously if not already started.
Reference: Lewis, S.M. et al. (2023). Medical-Surgical Nursing, 11th ed., Ch. 14 (Shock) & Surviving
Sepsis Campaign Guidelines 2021.
Q2. A patient with a history of COPD and chronic hypercapnia presents with acute dyspnea.
Arterial blood gas: pH 7.30, PaCO 60 mm Hg, HCO 30 mEq/L, PaO 55 mm Hg on room air. What
is the interpretation?
A. Acute respiratory acidosis with metabolic compensation
B. Chronic respiratory acidosis with acute exacerbation
C. Mixed metabolic alkalosis and respiratory acidosis
D. Acute respiratory acidosis with no compensation
Correct Answer: B. Chronic respiratory acidosis with acute exacerbation
Rationale: The elevated HCO ƒ { (30 mEq/L) indicates chronic compensation for baseline hypercapnia.
The pH is acidic (7.30) and PaCO is high (60 mm Hg), reflecting an acute on chronic process. In chronic
respiratory acidosis, the expected HCO increases by 3-5 mEq/L per 10 mm Hg increase in PaCO. This
patient's HCO matches chronic compensation with an additional acute rise in PaCO.
Why Wrong:
A - Metabolic compensation would not be present in an acute-only acidosis; the elevated HCO
suggests chronicity.
C - Metabolic alkalosis would show pH >7.45 and HCO >30; here pH is low and PaCO high,
consistent with acidosis.
D - The HCO elevation indicates compensation, so it is not uncompensated.
Reference: Porth, C.M. (2023). Pathophysiology, 10th ed., Ch. 23 (Acid-Base Disorders).
Page 2
,Q3. A patient with 40% total body surface area burns arrives 2 hours after injury weighing 80 kg.
Using the Parkland formula, what is the total crystalloid volume to be infused in the first 24 hours?
A. 6,400 mL
B. 12,800 mL
C. 10,000 mL
D. 7,200 mL
Correct Answer: B. 12,800 mL
Rationale: The Parkland formula: 4 mL × weight (kg) × %TBSA. Here, 4 × 80 × 40 = 12,800 mL. Half is
given in the first 8 hours from the time of injury, and the remaining half over the next 16 hours. Since
arrival is at 2 hours, the first half (6,400 mL) must be infused over 6 hours (8 - 2 = 6).
Why Wrong:
A - 6,400 mL is only half of the calculated 24-hour volume.
C - 10,000 mL does not correspond to any standard calculation (4 × 80 × 40 = 12,800).
D - 7,200 mL would result from an incorrect formula, e.g., 2 mL/kg/%TBSA.
Reference: Lewis, S.M. et al. (2023). Medical-Surgical Nursing, 11th ed., Ch. 57 (Burn Care).
Q4. A patient with an inferior ST-elevation myocardial infarction develops hypotension, muffled
heart sounds, and jugular venous distention. The nurse suspects cardiac tamponade. Which
intervention is priority?
A. Administer IV fluid bolus 500 mL
B. Prepare for pericardiocentesis
C. Administer morphine for pain
D. Activate the cardiac catheterization lab
Correct Answer: B. Prepare for pericardiocentesis
Rationale: Cardiac tamponade requires immediate decompression via pericardiocentesis. While fluids
may temporarily support preload, definitive treatment is drainage of pericardial fluid. The triad of
hypotension, muffled heart sounds, and JVD (Beck's triad) is classic for tamponade. Morphine can
worsen hypotension; activation of cath lab is appropriate for STEMI but not tamponade.
Why Wrong:
A - IV fluids are a temporizing measure but do not relieve tamponade; pericardiocentesis is
definitive.
C - Morphine may reduce preload and exacerbate hypotension in tamponade.
D - Cardiac catheterization would be for revascularization of STEMI, but tamponade requires
immediate pericardiocentesis.
Reference: Lewis, S.M. et al. (2023). Medical-Surgical Nursing, 11th ed., Ch. 33 (Cardiovascular
Disorders).
Page 3
, Q5. A patient with acute ischemic stroke has an INR of 2.8. Which factor most contraindicates
administration of alteplase?
A. Onset of symptoms 3 hours ago
B. Blood pressure 185/110 mm Hg
C. INR 2.8
D. Platelet count 120,000/mm³
Correct Answer: C. INR 2.8
Rationale: Alteplase is contraindicated if INR >1.7 in patients on warfarin. An INR of 2.8 indicates high
bleeding risk. Onset within 3 hours is within the window, BP >185/110 is a contraindication if not
controlled, but options only list the BP value without stating if it is sustained. Platelet count >100,000 is
acceptable. However, INR is an absolute contraindication.
Why Wrong:
A - Onset within 3 hours is within the standard 4.5-hour window for alteplase, so not
contraindicated.
B - BP >185/110 is a contraindication only if it does not respond to treatment; the question does not
indicate failed control, so it is less absolute than INR.
D - Platelet count 120,000/mm³ is above the minimum of 100,000, so not a contraindication.
Reference: American Heart Association. (2023). Guidelines for the Early Management of Patients With
Acute Ischemic Stroke.
Q6. A patient with sepsis develops petechiae, prolonged PT/PTT, elevated D-dimer, and fibrinogen
80 mg/dL. Which condition is most likely?
A. Thrombotic thrombocytopenic purpura
B. Heparin-induced thrombocytopenia
C. Disseminated intravascular coagulation
D. Immune thrombocytopenia
Correct Answer: C. Disseminated intravascular coagulation
Rationale: The combination of microvascular bleeding (petechiae), prolonged coagulation times, elevated
D-dimer (fibrin degradation), and low fibrinogen is classic for disseminated intravascular coagulation
(DIC). DIC often complicates sepsis. TTP shows microangiopathic hemolytic anemia and low platelets
but normal PT/PTT; HIT is related to heparin; ITP has low platelets only.
Why Wrong:
A - TTP features thrombocytopenia, microangiopathic hemolytic anemia, fever, neurological
changes, and renal dysfunction, not prolonged PT/PTT.
B - HIT occurs after heparin exposure and presents with thrombocytopenia and thrombosis, not
prolonged PT/PTT and low fibrinogen.
D - ITP is isolated thrombocytopenia without coagulation factor depletion.
Reference: Levi, M. (2022). Management of Disseminated Intravascular Coagulation. New England
Journal of Medicine, 386(23), 2200-2211.
Page 4
