NU 155 Medical-Surgical Nursing Comprehensive Final Exam
NU 155 Final Exam (2026/2027)
Medical-Surgical Nursing Comprehensive Final
Fluid & Electrolytes | Perioperative | Cardiovascular | Respiratory | Endocrine | Renal | GI | Infectious Diseases | Pain
Management | Oncologic Emergencies | Comprehensive Integration
80 Multiple-Choice Questions | Select the BEST answer | All questions weighted equally
Section Questions Score Section Questions Score
I. Fluid/Electrolyte 1–8 VI. Renal/Urinary 46–53
II. Perioperative 9–13 VII. GI Disorders 54–61
III. Cardiovascular 14–25 VIII. Infectious 62–68
Disease
IV. Respiratory 26–35 IX. Pain Management 69–72
V. Endocrine 36–45 X. Oncologic 73–76
Emergencies
TOTAL 1–80
SECTION I: FLUID, ELECTROLYTE & ACID-BASE IMBALANCES
1. A patient with hyponatremia (serum sodium 125 mEq/L) presents with confusion, muscle
twitching, and nausea. Which nursing intervention is the priority?
A. Restrict free water intake B. Administer hypertonic saline IV
C. Encourage increased oral fluid intake D. Administer a loop diuretic
Correct Answer: B. Administer hypertonic saline IV
Rationale: Severe hyponatremia (Na+ < 130 mEq/L) with neurological symptoms is a medical emergency
requiring hypertonic saline (3% NaCl) to rapidly raise serum sodium and prevent cerebral edema and
seizures. Restricting free water is appropriate for mild hyponatremia but insufficient when neurological
symptoms are present. Loop diuretics may worsen sodium loss. Encouraging fluids would further dilute
serum sodium.
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, NU 155 Medical-Surgical Nursing Comprehensive Final Exam
2. A patient with serum potassium of 6.8 mEq/L is noted to have tall, peaked T waves on the ECG.
Which medication should the nurse prepare to administer FIRST?
A. Regular insulin and 50% dextrose IV B. Potassium chloride infusion
C. Sodium polystyrene sulfonate (Kayexalate) orally D. Calcium gluconate IV
Correct Answer: D. Calcium gluconate IV
Rationale: Hyperkalemia with ECG changes (peaked T waves) requires immediate calcium gluconate to
stabilize cardiac cell membranes and prevent life-threatening dysrhythmias. Insulin + dextrose shifts
potassium intracellularly but takes 15–30 minutes. Kayexalate is slow-acting (hours). Potassium chloride
would worsen hyperkalemia. Calcium gluconate is the first-line cardiac stabilizer.
3. A patient with hypocalcemia (serum calcium 6.5 mg/dL) is at greatest risk for which
complication?
A. Hypertensive crisis B. Tetany and laryngospasm
C. Metabolic alkalosis D. Atrial fibrillation
Correct Answer: B. Tetany and laryngospasm
Rationale: Hypocalcemia increases neuromuscular excitability, leading to tetany, positive Trousseau's and
Chvostek's signs, and potentially life-threatening laryngospasm. Hypertensive crisis is unrelated.
Hypocalcemia typically causes metabolic alkalosis (not the reverse). Atrial fibrillation is associated with
hypercalcemia due to shortened QT interval.
4. A patient with diabetic ketoacidosis has the following ABG results: pH 7.25, PaCO2 30 mmHg,
HCO3- 15 mEq/L. The nurse interprets this as which acid-base imbalance?
A. Respiratory acidosis with partial B. Metabolic acidosis with respiratory
compensation compensation
C. Respiratory alkalosis with metabolic D. Metabolic alkalosis with respiratory
compensation compensation
Correct Answer: B. Metabolic acidosis with respiratory compensation
Rationale: The low pH (7.25) indicates acidosis. The low HCO3- (15 mEq/L) identifies it as metabolic in
origin. The low PaCO2 (30 mmHg) reflects hyperventilation (Kussmaul respirations) as the respiratory
system attempts to compensate by blowing off CO2. This is a classic DKA ABG pattern.
5. A patient experiencing acute anxiety has a respiratory rate of 36 breaths/min. The ABG shows
pH 7.52, PaCO2 26 mmHg, HCO3- 24 mEq/L. Which condition does the nurse identify?
A. Metabolic alkalosis B. Respiratory acidosis
C. Respiratory alkalosis D. Metabolic acidosis
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, NU 155 Medical-Surgical Nursing Comprehensive Final Exam
Correct Answer: C. Respiratory alkalosis
Rationale: The elevated pH (7.52) indicates alkalosis. The low PaCO2 (26 mmHg) identifies the cause as
respiratory (hyperventilation blowing off excessive CO2). The normal HCO3- (24 mEq/L) indicates this is
an acute uncompensated respiratory alkalosis, consistent with anxiety-induced hyperventilation syndrome.
6. A postoperative patient has dry mucous membranes, decreased skin turgor, orthostatic
hypotension, and a heart rate of 110 bpm. Which IV fluid should the nurse expect to be ordered
first?
A. Dextrose 5% in water (D5W) B. 0.9% Normal saline
C. Lactated Ringer's solution D. 0.45% Normal saline
Correct Answer: B. 0.9% Normal saline
Rationale: The patient demonstrates signs of fluid volume deficit (isotonic dehydration): dry mucous
membranes, decreased skin turgor, orthostatic hypotension, and tachycardia. Isotonic crystalloids (0.9%
NS or LR) are first-line for acute fluid volume deficit. D5W distributes into both intracellular and
extracellular compartments, making it less effective for rapid intravascular replacement. Half-normal
saline is hypotonic.
7. A patient with fluid volume excess presents with crackles in the lungs, jugular vein distension,
and 3+ pitting edema in the lower extremities. Which diuretic is most appropriate for rapid
diuresis?
A. Spironolactone (Aldactone) B. Hydrochlorothiazide (HCTZ)
C. Furosemide (Lasix) D. Mannitol (Osmitrol)
Correct Answer: C. Furosemide (Lasix)
Rationale: Furosemide is a potent loop diuretic that acts on the ascending loop of Henle to produce rapid
and significant diuresis. It is the first-line diuretic for acute fluid volume excess and pulmonary edema.
Spironolactone is a weak potassium-sparing diuretic. HCTZ is a milder thiazide diuretic. Mannitol is an
osmotic diuretic used primarily for cerebral edema.
8. A patient diagnosed with SIADH (Syndrome of Inappropriate Antidiuretic Hormone) has a
serum sodium of 118 mEq/L. Which intervention is the priority?
A. Administer 3% hypertonic saline and fluid B. Encourage increased fluid intake
restrict
C. Administer normal saline at 150 mL/hr D. Give desmopressin (DDAVP)
subcutaneously
Correct Answer: A. Administer 3% hypertonic saline and fluid restrict
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, NU 155 Medical-Surgical Nursing Comprehensive Final Exam
Rationale: SIADH causes excessive water retention leading to dilutional hyponatremia. With severe
hyponatremia (Na+ < 120 mEq/L), hypertonic saline and fluid restriction (typically 500–800 mL/day) are
the priority. Increasing fluids worsens the condition. Normal saline can paradoxically worsen
hyponatremia in SIADH due to concentrated urine excretion of sodium. Desmopressin would further
worsen SIADH.
SECTION II: PERIOPERATIVE NURSING
9. During the preoperative assessment, which finding requires the nurse to notify the surgeon
IMMEDIATELY before proceeding with surgery?
A. Patient reports allergies to shellfish B. Patient took ibuprofen 2 hours ago
C. Patient ate a light breakfast 3 hours ago D. Patient has a mild cough without fever
Correct Answer: C. Patient ate a light breakfast 3 hours ago
Rationale: The patient ate within the NPO period, creating a significant risk for aspiration during
anesthesia. This requires immediate surgeon notification and likely surgery postponement. Shellfish allergy
is important to note but not a same-day surgery cancellation unless contrast is planned. Ibuprofen 2 hours
ago should be noted but is less critical than aspiration risk. A mild cough without fever is not an automatic
cancellation.
10. A patient in the supine position for an extended surgical procedure is at greatest risk for which
complication?
A. Brachial plexus injury B. Plantar flexion contracture
C. Pressure injury on the sacrum D. Compartment syndrome of the forearm
Correct Answer: C. Pressure injury on the sacrum
Rationale: The supine position concentrates body weight on the sacrum, heels, and occiput, making these
areas highest risk for pressure injuries during prolonged surgery. Brachial plexus injury is associated with
lateral or prone positioning. Plantar flexion contracture occurs with prolonged sitting. Forearm
compartment syndrome is associated with lithotomy positioning.
11. On the second postoperative day, a patient develops a temperature of 101.4°F (38.6°C),
dyspnea, and decreased breath sounds at the right base. Which complication does the nurse
suspect?
A. Deep vein thrombosis B. Atelectasis
C. Wound infection D. Hemorrhage
Correct Answer: B. Atelectasis
4
NU 155 Final Exam (2026/2027)
Medical-Surgical Nursing Comprehensive Final
Fluid & Electrolytes | Perioperative | Cardiovascular | Respiratory | Endocrine | Renal | GI | Infectious Diseases | Pain
Management | Oncologic Emergencies | Comprehensive Integration
80 Multiple-Choice Questions | Select the BEST answer | All questions weighted equally
Section Questions Score Section Questions Score
I. Fluid/Electrolyte 1–8 VI. Renal/Urinary 46–53
II. Perioperative 9–13 VII. GI Disorders 54–61
III. Cardiovascular 14–25 VIII. Infectious 62–68
Disease
IV. Respiratory 26–35 IX. Pain Management 69–72
V. Endocrine 36–45 X. Oncologic 73–76
Emergencies
TOTAL 1–80
SECTION I: FLUID, ELECTROLYTE & ACID-BASE IMBALANCES
1. A patient with hyponatremia (serum sodium 125 mEq/L) presents with confusion, muscle
twitching, and nausea. Which nursing intervention is the priority?
A. Restrict free water intake B. Administer hypertonic saline IV
C. Encourage increased oral fluid intake D. Administer a loop diuretic
Correct Answer: B. Administer hypertonic saline IV
Rationale: Severe hyponatremia (Na+ < 130 mEq/L) with neurological symptoms is a medical emergency
requiring hypertonic saline (3% NaCl) to rapidly raise serum sodium and prevent cerebral edema and
seizures. Restricting free water is appropriate for mild hyponatremia but insufficient when neurological
symptoms are present. Loop diuretics may worsen sodium loss. Encouraging fluids would further dilute
serum sodium.
1
, NU 155 Medical-Surgical Nursing Comprehensive Final Exam
2. A patient with serum potassium of 6.8 mEq/L is noted to have tall, peaked T waves on the ECG.
Which medication should the nurse prepare to administer FIRST?
A. Regular insulin and 50% dextrose IV B. Potassium chloride infusion
C. Sodium polystyrene sulfonate (Kayexalate) orally D. Calcium gluconate IV
Correct Answer: D. Calcium gluconate IV
Rationale: Hyperkalemia with ECG changes (peaked T waves) requires immediate calcium gluconate to
stabilize cardiac cell membranes and prevent life-threatening dysrhythmias. Insulin + dextrose shifts
potassium intracellularly but takes 15–30 minutes. Kayexalate is slow-acting (hours). Potassium chloride
would worsen hyperkalemia. Calcium gluconate is the first-line cardiac stabilizer.
3. A patient with hypocalcemia (serum calcium 6.5 mg/dL) is at greatest risk for which
complication?
A. Hypertensive crisis B. Tetany and laryngospasm
C. Metabolic alkalosis D. Atrial fibrillation
Correct Answer: B. Tetany and laryngospasm
Rationale: Hypocalcemia increases neuromuscular excitability, leading to tetany, positive Trousseau's and
Chvostek's signs, and potentially life-threatening laryngospasm. Hypertensive crisis is unrelated.
Hypocalcemia typically causes metabolic alkalosis (not the reverse). Atrial fibrillation is associated with
hypercalcemia due to shortened QT interval.
4. A patient with diabetic ketoacidosis has the following ABG results: pH 7.25, PaCO2 30 mmHg,
HCO3- 15 mEq/L. The nurse interprets this as which acid-base imbalance?
A. Respiratory acidosis with partial B. Metabolic acidosis with respiratory
compensation compensation
C. Respiratory alkalosis with metabolic D. Metabolic alkalosis with respiratory
compensation compensation
Correct Answer: B. Metabolic acidosis with respiratory compensation
Rationale: The low pH (7.25) indicates acidosis. The low HCO3- (15 mEq/L) identifies it as metabolic in
origin. The low PaCO2 (30 mmHg) reflects hyperventilation (Kussmaul respirations) as the respiratory
system attempts to compensate by blowing off CO2. This is a classic DKA ABG pattern.
5. A patient experiencing acute anxiety has a respiratory rate of 36 breaths/min. The ABG shows
pH 7.52, PaCO2 26 mmHg, HCO3- 24 mEq/L. Which condition does the nurse identify?
A. Metabolic alkalosis B. Respiratory acidosis
C. Respiratory alkalosis D. Metabolic acidosis
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, NU 155 Medical-Surgical Nursing Comprehensive Final Exam
Correct Answer: C. Respiratory alkalosis
Rationale: The elevated pH (7.52) indicates alkalosis. The low PaCO2 (26 mmHg) identifies the cause as
respiratory (hyperventilation blowing off excessive CO2). The normal HCO3- (24 mEq/L) indicates this is
an acute uncompensated respiratory alkalosis, consistent with anxiety-induced hyperventilation syndrome.
6. A postoperative patient has dry mucous membranes, decreased skin turgor, orthostatic
hypotension, and a heart rate of 110 bpm. Which IV fluid should the nurse expect to be ordered
first?
A. Dextrose 5% in water (D5W) B. 0.9% Normal saline
C. Lactated Ringer's solution D. 0.45% Normal saline
Correct Answer: B. 0.9% Normal saline
Rationale: The patient demonstrates signs of fluid volume deficit (isotonic dehydration): dry mucous
membranes, decreased skin turgor, orthostatic hypotension, and tachycardia. Isotonic crystalloids (0.9%
NS or LR) are first-line for acute fluid volume deficit. D5W distributes into both intracellular and
extracellular compartments, making it less effective for rapid intravascular replacement. Half-normal
saline is hypotonic.
7. A patient with fluid volume excess presents with crackles in the lungs, jugular vein distension,
and 3+ pitting edema in the lower extremities. Which diuretic is most appropriate for rapid
diuresis?
A. Spironolactone (Aldactone) B. Hydrochlorothiazide (HCTZ)
C. Furosemide (Lasix) D. Mannitol (Osmitrol)
Correct Answer: C. Furosemide (Lasix)
Rationale: Furosemide is a potent loop diuretic that acts on the ascending loop of Henle to produce rapid
and significant diuresis. It is the first-line diuretic for acute fluid volume excess and pulmonary edema.
Spironolactone is a weak potassium-sparing diuretic. HCTZ is a milder thiazide diuretic. Mannitol is an
osmotic diuretic used primarily for cerebral edema.
8. A patient diagnosed with SIADH (Syndrome of Inappropriate Antidiuretic Hormone) has a
serum sodium of 118 mEq/L. Which intervention is the priority?
A. Administer 3% hypertonic saline and fluid B. Encourage increased fluid intake
restrict
C. Administer normal saline at 150 mL/hr D. Give desmopressin (DDAVP)
subcutaneously
Correct Answer: A. Administer 3% hypertonic saline and fluid restrict
3
, NU 155 Medical-Surgical Nursing Comprehensive Final Exam
Rationale: SIADH causes excessive water retention leading to dilutional hyponatremia. With severe
hyponatremia (Na+ < 120 mEq/L), hypertonic saline and fluid restriction (typically 500–800 mL/day) are
the priority. Increasing fluids worsens the condition. Normal saline can paradoxically worsen
hyponatremia in SIADH due to concentrated urine excretion of sodium. Desmopressin would further
worsen SIADH.
SECTION II: PERIOPERATIVE NURSING
9. During the preoperative assessment, which finding requires the nurse to notify the surgeon
IMMEDIATELY before proceeding with surgery?
A. Patient reports allergies to shellfish B. Patient took ibuprofen 2 hours ago
C. Patient ate a light breakfast 3 hours ago D. Patient has a mild cough without fever
Correct Answer: C. Patient ate a light breakfast 3 hours ago
Rationale: The patient ate within the NPO period, creating a significant risk for aspiration during
anesthesia. This requires immediate surgeon notification and likely surgery postponement. Shellfish allergy
is important to note but not a same-day surgery cancellation unless contrast is planned. Ibuprofen 2 hours
ago should be noted but is less critical than aspiration risk. A mild cough without fever is not an automatic
cancellation.
10. A patient in the supine position for an extended surgical procedure is at greatest risk for which
complication?
A. Brachial plexus injury B. Plantar flexion contracture
C. Pressure injury on the sacrum D. Compartment syndrome of the forearm
Correct Answer: C. Pressure injury on the sacrum
Rationale: The supine position concentrates body weight on the sacrum, heels, and occiput, making these
areas highest risk for pressure injuries during prolonged surgery. Brachial plexus injury is associated with
lateral or prone positioning. Plantar flexion contracture occurs with prolonged sitting. Forearm
compartment syndrome is associated with lithotomy positioning.
11. On the second postoperative day, a patient develops a temperature of 101.4°F (38.6°C),
dyspnea, and decreased breath sounds at the right base. Which complication does the nurse
suspect?
A. Deep vein thrombosis B. Atelectasis
C. Wound infection D. Hemorrhage
Correct Answer: B. Atelectasis
4
