NU 185 Exam 4 Medical Surgical Nursing II Galen
Study Assessment Exam 4 Practice Question, Exams
of Nursing
1. A patient with chronic heart failure is prescribed sacubitril/valsartan. Which assessment
finding requires the nurse to withhold the dose and notify the provider?
A. Potassium 4.8 mEq/L
B. Systolic BP 84 mm Hg
C. Heart rate 92 beats/min
D. Serum creatinine 1.1 mg/dL
Answer: B
Rationale: Sacubitril/valsartan is an ARNI that causes vasodilation and can produce
symptomatic hypotension; a systolic BP below 90 mm Hg warrants withholding and notification.
Potassium of 4.8 mEq/L, HR 92, and creatinine 1.1 mg/dL are within acceptable ranges. The
other options do not represent contraindications to administration.
2. A patient with acute respiratory distress syndrome (ARDS) is being mechanically
ventilated. Which ventilator strategy best reflects current lung-protective standards?
A. Tidal volume 12 mL/kg predicted body weight
B. High tidal volumes to improve oxygenation
C. Tidal volume 6 mL/kg predicted body weight with plateau pressure <30 cm H2O
D. Permissive hypercapnia is contraindicated
Answer: C
Rationale: Low tidal volume ventilation (6 mL/kg predicted body weight) with plateau pressures
kept below 30 cm H2O reduces ventilator-induced lung injury and mortality in ARDS. High tidal
volumes and 12 mL/kg are harmful. Permissive hypercapnia is an accepted adjunct, not
contraindicated.
3. Which laboratory finding is most consistent with acute kidney injury (AKI) due to
prerenal causes?
A. Fractional excretion of sodium (FENa) <1%
B. Urine sodium >40 mEq/L
C. Urine osmolality <300 mOsm/kg
D. BUN-to-creatinine ratio <10:1
Answer: A
Rationale: In prerenal AKI, the kidneys avidly reabsorb sodium, producing a FENa <1%, urine
sodium <20 mEq/L, urine osmolality >500 mOsm/kg, and BUN-to-creatinine ratio >20:1. The
Page 1
,other options reflect intrarenal or postrenal injury patterns.
4. A patient with type 1 diabetes is admitted with diabetic ketoacidosis. Which prescription
should the nurse question?
A. 0.9% sodium chloride IV bolus
B. Regular insulin IV infusion
C. Sodium bicarbonate IV push for pH 7.25
D. Potassium chloride 20 mEq/L in IV fluids when K+ is 4.0 mEq/L
Answer: C
Rationale: Sodium bicarbonate is not routinely indicated in DKA unless pH is <6.9; at pH 7.25 it
is unnecessary and may cause paradoxical CNS acidosis and hypokalemia. Fluid resuscitation,
insulin infusion, and potassium replacement when K+ is 4.0 mEq/L are appropriate.
5. A patient is admitted with an acute ischemic stroke and presents 2 hours after symptom
onset. Which finding is an absolute contraindication to IV thrombolytic therapy?
A. Blood pressure 178/98 mm Hg
B. Platelet count 180,000/mm3
C. INR 1.1
D. History of intracranial hemorrhage
Answer: D
Rationale: Prior intracranial hemorrhage is an absolute contraindication to IV thrombolysis.
Blood pressure of 178/98 mm Hg can be lowered to <185/110 mm Hg to permit therapy. Normal
platelet count and INR 1.1 are not contraindications.
6. A patient with a below-the-knee amputation reports a sharp, burning sensation in the
missing foot. Which intervention is most appropriate initially?
A. Apply a tight compression wrap to the residual limb
B. Administer prescribed gabapentin
C. Elevate the residual limb on a pillow for 24 hours
D. Reposition the patient prone every 2 hours
Answer: B
Rationale: Phantom limb pain is neuropathic and responds to agents such as gabapentin.
Compression wraps and elevation address residual limb edema, not neuropathic pain. Prone
positioning is used for hip flexion contracture prevention, not phantom pain.
7. A patient with cirrhosis has a serum ammonia level of 110 mcg/dL and is confused.
Which prescription should the nurse expect?
A. Increase dietary protein to 1.5 g/kg/day
B. Administer lactulose to produce 2-3 soft stools daily
C. Administer a benzodiazepine for agitation
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, D. Restrict oral fluids to 1 L/day
Answer: B
Rationale: Lactulose traps ammonia in the gut and promotes its excretion, targeting 2-3 soft
stools per day. Protein should not be restricted long-term and may be increased.
Benzodiazepines worsen encephalopathy. Fluid restriction is not indicated for hepatic
encephalopathy.
8. A patient receiving chemotherapy has a platelet count of 18,000/mm3. Which nursing
action is the priority?
A. Administer aspirin for mild headache
B. Initiate bleeding precautions and avoid IM injections
C. Encourage vigorous oral hygiene with a firm toothbrush
D. Apply warm compresses to ecchymotic areas
Answer: B
Rationale: Severe thrombocytopenia (platelets <20,000/mm3) requires bleeding precautions and
avoidance of invasive procedures such as IM injections. Aspirin and firm toothbrushes increase
bleeding risk. Warm compresses may worsen bleeding.
9. A patient is scheduled for a cardiac catheterization via the femoral artery. Which
post-procedure finding requires immediate intervention?
A. Radial pulse 1+ and equal to the opposite side
B. Small amount of serosanguineous oozing at the site
C. Absent pedal pulse on the affected extremity
D. Complaint of mild back discomfort
Answer: C
Rationale: An absent pedal pulse after femoral arterial access suggests arterial occlusion or
hematoma formation and requires immediate assessment and provider notification. Mild oozing,
1+ radial pulse, and back discomfort are expected findings.
10. A patient with acute decompensated heart failure is receiving IV furosemide. Which
assessment finding best indicates that the diuretic therapy is producing the desired
hemodynamic effect?
A. Serum potassium has decreased from 4.2 to 3.4 mEq/L
B. Urine output has increased and jugular venous distention has decreased
C. Blood pressure has fallen from 138/82 to 104/68 mm Hg
D. The patient reports decreased thirst and dry mouth
Answer: B
Rationale: Effective diuresis in decompensated heart failure is demonstrated by increased urine
output with reduced preload, evidenced by decreased jugular venous distention. Hypokalemia,
hypotension, and thirst are adverse or incidental effects, not indicators of therapeutic success.
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Study Assessment Exam 4 Practice Question, Exams
of Nursing
1. A patient with chronic heart failure is prescribed sacubitril/valsartan. Which assessment
finding requires the nurse to withhold the dose and notify the provider?
A. Potassium 4.8 mEq/L
B. Systolic BP 84 mm Hg
C. Heart rate 92 beats/min
D. Serum creatinine 1.1 mg/dL
Answer: B
Rationale: Sacubitril/valsartan is an ARNI that causes vasodilation and can produce
symptomatic hypotension; a systolic BP below 90 mm Hg warrants withholding and notification.
Potassium of 4.8 mEq/L, HR 92, and creatinine 1.1 mg/dL are within acceptable ranges. The
other options do not represent contraindications to administration.
2. A patient with acute respiratory distress syndrome (ARDS) is being mechanically
ventilated. Which ventilator strategy best reflects current lung-protective standards?
A. Tidal volume 12 mL/kg predicted body weight
B. High tidal volumes to improve oxygenation
C. Tidal volume 6 mL/kg predicted body weight with plateau pressure <30 cm H2O
D. Permissive hypercapnia is contraindicated
Answer: C
Rationale: Low tidal volume ventilation (6 mL/kg predicted body weight) with plateau pressures
kept below 30 cm H2O reduces ventilator-induced lung injury and mortality in ARDS. High tidal
volumes and 12 mL/kg are harmful. Permissive hypercapnia is an accepted adjunct, not
contraindicated.
3. Which laboratory finding is most consistent with acute kidney injury (AKI) due to
prerenal causes?
A. Fractional excretion of sodium (FENa) <1%
B. Urine sodium >40 mEq/L
C. Urine osmolality <300 mOsm/kg
D. BUN-to-creatinine ratio <10:1
Answer: A
Rationale: In prerenal AKI, the kidneys avidly reabsorb sodium, producing a FENa <1%, urine
sodium <20 mEq/L, urine osmolality >500 mOsm/kg, and BUN-to-creatinine ratio >20:1. The
Page 1
,other options reflect intrarenal or postrenal injury patterns.
4. A patient with type 1 diabetes is admitted with diabetic ketoacidosis. Which prescription
should the nurse question?
A. 0.9% sodium chloride IV bolus
B. Regular insulin IV infusion
C. Sodium bicarbonate IV push for pH 7.25
D. Potassium chloride 20 mEq/L in IV fluids when K+ is 4.0 mEq/L
Answer: C
Rationale: Sodium bicarbonate is not routinely indicated in DKA unless pH is <6.9; at pH 7.25 it
is unnecessary and may cause paradoxical CNS acidosis and hypokalemia. Fluid resuscitation,
insulin infusion, and potassium replacement when K+ is 4.0 mEq/L are appropriate.
5. A patient is admitted with an acute ischemic stroke and presents 2 hours after symptom
onset. Which finding is an absolute contraindication to IV thrombolytic therapy?
A. Blood pressure 178/98 mm Hg
B. Platelet count 180,000/mm3
C. INR 1.1
D. History of intracranial hemorrhage
Answer: D
Rationale: Prior intracranial hemorrhage is an absolute contraindication to IV thrombolysis.
Blood pressure of 178/98 mm Hg can be lowered to <185/110 mm Hg to permit therapy. Normal
platelet count and INR 1.1 are not contraindications.
6. A patient with a below-the-knee amputation reports a sharp, burning sensation in the
missing foot. Which intervention is most appropriate initially?
A. Apply a tight compression wrap to the residual limb
B. Administer prescribed gabapentin
C. Elevate the residual limb on a pillow for 24 hours
D. Reposition the patient prone every 2 hours
Answer: B
Rationale: Phantom limb pain is neuropathic and responds to agents such as gabapentin.
Compression wraps and elevation address residual limb edema, not neuropathic pain. Prone
positioning is used for hip flexion contracture prevention, not phantom pain.
7. A patient with cirrhosis has a serum ammonia level of 110 mcg/dL and is confused.
Which prescription should the nurse expect?
A. Increase dietary protein to 1.5 g/kg/day
B. Administer lactulose to produce 2-3 soft stools daily
C. Administer a benzodiazepine for agitation
Page 2
, D. Restrict oral fluids to 1 L/day
Answer: B
Rationale: Lactulose traps ammonia in the gut and promotes its excretion, targeting 2-3 soft
stools per day. Protein should not be restricted long-term and may be increased.
Benzodiazepines worsen encephalopathy. Fluid restriction is not indicated for hepatic
encephalopathy.
8. A patient receiving chemotherapy has a platelet count of 18,000/mm3. Which nursing
action is the priority?
A. Administer aspirin for mild headache
B. Initiate bleeding precautions and avoid IM injections
C. Encourage vigorous oral hygiene with a firm toothbrush
D. Apply warm compresses to ecchymotic areas
Answer: B
Rationale: Severe thrombocytopenia (platelets <20,000/mm3) requires bleeding precautions and
avoidance of invasive procedures such as IM injections. Aspirin and firm toothbrushes increase
bleeding risk. Warm compresses may worsen bleeding.
9. A patient is scheduled for a cardiac catheterization via the femoral artery. Which
post-procedure finding requires immediate intervention?
A. Radial pulse 1+ and equal to the opposite side
B. Small amount of serosanguineous oozing at the site
C. Absent pedal pulse on the affected extremity
D. Complaint of mild back discomfort
Answer: C
Rationale: An absent pedal pulse after femoral arterial access suggests arterial occlusion or
hematoma formation and requires immediate assessment and provider notification. Mild oozing,
1+ radial pulse, and back discomfort are expected findings.
10. A patient with acute decompensated heart failure is receiving IV furosemide. Which
assessment finding best indicates that the diuretic therapy is producing the desired
hemodynamic effect?
A. Serum potassium has decreased from 4.2 to 3.4 mEq/L
B. Urine output has increased and jugular venous distention has decreased
C. Blood pressure has fallen from 138/82 to 104/68 mm Hg
D. The patient reports decreased thirst and dry mouth
Answer: B
Rationale: Effective diuresis in decompensated heart failure is demonstrated by increased urine
output with reduced preload, evidenced by decreased jugular venous distention. Hypokalemia,
hypotension, and thirst are adverse or incidental effects, not indicators of therapeutic success.
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