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GALEN NU 185 EXAM 3 — MED-SURGICAL NURSING II | NCLEX-STYLE
EXAM COMPREHENSIVE QUESTIONS AND CORRECT ANSWERS LATEST
EDITION 2026
GALEN NU 185 EXAM 3 — MED-SURGICAL NURSING II | NCLEX-STYLE EXAM
10-POINT EXAM COVERAGE SUMMARY
1. Gastrointestinal & Hepatic Disorders – Chronic gastritis, GERD, PUD perforation,
dehydration from vomiting, cirrhosis, hepatic encephalopathy, pancreatitis, EGD post-
procedure care
2. Renal & Urinary Disorders – Acute tubular necrosis, CKD, hemodialysis medication
management, AKI oliguric phase, hyperkalemia, urosepsis
3. Endocrine Disorders – Cushing's syndrome, Addison's disease, diabetes mellitus, DKA,
thyroid disorders, SIADH, diabetes insipidus
4. Cardiovascular Disorders – Heart failure, digoxin toxicity, transfusion reactions,
anticoagulation, dysrhythmias, DVT
5. Respiratory Disorders – COPD, asthma, pneumonia, tuberculosis, ABG interpretation,
chest tubes, pulmonary embolism
6. Neurological Disorders – Increased ICP, stroke, seizures, head injury, meningitis, Guillain-
Barré, myasthenia gravis
7. Musculoskeletal & Perioperative Care – Fractures, osteomyelitis, hip precautions, DVT
prevention, compartment syndrome
8. Fluid, Electrolyte & Acid-Base Balance – Potassium imbalances, metabolic acidosis, ABG
analysis, IV fluid resuscitation
9. Hematologic & Oncologic Disorders – Anemia, thrombocytopenia, DIC, neutropenia,
tumor lysis syndrome
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10. Emergency, Sepsis & Prioritization – Septic shock, ABCs, naloxone, rapid response,
disaster triage
SECTION 1: GASTROINTESTINAL & HEPATIC DISORDERS (30 QUESTIONS)
1. A nurse is teaching a client newly diagnosed with chronic gastritis. Which statement by the
client indicates a need for further teaching?
A) "I will avoid drinking alcohol."
B) "I should take NSAIDs regularly for my joint pain."
C) "I will quit smoking."
D) "I will follow up with my provider about my H. pylori test."
Rationale: NSAIDs are a major irritant to the gastric lining and a common cause of chronic
gastritis. Clients with chronic gastritis should avoid regular NSAID use. The other choices reflect
appropriate understanding and management.
2. Which statement made by a client with GERD indicates correct understanding of discharge
teaching?
A) "I'll lie down right after eating to help with digestion."
B) "I will eat small meals throughout the day."
C) "I should avoid elevating the head of my bed."
D) "Spicy foods help reduce acid production."
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Rationale: Small, frequent meals reduce gastric pressure and acid reflux. Lying down after meals
and spicy foods worsen GERD. The head of the bed should be elevated 6-8 inches to reduce
nighttime reflux.
3. A client with acute gastritis reports vomiting for 12 hours and shows signs of dry mucous
membranes and poor skin turgor. Which intervention takes priority?
A) Begin a clear liquid diet
B) Administer antiemetic medication
C) Initiate IV fluid replacement
D) Administer oral rehydration therapy
Rationale: The client is showing signs of dehydration after 12 hours of vomiting. IV fluid
replacement is the priority to restore fluid volume and prevent further complications.
4. A client with a history of peptic ulcer disease presents with a rigid abdomen and severe pain.
Which action should the nurse take first?
A) Administer prescribed pain medication
B) Notify the healthcare provider
C) Prepare the client for surgery
D) Place the client in a supine position
Rationale: A rigid abdomen and severe pain in a client with peptic ulcer disease may indicate
perforation, a life-threatening emergency. The nurse should notify the healthcare provider
immediately. Pain medication should not be given until a full assessment is completed.
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5. A nurse is caring for a patient who has just returned to the unit after an
esophagogastroduodenoscopy (EGD). Which nursing action is the absolute priority before
allowing the patient to consume oral fluids or food?
A) Assessing for the return of the gag reflex
B) Monitoring the patient's blood pressure and heart rate
C) Checking the patient's stool for occult blood
D) Administering ordered analgesic medication for throat soreness
Rationale: During an EGD, the local airway and throat are anesthetized to prevent gagging and
coughing. The nurse must verify that the gag reflex has fully returned to prevent aspiration.
6. A patient with a history of liver cirrhosis is admitted with severe hepatic encephalopathy. The
nurse notes extreme asterixis, confusion, and fetor hepaticus. Which laboratory value should
the nurse monitor closely to track the therapeutic efficacy of prescribed lactulose?
A) Serum bilirubin
B) Alanine aminotransferase (ALT)
C) Serum ammonia
D) Prothrombin time (PT/INR)
Rationale: Hepatic encephalopathy is primarily driven by elevated blood ammonia levels.
Lactulose works by trapping ammonia in the gut and expelling it through the stool.
7. A client admitted with acute pancreatitis reports increasing abdominal pain. Assessment
reveals BP 88/54 mmHg, HR 126/min, RR 28/min, oxygen saturation 95%, abdomen rigid with
absent bowel sounds. Which finding concerns the nurse the most?
A) Absent bowel sounds
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GALEN NU 185 EXAM 3 — MED-SURGICAL NURSING II | NCLEX-STYLE
EXAM COMPREHENSIVE QUESTIONS AND CORRECT ANSWERS LATEST
EDITION 2026
GALEN NU 185 EXAM 3 — MED-SURGICAL NURSING II | NCLEX-STYLE EXAM
10-POINT EXAM COVERAGE SUMMARY
1. Gastrointestinal & Hepatic Disorders – Chronic gastritis, GERD, PUD perforation,
dehydration from vomiting, cirrhosis, hepatic encephalopathy, pancreatitis, EGD post-
procedure care
2. Renal & Urinary Disorders – Acute tubular necrosis, CKD, hemodialysis medication
management, AKI oliguric phase, hyperkalemia, urosepsis
3. Endocrine Disorders – Cushing's syndrome, Addison's disease, diabetes mellitus, DKA,
thyroid disorders, SIADH, diabetes insipidus
4. Cardiovascular Disorders – Heart failure, digoxin toxicity, transfusion reactions,
anticoagulation, dysrhythmias, DVT
5. Respiratory Disorders – COPD, asthma, pneumonia, tuberculosis, ABG interpretation,
chest tubes, pulmonary embolism
6. Neurological Disorders – Increased ICP, stroke, seizures, head injury, meningitis, Guillain-
Barré, myasthenia gravis
7. Musculoskeletal & Perioperative Care – Fractures, osteomyelitis, hip precautions, DVT
prevention, compartment syndrome
8. Fluid, Electrolyte & Acid-Base Balance – Potassium imbalances, metabolic acidosis, ABG
analysis, IV fluid resuscitation
9. Hematologic & Oncologic Disorders – Anemia, thrombocytopenia, DIC, neutropenia,
tumor lysis syndrome
1|Page
,Page 2 of 102
10. Emergency, Sepsis & Prioritization – Septic shock, ABCs, naloxone, rapid response,
disaster triage
SECTION 1: GASTROINTESTINAL & HEPATIC DISORDERS (30 QUESTIONS)
1. A nurse is teaching a client newly diagnosed with chronic gastritis. Which statement by the
client indicates a need for further teaching?
A) "I will avoid drinking alcohol."
B) "I should take NSAIDs regularly for my joint pain."
C) "I will quit smoking."
D) "I will follow up with my provider about my H. pylori test."
Rationale: NSAIDs are a major irritant to the gastric lining and a common cause of chronic
gastritis. Clients with chronic gastritis should avoid regular NSAID use. The other choices reflect
appropriate understanding and management.
2. Which statement made by a client with GERD indicates correct understanding of discharge
teaching?
A) "I'll lie down right after eating to help with digestion."
B) "I will eat small meals throughout the day."
C) "I should avoid elevating the head of my bed."
D) "Spicy foods help reduce acid production."
2|Page
,Page 3 of 102
Rationale: Small, frequent meals reduce gastric pressure and acid reflux. Lying down after meals
and spicy foods worsen GERD. The head of the bed should be elevated 6-8 inches to reduce
nighttime reflux.
3. A client with acute gastritis reports vomiting for 12 hours and shows signs of dry mucous
membranes and poor skin turgor. Which intervention takes priority?
A) Begin a clear liquid diet
B) Administer antiemetic medication
C) Initiate IV fluid replacement
D) Administer oral rehydration therapy
Rationale: The client is showing signs of dehydration after 12 hours of vomiting. IV fluid
replacement is the priority to restore fluid volume and prevent further complications.
4. A client with a history of peptic ulcer disease presents with a rigid abdomen and severe pain.
Which action should the nurse take first?
A) Administer prescribed pain medication
B) Notify the healthcare provider
C) Prepare the client for surgery
D) Place the client in a supine position
Rationale: A rigid abdomen and severe pain in a client with peptic ulcer disease may indicate
perforation, a life-threatening emergency. The nurse should notify the healthcare provider
immediately. Pain medication should not be given until a full assessment is completed.
3|Page
, Page 4 of 102
5. A nurse is caring for a patient who has just returned to the unit after an
esophagogastroduodenoscopy (EGD). Which nursing action is the absolute priority before
allowing the patient to consume oral fluids or food?
A) Assessing for the return of the gag reflex
B) Monitoring the patient's blood pressure and heart rate
C) Checking the patient's stool for occult blood
D) Administering ordered analgesic medication for throat soreness
Rationale: During an EGD, the local airway and throat are anesthetized to prevent gagging and
coughing. The nurse must verify that the gag reflex has fully returned to prevent aspiration.
6. A patient with a history of liver cirrhosis is admitted with severe hepatic encephalopathy. The
nurse notes extreme asterixis, confusion, and fetor hepaticus. Which laboratory value should
the nurse monitor closely to track the therapeutic efficacy of prescribed lactulose?
A) Serum bilirubin
B) Alanine aminotransferase (ALT)
C) Serum ammonia
D) Prothrombin time (PT/INR)
Rationale: Hepatic encephalopathy is primarily driven by elevated blood ammonia levels.
Lactulose works by trapping ammonia in the gut and expelling it through the stool.
7. A client admitted with acute pancreatitis reports increasing abdominal pain. Assessment
reveals BP 88/54 mmHg, HR 126/min, RR 28/min, oxygen saturation 95%, abdomen rigid with
absent bowel sounds. Which finding concerns the nurse the most?
A) Absent bowel sounds
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