NU 185 Medical Surgical Nursing II Comprehensive
Exam Prep Comprehensive Study Guide 2026, Exams
of Nursing
1. A patient with type 1 diabetes is admitted with nausea, vomiting, and abdominal pain.
ABG shows pH 7.22, PaCO2 28 mm Hg, HCO3 10 mEq/L; glucose is 512 mg/dL and serum
ketones are positive. Which prescription should the nurse question?
A. IV regular insulin infusion at 0.1 unit/kg/hr
B. IV sodium bicarbonate 100 mEq bolus now
C. 0.9% sodium chloride IV bolus followed by continuous infusion
D. Hourly point-of-care glucose and potassium monitoring
Answer: B
Rationale: Bicarbonate is not routinely indicated in DKA and can cause paradoxical CNS
acidosis and hypokalemia; it is reserved for severe acidosis (pH < 6.9). Fluid resuscitation,
insulin infusion, and electrolyte monitoring are standard DKA management.
2. A patient is 6 hours post-thyroidectomy and reports tingling around the mouth and
fingertips. Which assessment finding is most consistent with the suspected complication?
A. Positive Trousseau's sign with carpopedal spasm
B. Bradycardia with hypertension and warm dry skin
C. Unilateral hoarseness and difficulty swallowing
D. Bulging eyes with lid lag and exophthalmos
Answer: A
Rationale: Perioral and digital paresthesias after thyroidectomy suggest hypocalcemia from
parathyroid injury; Trousseau's sign is a classic neuromuscular manifestation. Hoarseness
reflects recurrent laryngeal nerve injury, while the other options describe thyroid storm or
Graves' disease.
3. A patient with chronic kidney disease (stage 4) has laboratory results: K+ 6.4 mEq/L,
BUN 68 mg/dL, creatinine 4.2 mg/dL, and peaked T waves on ECG. Which intervention
should the nurse anticipate first?
A. Administer oral sodium polystyrene sulfonate
B. Initiate hemodialysis emergently
C. Administer IV calcium gluconate
D. Administer IV regular insulin with dextrose
Answer: C
Page 1
,Rationale: IV calcium gluconate is given first to stabilize the myocardium against arrhythmias from hyperkalemia without
lowering serum potassium. Insulin/dextrose and polystyrene shift or remove potassium but do not provide immediate cardiac
protection.
4. A patient with an acute ischemic stroke has sudden onset of severe headache, vomiting,
and decreased level of consciousness 24 hours after receiving IV alteplase. Which action
should the nurse take first?
A. Administer the next scheduled dose of aspirin
B. Stop the infusion and notify the provider immediately
C. Elevate the head of the bed and reassess in 30 minutes
D. Obtain a routine blood glucose level before acting
Answer: B
Rationale: These findings suggest intracranial hemorrhage, the most feared complication of
thrombolysis; the infusion must be stopped and the provider notified immediately for emergent
imaging. Aspirin is contraindicated within 24 hours of alteplase, and delaying action is unsafe.
5. A patient with a new colostomy following abdominal perineal resection has a stoma that
is dark blue and dry 12 hours postoperatively. Which interpretation is most accurate?
A. This is an expected finding for a healthy stoma
B. The stoma indicates inadequate perfusion and requires immediate provider notification
C. The stoma is edematous and should be monitored for 48 hours
D. The stoma needs a larger appliance to accommodate swelling
Answer: B
Rationale: A healthy stoma is pink to red, moist, and shiny; a dark blue, dry, or dusky stoma
indicates ischemia and possible necrosis requiring urgent evaluation. Edema is expected, but
color change to blue/black is not.
6. A patient with a below-the-knee amputation reports a sharp, shooting pain in the missing
foot. Which intervention should the nurse implement first?
A. Explain that the pain is imaginary and will resolve
B. Administer the prescribed opioid analgesic
C. Apply a heating pad to the residual limb
D. Reposition the residual limb and apply a cold compress
Answer: B
Rationale: Phantom limb pain is real neuropathic pain and should be treated with prescribed
analgesics, including opioids, gabapentin, or mirror therapy. Dismissing the pain or applying
heat to the residual limb is inappropriate and unsafe.
7. A patient receiving a blood transfusion develops fever, chills, and flank pain 15 minutes
into the infusion. Which action should the nurse take first?
Page 2
, A. Slow the transfusion and administer acetaminophen
B. Stop the transfusion and maintain IV access with 0.9% sodium chloride
C. Obtain a urine specimen and continue the transfusion
D. Administer diphenhydramine and restart the transfusion
Answer: B
Rationale: Fever, chills, and flank pain suggest an acute hemolytic transfusion reaction; the
transfusion must be stopped immediately and IV access maintained with normal saline. Slowing
or continuing the transfusion can worsen the reaction.
8. A patient with COPD has an oxygen saturation of 86% on room air. Which oxygen
delivery method is most appropriate to maintain SpO2 between 88% and 92%?
A. Nonrebreather mask at 10 L/min
B. Venturi mask at 24% to 28%
C. Simple face mask at 8 L/min
D. Nasal cannula at 6 L/min
Answer: B
Rationale: A Venturi mask provides precise low-flow oxygen concentrations (24%–28%) to target
SpO2 88%-92% in COPD, avoiding oxygen-induced hypercapnia. High-flow devices may exceed
the target range and risk carbon dioxide retention.
9. A patient with acute pancreatitis has the following laboratory results: serum lipase 1,200
U/L, calcium 7.8 mg/dL, glucose 210 mg/dL, and WBC 18,000/mm³. Which finding
requires immediate nursing intervention?
A. Serum lipase elevation
B. Serum calcium of 7.8 mg/dL
C. Blood glucose of 210 mg/dL
D. WBC of 18,000/mm³
Answer: B
Rationale: Hypocalcemia in acute pancreatitis can cause tetany, seizures, and arrhythmias; a
calcium level below 8 mg/dL requires prompt treatment. Lipase elevation and leukocytosis are
expected, and glucose of 210 mg/dL is not immediately life-threatening.
10. A patient with an acute exacerbation of heart failure is started on IV furosemide.
Which assessment finding best indicates the medication is producing the desired
therapeutic effect?
A. Serum potassium rises from 3.2 to 4.0 mEq/L
B. Urine output increases with a corresponding decrease in body weight
C. Heart rate decreases from 112 to 88 beats/min
D. Bilateral crackles become more diffuse on auscultation
Answer: B
Page 3
Exam Prep Comprehensive Study Guide 2026, Exams
of Nursing
1. A patient with type 1 diabetes is admitted with nausea, vomiting, and abdominal pain.
ABG shows pH 7.22, PaCO2 28 mm Hg, HCO3 10 mEq/L; glucose is 512 mg/dL and serum
ketones are positive. Which prescription should the nurse question?
A. IV regular insulin infusion at 0.1 unit/kg/hr
B. IV sodium bicarbonate 100 mEq bolus now
C. 0.9% sodium chloride IV bolus followed by continuous infusion
D. Hourly point-of-care glucose and potassium monitoring
Answer: B
Rationale: Bicarbonate is not routinely indicated in DKA and can cause paradoxical CNS
acidosis and hypokalemia; it is reserved for severe acidosis (pH < 6.9). Fluid resuscitation,
insulin infusion, and electrolyte monitoring are standard DKA management.
2. A patient is 6 hours post-thyroidectomy and reports tingling around the mouth and
fingertips. Which assessment finding is most consistent with the suspected complication?
A. Positive Trousseau's sign with carpopedal spasm
B. Bradycardia with hypertension and warm dry skin
C. Unilateral hoarseness and difficulty swallowing
D. Bulging eyes with lid lag and exophthalmos
Answer: A
Rationale: Perioral and digital paresthesias after thyroidectomy suggest hypocalcemia from
parathyroid injury; Trousseau's sign is a classic neuromuscular manifestation. Hoarseness
reflects recurrent laryngeal nerve injury, while the other options describe thyroid storm or
Graves' disease.
3. A patient with chronic kidney disease (stage 4) has laboratory results: K+ 6.4 mEq/L,
BUN 68 mg/dL, creatinine 4.2 mg/dL, and peaked T waves on ECG. Which intervention
should the nurse anticipate first?
A. Administer oral sodium polystyrene sulfonate
B. Initiate hemodialysis emergently
C. Administer IV calcium gluconate
D. Administer IV regular insulin with dextrose
Answer: C
Page 1
,Rationale: IV calcium gluconate is given first to stabilize the myocardium against arrhythmias from hyperkalemia without
lowering serum potassium. Insulin/dextrose and polystyrene shift or remove potassium but do not provide immediate cardiac
protection.
4. A patient with an acute ischemic stroke has sudden onset of severe headache, vomiting,
and decreased level of consciousness 24 hours after receiving IV alteplase. Which action
should the nurse take first?
A. Administer the next scheduled dose of aspirin
B. Stop the infusion and notify the provider immediately
C. Elevate the head of the bed and reassess in 30 minutes
D. Obtain a routine blood glucose level before acting
Answer: B
Rationale: These findings suggest intracranial hemorrhage, the most feared complication of
thrombolysis; the infusion must be stopped and the provider notified immediately for emergent
imaging. Aspirin is contraindicated within 24 hours of alteplase, and delaying action is unsafe.
5. A patient with a new colostomy following abdominal perineal resection has a stoma that
is dark blue and dry 12 hours postoperatively. Which interpretation is most accurate?
A. This is an expected finding for a healthy stoma
B. The stoma indicates inadequate perfusion and requires immediate provider notification
C. The stoma is edematous and should be monitored for 48 hours
D. The stoma needs a larger appliance to accommodate swelling
Answer: B
Rationale: A healthy stoma is pink to red, moist, and shiny; a dark blue, dry, or dusky stoma
indicates ischemia and possible necrosis requiring urgent evaluation. Edema is expected, but
color change to blue/black is not.
6. A patient with a below-the-knee amputation reports a sharp, shooting pain in the missing
foot. Which intervention should the nurse implement first?
A. Explain that the pain is imaginary and will resolve
B. Administer the prescribed opioid analgesic
C. Apply a heating pad to the residual limb
D. Reposition the residual limb and apply a cold compress
Answer: B
Rationale: Phantom limb pain is real neuropathic pain and should be treated with prescribed
analgesics, including opioids, gabapentin, or mirror therapy. Dismissing the pain or applying
heat to the residual limb is inappropriate and unsafe.
7. A patient receiving a blood transfusion develops fever, chills, and flank pain 15 minutes
into the infusion. Which action should the nurse take first?
Page 2
, A. Slow the transfusion and administer acetaminophen
B. Stop the transfusion and maintain IV access with 0.9% sodium chloride
C. Obtain a urine specimen and continue the transfusion
D. Administer diphenhydramine and restart the transfusion
Answer: B
Rationale: Fever, chills, and flank pain suggest an acute hemolytic transfusion reaction; the
transfusion must be stopped immediately and IV access maintained with normal saline. Slowing
or continuing the transfusion can worsen the reaction.
8. A patient with COPD has an oxygen saturation of 86% on room air. Which oxygen
delivery method is most appropriate to maintain SpO2 between 88% and 92%?
A. Nonrebreather mask at 10 L/min
B. Venturi mask at 24% to 28%
C. Simple face mask at 8 L/min
D. Nasal cannula at 6 L/min
Answer: B
Rationale: A Venturi mask provides precise low-flow oxygen concentrations (24%–28%) to target
SpO2 88%-92% in COPD, avoiding oxygen-induced hypercapnia. High-flow devices may exceed
the target range and risk carbon dioxide retention.
9. A patient with acute pancreatitis has the following laboratory results: serum lipase 1,200
U/L, calcium 7.8 mg/dL, glucose 210 mg/dL, and WBC 18,000/mm³. Which finding
requires immediate nursing intervention?
A. Serum lipase elevation
B. Serum calcium of 7.8 mg/dL
C. Blood glucose of 210 mg/dL
D. WBC of 18,000/mm³
Answer: B
Rationale: Hypocalcemia in acute pancreatitis can cause tetany, seizures, and arrhythmias; a
calcium level below 8 mg/dL requires prompt treatment. Lipase elevation and leukocytosis are
expected, and glucose of 210 mg/dL is not immediately life-threatening.
10. A patient with an acute exacerbation of heart failure is started on IV furosemide.
Which assessment finding best indicates the medication is producing the desired
therapeutic effect?
A. Serum potassium rises from 3.2 to 4.0 mEq/L
B. Urine output increases with a corresponding decrease in body weight
C. Heart rate decreases from 112 to 88 beats/min
D. Bilateral crackles become more diffuse on auscultation
Answer: B
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