NU 155 Exam 1, 2, 3 & Final Exam – Medical-
Surgical Nursing I (Galen College of Nursing)
2026 | Complete Study Guide | Verified
Questions, Correct Answers & Rationales |
Comprehensive Exam Prep
NU 155 MEDICAL-SURGICAL NURSING I COMPREHENSIVE EXAM PREPARATION
DOCUMENT OVERVIEW ─────────────────
• Complete question study guide covering all major medical-surgical nursing topics;
use this material to test your mastery across fluid/electrolytes, cardiovascular,
respiratory, GI, renal, neurological, endocrine, and perioperative nursing content.
• Study strategy: Work through sections systematically, review rationales carefully
to deepen understanding, and reattempt challenging questions until you
consistently score 85% or higher on all topic areas.
═══════════════════════════════════════════════════════
══════════════════════
QUESTIONS 1–50: FLUID, ELECTROLYTE & ACID-BASE BALANCE
═══════════════════════════════════════════════════════
══════════════════════
1. A 68-year-old male patient presents with serum sodium of 128 mEq/L.
Which clinical manifestation would the nurse expect to assess?
A) Hyperreflexia and muscle rigidity
B) Lethargy, confusion, and possible seizures
C) Thirst and dry mucous membranes
D) Polydipsia and polyuria
E) Elevated blood pressure and tachycardia
CORRECT ANSWER: B) Lethargy, confusion, and possible seizures
Rationale: Hyponatremia (sodium <130 mEq/L) causes cerebral edema as water
shifts into cells. This results in altered mental status, lethargy, confusion, headache,
and potentially seizures or coma if severe. The patient's sodium level of 128 mEq/L
,is moderately low. Hyperreflexia occurs with hypernatremia, not hyponatremia.
Thirst and dry mucous membranes are signs of hypernatremia. The other options
represent incorrect or opposite manifestations of electrolyte imbalance.
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────────────────────────
2. Which IV fluid would be most appropriate for a patient with severe
hyponatremia who is symptomatic?
A) 0.45% sodium chloride solution
B) 3% sodium chloride solution
C) 5% dextrose in water
D) Lactated Ringer's solution
E) 0.9% sodium chloride solution
CORRECT ANSWER: B) 3% sodium chloride solution
Rationale: Symptomatic hyponatremia (with seizures, altered mental status, or
severe neurological symptoms) requires hypertonic saline (3% NaCl) to raise serum
sodium rapidly and prevent cerebral edema or cerebral herniation. However,
correction must be gradual (8–10 mEq/L per 24 hours) to prevent osmotic
demyelination syndrome. Hypotonic solutions (0.45% or 5% dextrose) would
worsen hyponatremia. Isotonic solutions (0.9%, LR) are too dilute for symptomatic
cases.
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────────────────────────
3. A patient receiving furosemide diuretic therapy develops muscle cramps
and weakness. What electrolyte imbalance is most likely responsible?
A) Hypermagnesemia
B) Hypokalemia
C) Hypercalcemia
D) Hyperphosphatemia
,E) Hypernatremia
CORRECT ANSWER: B) Hypokalemia
Rationale: Loop diuretics like furosemide increase renal excretion of potassium,
leading to hypokalemia. Low serum potassium (<3.5 mEq/L) disrupts cellular
function and causes muscle weakness, cramps, fatigue, and potentially cardiac
arrhythmias. Patients on chronic diuretics require potassium supplementation and
monitoring. The other electrolyte abnormalities do not typically cause these
symptoms in the setting of diuretic use.
───────────────────────────────────────────────────────
────────────────────────
4. A patient has serum potassium of 6.8 mEq/L. Which ECG change would the
nurse anticipate observing first?
A) Prolonged QT interval
B) Peaked (tented) T waves
C) Widened QRS complex
D) Flattened P waves
E) ST segment elevation
CORRECT ANSWER: B) Peaked (tented) T waves
Rationale: Hyperkalemia progressively affects the heart in a predictable sequence:
peaked T waves appear first (earliest sign at K+ >6 mEq/L), followed by PR
prolongation, widened QRS, flattened P waves, and eventually bradycardia and
cardiac arrest if untreated. The peaked T wave is the hallmark early ECG finding in
hyperkalemia and should prompt immediate intervention. This precedes the more
severe ECG changes.
───────────────────────────────────────────────────────
────────────────────────
5. The nurse is treating a patient with hyperkalemia. Which medication acts
most rapidly to lower serum potassium?
A) Sodium polystyrene sulfonate (Kayexalate)
, B) Sodium bicarbonate
C) Calcium gluconate
D) Regular insulin with dextrose
E) Spironolactone
CORRECT ANSWER: D) Regular insulin with dextrose
Rationale: Insulin shifts potassium intracellularly within 10–20 minutes by
stimulating the Na-K-ATPase pump, making it one of the fastest methods to lower
serum potassium. Dextrose is given concurrently to prevent hypoglycemia. Calcium
gluconate stabilizes the cardiac membrane (does not lower K+) and acts within
minutes. Sodium bicarbonate works in 30–60 minutes. Kayexalate takes hours and
is used for chronic management. Spironolactone prevents renal potassium
excretion and worsens hyperkalemia.
───────────────────────────────────────────────────────
────────────────────────
6. A patient with acute kidney injury has calcium level of 7.2 mg/dL. Which
clinical manifestation is most concerning?
A) Constipation and polyuria
B) Muscle tetany and positive Chvostek's sign
C) Lethargy and confusion
D) Hypertension and tachycardia
E) Hyperactive bowel sounds and diarrhea
CORRECT ANSWER: B) Muscle tetany and positive Chvostek's sign
Rationale: Hypocalcemia (normal: 8.5–10.5 mg/dL) causes increased neuromuscular
excitability, resulting in muscle tetany, tremors, paresthesias, and positive
Chvostek's and Trousseau's signs. Severe hypocalcemia can lead to laryngospasm,
seizures, or tetany—life-threatening emergencies. These signs reflect
hyperexcitability of nerves and muscles due to calcium's role in membrane stability.
The other options are associated with hypercalcemia or other conditions.
Surgical Nursing I (Galen College of Nursing)
2026 | Complete Study Guide | Verified
Questions, Correct Answers & Rationales |
Comprehensive Exam Prep
NU 155 MEDICAL-SURGICAL NURSING I COMPREHENSIVE EXAM PREPARATION
DOCUMENT OVERVIEW ─────────────────
• Complete question study guide covering all major medical-surgical nursing topics;
use this material to test your mastery across fluid/electrolytes, cardiovascular,
respiratory, GI, renal, neurological, endocrine, and perioperative nursing content.
• Study strategy: Work through sections systematically, review rationales carefully
to deepen understanding, and reattempt challenging questions until you
consistently score 85% or higher on all topic areas.
═══════════════════════════════════════════════════════
══════════════════════
QUESTIONS 1–50: FLUID, ELECTROLYTE & ACID-BASE BALANCE
═══════════════════════════════════════════════════════
══════════════════════
1. A 68-year-old male patient presents with serum sodium of 128 mEq/L.
Which clinical manifestation would the nurse expect to assess?
A) Hyperreflexia and muscle rigidity
B) Lethargy, confusion, and possible seizures
C) Thirst and dry mucous membranes
D) Polydipsia and polyuria
E) Elevated blood pressure and tachycardia
CORRECT ANSWER: B) Lethargy, confusion, and possible seizures
Rationale: Hyponatremia (sodium <130 mEq/L) causes cerebral edema as water
shifts into cells. This results in altered mental status, lethargy, confusion, headache,
and potentially seizures or coma if severe. The patient's sodium level of 128 mEq/L
,is moderately low. Hyperreflexia occurs with hypernatremia, not hyponatremia.
Thirst and dry mucous membranes are signs of hypernatremia. The other options
represent incorrect or opposite manifestations of electrolyte imbalance.
───────────────────────────────────────────────────────
────────────────────────
2. Which IV fluid would be most appropriate for a patient with severe
hyponatremia who is symptomatic?
A) 0.45% sodium chloride solution
B) 3% sodium chloride solution
C) 5% dextrose in water
D) Lactated Ringer's solution
E) 0.9% sodium chloride solution
CORRECT ANSWER: B) 3% sodium chloride solution
Rationale: Symptomatic hyponatremia (with seizures, altered mental status, or
severe neurological symptoms) requires hypertonic saline (3% NaCl) to raise serum
sodium rapidly and prevent cerebral edema or cerebral herniation. However,
correction must be gradual (8–10 mEq/L per 24 hours) to prevent osmotic
demyelination syndrome. Hypotonic solutions (0.45% or 5% dextrose) would
worsen hyponatremia. Isotonic solutions (0.9%, LR) are too dilute for symptomatic
cases.
───────────────────────────────────────────────────────
────────────────────────
3. A patient receiving furosemide diuretic therapy develops muscle cramps
and weakness. What electrolyte imbalance is most likely responsible?
A) Hypermagnesemia
B) Hypokalemia
C) Hypercalcemia
D) Hyperphosphatemia
,E) Hypernatremia
CORRECT ANSWER: B) Hypokalemia
Rationale: Loop diuretics like furosemide increase renal excretion of potassium,
leading to hypokalemia. Low serum potassium (<3.5 mEq/L) disrupts cellular
function and causes muscle weakness, cramps, fatigue, and potentially cardiac
arrhythmias. Patients on chronic diuretics require potassium supplementation and
monitoring. The other electrolyte abnormalities do not typically cause these
symptoms in the setting of diuretic use.
───────────────────────────────────────────────────────
────────────────────────
4. A patient has serum potassium of 6.8 mEq/L. Which ECG change would the
nurse anticipate observing first?
A) Prolonged QT interval
B) Peaked (tented) T waves
C) Widened QRS complex
D) Flattened P waves
E) ST segment elevation
CORRECT ANSWER: B) Peaked (tented) T waves
Rationale: Hyperkalemia progressively affects the heart in a predictable sequence:
peaked T waves appear first (earliest sign at K+ >6 mEq/L), followed by PR
prolongation, widened QRS, flattened P waves, and eventually bradycardia and
cardiac arrest if untreated. The peaked T wave is the hallmark early ECG finding in
hyperkalemia and should prompt immediate intervention. This precedes the more
severe ECG changes.
───────────────────────────────────────────────────────
────────────────────────
5. The nurse is treating a patient with hyperkalemia. Which medication acts
most rapidly to lower serum potassium?
A) Sodium polystyrene sulfonate (Kayexalate)
, B) Sodium bicarbonate
C) Calcium gluconate
D) Regular insulin with dextrose
E) Spironolactone
CORRECT ANSWER: D) Regular insulin with dextrose
Rationale: Insulin shifts potassium intracellularly within 10–20 minutes by
stimulating the Na-K-ATPase pump, making it one of the fastest methods to lower
serum potassium. Dextrose is given concurrently to prevent hypoglycemia. Calcium
gluconate stabilizes the cardiac membrane (does not lower K+) and acts within
minutes. Sodium bicarbonate works in 30–60 minutes. Kayexalate takes hours and
is used for chronic management. Spironolactone prevents renal potassium
excretion and worsens hyperkalemia.
───────────────────────────────────────────────────────
────────────────────────
6. A patient with acute kidney injury has calcium level of 7.2 mg/dL. Which
clinical manifestation is most concerning?
A) Constipation and polyuria
B) Muscle tetany and positive Chvostek's sign
C) Lethargy and confusion
D) Hypertension and tachycardia
E) Hyperactive bowel sounds and diarrhea
CORRECT ANSWER: B) Muscle tetany and positive Chvostek's sign
Rationale: Hypocalcemia (normal: 8.5–10.5 mg/dL) causes increased neuromuscular
excitability, resulting in muscle tetany, tremors, paresthesias, and positive
Chvostek's and Trousseau's signs. Severe hypocalcemia can lead to laryngospasm,
seizures, or tetany—life-threatening emergencies. These signs reflect
hyperexcitability of nerves and muscles due to calcium's role in membrane stability.
The other options are associated with hypercalcemia or other conditions.
