NU 185 Exam 4: Advanced Medical-Surgical Nursing … 2026/2027 • Verified • Assured Grade A+
✓ VERIFIED • 2026/2027 UPDATE • 100% ACCURATE
NU 185 Exam 4: Advanced Medical-Surgical Nursing II
Comprehensive Review 2026/2027 UPDATE |Galen College
ACTUAL EXAM QUESTIONS & VERIFIED ANSWERS
with Clear, Detailed Rationales
Document Type: Exam (Elaborations) / Study Guide
Academic Year:
Total Questions: 50 Multiple Choice
Includes: Correct Answers + Rationales
Grade: A+ Assured
ASSURED GRADE A+
Exam (Elaborations) • Detailed Rationales Page 1
,NU 185 Exam 4: Advanced Medical-Surgical Nursing … 2026/2027 • Verified • Assured Grade A+
Questions & Verified Answers
1. A patient with Diabetic Ketoacidosis (DKA) is receiving a continuous insulin infusion. The
nurse notes the blood glucose has dropped from 550 mg/dL to 240 mg/dL. What is the most
appropriate next action?
A. is receiving a continuous insulin infusion. The nurse notes the blood glucose has dropped from 550
mg/dL to 240 mg/dL. What is the most appropriate next action?
B. Increase the rate of the insulin infusion to ensure ketosis is resolved.
C. Discontinue the insulin infusion immediately.
D. Administer subcutaneous glargine and stop the IV pump.
Answer: A
Rationale: When blood glucose levels reach approximately 250 mg/dL in DKA, dextrose is added to
the IV fluids (usually D5 0.45% NS) to prevent rapid drops in glucose and cerebral edema while the
insulin continues to clear ketones. In practice, this guides the nurse to set priorities and protect the
client from harm. Safety, nutrition, and clear communication are frequent priorities. Understanding this
helps the nurse notice early warning signs and act before the problem gets worse. Early action often
prevents bigger complications for the client.
2. A nurse is caring for a patient with Syndrome of Inappropriate Antidiuretic Hormone
(SIADH). Which laboratory finding is most consistent with this diagnosis?
A. Serum sodium 150 mEq/L and Urine Specific Gravity 1.002
B. Serum sodium 122 mEq/L and Urine Specific Gravity 1.035
C. Serum osmolality 310 mOsm/kg and polyuria
D. Blood Urea Nitrogen (BUN) 35 mg/dL and dehydration
Answer: B
Rationale: SIADH is characterized by excessive ADH, leading to water retention, dilutional
hyponatremia (sodium < 135), and highly concentrated urine (high specific gravity). This knowledge
supports safe care and helps the nurse teach the client and family clearly and simply. Clear teaching
improves cooperation and reduces anxiety. Clear understanding of this concept improves both test
performance and everyday clinical judgment. Practice applying it to short case scenarios to lock the
idea in place.
Exam (Elaborations) • Detailed Rationales Page 2
, NU 185 Exam 4: Advanced Medical-Surgical Nursing … 2026/2027 • Verified • Assured Grade A+
3. A patient with a head injury exhibits a blood pressure of 180/60 mmHg, a pulse of 48 bpm,
and irregular respirations. Which condition should the nurse suspect?
A. Neurogenic Shock
B. Hypovolemic Shock
C. Increased Intracranial Pressure (ICP)
D. Cardiac Tamponade
Answer: C
Rationale: The combination of systolic hypertension with a widening pulse pressure, bradycardia, and
irregular respirations is known as Cushing’s Triad, a late sign of increased ICP. In practice, this guides
the nurse to set priorities and protect the client from harm. Safety, nutrition, and clear communication
are frequent priorities. Understanding this helps the nurse notice early warning signs and act before
the problem gets worse. Early action often prevents bigger complications for the client.
4. In the management of Hyperosmolar Hyperglycemic State (HHS), which intervention is the
priority?
A. Low-dose IV insulin to correct hyperkalemia
B. Administration of bicarbonate for metabolic acidosis
C. Aggressive fluid resuscitation with Normal Saline
D. Initiating hemodialysis to remove excess glucose
Answer: C
Rationale: HHS involves extreme dehydration. The priority is vigorous fluid replacement to restore
circulatory volume and renal perfusion, usually before starting insulin. This is important because the
nurse must choose the action that keeps the client safest while still meeting their basic needs. Always
think about safety first when answering these questions. This knowledge supports safe care and helps
the nurse teach the client and family clearly and simply. Clear teaching improves cooperation and
reduces anxiety.
Exam (Elaborations) • Detailed Rationales Page 3
✓ VERIFIED • 2026/2027 UPDATE • 100% ACCURATE
NU 185 Exam 4: Advanced Medical-Surgical Nursing II
Comprehensive Review 2026/2027 UPDATE |Galen College
ACTUAL EXAM QUESTIONS & VERIFIED ANSWERS
with Clear, Detailed Rationales
Document Type: Exam (Elaborations) / Study Guide
Academic Year:
Total Questions: 50 Multiple Choice
Includes: Correct Answers + Rationales
Grade: A+ Assured
ASSURED GRADE A+
Exam (Elaborations) • Detailed Rationales Page 1
,NU 185 Exam 4: Advanced Medical-Surgical Nursing … 2026/2027 • Verified • Assured Grade A+
Questions & Verified Answers
1. A patient with Diabetic Ketoacidosis (DKA) is receiving a continuous insulin infusion. The
nurse notes the blood glucose has dropped from 550 mg/dL to 240 mg/dL. What is the most
appropriate next action?
A. is receiving a continuous insulin infusion. The nurse notes the blood glucose has dropped from 550
mg/dL to 240 mg/dL. What is the most appropriate next action?
B. Increase the rate of the insulin infusion to ensure ketosis is resolved.
C. Discontinue the insulin infusion immediately.
D. Administer subcutaneous glargine and stop the IV pump.
Answer: A
Rationale: When blood glucose levels reach approximately 250 mg/dL in DKA, dextrose is added to
the IV fluids (usually D5 0.45% NS) to prevent rapid drops in glucose and cerebral edema while the
insulin continues to clear ketones. In practice, this guides the nurse to set priorities and protect the
client from harm. Safety, nutrition, and clear communication are frequent priorities. Understanding this
helps the nurse notice early warning signs and act before the problem gets worse. Early action often
prevents bigger complications for the client.
2. A nurse is caring for a patient with Syndrome of Inappropriate Antidiuretic Hormone
(SIADH). Which laboratory finding is most consistent with this diagnosis?
A. Serum sodium 150 mEq/L and Urine Specific Gravity 1.002
B. Serum sodium 122 mEq/L and Urine Specific Gravity 1.035
C. Serum osmolality 310 mOsm/kg and polyuria
D. Blood Urea Nitrogen (BUN) 35 mg/dL and dehydration
Answer: B
Rationale: SIADH is characterized by excessive ADH, leading to water retention, dilutional
hyponatremia (sodium < 135), and highly concentrated urine (high specific gravity). This knowledge
supports safe care and helps the nurse teach the client and family clearly and simply. Clear teaching
improves cooperation and reduces anxiety. Clear understanding of this concept improves both test
performance and everyday clinical judgment. Practice applying it to short case scenarios to lock the
idea in place.
Exam (Elaborations) • Detailed Rationales Page 2
, NU 185 Exam 4: Advanced Medical-Surgical Nursing … 2026/2027 • Verified • Assured Grade A+
3. A patient with a head injury exhibits a blood pressure of 180/60 mmHg, a pulse of 48 bpm,
and irregular respirations. Which condition should the nurse suspect?
A. Neurogenic Shock
B. Hypovolemic Shock
C. Increased Intracranial Pressure (ICP)
D. Cardiac Tamponade
Answer: C
Rationale: The combination of systolic hypertension with a widening pulse pressure, bradycardia, and
irregular respirations is known as Cushing’s Triad, a late sign of increased ICP. In practice, this guides
the nurse to set priorities and protect the client from harm. Safety, nutrition, and clear communication
are frequent priorities. Understanding this helps the nurse notice early warning signs and act before
the problem gets worse. Early action often prevents bigger complications for the client.
4. In the management of Hyperosmolar Hyperglycemic State (HHS), which intervention is the
priority?
A. Low-dose IV insulin to correct hyperkalemia
B. Administration of bicarbonate for metabolic acidosis
C. Aggressive fluid resuscitation with Normal Saline
D. Initiating hemodialysis to remove excess glucose
Answer: C
Rationale: HHS involves extreme dehydration. The priority is vigorous fluid replacement to restore
circulatory volume and renal perfusion, usually before starting insulin. This is important because the
nurse must choose the action that keeps the client safest while still meeting their basic needs. Always
think about safety first when answering these questions. This knowledge supports safe care and helps
the nurse teach the client and family clearly and simply. Clear teaching improves cooperation and
reduces anxiety.
Exam (Elaborations) • Detailed Rationales Page 3
