# NU 189/ NU189 EXAM 2– MEDICAL-SURGICAL NURSING II REVIEW | 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. Hematologic Disorders and Anemias
2. Hemostasis, Coagulation, and Disseminated Intravascular Coagulation
3. Oncology, Cancer Biology, and Cancer Therapies
4. Chemotherapy, Radiation, and Oncologic Nursing Care
5. Immune Disorders and Immunosuppression
6. Autoimmune and Connective-Tissue Disorders
7. HIV/AIDS and Opportunistic Infections
8. Burns, Wound Healing, and Fluid Management
9. Dermatologic Conditions and Skin Integrity
10. Clinical Judgment, Patient Safety, and Nursing Management
INTRODUCTION
This 100-question practice assessment is designed to support preparation for NU
189/NU189 Medical-Surgical Nursing II Exam 2 at Galen. Galen's NU 189 course emphasizes
increasingly complex adult health problems, pharmacotherapeutic considerations,
rehabilitation, legal and ethical responsibilities, communication, and systematic nursing-
process decision-making. Publicly available 2026/2027 study materials associated with Exam
2 emphasize hematology, oncology, burns, wound care, immune disorders, and related
clinical judgment. The questions below are original exam-preparation practice questions, not
claimed to be official or leaked examination items.
SECTION ONE: QUESTIONS 1–100
Question 1.
A client with iron-deficiency anemia asks why the provider prescribed oral ferrous sulfate.
Which response by the nurse is most accurate?
A. “It directly replaces red blood cells that have already been destroyed.”
B. “It provides iron needed for hemoglobin synthesis and red blood cell production.”
C. “It prevents the kidneys from excreting excess iron.”
D. “It immediately increases oxygen saturation within minutes.”
,Correct Answer: B. It provides iron needed for hemoglobin synthesis and red blood cell
production.
Explanation: Iron is required for hemoglobin synthesis. Replacing deficient iron allows the
bone marrow to produce adequately hemoglobinized red blood cells. Improvement is
gradual rather than immediate.
Question 2.
Which laboratory finding is most consistent with iron-deficiency anemia?
A. Increased serum ferritin
B. Increased hemoglobin
C. Decreased serum ferritin
D. Increased vitamin B12
Correct Answer: C. Decreased serum ferritin
Explanation: Ferritin reflects stored iron. A low ferritin level strongly supports depleted iron
stores and is characteristic of iron-deficiency anemia. Other findings commonly include low
hemoglobin and hematocrit with microcytosis.
Question 3.
The nurse is teaching a client taking oral iron therapy. Which statement indicates correct
understanding?
A. “I should take it with an antacid to prevent stomach irritation.”
B. “I should expect my stools to become lighter in color.”
C. “Taking it with vitamin C may improve iron absorption.”
D. “I can stop taking it as soon as my fatigue improves.”
Correct Answer: C. “Taking it with vitamin C may improve iron absorption.”
Explanation: Vitamin C enhances absorption of non-heme iron. Iron commonly causes dark
or black stools and gastrointestinal effects. Therapy generally continues long enough to
replenish iron stores, not merely until symptoms improve.
Question 4.
A client with pernicious anemia asks why vitamin B12 injections are necessary. Which
explanation is best?
,A. “Your body cannot adequately absorb vitamin B12 through the gastrointestinal tract.”
B. “The injections prevent excessive destruction of platelets.”
C. “Vitamin B12 injections directly stimulate white blood cell production.”
D. “The injections replace folic acid that is missing from your diet.”
Correct Answer: A. “Your body cannot adequately absorb vitamin B12 through the
gastrointestinal tract.”
Explanation: Pernicious anemia is associated with impaired intrinsic-factor-mediated
absorption of vitamin B12. Parenteral replacement bypasses the impaired gastrointestinal
absorption mechanism.
Question 5.
Which assessment finding is particularly concerning in a client with severe vitamin B12
deficiency?
A. Mild thirst
B. Paresthesias and difficulty maintaining balance
C. Increased appetite
D. Warm, flushed skin
Correct Answer: B. Paresthesias and difficulty maintaining balance
Explanation: Vitamin B12 deficiency can cause neurologic dysfunction, including
paresthesias, impaired proprioception, gait disturbances, and other neurologic changes.
Neurologic injury may become permanent if treatment is delayed.
Question 6.
A client with sickle cell disease is admitted with severe pain. Which intervention should the
nurse prioritize?
A. Restrict oral fluids
B. Encourage hydration and administer prescribed analgesia
C. Apply prolonged cold therapy to painful areas
D. Encourage strenuous exercise
Correct Answer: B. Encourage hydration and administer prescribed analgesia
Explanation: Vaso-occlusive episodes cause tissue ischemia and severe pain. Hydration helps
reduce blood viscosity, while appropriate analgesia treats the acute pain. Cold exposure and
dehydration can worsen sickling.
, Question 7.
Which finding in a client with sickle cell disease requires the most immediate follow-up?
A. Mild fatigue
B. Chronic joint discomfort
C. Sudden chest pain, fever, and hypoxemia
D. Decreased appetite for one meal
Correct Answer: C. Sudden chest pain, fever, and hypoxemia
Explanation: These findings are concerning for acute chest syndrome, a potentially life-
threatening complication of sickle cell disease. Prompt assessment and treatment are
essential because respiratory deterioration can occur rapidly.
Question 8.
A client with aplastic anemia has a markedly decreased platelet count. Which nursing action
is most appropriate?
A. Use a soft toothbrush and minimize trauma
B. Encourage contact sports
C. Administer intramuscular injections routinely
D. Encourage use of aspirin for headache
Correct Answer: A. Use a soft toothbrush and minimize trauma
Explanation: Thrombocytopenia increases bleeding risk. Injury prevention, avoidance of
unnecessary invasive procedures, soft oral care, and monitoring for bleeding are important.
Aspirin can further impair platelet function.
Question 9.
A client with polycythemia vera reports a new severe headache and blurred vision. What is
the nurse's priority?
A. Encourage prolonged bed rest
B. Assess for complications related to increased blood viscosity and notify the provider
C. Give an iron supplement
D. Restrict all fluids
Correct Answer: B. Assess for complications related to increased blood viscosity and notify
the provider
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. Hematologic Disorders and Anemias
2. Hemostasis, Coagulation, and Disseminated Intravascular Coagulation
3. Oncology, Cancer Biology, and Cancer Therapies
4. Chemotherapy, Radiation, and Oncologic Nursing Care
5. Immune Disorders and Immunosuppression
6. Autoimmune and Connective-Tissue Disorders
7. HIV/AIDS and Opportunistic Infections
8. Burns, Wound Healing, and Fluid Management
9. Dermatologic Conditions and Skin Integrity
10. Clinical Judgment, Patient Safety, and Nursing Management
INTRODUCTION
This 100-question practice assessment is designed to support preparation for NU
189/NU189 Medical-Surgical Nursing II Exam 2 at Galen. Galen's NU 189 course emphasizes
increasingly complex adult health problems, pharmacotherapeutic considerations,
rehabilitation, legal and ethical responsibilities, communication, and systematic nursing-
process decision-making. Publicly available 2026/2027 study materials associated with Exam
2 emphasize hematology, oncology, burns, wound care, immune disorders, and related
clinical judgment. The questions below are original exam-preparation practice questions, not
claimed to be official or leaked examination items.
SECTION ONE: QUESTIONS 1–100
Question 1.
A client with iron-deficiency anemia asks why the provider prescribed oral ferrous sulfate.
Which response by the nurse is most accurate?
A. “It directly replaces red blood cells that have already been destroyed.”
B. “It provides iron needed for hemoglobin synthesis and red blood cell production.”
C. “It prevents the kidneys from excreting excess iron.”
D. “It immediately increases oxygen saturation within minutes.”
,Correct Answer: B. It provides iron needed for hemoglobin synthesis and red blood cell
production.
Explanation: Iron is required for hemoglobin synthesis. Replacing deficient iron allows the
bone marrow to produce adequately hemoglobinized red blood cells. Improvement is
gradual rather than immediate.
Question 2.
Which laboratory finding is most consistent with iron-deficiency anemia?
A. Increased serum ferritin
B. Increased hemoglobin
C. Decreased serum ferritin
D. Increased vitamin B12
Correct Answer: C. Decreased serum ferritin
Explanation: Ferritin reflects stored iron. A low ferritin level strongly supports depleted iron
stores and is characteristic of iron-deficiency anemia. Other findings commonly include low
hemoglobin and hematocrit with microcytosis.
Question 3.
The nurse is teaching a client taking oral iron therapy. Which statement indicates correct
understanding?
A. “I should take it with an antacid to prevent stomach irritation.”
B. “I should expect my stools to become lighter in color.”
C. “Taking it with vitamin C may improve iron absorption.”
D. “I can stop taking it as soon as my fatigue improves.”
Correct Answer: C. “Taking it with vitamin C may improve iron absorption.”
Explanation: Vitamin C enhances absorption of non-heme iron. Iron commonly causes dark
or black stools and gastrointestinal effects. Therapy generally continues long enough to
replenish iron stores, not merely until symptoms improve.
Question 4.
A client with pernicious anemia asks why vitamin B12 injections are necessary. Which
explanation is best?
,A. “Your body cannot adequately absorb vitamin B12 through the gastrointestinal tract.”
B. “The injections prevent excessive destruction of platelets.”
C. “Vitamin B12 injections directly stimulate white blood cell production.”
D. “The injections replace folic acid that is missing from your diet.”
Correct Answer: A. “Your body cannot adequately absorb vitamin B12 through the
gastrointestinal tract.”
Explanation: Pernicious anemia is associated with impaired intrinsic-factor-mediated
absorption of vitamin B12. Parenteral replacement bypasses the impaired gastrointestinal
absorption mechanism.
Question 5.
Which assessment finding is particularly concerning in a client with severe vitamin B12
deficiency?
A. Mild thirst
B. Paresthesias and difficulty maintaining balance
C. Increased appetite
D. Warm, flushed skin
Correct Answer: B. Paresthesias and difficulty maintaining balance
Explanation: Vitamin B12 deficiency can cause neurologic dysfunction, including
paresthesias, impaired proprioception, gait disturbances, and other neurologic changes.
Neurologic injury may become permanent if treatment is delayed.
Question 6.
A client with sickle cell disease is admitted with severe pain. Which intervention should the
nurse prioritize?
A. Restrict oral fluids
B. Encourage hydration and administer prescribed analgesia
C. Apply prolonged cold therapy to painful areas
D. Encourage strenuous exercise
Correct Answer: B. Encourage hydration and administer prescribed analgesia
Explanation: Vaso-occlusive episodes cause tissue ischemia and severe pain. Hydration helps
reduce blood viscosity, while appropriate analgesia treats the acute pain. Cold exposure and
dehydration can worsen sickling.
, Question 7.
Which finding in a client with sickle cell disease requires the most immediate follow-up?
A. Mild fatigue
B. Chronic joint discomfort
C. Sudden chest pain, fever, and hypoxemia
D. Decreased appetite for one meal
Correct Answer: C. Sudden chest pain, fever, and hypoxemia
Explanation: These findings are concerning for acute chest syndrome, a potentially life-
threatening complication of sickle cell disease. Prompt assessment and treatment are
essential because respiratory deterioration can occur rapidly.
Question 8.
A client with aplastic anemia has a markedly decreased platelet count. Which nursing action
is most appropriate?
A. Use a soft toothbrush and minimize trauma
B. Encourage contact sports
C. Administer intramuscular injections routinely
D. Encourage use of aspirin for headache
Correct Answer: A. Use a soft toothbrush and minimize trauma
Explanation: Thrombocytopenia increases bleeding risk. Injury prevention, avoidance of
unnecessary invasive procedures, soft oral care, and monitoring for bleeding are important.
Aspirin can further impair platelet function.
Question 9.
A client with polycythemia vera reports a new severe headache and blurred vision. What is
the nurse's priority?
A. Encourage prolonged bed rest
B. Assess for complications related to increased blood viscosity and notify the provider
C. Give an iron supplement
D. Restrict all fluids
Correct Answer: B. Assess for complications related to increased blood viscosity and notify
the provider
