NU 185 Final Exam: Med-Surg II - Galen College of Nursing
Updated and Latest Questions and Correct Answers with
Rationale
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is on mechanical ventilation with High
Positive End-Expiratory Pressure (PEEP). Which assessment finding most concerns the nurse?
A. Oxygen saturation of 94%
B. Respiratory rate of 24 breaths per minute
C. Heart rate of 105 beats per minute
D. Blood pressure of 88/50 mmHg
Correct Answer: D
Rationale: High levels of PEEP are used to open collapsed alveoli and improve oxygenation in ARDS
patients. However, increased intrathoracic pressure from PEEP can significantly reduce venous return to
the heart. This reduction leads to a decrease in cardiac output and potentially severe hypotension. A
blood pressure of 88/50 mmHg indicates hemodynamic instability that requires immediate intervention.
The nurse must monitor for these cardiovascular side effects while maintaining respiratory support.
2. The nurse is caring for a patient undergoing peritoneal dialysis who complains of abdominal pain and
reports that the outflow is cloudy. What is the priority action?
A. Irrigate the catheter with heparin
B. Change the patient’s position to increase drainage
C. Obtain a sample of the effluent for culture
D. Administer prescribed pain medication
Correct Answer: C
,Rationale: Cloudy dialysate outflow is the most common early sign of peritonitis in patients receiving
peritoneal dialysis. The nurse should also assess for fever and rebound tenderness as part of the clinical
picture. Obtaining a sample of the effluent for culture and sensitivity is necessary to identify the infecting
organism. Prompt treatment with antibiotics is essential to prevent systemic infection and catheter loss.
Education on sterile technique during bag changes is the primary method for preventing this
complication.
3. A patient develops Ventricular Tachycardia (VT) and remains conscious with a palpable pulse. Which
medication should the nurse anticipate administering?
A. Epinephrine
B. Amiodarone
C. Atropine
D. Digoxin
Correct Answer: B
Rationale: Ventricular Tachycardia with a pulse is an unstable rhythm that requires prompt
pharmacological or electrical intervention. Amiodarone is a Class III antiarrhythmic drug commonly used
to stabilize the heart’s electrical activity. It works by prolonging the action potential and refractory
period in cardiac tissue. Epinephrine is reserved for pulseless rhythms during advanced cardiac life
support protocols. The nurse must also be prepared for synchronized cardioversion if the patient’s
condition deteriorates.
4. Which laboratory value is most indicative of successful treatment in a patient being managed for Diabetic
Ketoacidosis (DKA)?
A. Blood glucose of 250 mg/dL
B. Serum potassium of 4.0 mEq/L
, C. Bicarbonate level of 20 mEq/L
D. pH of 7.36
Correct Answer: D
Rationale: The primary goal of DKA treatment is to resolve the metabolic acidosis caused by ketone
production. While lowering blood glucose is important, the pH level directly reflects the normalization of
acid-base balance. A pH of 7.36 is within the normal range, suggesting that the ketoacidosis is resolving.
Insulin therapy is continued until the anion gap closes and the pH stabilizes. Monitoring electrolyte levels,
especially potassium, is also critical during the insulin infusion process.
5. A patient with cirrhosis and hepatic encephalopathy is prescribed Lactulose. How should the nurse
evaluate the effectiveness of this medication?
A. Decreased abdominal girth
B. Increased serum albumin levels
C. Improved level of consciousness
D. Reduction in spider angiomas
Correct Answer: C
Rationale: Lactulose is administered to patients with hepatic encephalopathy to reduce serum ammonia
levels. It works by trapping ammonia in the gut and promoting its excretion through frequent bowel
movements. High levels of ammonia cross the blood-brain barrier and cause significant neurological
impairment and confusion. As ammonia levels drop, the patient’s mental status and level of
consciousness should improve. Therefore, improved cognitive function is the primary indicator that the
therapy is working effectively.
Updated and Latest Questions and Correct Answers with
Rationale
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is on mechanical ventilation with High
Positive End-Expiratory Pressure (PEEP). Which assessment finding most concerns the nurse?
A. Oxygen saturation of 94%
B. Respiratory rate of 24 breaths per minute
C. Heart rate of 105 beats per minute
D. Blood pressure of 88/50 mmHg
Correct Answer: D
Rationale: High levels of PEEP are used to open collapsed alveoli and improve oxygenation in ARDS
patients. However, increased intrathoracic pressure from PEEP can significantly reduce venous return to
the heart. This reduction leads to a decrease in cardiac output and potentially severe hypotension. A
blood pressure of 88/50 mmHg indicates hemodynamic instability that requires immediate intervention.
The nurse must monitor for these cardiovascular side effects while maintaining respiratory support.
2. The nurse is caring for a patient undergoing peritoneal dialysis who complains of abdominal pain and
reports that the outflow is cloudy. What is the priority action?
A. Irrigate the catheter with heparin
B. Change the patient’s position to increase drainage
C. Obtain a sample of the effluent for culture
D. Administer prescribed pain medication
Correct Answer: C
,Rationale: Cloudy dialysate outflow is the most common early sign of peritonitis in patients receiving
peritoneal dialysis. The nurse should also assess for fever and rebound tenderness as part of the clinical
picture. Obtaining a sample of the effluent for culture and sensitivity is necessary to identify the infecting
organism. Prompt treatment with antibiotics is essential to prevent systemic infection and catheter loss.
Education on sterile technique during bag changes is the primary method for preventing this
complication.
3. A patient develops Ventricular Tachycardia (VT) and remains conscious with a palpable pulse. Which
medication should the nurse anticipate administering?
A. Epinephrine
B. Amiodarone
C. Atropine
D. Digoxin
Correct Answer: B
Rationale: Ventricular Tachycardia with a pulse is an unstable rhythm that requires prompt
pharmacological or electrical intervention. Amiodarone is a Class III antiarrhythmic drug commonly used
to stabilize the heart’s electrical activity. It works by prolonging the action potential and refractory
period in cardiac tissue. Epinephrine is reserved for pulseless rhythms during advanced cardiac life
support protocols. The nurse must also be prepared for synchronized cardioversion if the patient’s
condition deteriorates.
4. Which laboratory value is most indicative of successful treatment in a patient being managed for Diabetic
Ketoacidosis (DKA)?
A. Blood glucose of 250 mg/dL
B. Serum potassium of 4.0 mEq/L
, C. Bicarbonate level of 20 mEq/L
D. pH of 7.36
Correct Answer: D
Rationale: The primary goal of DKA treatment is to resolve the metabolic acidosis caused by ketone
production. While lowering blood glucose is important, the pH level directly reflects the normalization of
acid-base balance. A pH of 7.36 is within the normal range, suggesting that the ketoacidosis is resolving.
Insulin therapy is continued until the anion gap closes and the pH stabilizes. Monitoring electrolyte levels,
especially potassium, is also critical during the insulin infusion process.
5. A patient with cirrhosis and hepatic encephalopathy is prescribed Lactulose. How should the nurse
evaluate the effectiveness of this medication?
A. Decreased abdominal girth
B. Increased serum albumin levels
C. Improved level of consciousness
D. Reduction in spider angiomas
Correct Answer: C
Rationale: Lactulose is administered to patients with hepatic encephalopathy to reduce serum ammonia
levels. It works by trapping ammonia in the gut and promoting its excretion through frequent bowel
movements. High levels of ammonia cross the blood-brain barrier and cause significant neurological
impairment and confusion. As ammonia levels drop, the patient’s mental status and level of
consciousness should improve. Therefore, improved cognitive function is the primary indicator that the
therapy is working effectively.
