NURS 366 EXAM 2 | ALL QUESTIONS AND CORRECT
ANSWERS | LATEST VERSIONS 2026/2027| JUST
RELEASED
Adult Health Nursing II | Key Domains: Nursing Management of Endocrine Disorders,
Gastrointestinal & Hepatic Disorders, Renal & Urinary Disorders, Musculoskeletal Disorders,
Integumentary Disorders, Oncologic Nursing, Perioperative Nursing Care, and Complex Multisystem
Health Alterations | Expert-Aligned Structure | Exam-Ready Format
Introduction
This structured NURS 366 Exam 2 for 2026/2027 provides 75 high-quality exam-style questions
with correct answers and rationales. It emphasizes the nursing process for complex adult
medical-surgical conditions, including pathophysiology, evidence-based interventions, patient
education, and collaborative management to restore health, promote adaptation, and prevent
complications.
Answer Format
All correct answers appear in bold and cyan blue, accompanied by concise rationales explaining
the pathophysiological basis for the symptom, the priority nursing intervention, a key diagnostic
finding, or a critical patient teaching point, and why alternative options are incorrect, lower priority,
or potentially harmful.
1. A patient with diabetic ketoacidosis (DKA) has a serum potassium level of 5.8 mEq/L. After
initiating insulin therapy, the nurse should anticipate:
a) Continued elevation of potassium
b) A rapid drop in serum potassium requiring replacement
c) No change in potassium levels
, d) Development of hypocalcemia
Insulin drives potassium into cells, causing serum levels to fall rapidly—even if total body potassium is
depleted. Despite an initially high or normal serum K+, patients in DKA are total-body potassium
deficient and require careful replacement once urine output is confirmed.
2. The priority nursing intervention for a patient with acute pancreatitis is:
a) Administering oral pancreatic enzymes
b) Maintaining NPO status and providing aggressive IV fluid resuscitation
c) Encouraging high-protein oral intake
d) Applying a heating pad to the abdomen
NPO status rests the pancreas and prevents stimulation of enzyme secretion. IV fluids are critical to
counteract third-spacing, hypovolemia, and prevent renal failure. Oral intake is withheld until pain
and enzyme levels improve.
3. A patient with cirrhosis develops asterixis. The nurse recognizes this as a sign of:
a) Hypocalcemia
b) Hepatic encephalopathy due to elevated ammonia levels
c) Hypoglycemia
d) Peripheral neuropathy
Asterixis (“liver flap”) is a flapping tremor of the hands when arms are extended, caused by ammonia
crossing the blood-brain barrier and affecting neurotransmission. It is a classic sign of hepatic
encephalopathy in advanced liver disease.
4. Which assessment finding is most concerning in a patient 24 hours post-op after a total hip
arthroplasty?
, a) Pain rated 5/10 with ambulation
b) Sudden onset of shortness of breath and tachycardia
c) Surgical site swelling
d) Temperature of 100.4°F (38°C)
Sudden dyspnea and tachycardia in the postoperative period are hallmark signs of pulmonary
embolism—a life-threatening complication of immobility. Immediate assessment and intervention
(e.g., oxygen, notify provider) are critical.
5. A patient with acute kidney injury (AKI) has a serum creatinine of 3.2 mg/dL and a urine
output of 300 mL in 24 hours. The nurse identifies this as:
a) Prerenal AKI
b) Intrinsic (intrarenal) AKI, likely in the oliguric phase
c) Postrenal AKI
d) Chronic kidney disease
Oliguria (<400 mL/day) with rising creatinine suggests intrinsic AKI (e.g., acute tubular necrosis).
Prerenal AKI typically responds to fluid resuscitation; postrenal is due to obstruction. CKD develops
over months to years.
6. The nurse caring for a patient with Cushing’s syndrome should monitor for:
a) Hypotension and weight loss
b) Hyperglycemia, hypertension, and muscle weakness
c) Bradycardia and hypoglycemia
, d) Tremors and insomnia
Cushing’s syndrome results from excess cortisol, causing central obesity, moon face, buffalo hump,
hyperglycemia (insulin resistance), hypertension (sodium retention), and proximal muscle weakness.
Skin thinning and easy bruising are also common.
7. A patient with a new colostomy is learning self-care. Which statement indicates effective
teaching?
a) “I’ll change the pouch only when it leaks.”
b) “I’ll measure my stoma weekly and cut the skin barrier to fit snugly around it.”
c) “I should avoid all fiber to prevent blockage.”
d) “I’ll use alcohol to clean the skin around the stoma.”
The stoma shrinks over 6–8 weeks post-op. The skin barrier should be cut 1/8–1/16 inch larger than
the stoma to protect peristomal skin. Alcohol is irritating; gentle soap and water are recommended.
Fiber is gradually reintroduced to regulate output.
8. In the immediate postoperative period, the priority assessment for any surgical patient is:
a) Pain level
b) Airway patency and respiratory status
c) Incisional bleeding
d) Urine output
Following the ABCs (Airway, Breathing, Circulation), ensuring a patent airway and adequate
ventilation is the highest priority due to risks from anesthesia, opioids, and supine positioning (e.g.,
aspiration, atelectasis).
ANSWERS | LATEST VERSIONS 2026/2027| JUST
RELEASED
Adult Health Nursing II | Key Domains: Nursing Management of Endocrine Disorders,
Gastrointestinal & Hepatic Disorders, Renal & Urinary Disorders, Musculoskeletal Disorders,
Integumentary Disorders, Oncologic Nursing, Perioperative Nursing Care, and Complex Multisystem
Health Alterations | Expert-Aligned Structure | Exam-Ready Format
Introduction
This structured NURS 366 Exam 2 for 2026/2027 provides 75 high-quality exam-style questions
with correct answers and rationales. It emphasizes the nursing process for complex adult
medical-surgical conditions, including pathophysiology, evidence-based interventions, patient
education, and collaborative management to restore health, promote adaptation, and prevent
complications.
Answer Format
All correct answers appear in bold and cyan blue, accompanied by concise rationales explaining
the pathophysiological basis for the symptom, the priority nursing intervention, a key diagnostic
finding, or a critical patient teaching point, and why alternative options are incorrect, lower priority,
or potentially harmful.
1. A patient with diabetic ketoacidosis (DKA) has a serum potassium level of 5.8 mEq/L. After
initiating insulin therapy, the nurse should anticipate:
a) Continued elevation of potassium
b) A rapid drop in serum potassium requiring replacement
c) No change in potassium levels
, d) Development of hypocalcemia
Insulin drives potassium into cells, causing serum levels to fall rapidly—even if total body potassium is
depleted. Despite an initially high or normal serum K+, patients in DKA are total-body potassium
deficient and require careful replacement once urine output is confirmed.
2. The priority nursing intervention for a patient with acute pancreatitis is:
a) Administering oral pancreatic enzymes
b) Maintaining NPO status and providing aggressive IV fluid resuscitation
c) Encouraging high-protein oral intake
d) Applying a heating pad to the abdomen
NPO status rests the pancreas and prevents stimulation of enzyme secretion. IV fluids are critical to
counteract third-spacing, hypovolemia, and prevent renal failure. Oral intake is withheld until pain
and enzyme levels improve.
3. A patient with cirrhosis develops asterixis. The nurse recognizes this as a sign of:
a) Hypocalcemia
b) Hepatic encephalopathy due to elevated ammonia levels
c) Hypoglycemia
d) Peripheral neuropathy
Asterixis (“liver flap”) is a flapping tremor of the hands when arms are extended, caused by ammonia
crossing the blood-brain barrier and affecting neurotransmission. It is a classic sign of hepatic
encephalopathy in advanced liver disease.
4. Which assessment finding is most concerning in a patient 24 hours post-op after a total hip
arthroplasty?
, a) Pain rated 5/10 with ambulation
b) Sudden onset of shortness of breath and tachycardia
c) Surgical site swelling
d) Temperature of 100.4°F (38°C)
Sudden dyspnea and tachycardia in the postoperative period are hallmark signs of pulmonary
embolism—a life-threatening complication of immobility. Immediate assessment and intervention
(e.g., oxygen, notify provider) are critical.
5. A patient with acute kidney injury (AKI) has a serum creatinine of 3.2 mg/dL and a urine
output of 300 mL in 24 hours. The nurse identifies this as:
a) Prerenal AKI
b) Intrinsic (intrarenal) AKI, likely in the oliguric phase
c) Postrenal AKI
d) Chronic kidney disease
Oliguria (<400 mL/day) with rising creatinine suggests intrinsic AKI (e.g., acute tubular necrosis).
Prerenal AKI typically responds to fluid resuscitation; postrenal is due to obstruction. CKD develops
over months to years.
6. The nurse caring for a patient with Cushing’s syndrome should monitor for:
a) Hypotension and weight loss
b) Hyperglycemia, hypertension, and muscle weakness
c) Bradycardia and hypoglycemia
, d) Tremors and insomnia
Cushing’s syndrome results from excess cortisol, causing central obesity, moon face, buffalo hump,
hyperglycemia (insulin resistance), hypertension (sodium retention), and proximal muscle weakness.
Skin thinning and easy bruising are also common.
7. A patient with a new colostomy is learning self-care. Which statement indicates effective
teaching?
a) “I’ll change the pouch only when it leaks.”
b) “I’ll measure my stoma weekly and cut the skin barrier to fit snugly around it.”
c) “I should avoid all fiber to prevent blockage.”
d) “I’ll use alcohol to clean the skin around the stoma.”
The stoma shrinks over 6–8 weeks post-op. The skin barrier should be cut 1/8–1/16 inch larger than
the stoma to protect peristomal skin. Alcohol is irritating; gentle soap and water are recommended.
Fiber is gradually reintroduced to regulate output.
8. In the immediate postoperative period, the priority assessment for any surgical patient is:
a) Pain level
b) Airway patency and respiratory status
c) Incisional bleeding
d) Urine output
Following the ABCs (Airway, Breathing, Circulation), ensuring a patent airway and adequate
ventilation is the highest priority due to risks from anesthesia, opioids, and supine positioning (e.g.,
aspiration, atelectasis).
