NU 186 Exam 1 V2 | NU 186 Medical-
Surgical Nursing II-A | NCLEX (NGN) Q&A
with Rationale (NU186 Exam 1) | Galen
1. A nurse is caring for a client with a history of Chronic Obstructive Pulmonary Disease
(COPD) who is experiencing increased dyspnea. The arterial blood gas (ABG) results are: pH
7.30, PaCO2 52 mmHg, and HCO3 26 mEq/L. Which acid-base imbalance is the client
experiencing?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Acidosis
D. Respiratory Alkalosis
Correct Answer: C
Explanation; The client’s pH is below 7.35, indicating acidosis, and the PaCO2 is elevated
above 45 mmHg, which points to a respiratory cause. The bicarbonate (HCO3) level is
within the normal range, suggesting that the kidneys have not yet compensated for the
respiratory issue. This pattern is characteristic of respiratory acidosis, often seen in clients
with chronic obstructive conditions who retain carbon dioxide.
,2. A client is admitted with Acute Kidney Injury (AKI) due to severe dehydration. Which phase
of AKI is characterized by a significant decrease in urine output, typically less than 400
mL/day?
A. Onset Phase
B. Oliguric Phase
C. Diuretic Phase
D. Recovery Phase
Correct Answer: B
Explanation; The oliguric phase of AKI is defined by a urine output of less than 400 mL in
24 hours. During this phase, the nurse must monitor for fluid volume excess, electrolyte
imbalances, and metabolic acidosis. This phase can last from 1 to 2 weeks and is followed
by the diuretic phase as kidney function begins to return.
3. A nurse is assessing a client who is 24 hours postoperative following abdominal surgery.
Which of the following findings should the nurse prioritize to prevent respiratory
complications? (Select All That Apply)
A. Encourage the use of the incentive spirometer every hour while awake.
B. Maintain the client in a supine position at all times.
C. Instruct the client to perform coughing and deep breathing exercises.
D. Monitor oxygen saturation levels via pulse oximetry.
,E. Encourage early ambulation as tolerated.
F. Administer opioid analgesics strictly on a PRN basis without assessment.
Correct Answer: A, C, D, E
Explanation; Postoperative respiratory care focuses on expanding the lungs and clearing
secretions to prevent atelectasis and pneumonia. Using an incentive spirometer, coughing,
and deep breathing are direct interventions to improve ventilation. Early ambulation is
also critical for overall recovery and lung expansion, while pulse oximetry provides
necessary data on gas exchange.
4. The nurse is reviewing the lab results of a client with Chronic Kidney Disease (CKD). The
potassium level is 6.2 mEq/L. Which medication does the nurse anticipate the provider will
order to shift potassium into the cells?
A. Sodium polystyrene sulfonate
B. Furosemide
C. Calcium gluconate
D. Regular insulin and Dextrose 50%
Correct Answer: D
Explanation; Administering regular insulin IV along with dextrose 50% helps to shift
potassium from the extracellular fluid into the intracellular compartment, quickly lowering
serum potassium levels. Sodium polystyrene sulfonate is used to actually remove
potassium from the body via the GI tract, which takes longer. Calcium gluconate is used to
, protect the heart from the effects of hyperkalemia but does not lower the potassium level
itself.
5. A client with a new arteriovenous (AV) fistula in the left arm is being prepared for
discharge. Which instruction should the nurse include in the teaching plan?
A. Sleep on the left side to keep the arm supported.
B. Check blood pressure daily in the left arm.
C. Carry heavy bags with the left arm to strengthen the vessel.
D. Assess the site daily for a bruit and a thrill.
Correct Answer: D
Explanation; A bruit (sound) and thrill (vibration) are positive indicators that the AV
fistula is patent and functioning. Clients must be taught to avoid constrictive clothing, blood
pressure cuffs, or heavy lifting on the affected arm to prevent thrombosis. Maintaining the
integrity of the access site is vital for successful long-term hemodialysis therapy.
6. A nurse is assessing a client with hypokalemia. Which of the following clinical
manifestations should the nurse expect to observe?
A. Hyperactive bowel sounds
B. Peaked T waves on ECG
C. Muscle weakness and leg cramps
D. Increased deep tendon reflexes
Surgical Nursing II-A | NCLEX (NGN) Q&A
with Rationale (NU186 Exam 1) | Galen
1. A nurse is caring for a client with a history of Chronic Obstructive Pulmonary Disease
(COPD) who is experiencing increased dyspnea. The arterial blood gas (ABG) results are: pH
7.30, PaCO2 52 mmHg, and HCO3 26 mEq/L. Which acid-base imbalance is the client
experiencing?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Acidosis
D. Respiratory Alkalosis
Correct Answer: C
Explanation; The client’s pH is below 7.35, indicating acidosis, and the PaCO2 is elevated
above 45 mmHg, which points to a respiratory cause. The bicarbonate (HCO3) level is
within the normal range, suggesting that the kidneys have not yet compensated for the
respiratory issue. This pattern is characteristic of respiratory acidosis, often seen in clients
with chronic obstructive conditions who retain carbon dioxide.
,2. A client is admitted with Acute Kidney Injury (AKI) due to severe dehydration. Which phase
of AKI is characterized by a significant decrease in urine output, typically less than 400
mL/day?
A. Onset Phase
B. Oliguric Phase
C. Diuretic Phase
D. Recovery Phase
Correct Answer: B
Explanation; The oliguric phase of AKI is defined by a urine output of less than 400 mL in
24 hours. During this phase, the nurse must monitor for fluid volume excess, electrolyte
imbalances, and metabolic acidosis. This phase can last from 1 to 2 weeks and is followed
by the diuretic phase as kidney function begins to return.
3. A nurse is assessing a client who is 24 hours postoperative following abdominal surgery.
Which of the following findings should the nurse prioritize to prevent respiratory
complications? (Select All That Apply)
A. Encourage the use of the incentive spirometer every hour while awake.
B. Maintain the client in a supine position at all times.
C. Instruct the client to perform coughing and deep breathing exercises.
D. Monitor oxygen saturation levels via pulse oximetry.
,E. Encourage early ambulation as tolerated.
F. Administer opioid analgesics strictly on a PRN basis without assessment.
Correct Answer: A, C, D, E
Explanation; Postoperative respiratory care focuses on expanding the lungs and clearing
secretions to prevent atelectasis and pneumonia. Using an incentive spirometer, coughing,
and deep breathing are direct interventions to improve ventilation. Early ambulation is
also critical for overall recovery and lung expansion, while pulse oximetry provides
necessary data on gas exchange.
4. The nurse is reviewing the lab results of a client with Chronic Kidney Disease (CKD). The
potassium level is 6.2 mEq/L. Which medication does the nurse anticipate the provider will
order to shift potassium into the cells?
A. Sodium polystyrene sulfonate
B. Furosemide
C. Calcium gluconate
D. Regular insulin and Dextrose 50%
Correct Answer: D
Explanation; Administering regular insulin IV along with dextrose 50% helps to shift
potassium from the extracellular fluid into the intracellular compartment, quickly lowering
serum potassium levels. Sodium polystyrene sulfonate is used to actually remove
potassium from the body via the GI tract, which takes longer. Calcium gluconate is used to
, protect the heart from the effects of hyperkalemia but does not lower the potassium level
itself.
5. A client with a new arteriovenous (AV) fistula in the left arm is being prepared for
discharge. Which instruction should the nurse include in the teaching plan?
A. Sleep on the left side to keep the arm supported.
B. Check blood pressure daily in the left arm.
C. Carry heavy bags with the left arm to strengthen the vessel.
D. Assess the site daily for a bruit and a thrill.
Correct Answer: D
Explanation; A bruit (sound) and thrill (vibration) are positive indicators that the AV
fistula is patent and functioning. Clients must be taught to avoid constrictive clothing, blood
pressure cuffs, or heavy lifting on the affected arm to prevent thrombosis. Maintaining the
integrity of the access site is vital for successful long-term hemodialysis therapy.
6. A nurse is assessing a client with hypokalemia. Which of the following clinical
manifestations should the nurse expect to observe?
A. Hyperactive bowel sounds
B. Peaked T waves on ECG
C. Muscle weakness and leg cramps
D. Increased deep tendon reflexes
