NU 186 Final Exam V1 | NU 186 Medical-
Surgical Nursing II-A | NCLEX (NGN) Q&A
with Rationale (NU186 Final Exam) | Galen
1. A patient with Type 1 Diabetes Mellitus presents to the clinic with confusion, diaphoresis,
and a heart rate of 115 bpm. After checking the fingerstick glucose and finding it to be 48
mg/dL, which intervention should the nurse perform first?
A. Administer 1 mg of Glucagon intramuscularly.
B. Provide a complex carbohydrate and protein snack like whole-wheat crackers and
cheese.
C. Notify the healthcare provider of the critical blood glucose level.
D. Administer 15 grams of simple carbohydrates such as 4 oz of orange juice.
Correct Answer: D
Explanation: The patient is experiencing symptomatic hypoglycemia, and the immediate
priority is to raise blood glucose levels. According to the ‘Rule of 15,’ the nurse should first
provide 15 grams of rapid-acting simple carbohydrates if the patient is conscious and able
to swallow. Following this intervention, the nurse should recheck the glucose in 15 minutes
to determine if further treatment is needed. Complex carbohydrates and proteins are used
only after the glucose has stabilized to prevent subsequent drops. Notification of the
provider and glucagon administration are secondary or reserved for patients who cannot
take oral intake.
,2. The nurse is assessing a patient diagnosed with left-sided heart failure. Which clinical
manifestations should the nurse expect to find? (Select all that apply)
A. Crackles or wheezing in lungs
B. Peripheral edema in the lower extremities
C. Dyspnea on exertion
D. Jugular venous distention (JVD)
E. Paroxysmal nocturnal dyspnea (PND)
F. Orthopnea
Correct Answer: A, C, E, F
Explanation: Left-sided heart failure primarily involves the backflow of blood into the
pulmonary circulation, leading to symptoms of pulmonary congestion. Expected findings
include crackles, dyspnea, paroxysmal nocturnal dyspnea, and orthopnea because the left
ventricle cannot effectively pump blood into the systemic circulation. Conversely,
peripheral edema and JVD are classic signs of right-sided heart failure, where blood backs
up into the systemic venous system. Distinguishing between these two conditions is vital
for targeted assessment and nursing care in medical-surgical environments.
3. A patient with Chronic Obstructive Pulmonary Disease (COPD) is being taught pursed-lip
breathing. What is the primary purpose of this technique?
A. To prevent airway collapse by maintaining positive pressure in the airways.
B. To strengthen the intercostal muscles and diaphragm.
,C. To increase the respiratory rate to blow off excess carbon dioxide.
D. To reduce the amount of oxygen needed during physical activity.
Correct Answer: A
Explanation: Pursed-lip breathing is designed to prolong exhalation and create a back-
pressure that keeps the airways open longer. This process helps to prevent airway collapse
and promotes the removal of trapped air from the alveoli, which is a common issue in
COPD patients. By effectively clearing more air, the patient can reduce the work of
breathing and improve gas exchange. It does not primarily strengthen muscles or increase
the rate, but rather optimizes the expiratory phase of the respiratory cycle.
4. A patient who underwent a total hip arthroplasty 24 hours ago is preparing for discharge.
Which statement by the patient indicates a need for further teaching regarding post-
operative precautions?
A. ‘I will use a raised toilet seat at home.’
B. ‘I will lean forward to put on my socks and shoes.’
C. ‘I will avoid crossing my legs when sitting in a chair.’
D. ‘I will place a pillow between my legs when I sleep on my side.’
Correct Answer: B
Explanation: Following a total hip arthroplasty, patients must adhere to hip precautions to
prevent dislocation, which includes avoiding hip flexion greater than 90 degrees. Leaning
forward to put on shoes and socks violates this rule and poses a high risk for joint
, displacement. The use of a raised toilet seat, avoiding crossing the legs (adduction), and
using an abduction pillow are all correct safety measures. The nurse must ensure the
patient understands how to perform activities of daily living using assistive devices like
long-handled reachers.
5. A nurse is reviewing the laboratory results for a patient with Chronic Kidney Disease (CKD)
who is scheduled for hemodialysis. Which laboratory value requires immediate follow-up?
A. Hemoglobin of 10.2 g/dL
B. Creatinine of 4.5 mg/dL
C. Calcium of 8.6 mg/dL
D. Potassium of 6.8 mEq/L
Correct Answer: D
Explanation: A potassium level of 6.8 mEq/L indicates severe hyperkalemia, which is a
life-threatening electrolyte imbalance that can lead to cardiac dysrhythmias or arrest.
While patients with CKD often have elevated creatinine and low hemoglobin, these chronic
values are expected for the disease stage and do not represent an immediate physiological
crisis. The nurse must prioritize the high potassium level and prepare for emergency
interventions, such as the administration of calcium gluconate or insulin with dextrose,
prior to or during dialysis. Monitoring the EKG for peaked T-waves is also a critical nursing
action in this scenario.
Surgical Nursing II-A | NCLEX (NGN) Q&A
with Rationale (NU186 Final Exam) | Galen
1. A patient with Type 1 Diabetes Mellitus presents to the clinic with confusion, diaphoresis,
and a heart rate of 115 bpm. After checking the fingerstick glucose and finding it to be 48
mg/dL, which intervention should the nurse perform first?
A. Administer 1 mg of Glucagon intramuscularly.
B. Provide a complex carbohydrate and protein snack like whole-wheat crackers and
cheese.
C. Notify the healthcare provider of the critical blood glucose level.
D. Administer 15 grams of simple carbohydrates such as 4 oz of orange juice.
Correct Answer: D
Explanation: The patient is experiencing symptomatic hypoglycemia, and the immediate
priority is to raise blood glucose levels. According to the ‘Rule of 15,’ the nurse should first
provide 15 grams of rapid-acting simple carbohydrates if the patient is conscious and able
to swallow. Following this intervention, the nurse should recheck the glucose in 15 minutes
to determine if further treatment is needed. Complex carbohydrates and proteins are used
only after the glucose has stabilized to prevent subsequent drops. Notification of the
provider and glucagon administration are secondary or reserved for patients who cannot
take oral intake.
,2. The nurse is assessing a patient diagnosed with left-sided heart failure. Which clinical
manifestations should the nurse expect to find? (Select all that apply)
A. Crackles or wheezing in lungs
B. Peripheral edema in the lower extremities
C. Dyspnea on exertion
D. Jugular venous distention (JVD)
E. Paroxysmal nocturnal dyspnea (PND)
F. Orthopnea
Correct Answer: A, C, E, F
Explanation: Left-sided heart failure primarily involves the backflow of blood into the
pulmonary circulation, leading to symptoms of pulmonary congestion. Expected findings
include crackles, dyspnea, paroxysmal nocturnal dyspnea, and orthopnea because the left
ventricle cannot effectively pump blood into the systemic circulation. Conversely,
peripheral edema and JVD are classic signs of right-sided heart failure, where blood backs
up into the systemic venous system. Distinguishing between these two conditions is vital
for targeted assessment and nursing care in medical-surgical environments.
3. A patient with Chronic Obstructive Pulmonary Disease (COPD) is being taught pursed-lip
breathing. What is the primary purpose of this technique?
A. To prevent airway collapse by maintaining positive pressure in the airways.
B. To strengthen the intercostal muscles and diaphragm.
,C. To increase the respiratory rate to blow off excess carbon dioxide.
D. To reduce the amount of oxygen needed during physical activity.
Correct Answer: A
Explanation: Pursed-lip breathing is designed to prolong exhalation and create a back-
pressure that keeps the airways open longer. This process helps to prevent airway collapse
and promotes the removal of trapped air from the alveoli, which is a common issue in
COPD patients. By effectively clearing more air, the patient can reduce the work of
breathing and improve gas exchange. It does not primarily strengthen muscles or increase
the rate, but rather optimizes the expiratory phase of the respiratory cycle.
4. A patient who underwent a total hip arthroplasty 24 hours ago is preparing for discharge.
Which statement by the patient indicates a need for further teaching regarding post-
operative precautions?
A. ‘I will use a raised toilet seat at home.’
B. ‘I will lean forward to put on my socks and shoes.’
C. ‘I will avoid crossing my legs when sitting in a chair.’
D. ‘I will place a pillow between my legs when I sleep on my side.’
Correct Answer: B
Explanation: Following a total hip arthroplasty, patients must adhere to hip precautions to
prevent dislocation, which includes avoiding hip flexion greater than 90 degrees. Leaning
forward to put on shoes and socks violates this rule and poses a high risk for joint
, displacement. The use of a raised toilet seat, avoiding crossing the legs (adduction), and
using an abduction pillow are all correct safety measures. The nurse must ensure the
patient understands how to perform activities of daily living using assistive devices like
long-handled reachers.
5. A nurse is reviewing the laboratory results for a patient with Chronic Kidney Disease (CKD)
who is scheduled for hemodialysis. Which laboratory value requires immediate follow-up?
A. Hemoglobin of 10.2 g/dL
B. Creatinine of 4.5 mg/dL
C. Calcium of 8.6 mg/dL
D. Potassium of 6.8 mEq/L
Correct Answer: D
Explanation: A potassium level of 6.8 mEq/L indicates severe hyperkalemia, which is a
life-threatening electrolyte imbalance that can lead to cardiac dysrhythmias or arrest.
While patients with CKD often have elevated creatinine and low hemoglobin, these chronic
values are expected for the disease stage and do not represent an immediate physiological
crisis. The nurse must prioritize the high potassium level and prepare for emergency
interventions, such as the administration of calcium gluconate or insulin with dextrose,
prior to or during dialysis. Monitoring the EKG for peaked T-waves is also a critical nursing
action in this scenario.
