• NUR 6001 09/15/2026
NU 185 Medical-Surgical Nursing II Comprehensive
Exam Prep Comprehensive Study Guide
UPDATE Actual Questions & Verified Answers with
Detailed Clinical Rationales
A 58-year-old client, who has no health problems, asks the nurse about the Pneumovax vaccine. The nurse's
response to the client should be based on which information?
a. The vaccine is given annually before the flu season to those over 50 years of age.
b. The immunization is administered once to older adults or persons with a history of chronic illness.
c. The vaccine is for all ages and is given primarily to those persons traveling overseas to areas of infection.
d. The vaccine will prevent the occurrence of pneumococcal pneumonia for up to five years. –
Correct Answer :B
Rationale
P 1
, • NUR 6001 09/15/2026
It is recommended by the CDC (Dec 2016) that persons over 65 years of age and those with a history of chronic
illness receive the vaccine once in a lifetime.
39. A client who is HIV positive asks the nurse, "How will I know when I have AIDS?" Which response is best for
the nurse to provide?
a. "Diagnosis of AIDS is made when you have 2 positive ELISA test results."
b. "Diagnosis is made when both the ELISA and the Western Blot tests are positive."
c. "I can tell that you are afraid of being diagnosed with AIDS. Would you like for me to call your minister?"
d. "AIDS is diagnosed when a specific opportunistic infection is found in an otherwise healthy individual." -
Correct Answer :D
Rationale
AIDS is diagnosed when one of several processes defined by the CDC is present in an individual who is not
otherwise immunosuppressed (PCP, candidacies, cryptococcus, cryptosporidiosis, Kaposi's sarcoma, CNS
lymphomas) and/or a CD4+ T cell countless than 200 (normal count 1,000).
40. The nurse assesses a client with advanced cirrhosis of the liver for signs of hepatic encephalopathy. Which
finding would the nurse consider an indication of progressive hepatic encephalopathy?
a. An increase in abdominal girth.
b. Hypertension and a bounding pulse.
c. Decreased bowel sounds.
d. Difficulty in handwriting. - Correct Answer :D
Rationale
A daily record in handwriting may provide evidence of progression or reversal of hepatic encephalopathy leading
to coma (D). (A) is a sign of ascites. (B) are not seen with hepatic encephalopathy. (C) does not indicate an
increase in serum ammonia level which is the primary cause of hepatic encephalopathy.
P 2
, • NUR 6001 09/15/2026
41. In preparing a discharge plan for a 22-year-old male client diagnosed with Buerger's disease (thromboangiitis
obliterans), which referral is most important?
a. Genetic counseling.
b. Twelve-step recovery program.
c. Clinical nutritionist.
d. Smoking cessation program. - Correct Answer :D
Rationale
Buerger's disease is strongly related to smoking or the use of some other form of tobacco which affects the
circulation in the arms and legs leading to infection and gangrene and sometimes amputation of the affected
area. The most effective means of controlling symptoms and disease progression is through smoking cessation.
The cause of Buerger's disease is unknown; a genetic predisposition is possible, but unproven.
42. The nurse is assessing a client who smokes cigarettes and has been diagnosed with emphysema. Which
finding would the nurse expect this client to exhibit?
a. A decreased total lung capacity.
b. Normal arterial blood gases.
c. Normal skin coloring.
d. An absence of sputum. - Correct Answer :C
Rationale
The differentiation between the "pink puffer" and the "blue bloater" is a well-known method of differentiating
clients exhibiting symptoms of emphysema (normal color but puffing respirations) from those exhibiting
symptoms of chronic bronchitis (edematous, cyanotic, shallow respirations).
43. How should the nurse position the electrodes for modified chest lead one (MCL I) telemetry monitoring?
P 3
, • NUR 6001 09/15/2026
a. Positive polarity right shoulder, negative polarity left shoulder, ground left chest nipple line.
b. Positive polarity left shoulder, negative polarity right chest nipple line, ground left chest nipple line.
c. Positive polarity right chest nipple line, negative polarity left chest nipple line, ground left shoulder.
d. Negative polarity left shoulder, positive polarity right chest nipple line, ground left chest nipple line. - Correct
Answer :D
Rationale
In MCL I monitoring, the positive electrode is placed on the client's mid-chest to the right of the sternum, and
the negative electrode is placed on the upper left part of the chest. The ground may be placed anywhere, but is
usually placed on the lower left portion of the chest.
44. During suctioning, a client with an uncuffed tracheostomy tube begins to cough violently and dislodges the
tracheostomy tube. Which action should the nurse implement first?
a. Notify the healthcare provider for reinsertion.
b. Attempt to reinsert the tracheostomy tube.
c. Position the client in a lateral position with the neck extended.
d. Ventilate client's tracheostomy stoma with a manual bag-mask. - Correct Answer :B
Rationale
The nurse should attempt to reinsert the tracheostomy tube by using a hemostat to open the tracheostomy or
by grasping the retention sutures (if present) to spread the opening in insert a replacement tube (with its
obturator) into the stoma. Once in place, the obturator should immediately be removed.
45. A client with a completed ischemic stroke has a blood pressure of 180/90 mm Hg. Which action should the
nurse implement?
a. Position the head of the bed (HOB) flat.
P 4
NU 185 Medical-Surgical Nursing II Comprehensive
Exam Prep Comprehensive Study Guide
UPDATE Actual Questions & Verified Answers with
Detailed Clinical Rationales
A 58-year-old client, who has no health problems, asks the nurse about the Pneumovax vaccine. The nurse's
response to the client should be based on which information?
a. The vaccine is given annually before the flu season to those over 50 years of age.
b. The immunization is administered once to older adults or persons with a history of chronic illness.
c. The vaccine is for all ages and is given primarily to those persons traveling overseas to areas of infection.
d. The vaccine will prevent the occurrence of pneumococcal pneumonia for up to five years. –
Correct Answer :B
Rationale
P 1
, • NUR 6001 09/15/2026
It is recommended by the CDC (Dec 2016) that persons over 65 years of age and those with a history of chronic
illness receive the vaccine once in a lifetime.
39. A client who is HIV positive asks the nurse, "How will I know when I have AIDS?" Which response is best for
the nurse to provide?
a. "Diagnosis of AIDS is made when you have 2 positive ELISA test results."
b. "Diagnosis is made when both the ELISA and the Western Blot tests are positive."
c. "I can tell that you are afraid of being diagnosed with AIDS. Would you like for me to call your minister?"
d. "AIDS is diagnosed when a specific opportunistic infection is found in an otherwise healthy individual." -
Correct Answer :D
Rationale
AIDS is diagnosed when one of several processes defined by the CDC is present in an individual who is not
otherwise immunosuppressed (PCP, candidacies, cryptococcus, cryptosporidiosis, Kaposi's sarcoma, CNS
lymphomas) and/or a CD4+ T cell countless than 200 (normal count 1,000).
40. The nurse assesses a client with advanced cirrhosis of the liver for signs of hepatic encephalopathy. Which
finding would the nurse consider an indication of progressive hepatic encephalopathy?
a. An increase in abdominal girth.
b. Hypertension and a bounding pulse.
c. Decreased bowel sounds.
d. Difficulty in handwriting. - Correct Answer :D
Rationale
A daily record in handwriting may provide evidence of progression or reversal of hepatic encephalopathy leading
to coma (D). (A) is a sign of ascites. (B) are not seen with hepatic encephalopathy. (C) does not indicate an
increase in serum ammonia level which is the primary cause of hepatic encephalopathy.
P 2
, • NUR 6001 09/15/2026
41. In preparing a discharge plan for a 22-year-old male client diagnosed with Buerger's disease (thromboangiitis
obliterans), which referral is most important?
a. Genetic counseling.
b. Twelve-step recovery program.
c. Clinical nutritionist.
d. Smoking cessation program. - Correct Answer :D
Rationale
Buerger's disease is strongly related to smoking or the use of some other form of tobacco which affects the
circulation in the arms and legs leading to infection and gangrene and sometimes amputation of the affected
area. The most effective means of controlling symptoms and disease progression is through smoking cessation.
The cause of Buerger's disease is unknown; a genetic predisposition is possible, but unproven.
42. The nurse is assessing a client who smokes cigarettes and has been diagnosed with emphysema. Which
finding would the nurse expect this client to exhibit?
a. A decreased total lung capacity.
b. Normal arterial blood gases.
c. Normal skin coloring.
d. An absence of sputum. - Correct Answer :C
Rationale
The differentiation between the "pink puffer" and the "blue bloater" is a well-known method of differentiating
clients exhibiting symptoms of emphysema (normal color but puffing respirations) from those exhibiting
symptoms of chronic bronchitis (edematous, cyanotic, shallow respirations).
43. How should the nurse position the electrodes for modified chest lead one (MCL I) telemetry monitoring?
P 3
, • NUR 6001 09/15/2026
a. Positive polarity right shoulder, negative polarity left shoulder, ground left chest nipple line.
b. Positive polarity left shoulder, negative polarity right chest nipple line, ground left chest nipple line.
c. Positive polarity right chest nipple line, negative polarity left chest nipple line, ground left shoulder.
d. Negative polarity left shoulder, positive polarity right chest nipple line, ground left chest nipple line. - Correct
Answer :D
Rationale
In MCL I monitoring, the positive electrode is placed on the client's mid-chest to the right of the sternum, and
the negative electrode is placed on the upper left part of the chest. The ground may be placed anywhere, but is
usually placed on the lower left portion of the chest.
44. During suctioning, a client with an uncuffed tracheostomy tube begins to cough violently and dislodges the
tracheostomy tube. Which action should the nurse implement first?
a. Notify the healthcare provider for reinsertion.
b. Attempt to reinsert the tracheostomy tube.
c. Position the client in a lateral position with the neck extended.
d. Ventilate client's tracheostomy stoma with a manual bag-mask. - Correct Answer :B
Rationale
The nurse should attempt to reinsert the tracheostomy tube by using a hemostat to open the tracheostomy or
by grasping the retention sutures (if present) to spread the opening in insert a replacement tube (with its
obturator) into the stoma. Once in place, the obturator should immediately be removed.
45. A client with a completed ischemic stroke has a blood pressure of 180/90 mm Hg. Which action should the
nurse implement?
a. Position the head of the bed (HOB) flat.
P 4
