NU 185
MEDICAL-SURGICAL NURSING II
Exam 4 Comprehensive Study Guide
UPDATE
50 Multiple-Choice Questions
Complete Answers with Detailed Rationales
Aligned with Medical-Surgical Nursing Standards
Galen College | NU 185 | Medical-Surgical Nursing II
Cardiac • Respiratory • Endocrine • GI • Renal • Neurological • Perioperative
For academic study and exam review • Verify with current course materials
,NU 185 | Exam 4 Study Guide | 2026/2027 UPDATE
How to Use This Review
This comprehensive exam review contains high-yield multiple-choice questions covering the core clinical topics of NU 185
Medical-Surgical Nursing II. Each item is followed by the correct answer and an expanded rationale that explains the
underlying pathophysiology or nursing priority, why the correct option is preferred, and why the distractors are incorrect.
Topics span cardiovascular, respiratory, endocrine, gastrointestinal, renal, neurological, and perioperative care. Study tip:
Attempt each question before reading the answer. Then carefully review the detailed rationale and relate the concepts to
clinical practice.
Topic Index (Selected High-Yield Areas)
• Heart failure (left vs right), ACS, arrhythmias, hypertension management
• COPD, asthma, pneumonia, respiratory failure, ABG interpretation
• Diabetes mellitus, thyroid disorders, adrenal crises and emergencies
• GI bleeding, pancreatitis, liver disease, bowel obstruction priorities
• Acute kidney injury, CKD, fluid & electrolyte imbalances
• Stroke, increased ICP, seizures, neurological assessment
• Perioperative care, post-op complications, pain management
• Infection, sepsis, shock states, and priority nursing interventions
Page 2
, NU 185 | Exam 4 Study Guide | 2026/2027 UPDATE
Question 1
A patient with Chronic Kidney Disease (CKD) presents with a serum potassium level of 6.8 mEq/L. Which of the
following provider orders should the nurse implement first?
A. Administer sodium polystyrene sulfonate orally
B. Administer IV regular insulin and 50% dextrose
C. Initiate a low-potassium diet
D. Obtain a 12-lead Electrocardiogram (ECG)
Answer: D
Rationale
Safety first: Hyperkalemia (6.8 mEq/L) can cause life-threatening arrhythmias. The nurse must first assess the cardiac rhythm
with an ECG to determine the severity and the need for calcium gluconate before administering shifting agents or resins.
Question 2
A nurse is caring for a patient in Diabetic Ketoacidosis (DKA). The patient’s arterial blood gas (ABG) shows a pH of 7.28
and an HCO3 of 14 mEq/L. Which respiratory pattern is expected?
A. Cheyne-Stokes respirations
B. Bradypnea
C. Kussmaul respirations
D. Apneustic breathing
Answer: C
Rationale
Kussmaul respirations (rapid, deep breathing) are a compensatory mechanism in metabolic acidosis to blow off carbon dioxide
and increase blood pH. Understanding this concept is essential for safe clinical decision-making. Incorrect choices often reflect
common misconceptions about pathophysiology or prioritization. Always link assessment data to the primary disease process
and anticipated complications.
Page 3
MEDICAL-SURGICAL NURSING II
Exam 4 Comprehensive Study Guide
UPDATE
50 Multiple-Choice Questions
Complete Answers with Detailed Rationales
Aligned with Medical-Surgical Nursing Standards
Galen College | NU 185 | Medical-Surgical Nursing II
Cardiac • Respiratory • Endocrine • GI • Renal • Neurological • Perioperative
For academic study and exam review • Verify with current course materials
,NU 185 | Exam 4 Study Guide | 2026/2027 UPDATE
How to Use This Review
This comprehensive exam review contains high-yield multiple-choice questions covering the core clinical topics of NU 185
Medical-Surgical Nursing II. Each item is followed by the correct answer and an expanded rationale that explains the
underlying pathophysiology or nursing priority, why the correct option is preferred, and why the distractors are incorrect.
Topics span cardiovascular, respiratory, endocrine, gastrointestinal, renal, neurological, and perioperative care. Study tip:
Attempt each question before reading the answer. Then carefully review the detailed rationale and relate the concepts to
clinical practice.
Topic Index (Selected High-Yield Areas)
• Heart failure (left vs right), ACS, arrhythmias, hypertension management
• COPD, asthma, pneumonia, respiratory failure, ABG interpretation
• Diabetes mellitus, thyroid disorders, adrenal crises and emergencies
• GI bleeding, pancreatitis, liver disease, bowel obstruction priorities
• Acute kidney injury, CKD, fluid & electrolyte imbalances
• Stroke, increased ICP, seizures, neurological assessment
• Perioperative care, post-op complications, pain management
• Infection, sepsis, shock states, and priority nursing interventions
Page 2
, NU 185 | Exam 4 Study Guide | 2026/2027 UPDATE
Question 1
A patient with Chronic Kidney Disease (CKD) presents with a serum potassium level of 6.8 mEq/L. Which of the
following provider orders should the nurse implement first?
A. Administer sodium polystyrene sulfonate orally
B. Administer IV regular insulin and 50% dextrose
C. Initiate a low-potassium diet
D. Obtain a 12-lead Electrocardiogram (ECG)
Answer: D
Rationale
Safety first: Hyperkalemia (6.8 mEq/L) can cause life-threatening arrhythmias. The nurse must first assess the cardiac rhythm
with an ECG to determine the severity and the need for calcium gluconate before administering shifting agents or resins.
Question 2
A nurse is caring for a patient in Diabetic Ketoacidosis (DKA). The patient’s arterial blood gas (ABG) shows a pH of 7.28
and an HCO3 of 14 mEq/L. Which respiratory pattern is expected?
A. Cheyne-Stokes respirations
B. Bradypnea
C. Kussmaul respirations
D. Apneustic breathing
Answer: C
Rationale
Kussmaul respirations (rapid, deep breathing) are a compensatory mechanism in metabolic acidosis to blow off carbon dioxide
and increase blood pH. Understanding this concept is essential for safe clinical decision-making. Incorrect choices often reflect
common misconceptions about pathophysiology or prioritization. Always link assessment data to the primary disease process
and anticipated complications.
Page 3
