NUR 257 Exam 4 Units 9-12 Questions & Answers With
Rationales | 2026/2027 Edition | 150 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 prep document for NUR 257 Exam 4 covers Units 9-12, featuring 150
verified questions with detailed rationales. Designed for Galen College of Nursing students, it aligns
with the 2026/2027 curriculum and includes updated content on complex nursing concepts. Each
question is graded A+ to ensure high-quality review. Ideal for mastering key topics and achieving
exam success.
Key Features:
150 verified questions with rationales
Covers Units 9-12: Perioperative, Fluid & Electrolytes, Acid-Base Balance, and more
Updated for 2026/2027 academic year
Graded A+ solutions for confidence
Detailed answer explanations with distractor analysis
Updates for 2026:
- Updated rationales to reflect latest evidence-based practice
- Revised questions per 2026/2027 Galen College curriculum
- Added new questions on fluid and electrolyte imbalances
- Enhanced distractor explanations for critical thinking
- Incorporated recent NCLEX-style question formats
Abstract:
This document provides a rigorous review for NUR 257 Exam 4, focusing on Units 9-12. It contains 150 verified
questions and answers with rationales, designed to reinforce understanding of perioperative nursing, fluid and
electrolyte imbalances, acid-base balance, and related topics. Each question is accompanied by a rationale
explaining the correct answer and why distractors are incorrect, promoting deep learning. The content is aligned
with the 2026/2027 Galen College of Nursing curriculum and reflects current clinical guidelines. This resource is
essential for students seeking to achieve a high score on the exam and strengthen their clinical reasoning skills.
The questions are organized by content area, with weights approximating exam distribution. Updated for the latest
academic year, this document ensures students are well-prepared for both the exam and future nursing practice.
Keywords:
NUR 257 Exam 4, Perioperative nursing, Fluid and electrolytes, Acid-base balance, Galen College of Nursing,
NCLEX-style questions, Nursing rationales, 2026/2027 exam prep
Answer Format:
Each question is followed by the correct answer and a detailed rationale explaining the underlying concepts.
Incorrect options are analyzed with distractor explanations to clarify common misconceptions. This format
reinforces critical thinking and application of nursing knowledge.
Compliance Checklist:
Aligned with 2026/2027 Galen College of Nursing curriculum
150 verified questions with rationales
Graded A+ for accuracy
Updated per latest clinical guidelines
Page 1
, Includes NCLEX-style question formats
Content Area Overview:
Content Area Questions Key Topics Weight
Perioperative Nursing 1-40 Preoperative assessment, Intraoperative care, 27%
Postoperative complications, Anesthesia
types, Surgical asepsis
Fluid and Electrolyte Imbalances 41-80 Fluid volume deficit, Fluid volume excess, 27%
Sodium imbalances, Potassium imbalances,
Calcium imbalances
Acid-Base Balance 81-110 Respiratory acidosis, Respiratory alkalosis, 20%
Metabolic acidosis, Metabolic alkalosis,
Compensation mechanisms
Intravenous Therapy and Blood 111-130 IV solutions, IV administration, Blood 13%
Transfusions transfusion reactions, Central lines,
Peripheral IV care
Shock and Sepsis 131-150 Hypovolemic shock, Cardiogenic shock, 13%
Septic shock, Anaphylactic shock, Nursing
management
Page 2
,Q1. A patient with acute ischemic stroke receives alteplase (tPA) 0.9 mg/kg IV, with 10% given as a bolus and
the remainder infused over 60 minutes. The patient weighs 70 kg. Thirty minutes into the infusion, the nurse
notes new-onset severe headache, vomiting, and a sudden increase in blood pressure to 220/110 mmHg.
Which action is most appropriate?
A. Administer acetaminophen for headache and continue tPA infusion at the prescribed rate.
B. Stop the tPA infusion immediately, obtain stat CT scan, and administer antihypertensives per protocol.
C. Slow the tPA infusion to half-rate and reassess neurological status in 15 minutes.
D. Administer IV labetalol to lower blood pressure and continue tPA infusion.
Correct Answer: B. Stop the tPA infusion immediately, obtain stat CT scan, and administer
antihypertensives per protocol.
Rationale: New-onset severe headache, vomiting, and acute hypertension during tPA infusion are classic signs of
intracranial hemorrhage, a life-threatening complication. The tPA must be stopped immediately to reduce further
bleeding, a stat CT confirms hemorrhage, and antihypertensives are indicated to reduce bleeding risk. Continuing
tPA (A, C, D) would worsen hemorrhage.
Why Wrong:
A - Acetaminophen does not address the underlying hemorrhage, and continuing tPA is contraindicated with
suspected intracranial bleeding.
C - Slowing the infusion does not prevent hemorrhage progression; immediate cessation is required.
D - Antihypertensives alone without stopping tPA will not halt ongoing bleeding.
Reference: Hinkle, J.L., & Cheever, K.H. (2026). Brunner & Suddarth's Textbook of Medical-Surgical Nursing,
16th Ed., Ch. 68. Lippincott Williams & Wilkins.
Q2. A patient with diabetic ketoacidosis (DKA) is receiving IV regular insulin at 0.1 units/kg/hr. Serum
potassium on admission was 4.8 mEq/L. After 2 hours of insulin therapy, the potassium level drops to 3.2
mEq/L. Which intervention should the nurse prioritize?
A. Decrease the insulin infusion rate by half to prevent further hypokalemia.
B. Add potassium chloride 20 mEq to the current IV fluids and continue insulin at the same rate.
C. Administer IV potassium bolus of 10 mEq over 1 hour and reassess.
D. Switch to subcutaneous insulin to allow better control of potassium shifts.
Correct Answer: B. Add potassium chloride 20 mEq to the current IV fluids and continue insulin at the same
rate.
Rationale: In DKA, insulin drives potassium into cells, causing hypokalemia. The priority is to replace potassium
while continuing insulin to correct acidosis. Adding KCl to IV fluids is standard, as potassium should not exceed 40
mEq/L in peripheral IV. Decreasing insulin (A) would delay acidosis correction; IV bolus potassium (C) is not
recommended due to cardiac risks; switching to subcutaneous (D) is not appropriate for acute DKA.
Why Wrong:
A - Insulin should not be decreased because it is essential for resolving acidosis; potassium replacement is
needed.
C - IV potassium bolus can cause cardiac arrhythmias; replacement should be via infusion.
D - Subcutaneous insulin is not appropriate for acute DKA; IV insulin is required for rapid titration.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 45. Elsevier.
Q3. A patient with cirrhosis and ascites is prescribed spironolactone 100 mg daily. The nurse reviews
laboratory results: sodium 130 mEq/L, potassium 5.6 mEq/L, BUN 28 mg/dL, creatinine 1.4 mg/dL. Which
action is most appropriate?
A. Administer the spironolactone as prescribed and monitor urine output.
B. Hold the spironolactone and notify the provider due to hyperkalemia.
C. Administer spironolactone with a potassium supplement to correct hyponatremia.
D. Give spironolactone and increase dietary potassium intake.
Page 3
, Correct Answer: B. Hold the spironolactone and notify the provider due to hyperkalemia.
Rationale: Spironolactone is a potassium-sparing diuretic. The patient has hyperkalemia (K+ 5.6 mEq/L), which is a
contraindication. Administering it could worsen hyperkalemia and cause cardiac arrhythmias. The nurse should hold the
medication and notify the provider. Potassium supplements (C, D) would exacerbate hyperkalemia.
Why Wrong:
A - Administering spironolactone with hyperkalemia is dangerous and could precipitate cardiac arrest.
C - Potassium supplement is contraindicated; hyponatremia is managed separately.
D - Increasing dietary potassium would worsen hyperkalemia.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 43. Elsevier.
Q4. A patient with acute pancreatitis has a nasogastric tube to low intermittent suction. The nurse assesses
the patient and notes absent bowel sounds, abdominal distension, and serum calcium of 7.2 mg/dL. Which
intervention is most important?
A. Administer IV calcium gluconate as prescribed.
B. Increase the NG suction pressure to relieve distension.
C. Reposition the patient to the left lateral decubitus position.
D. Prepare the patient for paracentesis.
Correct Answer: A. Administer IV calcium gluconate as prescribed.
Rationale: Hypocalcemia (Ca < 8.5 mg/dL) in acute pancreatitis indicates fat necrosis and calcium sequestration.
Severe hypocalcemia can cause tetany, seizures, and cardiac arrhythmias. IV calcium gluconate is the priority.
Increasing suction (B) is not indicated and may cause mucosal damage; repositioning (C) does not address
hypocalcemia; paracentesis (D) is for ascites, not hypocalcemia.
Why Wrong:
B - Increasing NG suction pressure can cause gastric mucosal injury and does not treat hypocalcemia.
C - Repositioning may help comfort but does not correct life-threatening hypocalcemia.
D - Paracentesis is not indicated for hypocalcemia; it is used for ascites or diagnostic fluid removal.
Reference: Hinkle, J.L., & Cheever, K.H. (2026). Brunner & Suddarth's Textbook of Medical-Surgical Nursing,
16th Ed., Ch. 51. Lippincott Williams & Wilkins.
Q5. A patient admitted with acute kidney injury (AKI) due to prerenal causes has the following vital signs:
BP 90/60 mmHg, HR 110 bpm, urine output 20 mL over the past 2 hours. The nurse reviews the provider's
prescriptions. Which prescription should the nurse question?
A. IV normal saline bolus 500 mL over 30 minutes.
B. Furosemide 40 mg IV push.
C. Insert indwelling urinary catheter.
D. Monitor serum creatinine and BUN daily.
Correct Answer: B. Furosemide 40 mg IV push.
Rationale: In prerenal AKI, the priority is to restore renal perfusion with fluid resuscitation. Furosemide is a loop
diuretic that can worsen hypovolemia and further decrease renal blood flow, potentially converting prerenal AKI to
intrinsic AKI. The nurse should question this prescription until volume status is optimized. Fluid bolus (A) is
appropriate; catheter (C) and monitoring (D) are standard.
Why Wrong:
A - IV fluid bolus is appropriate to correct hypovolemia in prerenal AKI.
C - Urinary catheter is indicated to accurately measure urine output.
D - Monitoring renal function is standard and appropriate.
Reference: Hinkle, J.L., & Cheever, K.H. (2026). Brunner & Suddarth's Textbook of Medical-Surgical Nursing,
16th Ed., Ch. 54. Lippincott Williams & Wilkins.
Page 4
Rationales | 2026/2027 Edition | 150 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 prep document for NUR 257 Exam 4 covers Units 9-12, featuring 150
verified questions with detailed rationales. Designed for Galen College of Nursing students, it aligns
with the 2026/2027 curriculum and includes updated content on complex nursing concepts. Each
question is graded A+ to ensure high-quality review. Ideal for mastering key topics and achieving
exam success.
Key Features:
150 verified questions with rationales
Covers Units 9-12: Perioperative, Fluid & Electrolytes, Acid-Base Balance, and more
Updated for 2026/2027 academic year
Graded A+ solutions for confidence
Detailed answer explanations with distractor analysis
Updates for 2026:
- Updated rationales to reflect latest evidence-based practice
- Revised questions per 2026/2027 Galen College curriculum
- Added new questions on fluid and electrolyte imbalances
- Enhanced distractor explanations for critical thinking
- Incorporated recent NCLEX-style question formats
Abstract:
This document provides a rigorous review for NUR 257 Exam 4, focusing on Units 9-12. It contains 150 verified
questions and answers with rationales, designed to reinforce understanding of perioperative nursing, fluid and
electrolyte imbalances, acid-base balance, and related topics. Each question is accompanied by a rationale
explaining the correct answer and why distractors are incorrect, promoting deep learning. The content is aligned
with the 2026/2027 Galen College of Nursing curriculum and reflects current clinical guidelines. This resource is
essential for students seeking to achieve a high score on the exam and strengthen their clinical reasoning skills.
The questions are organized by content area, with weights approximating exam distribution. Updated for the latest
academic year, this document ensures students are well-prepared for both the exam and future nursing practice.
Keywords:
NUR 257 Exam 4, Perioperative nursing, Fluid and electrolytes, Acid-base balance, Galen College of Nursing,
NCLEX-style questions, Nursing rationales, 2026/2027 exam prep
Answer Format:
Each question is followed by the correct answer and a detailed rationale explaining the underlying concepts.
Incorrect options are analyzed with distractor explanations to clarify common misconceptions. This format
reinforces critical thinking and application of nursing knowledge.
Compliance Checklist:
Aligned with 2026/2027 Galen College of Nursing curriculum
150 verified questions with rationales
Graded A+ for accuracy
Updated per latest clinical guidelines
Page 1
, Includes NCLEX-style question formats
Content Area Overview:
Content Area Questions Key Topics Weight
Perioperative Nursing 1-40 Preoperative assessment, Intraoperative care, 27%
Postoperative complications, Anesthesia
types, Surgical asepsis
Fluid and Electrolyte Imbalances 41-80 Fluid volume deficit, Fluid volume excess, 27%
Sodium imbalances, Potassium imbalances,
Calcium imbalances
Acid-Base Balance 81-110 Respiratory acidosis, Respiratory alkalosis, 20%
Metabolic acidosis, Metabolic alkalosis,
Compensation mechanisms
Intravenous Therapy and Blood 111-130 IV solutions, IV administration, Blood 13%
Transfusions transfusion reactions, Central lines,
Peripheral IV care
Shock and Sepsis 131-150 Hypovolemic shock, Cardiogenic shock, 13%
Septic shock, Anaphylactic shock, Nursing
management
Page 2
,Q1. A patient with acute ischemic stroke receives alteplase (tPA) 0.9 mg/kg IV, with 10% given as a bolus and
the remainder infused over 60 minutes. The patient weighs 70 kg. Thirty minutes into the infusion, the nurse
notes new-onset severe headache, vomiting, and a sudden increase in blood pressure to 220/110 mmHg.
Which action is most appropriate?
A. Administer acetaminophen for headache and continue tPA infusion at the prescribed rate.
B. Stop the tPA infusion immediately, obtain stat CT scan, and administer antihypertensives per protocol.
C. Slow the tPA infusion to half-rate and reassess neurological status in 15 minutes.
D. Administer IV labetalol to lower blood pressure and continue tPA infusion.
Correct Answer: B. Stop the tPA infusion immediately, obtain stat CT scan, and administer
antihypertensives per protocol.
Rationale: New-onset severe headache, vomiting, and acute hypertension during tPA infusion are classic signs of
intracranial hemorrhage, a life-threatening complication. The tPA must be stopped immediately to reduce further
bleeding, a stat CT confirms hemorrhage, and antihypertensives are indicated to reduce bleeding risk. Continuing
tPA (A, C, D) would worsen hemorrhage.
Why Wrong:
A - Acetaminophen does not address the underlying hemorrhage, and continuing tPA is contraindicated with
suspected intracranial bleeding.
C - Slowing the infusion does not prevent hemorrhage progression; immediate cessation is required.
D - Antihypertensives alone without stopping tPA will not halt ongoing bleeding.
Reference: Hinkle, J.L., & Cheever, K.H. (2026). Brunner & Suddarth's Textbook of Medical-Surgical Nursing,
16th Ed., Ch. 68. Lippincott Williams & Wilkins.
Q2. A patient with diabetic ketoacidosis (DKA) is receiving IV regular insulin at 0.1 units/kg/hr. Serum
potassium on admission was 4.8 mEq/L. After 2 hours of insulin therapy, the potassium level drops to 3.2
mEq/L. Which intervention should the nurse prioritize?
A. Decrease the insulin infusion rate by half to prevent further hypokalemia.
B. Add potassium chloride 20 mEq to the current IV fluids and continue insulin at the same rate.
C. Administer IV potassium bolus of 10 mEq over 1 hour and reassess.
D. Switch to subcutaneous insulin to allow better control of potassium shifts.
Correct Answer: B. Add potassium chloride 20 mEq to the current IV fluids and continue insulin at the same
rate.
Rationale: In DKA, insulin drives potassium into cells, causing hypokalemia. The priority is to replace potassium
while continuing insulin to correct acidosis. Adding KCl to IV fluids is standard, as potassium should not exceed 40
mEq/L in peripheral IV. Decreasing insulin (A) would delay acidosis correction; IV bolus potassium (C) is not
recommended due to cardiac risks; switching to subcutaneous (D) is not appropriate for acute DKA.
Why Wrong:
A - Insulin should not be decreased because it is essential for resolving acidosis; potassium replacement is
needed.
C - IV potassium bolus can cause cardiac arrhythmias; replacement should be via infusion.
D - Subcutaneous insulin is not appropriate for acute DKA; IV insulin is required for rapid titration.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 45. Elsevier.
Q3. A patient with cirrhosis and ascites is prescribed spironolactone 100 mg daily. The nurse reviews
laboratory results: sodium 130 mEq/L, potassium 5.6 mEq/L, BUN 28 mg/dL, creatinine 1.4 mg/dL. Which
action is most appropriate?
A. Administer the spironolactone as prescribed and monitor urine output.
B. Hold the spironolactone and notify the provider due to hyperkalemia.
C. Administer spironolactone with a potassium supplement to correct hyponatremia.
D. Give spironolactone and increase dietary potassium intake.
Page 3
, Correct Answer: B. Hold the spironolactone and notify the provider due to hyperkalemia.
Rationale: Spironolactone is a potassium-sparing diuretic. The patient has hyperkalemia (K+ 5.6 mEq/L), which is a
contraindication. Administering it could worsen hyperkalemia and cause cardiac arrhythmias. The nurse should hold the
medication and notify the provider. Potassium supplements (C, D) would exacerbate hyperkalemia.
Why Wrong:
A - Administering spironolactone with hyperkalemia is dangerous and could precipitate cardiac arrest.
C - Potassium supplement is contraindicated; hyponatremia is managed separately.
D - Increasing dietary potassium would worsen hyperkalemia.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 43. Elsevier.
Q4. A patient with acute pancreatitis has a nasogastric tube to low intermittent suction. The nurse assesses
the patient and notes absent bowel sounds, abdominal distension, and serum calcium of 7.2 mg/dL. Which
intervention is most important?
A. Administer IV calcium gluconate as prescribed.
B. Increase the NG suction pressure to relieve distension.
C. Reposition the patient to the left lateral decubitus position.
D. Prepare the patient for paracentesis.
Correct Answer: A. Administer IV calcium gluconate as prescribed.
Rationale: Hypocalcemia (Ca < 8.5 mg/dL) in acute pancreatitis indicates fat necrosis and calcium sequestration.
Severe hypocalcemia can cause tetany, seizures, and cardiac arrhythmias. IV calcium gluconate is the priority.
Increasing suction (B) is not indicated and may cause mucosal damage; repositioning (C) does not address
hypocalcemia; paracentesis (D) is for ascites, not hypocalcemia.
Why Wrong:
B - Increasing NG suction pressure can cause gastric mucosal injury and does not treat hypocalcemia.
C - Repositioning may help comfort but does not correct life-threatening hypocalcemia.
D - Paracentesis is not indicated for hypocalcemia; it is used for ascites or diagnostic fluid removal.
Reference: Hinkle, J.L., & Cheever, K.H. (2026). Brunner & Suddarth's Textbook of Medical-Surgical Nursing,
16th Ed., Ch. 51. Lippincott Williams & Wilkins.
Q5. A patient admitted with acute kidney injury (AKI) due to prerenal causes has the following vital signs:
BP 90/60 mmHg, HR 110 bpm, urine output 20 mL over the past 2 hours. The nurse reviews the provider's
prescriptions. Which prescription should the nurse question?
A. IV normal saline bolus 500 mL over 30 minutes.
B. Furosemide 40 mg IV push.
C. Insert indwelling urinary catheter.
D. Monitor serum creatinine and BUN daily.
Correct Answer: B. Furosemide 40 mg IV push.
Rationale: In prerenal AKI, the priority is to restore renal perfusion with fluid resuscitation. Furosemide is a loop
diuretic that can worsen hypovolemia and further decrease renal blood flow, potentially converting prerenal AKI to
intrinsic AKI. The nurse should question this prescription until volume status is optimized. Fluid bolus (A) is
appropriate; catheter (C) and monitoring (D) are standard.
Why Wrong:
A - IV fluid bolus is appropriate to correct hypovolemia in prerenal AKI.
C - Urinary catheter is indicated to accurately measure urine output.
D - Monitoring renal function is standard and appropriate.
Reference: Hinkle, J.L., & Cheever, K.H. (2026). Brunner & Suddarth's Textbook of Medical-Surgical Nursing,
16th Ed., Ch. 54. Lippincott Williams & Wilkins.
Page 4
