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GALEN NU 185 EXAM 4 — MED-SURG NURSING II | NCLEX-STYLE EXAM
COMPREHENSIVE QUESTIONS AND CORRECT ANSWERS LATEST EDITION
2026
GALEN NU 185 EXAM 4 — MED-SURG NURSING II | NCLEX-STYLE EXAM
10-POINT EXAM COVERAGE SUMMARY
1. Cardiovascular Disorders – Heart failure (HFrEF/HFpEF), hypertension, coronary artery
disease, myocardial infarction, dysrhythmias, anticoagulation
2. Renal & Urinary Disorders – Chronic kidney disease, acute kidney injury, dialysis,
erythropoietin therapy, electrolyte imbalances
3. Gastrointestinal & Liver Disorders – Diverticulitis, gastritis, peptic ulcer disease,
cirrhosis, hepatitis, pancreatitis
4. Endocrine Disorders – Diabetes mellitus, thyroid disorders, adrenal disorders, pituitary
disorders (acromegaly)
5. Neurological Disorders – Stroke, seizures, Parkinson's disease, multiple sclerosis,
increased intracranial pressure
6. Respiratory Disorders – COPD, pneumonia, asthma, pulmonary embolism, ARDS,
mechanical ventilation
7. Musculoskeletal & Perioperative Care – Arthroplasty, fractures, traction, postoperative
complications, DVT prevention
8. Medication Management & Intravenous Therapy – High-alert medications, IV
calculations, TPN, blood transfusions
9. Infection Control, Sepsis & Emergency Nursing – Sepsis, isolation precautions, wound
care, emergency triage
10. Fluid, Electrolyte & Acid-Base Balance – Sodium, potassium, calcium, magnesium
imbalances; ABG interpretation
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SECTION 1: CARDIOVASCULAR DISORDERS (30 QUESTIONS)
1. A nurse is assessing a client with heart failure with preserved ejection fraction (HFpEF). Which
pathophysiological mechanism is primarily responsible for this condition?
A) Impaired contractility of the left ventricle
B) Reduced compliance and impaired relaxation of the left ventricle
C) Obstruction of the left ventricular outflow tract
D) Inadequate preload due to reduced venous return
Rationale: HFpEF (diastolic heart failure) is characterized by a stiff left ventricle that cannot
relax adequately during diastole. Impaired contractility is the hallmark of HFrEF.
2. A nurse is teaching a client with heart failure about a low-sodium diet. Which food selection
indicates correct understanding?
A) Grilled cheese sandwich with tomato soup
B) Broiled salmon with steamed asparagus
C) Canned beef stew with corn
D) Deli ham sandwich with pickles
Rationale: Broiled salmon and steamed asparagus are naturally low in sodium. Canned soup,
canned stew, deli meats, and pickles are high in sodium.
3. A nurse is assessing a client with suspected right-sided heart failure. Which finding should the
nurse expect?
A) Crackles in the lung bases
B) Jugular venous distention and peripheral edema
C) Orthopnea and paroxysmal nocturnal dyspnea
D) Pink frothy sputum
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Rationale: Right-sided heart failure causes systemic congestion, leading to JVD, peripheral
edema, and hepatomegaly. Left-sided failure causes pulmonary congestion.
4. A client with heart failure is prescribed furosemide. Which laboratory value should the nurse
monitor most closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Rationale: Loop diuretics like furosemide cause potassium loss (hypokalemia), which can lead to
dysrhythmias.
5. A nurse is teaching a client about digoxin. Which statement indicates a need for further
teaching?
A) "I will check my pulse before taking the medication."
B) "I will report nausea and visual changes."
C) "I will take my medication with an antacid."
D) "I will not take my medication if my pulse is below 60."
Rationale: Antacids decrease digoxin absorption. Clients should take digoxin consistently and
report signs of toxicity (nausea, visual disturbances).
6. A client with atrial fibrillation is prescribed warfarin. Which laboratory value should the nurse
monitor?
A) aPTT
B) INR
C) Platelet count
D) Hemoglobin
Rationale: Warfarin therapy is monitored with INR (target 2-3 for atrial fibrillation). aPTT
monitors heparin therapy.
7. A nurse is assessing a client with myocardial infarction. Which finding is most concerning?
A) Crushing chest pain unrelieved by nitroglycerin
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B) Mild fatigue
C) Occasional palpitations
D) Normal ECG
Rationale: Crushing chest pain unrelieved by nitroglycerin is the classic presentation of MI.
Immediate intervention is required.
8. A client is receiving nitroglycerin for angina. Which instruction should the nurse include?
A) "Call 911 if chest pain persists after three doses."
B) "Take five doses at once."
C) "Swallow the tablet whole."
D) "Take it only when you feel like it."
Rationale: Nitroglycerin is taken sublingually every 5 minutes for up to three doses. If pain
persists, call 911.
9. A nurse is assessing a client with hypertension. Which finding requires immediate
intervention?
A) Blood pressure of 180/110 mm Hg
B) Blood pressure of 120/80 mm Hg
C) Blood pressure of 110/70 mm Hg
D) Blood pressure of 100/60 mm Hg
Rationale: A blood pressure of 180/110 mm Hg indicates hypertensive crisis requiring
immediate intervention.
10. A nurse is teaching a client about a heart-healthy diet. Which statement indicates correct
understanding?
A) "I will eat fruits, vegetables, and whole grains."
B) "I will eat fried foods daily."
C) "I will increase saturated fats."
D) "I will skip breakfast."
Rationale: Fruits, vegetables, and whole grains are heart-healthy. Fried foods and saturated fats
increase cardiovascular risk.
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GALEN NU 185 EXAM 4 — MED-SURG NURSING II | NCLEX-STYLE EXAM
COMPREHENSIVE QUESTIONS AND CORRECT ANSWERS LATEST EDITION
2026
GALEN NU 185 EXAM 4 — MED-SURG NURSING II | NCLEX-STYLE EXAM
10-POINT EXAM COVERAGE SUMMARY
1. Cardiovascular Disorders – Heart failure (HFrEF/HFpEF), hypertension, coronary artery
disease, myocardial infarction, dysrhythmias, anticoagulation
2. Renal & Urinary Disorders – Chronic kidney disease, acute kidney injury, dialysis,
erythropoietin therapy, electrolyte imbalances
3. Gastrointestinal & Liver Disorders – Diverticulitis, gastritis, peptic ulcer disease,
cirrhosis, hepatitis, pancreatitis
4. Endocrine Disorders – Diabetes mellitus, thyroid disorders, adrenal disorders, pituitary
disorders (acromegaly)
5. Neurological Disorders – Stroke, seizures, Parkinson's disease, multiple sclerosis,
increased intracranial pressure
6. Respiratory Disorders – COPD, pneumonia, asthma, pulmonary embolism, ARDS,
mechanical ventilation
7. Musculoskeletal & Perioperative Care – Arthroplasty, fractures, traction, postoperative
complications, DVT prevention
8. Medication Management & Intravenous Therapy – High-alert medications, IV
calculations, TPN, blood transfusions
9. Infection Control, Sepsis & Emergency Nursing – Sepsis, isolation precautions, wound
care, emergency triage
10. Fluid, Electrolyte & Acid-Base Balance – Sodium, potassium, calcium, magnesium
imbalances; ABG interpretation
1|Page
,Page 2 of 76
SECTION 1: CARDIOVASCULAR DISORDERS (30 QUESTIONS)
1. A nurse is assessing a client with heart failure with preserved ejection fraction (HFpEF). Which
pathophysiological mechanism is primarily responsible for this condition?
A) Impaired contractility of the left ventricle
B) Reduced compliance and impaired relaxation of the left ventricle
C) Obstruction of the left ventricular outflow tract
D) Inadequate preload due to reduced venous return
Rationale: HFpEF (diastolic heart failure) is characterized by a stiff left ventricle that cannot
relax adequately during diastole. Impaired contractility is the hallmark of HFrEF.
2. A nurse is teaching a client with heart failure about a low-sodium diet. Which food selection
indicates correct understanding?
A) Grilled cheese sandwich with tomato soup
B) Broiled salmon with steamed asparagus
C) Canned beef stew with corn
D) Deli ham sandwich with pickles
Rationale: Broiled salmon and steamed asparagus are naturally low in sodium. Canned soup,
canned stew, deli meats, and pickles are high in sodium.
3. A nurse is assessing a client with suspected right-sided heart failure. Which finding should the
nurse expect?
A) Crackles in the lung bases
B) Jugular venous distention and peripheral edema
C) Orthopnea and paroxysmal nocturnal dyspnea
D) Pink frothy sputum
2|Page
,Page 3 of 76
Rationale: Right-sided heart failure causes systemic congestion, leading to JVD, peripheral
edema, and hepatomegaly. Left-sided failure causes pulmonary congestion.
4. A client with heart failure is prescribed furosemide. Which laboratory value should the nurse
monitor most closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Rationale: Loop diuretics like furosemide cause potassium loss (hypokalemia), which can lead to
dysrhythmias.
5. A nurse is teaching a client about digoxin. Which statement indicates a need for further
teaching?
A) "I will check my pulse before taking the medication."
B) "I will report nausea and visual changes."
C) "I will take my medication with an antacid."
D) "I will not take my medication if my pulse is below 60."
Rationale: Antacids decrease digoxin absorption. Clients should take digoxin consistently and
report signs of toxicity (nausea, visual disturbances).
6. A client with atrial fibrillation is prescribed warfarin. Which laboratory value should the nurse
monitor?
A) aPTT
B) INR
C) Platelet count
D) Hemoglobin
Rationale: Warfarin therapy is monitored with INR (target 2-3 for atrial fibrillation). aPTT
monitors heparin therapy.
7. A nurse is assessing a client with myocardial infarction. Which finding is most concerning?
A) Crushing chest pain unrelieved by nitroglycerin
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B) Mild fatigue
C) Occasional palpitations
D) Normal ECG
Rationale: Crushing chest pain unrelieved by nitroglycerin is the classic presentation of MI.
Immediate intervention is required.
8. A client is receiving nitroglycerin for angina. Which instruction should the nurse include?
A) "Call 911 if chest pain persists after three doses."
B) "Take five doses at once."
C) "Swallow the tablet whole."
D) "Take it only when you feel like it."
Rationale: Nitroglycerin is taken sublingually every 5 minutes for up to three doses. If pain
persists, call 911.
9. A nurse is assessing a client with hypertension. Which finding requires immediate
intervention?
A) Blood pressure of 180/110 mm Hg
B) Blood pressure of 120/80 mm Hg
C) Blood pressure of 110/70 mm Hg
D) Blood pressure of 100/60 mm Hg
Rationale: A blood pressure of 180/110 mm Hg indicates hypertensive crisis requiring
immediate intervention.
10. A nurse is teaching a client about a heart-healthy diet. Which statement indicates correct
understanding?
A) "I will eat fruits, vegetables, and whole grains."
B) "I will eat fried foods daily."
C) "I will increase saturated fats."
D) "I will skip breakfast."
Rationale: Fruits, vegetables, and whole grains are heart-healthy. Fried foods and saturated fats
increase cardiovascular risk.
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