NU 155 Exam 3 2026/2027 | Galen College of Nursing | Medical-Surgical Nursing
I | Comprehensive Practice Examination | High-Yield Questions, Answers &
Detailed Rationales | Cardiovascular, Respiratory, Wound Care, Pain
Management, Fluid & Electrolytes, Safety & Clinical Judgment | Complete Exam
Prep Guide
Question 1
A 68-year-old patient with heart failure presents with jugular venous distention, peripheral edema,
and crackles auscultated in both lung bases. The patient's serum sodium is 128 mEq/L. Which
intervention should the nurse anticipate implementing first?
A. Restrict oral fluid intake to 1,000 mL daily
B. Administer 3% normal saline at 50 mL/hr
C. Encourage increased oral fluid intake
D. Place the patient in Trendelenburg position
Correct Answer: A
Explanation: Fluid restriction is the initial intervention for hypervolemia with dilutional hyponatremia.
This addresses the underlying fluid overload while preventing complications such as pulmonary
edema.
Question 2
The nurse is caring for a patient who has a serum potassium level of 6.8 mEq/L. Which
electrocardiographic change should the nurse expect to observe?
A. Peaked T waves
B. Flattened T waves
C. Prominent U waves
,D. Prolonged PR interval
Correct Answer: A
Explanation: Peaked, tented T waves are the earliest and most characteristic ECG finding in
hyperkalemia. This life-threatening dysrhythmia requires immediate intervention to prevent cardiac
arrest.
Question 3
A patient undergoing chemotherapy develops severe nausea and vomiting for 48 hours. Laboratory
results reveal serum sodium of 130 mEq/L, potassium of 3.2 mEq/L, and chloride of 88 mEq/L. Which
intravenous fluid should the nurse anticipate administering?
A. 0.9% normal saline with 20 mEq KCl/L
B. 5% dextrose in water
C. 0.45% normal saline
D. 3% normal saline
Correct Answer: A
Explanation: This patient has hypovolemic hyponatremia with concurrent hypokalemia from
gastrointestinal losses. Isotonic saline with potassium replacement addresses both volume depletion
and electrolyte deficits.
Question 4
The nurse is assessing a patient with severe hypercalcemia secondary to malignancy. Which clinical
manifestation requires immediate nursing intervention?
A. Muscle cramps and paresthesias
B. Lethargy and confusion
C. Polyuria and polydipsia
,D. Positive Chvostek's sign
Correct Answer: B
Explanation: Lethargy and confusion indicate neurological impairment from severe hypercalcemia,
which can progress to coma. This requires emergency treatment with calcitonin and hydration.
Question 5
A patient with chronic kidney disease has a serum magnesium level of 3.8 mEq/L. Which medication
should the nurse question if prescribed?
A. Calcium gluconate
B. Magnesium hydroxide
C. Sodium polystyrene sulfonate
D. Sevelamer carbonate
Correct Answer: B
Explanation: Magnesium-containing antacids and laxatives must be avoided in renal failure as they
exacerbate hypermagnesemia. Magnesium hydroxide would further increase already elevated serum
magnesium levels.
Question 6
The nurse is preparing to administer intravenous potassium chloride to a patient. Which action is
essential for patient safety?
A. Administer the potassium as a rapid intravenous push
B. Infuse the potassium at a rate not exceeding 10 mEq/hr
C. Dilute the potassium in 50 mL of normal saline for IV push
D. Administer through a peripheral IV at 40 mEq/hr
, Correct Answer: B
Explanation: Intravenous potassium must never exceed 10 mEq/hr through a peripheral line. Rapid
administration can cause fatal cardiac arrhythmias, including ventricular fibrillation and cardiac arrest.
Question 7
A patient's arterial blood gas results show: pH 7.31, PaCO₂ 52 mmHg, HCO₃⁻ 24 mEq/L. Which nursing
intervention is most appropriate?
A. Administer sodium bicarbonate intravenously
B. Encourage deep breathing and coughing
C. Position the patient in high Fowler's position
D. Prepare for mechanical ventilation
Correct Answer: C
Explanation: The ABG reveals respiratory acidosis (elevated PaCO₂). High Fowler's position optimizes
diaphragmatic excursion and lung expansion, improving ventilation and CO₂ elimination.
Question 8
A patient with diabetic ketoacidosis has the following ABG results: pH 7.25, PaCO₂ 30 mmHg, HCO₃⁻ 14
mEq/L. Which compensatory mechanism is occurring?
A. Metabolic acidosis with respiratory compensation
B. Respiratory acidosis with metabolic compensation
C. Metabolic alkalosis with respiratory compensation
D. Respiratory alkalosis with metabolic compensation
Correct Answer: A
I | Comprehensive Practice Examination | High-Yield Questions, Answers &
Detailed Rationales | Cardiovascular, Respiratory, Wound Care, Pain
Management, Fluid & Electrolytes, Safety & Clinical Judgment | Complete Exam
Prep Guide
Question 1
A 68-year-old patient with heart failure presents with jugular venous distention, peripheral edema,
and crackles auscultated in both lung bases. The patient's serum sodium is 128 mEq/L. Which
intervention should the nurse anticipate implementing first?
A. Restrict oral fluid intake to 1,000 mL daily
B. Administer 3% normal saline at 50 mL/hr
C. Encourage increased oral fluid intake
D. Place the patient in Trendelenburg position
Correct Answer: A
Explanation: Fluid restriction is the initial intervention for hypervolemia with dilutional hyponatremia.
This addresses the underlying fluid overload while preventing complications such as pulmonary
edema.
Question 2
The nurse is caring for a patient who has a serum potassium level of 6.8 mEq/L. Which
electrocardiographic change should the nurse expect to observe?
A. Peaked T waves
B. Flattened T waves
C. Prominent U waves
,D. Prolonged PR interval
Correct Answer: A
Explanation: Peaked, tented T waves are the earliest and most characteristic ECG finding in
hyperkalemia. This life-threatening dysrhythmia requires immediate intervention to prevent cardiac
arrest.
Question 3
A patient undergoing chemotherapy develops severe nausea and vomiting for 48 hours. Laboratory
results reveal serum sodium of 130 mEq/L, potassium of 3.2 mEq/L, and chloride of 88 mEq/L. Which
intravenous fluid should the nurse anticipate administering?
A. 0.9% normal saline with 20 mEq KCl/L
B. 5% dextrose in water
C. 0.45% normal saline
D. 3% normal saline
Correct Answer: A
Explanation: This patient has hypovolemic hyponatremia with concurrent hypokalemia from
gastrointestinal losses. Isotonic saline with potassium replacement addresses both volume depletion
and electrolyte deficits.
Question 4
The nurse is assessing a patient with severe hypercalcemia secondary to malignancy. Which clinical
manifestation requires immediate nursing intervention?
A. Muscle cramps and paresthesias
B. Lethargy and confusion
C. Polyuria and polydipsia
,D. Positive Chvostek's sign
Correct Answer: B
Explanation: Lethargy and confusion indicate neurological impairment from severe hypercalcemia,
which can progress to coma. This requires emergency treatment with calcitonin and hydration.
Question 5
A patient with chronic kidney disease has a serum magnesium level of 3.8 mEq/L. Which medication
should the nurse question if prescribed?
A. Calcium gluconate
B. Magnesium hydroxide
C. Sodium polystyrene sulfonate
D. Sevelamer carbonate
Correct Answer: B
Explanation: Magnesium-containing antacids and laxatives must be avoided in renal failure as they
exacerbate hypermagnesemia. Magnesium hydroxide would further increase already elevated serum
magnesium levels.
Question 6
The nurse is preparing to administer intravenous potassium chloride to a patient. Which action is
essential for patient safety?
A. Administer the potassium as a rapid intravenous push
B. Infuse the potassium at a rate not exceeding 10 mEq/hr
C. Dilute the potassium in 50 mL of normal saline for IV push
D. Administer through a peripheral IV at 40 mEq/hr
, Correct Answer: B
Explanation: Intravenous potassium must never exceed 10 mEq/hr through a peripheral line. Rapid
administration can cause fatal cardiac arrhythmias, including ventricular fibrillation and cardiac arrest.
Question 7
A patient's arterial blood gas results show: pH 7.31, PaCO₂ 52 mmHg, HCO₃⁻ 24 mEq/L. Which nursing
intervention is most appropriate?
A. Administer sodium bicarbonate intravenously
B. Encourage deep breathing and coughing
C. Position the patient in high Fowler's position
D. Prepare for mechanical ventilation
Correct Answer: C
Explanation: The ABG reveals respiratory acidosis (elevated PaCO₂). High Fowler's position optimizes
diaphragmatic excursion and lung expansion, improving ventilation and CO₂ elimination.
Question 8
A patient with diabetic ketoacidosis has the following ABG results: pH 7.25, PaCO₂ 30 mmHg, HCO₃⁻ 14
mEq/L. Which compensatory mechanism is occurring?
A. Metabolic acidosis with respiratory compensation
B. Respiratory acidosis with metabolic compensation
C. Metabolic alkalosis with respiratory compensation
D. Respiratory alkalosis with metabolic compensation
Correct Answer: A
