Page 1 of 102
GALEN NU 185 EXAM 2 — MED-SURGICAL NURSING II | NCLEX-
STYLE EXAM 2026 QUESTIONS WITH VERIFIED QUESTIONS
DETAILED RATIONALES GRADED A+
GALEN NU 185 EXAM 2 — MED-SURGICAL NURSING II | NCLEX-STYLE EXAM
10-POINT EXAM COVERAGE SUMMARY
Cardiovascular System – Heart failure (left vs. right), digoxin administration, cardiac markers,
dysrhythmias, anticoagulation, transfusion reactions
Respiratory System – Chest tubes, ABG interpretation, COPD, pulmonary embolism, oxygen
therapy
Fluid, Electrolyte & Acid-Base Balance – DKA, potassium imbalances, calcium gluconate, ABG
analysis
Gastrointestinal & Hepatic Disorders – Pancreatitis, cirrhosis, hepatic encephalopathy, EGD
post-procedure care, lactulose therapy
Renal & Urinary Disorders – Acute kidney injury, hyperkalemia management, urosepsis, Foley
catheter care
Hematologic Disorders – Transfusion reactions, heparin therapy, aPTT monitoring, anemia
management
Musculoskeletal & Immobility – Osteomyelitis, fracture care, DVT prevention, traction, mobility
complications
Burns & Integumentary – Burn assessment, fluid resuscitation, wound care, infection
prevention
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Neurological Disorders – Ischemic stroke, CT scan priority, increased ICP, seizure management
Emergency, Sepsis & Prioritization – Septic shock, ABCs, naloxone administration, rapid
response
SECTION 1: CARDIOVASCULAR SYSTEM (30 QUESTIONS)
1. A patient with heart failure is prescribed digoxin 0.25 mg daily. Which assessment finding
should the nurse prioritize before administration?
A) Blood pressure of 110/70 mmHg
B) Apical pulse of 52 beats per minute
C) Respiratory rate of 18 breaths per minute
D) Serum potassium level of 4.5 mEq/L
Rationale: Digoxin is a cardiac glycoside that slows the heart rate. The apical pulse must be
checked for one full minute; if it is below 60 bpm, the dose should be withheld and the provider
notified.
2. Which clinical manifestation is most characteristic of left-sided heart failure?
A) Crackles in the lungs
B) Jugular venous distention
C) Peripheral edema
D) Splenomegaly
Rationale: Left-sided heart failure causes blood to back up into the pulmonary circulation,
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leading to pulmonary congestion and crackles. JVD, peripheral edema, and splenomegaly are
signs of right-sided failure.
3. A patient is diagnosed with right-sided heart failure. Which assessment finding should the
nurse expect?
A) Dyspnea on exertion
B) Orthopnea
C) Dependent edema
D) Frothy, pink-tinged sputum
Rationale: Right-sided heart failure leads to systemic venous congestion, resulting in peripheral
edema, JVD, and hepatomegaly. Dyspnea, orthopnea, and frothy sputum are signs of left-sided
failure.
4. Which layer of the heart is responsible for the forceful contractions that pump blood
throughout the body?
A) Epicardium
B) Myocardium
C) Endocardium
D) Pericardium
Rationale: The myocardium is the thick muscular middle layer responsible for the heart's
contractions and pumping action.
5. Which cardiac diagnostic marker is most specific for myocardial infarction?
A) CK-MB
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B) Myoglobin
C) Troponin
D) BNP
Rationale: Troponin is the most specific marker for myocardial injury due to its high specificity
for cardiac muscle and prolonged elevation (7-10 days) after MI.
6. A nurse is assessing a client for signs of a mild transfusion reaction. Which finding would the
nurse expect?
A) Fever and chills
B) Rash, hives, itching, and facial flushing
C) Hypotension and tachycardia
D) Low back pain and hematuria
Rationale: Mild transfusion reactions typically present with rash, hives, itching, and facial
flushing. Fever, chills, hypotension, tachycardia, and hematuria indicate a more severe reaction.
7. A client receiving IV morphine becomes difficult to arouse. Respirations are 7/min. Which
action should the nurse take first?
A) Administer naloxone
B) Give acetaminophen
C) Increase IV fluids
D) Reassess in 30 minutes
Rationale: Respiratory depression is the most serious adverse effect of opioids. Naloxone
reverses opioid effects rapidly.
GALEN NU 185 EXAM 2 — MED-SURGICAL NURSING II | NCLEX-
STYLE EXAM 2026 QUESTIONS WITH VERIFIED QUESTIONS
DETAILED RATIONALES GRADED A+
GALEN NU 185 EXAM 2 — MED-SURGICAL NURSING II | NCLEX-STYLE EXAM
10-POINT EXAM COVERAGE SUMMARY
Cardiovascular System – Heart failure (left vs. right), digoxin administration, cardiac markers,
dysrhythmias, anticoagulation, transfusion reactions
Respiratory System – Chest tubes, ABG interpretation, COPD, pulmonary embolism, oxygen
therapy
Fluid, Electrolyte & Acid-Base Balance – DKA, potassium imbalances, calcium gluconate, ABG
analysis
Gastrointestinal & Hepatic Disorders – Pancreatitis, cirrhosis, hepatic encephalopathy, EGD
post-procedure care, lactulose therapy
Renal & Urinary Disorders – Acute kidney injury, hyperkalemia management, urosepsis, Foley
catheter care
Hematologic Disorders – Transfusion reactions, heparin therapy, aPTT monitoring, anemia
management
Musculoskeletal & Immobility – Osteomyelitis, fracture care, DVT prevention, traction, mobility
complications
Burns & Integumentary – Burn assessment, fluid resuscitation, wound care, infection
prevention
,Page 2 of 102
Neurological Disorders – Ischemic stroke, CT scan priority, increased ICP, seizure management
Emergency, Sepsis & Prioritization – Septic shock, ABCs, naloxone administration, rapid
response
SECTION 1: CARDIOVASCULAR SYSTEM (30 QUESTIONS)
1. A patient with heart failure is prescribed digoxin 0.25 mg daily. Which assessment finding
should the nurse prioritize before administration?
A) Blood pressure of 110/70 mmHg
B) Apical pulse of 52 beats per minute
C) Respiratory rate of 18 breaths per minute
D) Serum potassium level of 4.5 mEq/L
Rationale: Digoxin is a cardiac glycoside that slows the heart rate. The apical pulse must be
checked for one full minute; if it is below 60 bpm, the dose should be withheld and the provider
notified.
2. Which clinical manifestation is most characteristic of left-sided heart failure?
A) Crackles in the lungs
B) Jugular venous distention
C) Peripheral edema
D) Splenomegaly
Rationale: Left-sided heart failure causes blood to back up into the pulmonary circulation,
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leading to pulmonary congestion and crackles. JVD, peripheral edema, and splenomegaly are
signs of right-sided failure.
3. A patient is diagnosed with right-sided heart failure. Which assessment finding should the
nurse expect?
A) Dyspnea on exertion
B) Orthopnea
C) Dependent edema
D) Frothy, pink-tinged sputum
Rationale: Right-sided heart failure leads to systemic venous congestion, resulting in peripheral
edema, JVD, and hepatomegaly. Dyspnea, orthopnea, and frothy sputum are signs of left-sided
failure.
4. Which layer of the heart is responsible for the forceful contractions that pump blood
throughout the body?
A) Epicardium
B) Myocardium
C) Endocardium
D) Pericardium
Rationale: The myocardium is the thick muscular middle layer responsible for the heart's
contractions and pumping action.
5. Which cardiac diagnostic marker is most specific for myocardial infarction?
A) CK-MB
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B) Myoglobin
C) Troponin
D) BNP
Rationale: Troponin is the most specific marker for myocardial injury due to its high specificity
for cardiac muscle and prolonged elevation (7-10 days) after MI.
6. A nurse is assessing a client for signs of a mild transfusion reaction. Which finding would the
nurse expect?
A) Fever and chills
B) Rash, hives, itching, and facial flushing
C) Hypotension and tachycardia
D) Low back pain and hematuria
Rationale: Mild transfusion reactions typically present with rash, hives, itching, and facial
flushing. Fever, chills, hypotension, tachycardia, and hematuria indicate a more severe reaction.
7. A client receiving IV morphine becomes difficult to arouse. Respirations are 7/min. Which
action should the nurse take first?
A) Administer naloxone
B) Give acetaminophen
C) Increase IV fluids
D) Reassess in 30 minutes
Rationale: Respiratory depression is the most serious adverse effect of opioids. Naloxone
reverses opioid effects rapidly.
