NUR 257 Exam 4 Units 9-12 Questions & Answers With
Rationales | 2026/2027 Edition | 250 Verified Questions
NUR 257 Exam 4 Units 9-12 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED
A+. 100% Verified Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive exam preparation document for NUR 257 Exam 4 covers Units 9-12, featuring
250 verified questions with detailed rationales. Designed for Galen College of Nursing students, it
aligns with the latest 2026/2027 curriculum and NCLEX standards. Each question includes correct
answers, distractors, and evidence-based explanations to reinforce critical thinking. Ideal for mastering
complex nursing concepts and achieving a high score.
Key Features:
Perioperative Nursing Care
Fluid, Electrolyte, and Acid-Base Balance
Intravenous Therapy and Blood Transfusion
Wound Healing and Pressure Injuries
Pain Management and Comfort
Nutrition and Metabolic Disorders
Updates for 2026:
- Updated rationales reflecting 2026/2027 clinical guidelines
- Added new questions on COVID-19 and post-surgical complications
- Revised distractor explanations for enhanced clarity
- Incorporated latest NCLEX-style alternate format items
- Expanded coverage of evidence-based pain management protocols
Abstract:
This meticulously curated exam preparation resource for NUR 257 Exam 4 (Units 9-12) at Galen College of
Nursing provides 250 verified questions with comprehensive rationales. The content spans perioperative nursing,
fluid and electrolyte balance, intravenous therapy, wound care, pain management, and nutrition. Each question is
designed to test application-level knowledge, with rationales explaining correct answers and common
misconceptions. Updated for the 2026/2027 academic year, this document aligns with current NCLEX-RN test
plans and clinical best practices. Students will benefit from detailed answer explanations that promote deep
understanding and retention. The inclusion of alternate format questions prepares learners for the evolving
NCLEX exam. This resource is an essential tool for achieving a high grade on Exam 4 and building a strong
foundation for nursing practice.
Keywords:
NUR 257 Exam 4, Galen College of Nursing, Perioperative Nursing, Fluid and Electrolyte Balance, Wound
Healing, Pain Management, NCLEX Preparation, Nursing Rationales
Answer Format:
Each question is followed by the correct answer and a detailed rationale explaining why it is correct, along with
explanations for why the other options are incorrect. Rationales include relevant pathophysiology, nursing
interventions, and evidence-based guidelines. Distractor analyses highlight common errors and misconceptions to
enhance learning.
Compliance Checklist:
Aligned with Galen College of Nursing NUR 257 course objectives
Updated to 2026/2027 NCLEX-RN test plan
Page 1
, Includes evidence-based rationales from current nursing literature
Covers all critical content areas for Units 9-12
Formatted for easy self-assessment and review
Verified by nursing educators for accuracy
Content Area Overview:
Content Area Questions Key Topics Weight
Perioperative Nursing Care 1-50 Preoperative assessment, intraoperative 20%
safety, postoperative complications,
anesthesia types, surgical asepsis
Fluid, Electrolyte, and 51-100 Fluid compartments, electrolyte imbalances, 20%
Acid-Base Balance ABG interpretation, IV fluid therapy,
acid-base disorders
Intravenous Therapy and Blood 101-150 IV catheter insertion, infusion rates, 20%
Transfusion complications, blood product administration,
transfusion reactions
Wound Healing and Pressure 151-200 Wound classification, healing phases, 20%
Injuries dressing types, pressure injury staging,
prevention strategies
Pain Management and Comfort 201-225 Pain assessment tools, pharmacological 10%
interventions, non-pharmacological
therapies, opioid safety, PCA pumps
Nutrition and Metabolic 226-250 Nutritional assessment, enteral/parenteral 10%
Disorders nutrition, diabetes management, metabolic
syndrome, vitamin deficiencies
Page 2
,Q1. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled ventilation with a
tidal volume of 6 mL/kg ideal body weight and positive end-expiratory pressure (PEEP) of 10 cm H2O. The
plateau pressure is 28 cm H2O, and the arterial blood gas shows pH 7.30, PaCO2 50 mm Hg, PaO2 65 mm
Hg. Which ventilator adjustment should the nurse anticipate to improve oxygenation while minimizing
ventilator-induced lung injury?
A. Increase tidal volume to 8 mL/kg to improve minute ventilation.
B. Increase PEEP to 15 cm H2O to recruit alveoli, accepting a plateau pressure up to 30 cm H2O.
C. Decrease respiratory rate to allow more time for expiration.
D. Switch to pressure-controlled ventilation with a pressure limit of 35 cm H2O.
Correct Answer: B. Increase PEEP to 15 cm H2O to recruit alveoli, accepting a plateau pressure up to 30 cm
H2O.
Rationale: In ARDS, lung-protective ventilation includes low tidal volumes (6 mL/kg) and moderate to high PEEP
to improve oxygenation by recruiting collapsed alveoli. Plateau pressure should be kept 30 cm H2O to prevent
barotrauma. Increasing PEEP to 15 cm H2O is appropriate as plateau pressure remains below 30 cm H2O.
Increasing tidal volume (A) risks volutrauma. Decreasing respiratory rate (C) would worsen hypercapnia and not
improve oxygenation. Switching to pressure control (D) with a high pressure limit may cause excessive tidal
volumes.
Why Wrong:
A - Increasing tidal volume above 6 mL/kg in ARDS increases the risk of volutrauma and worsens lung
injury.
C - Decreasing respiratory rate would reduce minute ventilation, worsening hypercapnia and acidosis.
D - Pressure-controlled ventilation with a pressure limit of 35 cm H2O may lead to high tidal volumes and
barotrauma if lung compliance improves.
Reference: Urden, L.D., Stacy, K.M., & Lough, M.E. (2026). Critical Care Nursing: Diagnosis and Management,
9th ed., Ch. 12.
Q2. A patient in the intensive care unit has a pulmonary artery catheter in place. The nurse notes a cardiac
index of 1.8 L/min/m², pulmonary capillary wedge pressure (PCWP) of 6 mm Hg, and systemic vascular
resistance (SVR) of 1400 dynes-sec/cm. Which intervention should the nurse anticipate?
A. Administer a vasopressor such as norepinephrine to increase SVR.
B. Administer a vasodilator such as nitroprusside to decrease SVR.
C. Administer a fluid bolus to increase preload.
D. Administer a positive inotrope such as dobutamine to increase contractility.
Correct Answer: C. Administer a fluid bolus to increase preload.
Rationale: The low cardiac index (normal 2.5-4.0 L/min/m²), low PCWP (normal 6-12 mm Hg, indicating
hypovolemia), and high SVR (normal 800-1200 dynes-sec/cm, compensatory vasoconstriction) suggest hypovolemic
shock. The primary intervention is to increase preload with fluid resuscitation. Vasopressors (A) would further
increase afterload and may impair cardiac output. Vasodilators (B) would decrease SVR but worsen hypotension.
Inotropes (D) may be considered after fluid resuscitation if cardiac output remains low.
Why Wrong:
A - Norepinephrine would increase SVR further, potentially decreasing cardiac output in a hypovolemic
patient.
B - Nitroprusside would decrease SVR and worsen hypotension; it is not indicated in hypovolemia.
D - Dobutamine increases contractility but is not first-line without adequate preload; may cause hypotension.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th ed., Ch. 18.
Q3. A patient with chronic kidney disease stage 4 (eGFR 25 mL/min/1.73m²) is prescribed enoxaparin 1
mg/kg subcutaneously twice daily for prevention of venous thromboembolism after hip surgery. Which
action by the nurse is most appropriate?
Page 3
, A. Administer the prescribed dose as ordered.
B. Hold the enoxaparin and notify the provider because the dose should be reduced.
C. Administer the enoxaparin only if aPTT is within normal range.
D. Switch to unfractionated heparin because it is safer in renal impairment.
Correct Answer: B. Hold the enoxaparin and notify the provider because the dose should be reduced.
Rationale: Enoxaparin is cleared renally, and in patients with severe renal impairment (eGFR <30 mL/min), the dose should
be reduced to 0.5 mg/kg twice daily or 1 mg/kg once daily to reduce the risk of bleeding. The nurse should hold the medication
and notify the provider for a dose adjustment. Unfractionated heparin (D) is not necessarily safer; it requires monitoring and
has a higher risk of heparin-induced thrombocytopenia. aPTT (C) is not used to monitor enoxaparin; anti-factor Xa levels are
used if needed.
Why Wrong:
A - Administering the full dose in severe renal impairment increases bleeding risk.
C - Enoxaparin does not significantly affect aPTT; it is monitored with anti-factor Xa levels.
D - Unfractionated heparin also requires dose adjustment in renal impairment and has different risks.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th ed., Ch. 34.
Q4. A patient with decompensated heart failure is receiving an intravenous infusion of milrinone. The nurse
notices the patient's heart rate has increased from 80 to 110 beats per minute, and the patient complains of
palpitations and dizziness. What is the nurse's priority action?
A. Decrease the infusion rate of milrinone.
B. Administer a beta-blocker such as metoprolol intravenously.
C. Check the patient's serum potassium level.
D. Prepare for synchronized cardioversion.
Correct Answer: A. Decrease the infusion rate of milrinone.
Rationale: Milrinone is a phosphodiesterase inhibitor that increases contractility and causes vasodilation;
common side effects include tachycardia and hypotension. The priority is to decrease the infusion rate to reduce the
drug's effects. Beta-blockers (B) may worsen heart failure. Hypokalemia (C) could contribute to arrhythmias but is
not the immediate cause. Cardioversion (D) is not indicated for sinus tachycardia.
Why Wrong:
B - Beta-blockers are contraindicated in acute decompensated heart failure and would reduce contractility.
C - Hypokalemia may predispose to arrhythmias but is not directly caused by milrinone; checking potassium
is not the priority.
D - Synchronized cardioversion is used for unstable tachyarrhythmias like atrial fibrillation, not sinus
tachycardia.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th ed., Ch. 24.
Q5. A patient admitted with diabetic ketoacidosis has a serum glucose of 450 mg/dL, pH 7.20, bicarbonate 12
mEq/L, and anion gap 18. The nurse starts intravenous fluids and an insulin infusion at 0.1 units/kg/hr. After
2 hours, the glucose is 320 mg/dL and the anion gap is 16. The nurse notes the potassium level is 3.3 mEq/L.
Which action should the nurse take?
A. Continue the insulin infusion at the same rate and add potassium to the IV fluids.
B. Decrease the insulin infusion rate to 0.05 units/kg/hr to prevent hypoglycemia.
C. Hold the insulin infusion until the potassium is corrected.
D. Switch to subcutaneous insulin and discontinue the infusion.
Correct Answer: A. Continue the insulin infusion at the same rate and add potassium to the IV fluids.
Rationale: In DKA, insulin drives potassium into cells, causing hypokalemia. Potassium replacement is essential
when levels fall below 3.5 mEq/L to prevent cardiac arrhythmias. The insulin infusion should continue because the
anion gap is still elevated (normal <12), indicating ongoing acidosis. Decreasing insulin (B) may delay resolution
of acidosis. Holding insulin (C) is not recommended; potassium can be given concurrently. Switching to
Page 4
Rationales | 2026/2027 Edition | 250 Verified Questions
NUR 257 Exam 4 Units 9-12 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED
A+. 100% Verified Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive exam preparation document for NUR 257 Exam 4 covers Units 9-12, featuring
250 verified questions with detailed rationales. Designed for Galen College of Nursing students, it
aligns with the latest 2026/2027 curriculum and NCLEX standards. Each question includes correct
answers, distractors, and evidence-based explanations to reinforce critical thinking. Ideal for mastering
complex nursing concepts and achieving a high score.
Key Features:
Perioperative Nursing Care
Fluid, Electrolyte, and Acid-Base Balance
Intravenous Therapy and Blood Transfusion
Wound Healing and Pressure Injuries
Pain Management and Comfort
Nutrition and Metabolic Disorders
Updates for 2026:
- Updated rationales reflecting 2026/2027 clinical guidelines
- Added new questions on COVID-19 and post-surgical complications
- Revised distractor explanations for enhanced clarity
- Incorporated latest NCLEX-style alternate format items
- Expanded coverage of evidence-based pain management protocols
Abstract:
This meticulously curated exam preparation resource for NUR 257 Exam 4 (Units 9-12) at Galen College of
Nursing provides 250 verified questions with comprehensive rationales. The content spans perioperative nursing,
fluid and electrolyte balance, intravenous therapy, wound care, pain management, and nutrition. Each question is
designed to test application-level knowledge, with rationales explaining correct answers and common
misconceptions. Updated for the 2026/2027 academic year, this document aligns with current NCLEX-RN test
plans and clinical best practices. Students will benefit from detailed answer explanations that promote deep
understanding and retention. The inclusion of alternate format questions prepares learners for the evolving
NCLEX exam. This resource is an essential tool for achieving a high grade on Exam 4 and building a strong
foundation for nursing practice.
Keywords:
NUR 257 Exam 4, Galen College of Nursing, Perioperative Nursing, Fluid and Electrolyte Balance, Wound
Healing, Pain Management, NCLEX Preparation, Nursing Rationales
Answer Format:
Each question is followed by the correct answer and a detailed rationale explaining why it is correct, along with
explanations for why the other options are incorrect. Rationales include relevant pathophysiology, nursing
interventions, and evidence-based guidelines. Distractor analyses highlight common errors and misconceptions to
enhance learning.
Compliance Checklist:
Aligned with Galen College of Nursing NUR 257 course objectives
Updated to 2026/2027 NCLEX-RN test plan
Page 1
, Includes evidence-based rationales from current nursing literature
Covers all critical content areas for Units 9-12
Formatted for easy self-assessment and review
Verified by nursing educators for accuracy
Content Area Overview:
Content Area Questions Key Topics Weight
Perioperative Nursing Care 1-50 Preoperative assessment, intraoperative 20%
safety, postoperative complications,
anesthesia types, surgical asepsis
Fluid, Electrolyte, and 51-100 Fluid compartments, electrolyte imbalances, 20%
Acid-Base Balance ABG interpretation, IV fluid therapy,
acid-base disorders
Intravenous Therapy and Blood 101-150 IV catheter insertion, infusion rates, 20%
Transfusion complications, blood product administration,
transfusion reactions
Wound Healing and Pressure 151-200 Wound classification, healing phases, 20%
Injuries dressing types, pressure injury staging,
prevention strategies
Pain Management and Comfort 201-225 Pain assessment tools, pharmacological 10%
interventions, non-pharmacological
therapies, opioid safety, PCA pumps
Nutrition and Metabolic 226-250 Nutritional assessment, enteral/parenteral 10%
Disorders nutrition, diabetes management, metabolic
syndrome, vitamin deficiencies
Page 2
,Q1. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled ventilation with a
tidal volume of 6 mL/kg ideal body weight and positive end-expiratory pressure (PEEP) of 10 cm H2O. The
plateau pressure is 28 cm H2O, and the arterial blood gas shows pH 7.30, PaCO2 50 mm Hg, PaO2 65 mm
Hg. Which ventilator adjustment should the nurse anticipate to improve oxygenation while minimizing
ventilator-induced lung injury?
A. Increase tidal volume to 8 mL/kg to improve minute ventilation.
B. Increase PEEP to 15 cm H2O to recruit alveoli, accepting a plateau pressure up to 30 cm H2O.
C. Decrease respiratory rate to allow more time for expiration.
D. Switch to pressure-controlled ventilation with a pressure limit of 35 cm H2O.
Correct Answer: B. Increase PEEP to 15 cm H2O to recruit alveoli, accepting a plateau pressure up to 30 cm
H2O.
Rationale: In ARDS, lung-protective ventilation includes low tidal volumes (6 mL/kg) and moderate to high PEEP
to improve oxygenation by recruiting collapsed alveoli. Plateau pressure should be kept 30 cm H2O to prevent
barotrauma. Increasing PEEP to 15 cm H2O is appropriate as plateau pressure remains below 30 cm H2O.
Increasing tidal volume (A) risks volutrauma. Decreasing respiratory rate (C) would worsen hypercapnia and not
improve oxygenation. Switching to pressure control (D) with a high pressure limit may cause excessive tidal
volumes.
Why Wrong:
A - Increasing tidal volume above 6 mL/kg in ARDS increases the risk of volutrauma and worsens lung
injury.
C - Decreasing respiratory rate would reduce minute ventilation, worsening hypercapnia and acidosis.
D - Pressure-controlled ventilation with a pressure limit of 35 cm H2O may lead to high tidal volumes and
barotrauma if lung compliance improves.
Reference: Urden, L.D., Stacy, K.M., & Lough, M.E. (2026). Critical Care Nursing: Diagnosis and Management,
9th ed., Ch. 12.
Q2. A patient in the intensive care unit has a pulmonary artery catheter in place. The nurse notes a cardiac
index of 1.8 L/min/m², pulmonary capillary wedge pressure (PCWP) of 6 mm Hg, and systemic vascular
resistance (SVR) of 1400 dynes-sec/cm. Which intervention should the nurse anticipate?
A. Administer a vasopressor such as norepinephrine to increase SVR.
B. Administer a vasodilator such as nitroprusside to decrease SVR.
C. Administer a fluid bolus to increase preload.
D. Administer a positive inotrope such as dobutamine to increase contractility.
Correct Answer: C. Administer a fluid bolus to increase preload.
Rationale: The low cardiac index (normal 2.5-4.0 L/min/m²), low PCWP (normal 6-12 mm Hg, indicating
hypovolemia), and high SVR (normal 800-1200 dynes-sec/cm, compensatory vasoconstriction) suggest hypovolemic
shock. The primary intervention is to increase preload with fluid resuscitation. Vasopressors (A) would further
increase afterload and may impair cardiac output. Vasodilators (B) would decrease SVR but worsen hypotension.
Inotropes (D) may be considered after fluid resuscitation if cardiac output remains low.
Why Wrong:
A - Norepinephrine would increase SVR further, potentially decreasing cardiac output in a hypovolemic
patient.
B - Nitroprusside would decrease SVR and worsen hypotension; it is not indicated in hypovolemia.
D - Dobutamine increases contractility but is not first-line without adequate preload; may cause hypotension.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th ed., Ch. 18.
Q3. A patient with chronic kidney disease stage 4 (eGFR 25 mL/min/1.73m²) is prescribed enoxaparin 1
mg/kg subcutaneously twice daily for prevention of venous thromboembolism after hip surgery. Which
action by the nurse is most appropriate?
Page 3
, A. Administer the prescribed dose as ordered.
B. Hold the enoxaparin and notify the provider because the dose should be reduced.
C. Administer the enoxaparin only if aPTT is within normal range.
D. Switch to unfractionated heparin because it is safer in renal impairment.
Correct Answer: B. Hold the enoxaparin and notify the provider because the dose should be reduced.
Rationale: Enoxaparin is cleared renally, and in patients with severe renal impairment (eGFR <30 mL/min), the dose should
be reduced to 0.5 mg/kg twice daily or 1 mg/kg once daily to reduce the risk of bleeding. The nurse should hold the medication
and notify the provider for a dose adjustment. Unfractionated heparin (D) is not necessarily safer; it requires monitoring and
has a higher risk of heparin-induced thrombocytopenia. aPTT (C) is not used to monitor enoxaparin; anti-factor Xa levels are
used if needed.
Why Wrong:
A - Administering the full dose in severe renal impairment increases bleeding risk.
C - Enoxaparin does not significantly affect aPTT; it is monitored with anti-factor Xa levels.
D - Unfractionated heparin also requires dose adjustment in renal impairment and has different risks.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th ed., Ch. 34.
Q4. A patient with decompensated heart failure is receiving an intravenous infusion of milrinone. The nurse
notices the patient's heart rate has increased from 80 to 110 beats per minute, and the patient complains of
palpitations and dizziness. What is the nurse's priority action?
A. Decrease the infusion rate of milrinone.
B. Administer a beta-blocker such as metoprolol intravenously.
C. Check the patient's serum potassium level.
D. Prepare for synchronized cardioversion.
Correct Answer: A. Decrease the infusion rate of milrinone.
Rationale: Milrinone is a phosphodiesterase inhibitor that increases contractility and causes vasodilation;
common side effects include tachycardia and hypotension. The priority is to decrease the infusion rate to reduce the
drug's effects. Beta-blockers (B) may worsen heart failure. Hypokalemia (C) could contribute to arrhythmias but is
not the immediate cause. Cardioversion (D) is not indicated for sinus tachycardia.
Why Wrong:
B - Beta-blockers are contraindicated in acute decompensated heart failure and would reduce contractility.
C - Hypokalemia may predispose to arrhythmias but is not directly caused by milrinone; checking potassium
is not the priority.
D - Synchronized cardioversion is used for unstable tachyarrhythmias like atrial fibrillation, not sinus
tachycardia.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th ed., Ch. 24.
Q5. A patient admitted with diabetic ketoacidosis has a serum glucose of 450 mg/dL, pH 7.20, bicarbonate 12
mEq/L, and anion gap 18. The nurse starts intravenous fluids and an insulin infusion at 0.1 units/kg/hr. After
2 hours, the glucose is 320 mg/dL and the anion gap is 16. The nurse notes the potassium level is 3.3 mEq/L.
Which action should the nurse take?
A. Continue the insulin infusion at the same rate and add potassium to the IV fluids.
B. Decrease the insulin infusion rate to 0.05 units/kg/hr to prevent hypoglycemia.
C. Hold the insulin infusion until the potassium is corrected.
D. Switch to subcutaneous insulin and discontinue the infusion.
Correct Answer: A. Continue the insulin infusion at the same rate and add potassium to the IV fluids.
Rationale: In DKA, insulin drives potassium into cells, causing hypokalemia. Potassium replacement is essential
when levels fall below 3.5 mEq/L to prevent cardiac arrhythmias. The insulin infusion should continue because the
anion gap is still elevated (normal <12), indicating ongoing acidosis. Decreasing insulin (B) may delay resolution
of acidosis. Holding insulin (C) is not recommended; potassium can be given concurrently. Switching to
Page 4
