NU 185: Med-Surge II EXAM 4 NU 185 Exam 4 Medical-Surgical
Nursing II (2026) PDF | Galen College of Nursing
,NU 185 – MED-SURG II
EXAM 4: 15 TOUGHEST & MOST-TESTED QUESTIONS (LONG CASE-BASED)
1. Acute Coronary Syndrome – Priority Action
A 64-year-old patient arrives in the ED with chest pressure radiating to the left arm, diaphoresis, nausea,
and shortness of breath. Vital signs: BP 96/60, HR 112, RR 24, SpO₂ 90% on room air.
What is the priority nursing action?
A. Obtain a detailed pain history
B. Administer oxygen
C. Start IV morphine
D. Draw cardiac enzymes
✅ Correct Answer: B
Rationale:
Airway and oxygenation come before pain control or labs. Hypoxia worsens myocardial ischemia.
2. Heart Failure – Fluid Overload Recognition
A patient with heart failure gains 3 lb in 2 days, has crackles, JVD, and reports worsening dyspnea.
Which finding requires immediate provider notification?
A. Fatigue
B. Weight gain
C. Crackles in lungs
D. Urine output of 20 mL/hr for 3 hours
✅ Correct Answer: D
Rationale:
Oliguria indicates decreased cardiac output and renal perfusion → emergency.
3. Pulmonary Embolism – Priority
A post-operative patient suddenly develops sharp chest pain, tachypnea, and anxiety. SpO₂ drops to
86%.
What is the priority nursing action?
, A. Place the patient in high-Fowler’s
B. Administer oxygen
C. Obtain a stat ECG
D. Notify the provider
✅ Correct Answer: B
Rationale:
Suspected PE → oxygen FIRST to correct hypoxemia.
4. COPD – Oxygen Therapy
A patient with severe COPD is on 4 L/min via nasal cannula and becomes drowsy with decreased
respirations.
What should the nurse do first?
A. Increase oxygen
B. Discontinue oxygen
C. Titrate oxygen to SpO₂ 88–92%
D. Prepare for intubation
✅ Correct Answer: C
Rationale:
COPD patients rely on hypoxic drive. Over-oxygenation causes CO₂ retention.
5. Diabetic Ketoacidosis – Initial Management
A patient with type 1 diabetes presents with glucose 540 mg/dL, fruity breath, Kussmaul respirations,
and dehydration.
What is the priority intervention?
A. Administer IV insulin
B. Start IV isotonic fluids
C. Give potassium
D. Administer sodium bicarbonate
✅ Correct Answer: B
Rationale:
Fluids first to restore circulation. Insulin follows once volume is corrected.
6. Hypoglycemia – Immediate Action
Nursing II (2026) PDF | Galen College of Nursing
,NU 185 – MED-SURG II
EXAM 4: 15 TOUGHEST & MOST-TESTED QUESTIONS (LONG CASE-BASED)
1. Acute Coronary Syndrome – Priority Action
A 64-year-old patient arrives in the ED with chest pressure radiating to the left arm, diaphoresis, nausea,
and shortness of breath. Vital signs: BP 96/60, HR 112, RR 24, SpO₂ 90% on room air.
What is the priority nursing action?
A. Obtain a detailed pain history
B. Administer oxygen
C. Start IV morphine
D. Draw cardiac enzymes
✅ Correct Answer: B
Rationale:
Airway and oxygenation come before pain control or labs. Hypoxia worsens myocardial ischemia.
2. Heart Failure – Fluid Overload Recognition
A patient with heart failure gains 3 lb in 2 days, has crackles, JVD, and reports worsening dyspnea.
Which finding requires immediate provider notification?
A. Fatigue
B. Weight gain
C. Crackles in lungs
D. Urine output of 20 mL/hr for 3 hours
✅ Correct Answer: D
Rationale:
Oliguria indicates decreased cardiac output and renal perfusion → emergency.
3. Pulmonary Embolism – Priority
A post-operative patient suddenly develops sharp chest pain, tachypnea, and anxiety. SpO₂ drops to
86%.
What is the priority nursing action?
, A. Place the patient in high-Fowler’s
B. Administer oxygen
C. Obtain a stat ECG
D. Notify the provider
✅ Correct Answer: B
Rationale:
Suspected PE → oxygen FIRST to correct hypoxemia.
4. COPD – Oxygen Therapy
A patient with severe COPD is on 4 L/min via nasal cannula and becomes drowsy with decreased
respirations.
What should the nurse do first?
A. Increase oxygen
B. Discontinue oxygen
C. Titrate oxygen to SpO₂ 88–92%
D. Prepare for intubation
✅ Correct Answer: C
Rationale:
COPD patients rely on hypoxic drive. Over-oxygenation causes CO₂ retention.
5. Diabetic Ketoacidosis – Initial Management
A patient with type 1 diabetes presents with glucose 540 mg/dL, fruity breath, Kussmaul respirations,
and dehydration.
What is the priority intervention?
A. Administer IV insulin
B. Start IV isotonic fluids
C. Give potassium
D. Administer sodium bicarbonate
✅ Correct Answer: B
Rationale:
Fluids first to restore circulation. Insulin follows once volume is corrected.
6. Hypoglycemia – Immediate Action
