NU 155 Exam 3 Medical-Surgical Nursing I (2026) PDF |
Galen College of Nursing Introduction
This Medical-Surgical Nursing I Exam 3 practice assessment is designed to
evaluate readiness for the Galen College of Nursing NU 155 course examination.
The exam measures clinical judgment, prioritization, pharmacologic
interventions, laboratory interpretation, and safe management of adult
medical-surgical conditions. Questions include multiple-choice and scenario-
based formats requiring synthesis of assessment cues, recognition of risk,
planning of interventions, and evaluation of outcomes. Emphasis is placed on
real-world application, patient safety, interdisciplinary collaboration, and
professional standards .
QUESTIONS
SECTION 1: Fluid, Electrolyte, and Acid-Base Balance
1. A client with heart failure has crackles in bilateral lung bases, 3+ pitting
edema in the lower extremities, and a brain natriuretic peptide (BNP) level of
1500 pg/mL. Which medication should the nurse anticipate administering first?
A. Metoprolol
B. Digoxin
C. IV furosemide
D. Spironolactone
Correct Answer: C
Rationale: Acute decompensated heart failure with pulmonary congestion
requires rapid fluid removal with an IV loop diuretic such as furosemide. A BNP
level of 1500 pg/mL indicates significant heart failure with high ventricular wall
stress (normal BNP is less than 100 pg/mL). IV furosemide acts quickly to reduce
preload and relieve pulmonary congestion. Metoprolol and spironolactone are
chronic management medications, while digoxin is used for symptom control in
chronic HF but not as the first-line acute intervention .
,2. A client with diabetic ketoacidosis has a serum potassium of 3.0 mEq/L and is
prescribed regular insulin IV. What is the nurse's priority action?
A. Administer the insulin as prescribed
B. Notify the healthcare provider and anticipate potassium replacement before
insulin administration
C. Hold the insulin and administer potassium only
D. Administer both insulin and potassium simultaneously
Correct Answer: B
Rationale: Insulin shifts potassium into cells, which can worsen
hypokalemia. A serum potassium of 3.0 mEq/L is below the normal range (3.5-5.0
mEq/L) and requires replacement before or concurrently with insulin therapy. The
nurse should notify the provider and anticipate potassium replacement before
insulin administration to prevent life-threatening cardiac dysrhythmias.
Administering insulin without potassium replacement in a hypokalemic patient
could precipitate severe hypokalemia .
3. A client with hypocalcemia has positive Chvostek and Trousseau signs. Which
nursing intervention is most important?
A. Administer potassium supplementation
B. Initiate seizure precautions and anticipate calcium replacement
C. Encourage ambulation
D. Restrict all fluids
Correct Answer: B
Rationale: Positive Chvostek and Trousseau signs indicate neuromuscular
irritability secondary to hypocalcemia. Severe hypocalcemia can cause tetany,
laryngospasm, and seizures. The priority is to initiate seizure precautions and
anticipate calcium replacement to prevent these life-threatening complications.
Potassium administration is not indicated, ambulation does not address the
underlying electrolyte imbalance, and fluid restriction is not appropriate .
,4. A client with acute kidney injury has a potassium level of 6.9 mEq/L and
peaked T waves on ECG. Which intervention should the nurse anticipate FIRST?
A. Sodium polystyrene sulfonate
B. Furosemide
C. IV calcium gluconate
D. Insulin with glucose
Correct Answer: C
Rationale: Hyperkalemia with ECG changes (peaked T waves) requires
immediate cardiac membrane stabilization with IV calcium gluconate. Calcium
gluconate does not lower potassium levels but protects the myocardium from
dysrhythmias. Sodium polystyrene sulfonate and insulin with glucose help lower
potassium but take longer to work. Furosemide promotes potassium excretion
but is not the immediate priority when ECG changes are present .
5. A client with heart failure has a serum sodium of 128 mEq/L. Which
assessment finding requires immediate intervention?
A. Mild ankle edema
B. Jugular venous distention
C. Confusion and lethargy
D. Crackles in lung bases
Correct Answer: C
Rationale: A serum sodium of 128 mEq/L indicates hyponatremia.
Confusion and lethargy are signs of cerebral edema, a life-threatening
complication of severe hyponatremia. This requires immediate intervention with
hypertonic saline or fluid restriction. Ankle edema, JVD, and crackles are expected
findings in heart failure but do not represent the immediate threat to life that
cerebral edema does .
6. The nurse is caring for a client receiving IV normal saline at 150 mL/hr. Which
finding indicates fluid volume overload?
, A. Blood pressure 128/76 mmHg
B. Urine output 60 mL/hr
C. Dyspnea and jugular venous distention
D. Heart rate 72 beats/min
Correct Answer: C
Rationale: Dyspnea and jugular venous distention are classic signs of fluid
volume overload, indicating that the client is receiving more fluid than the
cardiovascular system can handle. This requires immediate assessment and
possible adjustment of the infusion rate. The other options represent normal or
expected findings .
7. A client has arterial blood gas results: pH 7.30, PaCO2 50 mmHg, HCO3 24
mEq/L. How should the nurse interpret these results?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Correct Answer: C
Rationale: The pH is low (7.30), indicating acidosis. PaCO2 is elevated (50
mmHg), indicating respiratory acid retention. HCO3 is normal (24 mEq/L),
indicating no metabolic compensation. This is uncompensated respiratory
acidosis. Common causes include COPD, respiratory depression, and airway
obstruction .
8. A client with metabolic alkalosis is receiving IV fluids. Which medication
should the nurse question if ordered?
A. Potassium chloride
B. Sodium chloride
C. Acetazolamide
D. Sodium bicarbonate
Galen College of Nursing Introduction
This Medical-Surgical Nursing I Exam 3 practice assessment is designed to
evaluate readiness for the Galen College of Nursing NU 155 course examination.
The exam measures clinical judgment, prioritization, pharmacologic
interventions, laboratory interpretation, and safe management of adult
medical-surgical conditions. Questions include multiple-choice and scenario-
based formats requiring synthesis of assessment cues, recognition of risk,
planning of interventions, and evaluation of outcomes. Emphasis is placed on
real-world application, patient safety, interdisciplinary collaboration, and
professional standards .
QUESTIONS
SECTION 1: Fluid, Electrolyte, and Acid-Base Balance
1. A client with heart failure has crackles in bilateral lung bases, 3+ pitting
edema in the lower extremities, and a brain natriuretic peptide (BNP) level of
1500 pg/mL. Which medication should the nurse anticipate administering first?
A. Metoprolol
B. Digoxin
C. IV furosemide
D. Spironolactone
Correct Answer: C
Rationale: Acute decompensated heart failure with pulmonary congestion
requires rapid fluid removal with an IV loop diuretic such as furosemide. A BNP
level of 1500 pg/mL indicates significant heart failure with high ventricular wall
stress (normal BNP is less than 100 pg/mL). IV furosemide acts quickly to reduce
preload and relieve pulmonary congestion. Metoprolol and spironolactone are
chronic management medications, while digoxin is used for symptom control in
chronic HF but not as the first-line acute intervention .
,2. A client with diabetic ketoacidosis has a serum potassium of 3.0 mEq/L and is
prescribed regular insulin IV. What is the nurse's priority action?
A. Administer the insulin as prescribed
B. Notify the healthcare provider and anticipate potassium replacement before
insulin administration
C. Hold the insulin and administer potassium only
D. Administer both insulin and potassium simultaneously
Correct Answer: B
Rationale: Insulin shifts potassium into cells, which can worsen
hypokalemia. A serum potassium of 3.0 mEq/L is below the normal range (3.5-5.0
mEq/L) and requires replacement before or concurrently with insulin therapy. The
nurse should notify the provider and anticipate potassium replacement before
insulin administration to prevent life-threatening cardiac dysrhythmias.
Administering insulin without potassium replacement in a hypokalemic patient
could precipitate severe hypokalemia .
3. A client with hypocalcemia has positive Chvostek and Trousseau signs. Which
nursing intervention is most important?
A. Administer potassium supplementation
B. Initiate seizure precautions and anticipate calcium replacement
C. Encourage ambulation
D. Restrict all fluids
Correct Answer: B
Rationale: Positive Chvostek and Trousseau signs indicate neuromuscular
irritability secondary to hypocalcemia. Severe hypocalcemia can cause tetany,
laryngospasm, and seizures. The priority is to initiate seizure precautions and
anticipate calcium replacement to prevent these life-threatening complications.
Potassium administration is not indicated, ambulation does not address the
underlying electrolyte imbalance, and fluid restriction is not appropriate .
,4. A client with acute kidney injury has a potassium level of 6.9 mEq/L and
peaked T waves on ECG. Which intervention should the nurse anticipate FIRST?
A. Sodium polystyrene sulfonate
B. Furosemide
C. IV calcium gluconate
D. Insulin with glucose
Correct Answer: C
Rationale: Hyperkalemia with ECG changes (peaked T waves) requires
immediate cardiac membrane stabilization with IV calcium gluconate. Calcium
gluconate does not lower potassium levels but protects the myocardium from
dysrhythmias. Sodium polystyrene sulfonate and insulin with glucose help lower
potassium but take longer to work. Furosemide promotes potassium excretion
but is not the immediate priority when ECG changes are present .
5. A client with heart failure has a serum sodium of 128 mEq/L. Which
assessment finding requires immediate intervention?
A. Mild ankle edema
B. Jugular venous distention
C. Confusion and lethargy
D. Crackles in lung bases
Correct Answer: C
Rationale: A serum sodium of 128 mEq/L indicates hyponatremia.
Confusion and lethargy are signs of cerebral edema, a life-threatening
complication of severe hyponatremia. This requires immediate intervention with
hypertonic saline or fluid restriction. Ankle edema, JVD, and crackles are expected
findings in heart failure but do not represent the immediate threat to life that
cerebral edema does .
6. The nurse is caring for a client receiving IV normal saline at 150 mL/hr. Which
finding indicates fluid volume overload?
, A. Blood pressure 128/76 mmHg
B. Urine output 60 mL/hr
C. Dyspnea and jugular venous distention
D. Heart rate 72 beats/min
Correct Answer: C
Rationale: Dyspnea and jugular venous distention are classic signs of fluid
volume overload, indicating that the client is receiving more fluid than the
cardiovascular system can handle. This requires immediate assessment and
possible adjustment of the infusion rate. The other options represent normal or
expected findings .
7. A client has arterial blood gas results: pH 7.30, PaCO2 50 mmHg, HCO3 24
mEq/L. How should the nurse interpret these results?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Correct Answer: C
Rationale: The pH is low (7.30), indicating acidosis. PaCO2 is elevated (50
mmHg), indicating respiratory acid retention. HCO3 is normal (24 mEq/L),
indicating no metabolic compensation. This is uncompensated respiratory
acidosis. Common causes include COPD, respiratory depression, and airway
obstruction .
8. A client with metabolic alkalosis is receiving IV fluids. Which medication
should the nurse question if ordered?
A. Potassium chloride
B. Sodium chloride
C. Acetazolamide
D. Sodium bicarbonate
