NU 189/ NU189 EXAM 4– MEDICAL-SURGICAL NURSING II GUIDE | GALEN (LATEST
2026/2027 UPDATE) 100% VERIFIED QUESTIONS & ANSWERS | GRADE A –
COMPREHENSIVE QUESTIONS AND ANSWERS | VERIFIED AND WELL-DETAILED ANSWERS |
DETAILED EXPLANATIONS AND RATIONALES | COMPLETE EXAM PREPARATION STUDY
GUIDE | PRACTICE QUESTIONS | LATEST EXAM UPDATE
CORE DOMAINS
1. Cardiovascular disorders and nursing management
2. Neurologic disorders and increased intracranial pressure
3. Renal and urinary disorders
4. Hematologic disorders and anemia
5. Oncology and cancer-related care
6. Immunologic disorders, HIV, and infection prevention
7. Musculoskeletal and orthopedic disorders
8. Connective-tissue and inflammatory disorders
9. Gastrointestinal/hepatic disorders
10. Endocrine and metabolic disorders
INTRODUCTION
This 100-question practice assessment is designed to reinforce high-priority Medical-Surgical
Nursing II concepts through a mixture of foundational, application, clinical-judgment, and
scenario-based questions. It emphasizes recognition of clinically significant findings,
prioritization, patient safety, nursing interventions, disease mechanisms, therapeutic
principles, and interpretation of assessment findings. The questions are structured for active
exam preparation rather than simple memorization, with each answer followed by a concise
rationale explaining the underlying nursing concept and reasoning.
SECTION ONE: QUESTIONS 1–100
Question 1. A patient with suspected acute myocardial infarction arrives in the emergency
department reporting crushing substernal chest pain. Which diagnostic action should be
prioritized?
A. Obtain a 12-lead ECG
B. Schedule an echocardiogram for the following day
C. Obtain a fasting lipid panel
D. Begin cardiac rehabilitation teaching
,Correct Answer: A. Obtain a 12-lead ECG
Explanation: A 12-lead ECG rapidly identifies ischemic or infarction-related electrical
changes and is a priority in suspected acute coronary syndrome. Definitive diagnosis also
incorporates the clinical presentation and cardiac biomarkers.
Question 2. Which cardiac biomarker is most specific for myocardial injury?
A. C-reactive protein
B. B-type natriuretic peptide
C. Troponin
D. Serum sodium
Correct Answer: C. Troponin
Explanation: Cardiac troponins are highly specific indicators of myocardial injury. BNP is
primarily associated with ventricular stretch and heart failure, whereas CRP is an
inflammatory marker.
Question 3. A patient experiencing stable angina has been prescribed sublingual
nitroglycerin. Which instruction is most appropriate?
A. Take one dose and wait 30 minutes before repeating it.
B. Take the medication only after eating a meal.
C. Take one dose at onset and follow prescribed repeat dosing instructions if pain persists.
D. Swallow the tablet whole with water.
Correct Answer: C. Take one dose at onset and follow prescribed repeat dosing
instructions if pain persists.
Explanation: Sublingual nitroglycerin is administered at the onset of anginal pain. If pain
persists, repeat dosing follows the prescribed interval, and persistent pain after the
recommended doses requires emergency evaluation.
Question 4. A patient taking nitroglycerin reports dizziness when standing. Which
explanation is most appropriate?
A. Nitroglycerin commonly causes orthostatic hypotension.
B. Nitroglycerin causes severe hyperglycemia.
C. Dizziness indicates immediate myocardial rupture.
D. Nitroglycerin causes permanent bradycardia.
Correct Answer: A. Nitroglycerin commonly causes orthostatic hypotension.
,Explanation: Nitroglycerin causes vasodilation, which can lower blood pressure and produce
dizziness, particularly when changing positions. Patients should rise slowly and follow
prescribed safety instructions.
Question 5. A patient with heart failure develops severe dyspnea and pulmonary
congestion. Which position should the nurse use to facilitate breathing?
A. Supine
B. High Fowler's
C. Trendelenburg
D. Prone
Correct Answer: B. High Fowler's
Explanation: High Fowler's positioning promotes lung expansion and decreases venous
return to the heart, which can reduce pulmonary congestion and improve respiratory effort.
Question 6. Which assessment finding is most suggestive of worsening fluid retention in a
patient with heart failure?
A. Weight loss of 1 kg over a week
B. Increased urine output
C. Rapid weight gain over several days
D. Decreased peripheral edema
Correct Answer: C. Rapid weight gain over several days
Explanation: Rapid weight gain usually reflects fluid accumulation rather than increased
body tissue. Daily weights are therefore an important method of detecting changes in fluid
status.
Question 7. A patient with heart failure is prescribed digoxin. Which laboratory result
requires the greatest concern?
A. Potassium 3.1 mEq/L
B. Sodium 139 mEq/L
C. Calcium 9.2 mg/dL
D. Magnesium 2.0 mg/dL
Correct Answer: A. Potassium 3.1 mEq/L
, Explanation: Hypokalemia increases susceptibility to digoxin toxicity. The nurse should
recognize low potassium as an important safety concern and follow the prescribed plan
before administering the medication.
Question 8. Which finding is most characteristic of peripheral arterial disease?
A. Dependent rubor and intermittent claudication
B. Warm, edematous legs with brown pigmentation
C. Bilateral calf swelling after prolonged standing
D. Severe itching relieved by elevation
Correct Answer: A. Dependent rubor and intermittent claudication
Explanation: Peripheral arterial disease results from impaired arterial blood flow.
Claudication with activity and changes such as pallor with elevation and dependent rubor
are characteristic findings.
Question 9. Which intervention is appropriate for a patient with peripheral arterial
disease?
A. Encourage regular prescribed walking exercise.
B. Apply tightly wrapped compression bandages routinely.
C. Keep the legs elevated above the heart continuously.
D. Massage painful areas vigorously.
Correct Answer: A. Encourage regular prescribed walking exercise.
Explanation: Appropriately prescribed walking programs can improve functional circulation
and promote collateral circulation. Compression and elevation are generally associated more
with venous problems and may worsen arterial insufficiency.
Question 10. A patient with hypertrophic cardiomyopathy is being discharged. Which
complication should the nurse emphasize when teaching the patient about the disorder?
A. Sudden cardiac death
B. Chronic urinary retention
C. Peptic ulcer disease
D. Severe iron deficiency
Correct Answer: A. Sudden cardiac death
2026/2027 UPDATE) 100% VERIFIED QUESTIONS & ANSWERS | GRADE A –
COMPREHENSIVE QUESTIONS AND ANSWERS | VERIFIED AND WELL-DETAILED ANSWERS |
DETAILED EXPLANATIONS AND RATIONALES | COMPLETE EXAM PREPARATION STUDY
GUIDE | PRACTICE QUESTIONS | LATEST EXAM UPDATE
CORE DOMAINS
1. Cardiovascular disorders and nursing management
2. Neurologic disorders and increased intracranial pressure
3. Renal and urinary disorders
4. Hematologic disorders and anemia
5. Oncology and cancer-related care
6. Immunologic disorders, HIV, and infection prevention
7. Musculoskeletal and orthopedic disorders
8. Connective-tissue and inflammatory disorders
9. Gastrointestinal/hepatic disorders
10. Endocrine and metabolic disorders
INTRODUCTION
This 100-question practice assessment is designed to reinforce high-priority Medical-Surgical
Nursing II concepts through a mixture of foundational, application, clinical-judgment, and
scenario-based questions. It emphasizes recognition of clinically significant findings,
prioritization, patient safety, nursing interventions, disease mechanisms, therapeutic
principles, and interpretation of assessment findings. The questions are structured for active
exam preparation rather than simple memorization, with each answer followed by a concise
rationale explaining the underlying nursing concept and reasoning.
SECTION ONE: QUESTIONS 1–100
Question 1. A patient with suspected acute myocardial infarction arrives in the emergency
department reporting crushing substernal chest pain. Which diagnostic action should be
prioritized?
A. Obtain a 12-lead ECG
B. Schedule an echocardiogram for the following day
C. Obtain a fasting lipid panel
D. Begin cardiac rehabilitation teaching
,Correct Answer: A. Obtain a 12-lead ECG
Explanation: A 12-lead ECG rapidly identifies ischemic or infarction-related electrical
changes and is a priority in suspected acute coronary syndrome. Definitive diagnosis also
incorporates the clinical presentation and cardiac biomarkers.
Question 2. Which cardiac biomarker is most specific for myocardial injury?
A. C-reactive protein
B. B-type natriuretic peptide
C. Troponin
D. Serum sodium
Correct Answer: C. Troponin
Explanation: Cardiac troponins are highly specific indicators of myocardial injury. BNP is
primarily associated with ventricular stretch and heart failure, whereas CRP is an
inflammatory marker.
Question 3. A patient experiencing stable angina has been prescribed sublingual
nitroglycerin. Which instruction is most appropriate?
A. Take one dose and wait 30 minutes before repeating it.
B. Take the medication only after eating a meal.
C. Take one dose at onset and follow prescribed repeat dosing instructions if pain persists.
D. Swallow the tablet whole with water.
Correct Answer: C. Take one dose at onset and follow prescribed repeat dosing
instructions if pain persists.
Explanation: Sublingual nitroglycerin is administered at the onset of anginal pain. If pain
persists, repeat dosing follows the prescribed interval, and persistent pain after the
recommended doses requires emergency evaluation.
Question 4. A patient taking nitroglycerin reports dizziness when standing. Which
explanation is most appropriate?
A. Nitroglycerin commonly causes orthostatic hypotension.
B. Nitroglycerin causes severe hyperglycemia.
C. Dizziness indicates immediate myocardial rupture.
D. Nitroglycerin causes permanent bradycardia.
Correct Answer: A. Nitroglycerin commonly causes orthostatic hypotension.
,Explanation: Nitroglycerin causes vasodilation, which can lower blood pressure and produce
dizziness, particularly when changing positions. Patients should rise slowly and follow
prescribed safety instructions.
Question 5. A patient with heart failure develops severe dyspnea and pulmonary
congestion. Which position should the nurse use to facilitate breathing?
A. Supine
B. High Fowler's
C. Trendelenburg
D. Prone
Correct Answer: B. High Fowler's
Explanation: High Fowler's positioning promotes lung expansion and decreases venous
return to the heart, which can reduce pulmonary congestion and improve respiratory effort.
Question 6. Which assessment finding is most suggestive of worsening fluid retention in a
patient with heart failure?
A. Weight loss of 1 kg over a week
B. Increased urine output
C. Rapid weight gain over several days
D. Decreased peripheral edema
Correct Answer: C. Rapid weight gain over several days
Explanation: Rapid weight gain usually reflects fluid accumulation rather than increased
body tissue. Daily weights are therefore an important method of detecting changes in fluid
status.
Question 7. A patient with heart failure is prescribed digoxin. Which laboratory result
requires the greatest concern?
A. Potassium 3.1 mEq/L
B. Sodium 139 mEq/L
C. Calcium 9.2 mg/dL
D. Magnesium 2.0 mg/dL
Correct Answer: A. Potassium 3.1 mEq/L
, Explanation: Hypokalemia increases susceptibility to digoxin toxicity. The nurse should
recognize low potassium as an important safety concern and follow the prescribed plan
before administering the medication.
Question 8. Which finding is most characteristic of peripheral arterial disease?
A. Dependent rubor and intermittent claudication
B. Warm, edematous legs with brown pigmentation
C. Bilateral calf swelling after prolonged standing
D. Severe itching relieved by elevation
Correct Answer: A. Dependent rubor and intermittent claudication
Explanation: Peripheral arterial disease results from impaired arterial blood flow.
Claudication with activity and changes such as pallor with elevation and dependent rubor
are characteristic findings.
Question 9. Which intervention is appropriate for a patient with peripheral arterial
disease?
A. Encourage regular prescribed walking exercise.
B. Apply tightly wrapped compression bandages routinely.
C. Keep the legs elevated above the heart continuously.
D. Massage painful areas vigorously.
Correct Answer: A. Encourage regular prescribed walking exercise.
Explanation: Appropriately prescribed walking programs can improve functional circulation
and promote collateral circulation. Compression and elevation are generally associated more
with venous problems and may worsen arterial insufficiency.
Question 10. A patient with hypertrophic cardiomyopathy is being discharged. Which
complication should the nurse emphasize when teaching the patient about the disorder?
A. Sudden cardiac death
B. Chronic urinary retention
C. Peptic ulcer disease
D. Severe iron deficiency
Correct Answer: A. Sudden cardiac death
