Galen NSG 3800 Exam 3 – Adult Health II (2026) Actual Q&A PDF, Exams of Nursing

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Galen NSG 3800 Exam 3 – Adult Health II

(2026) Actual Q&A PDF

1. Which clinical term describes the symptom where the patient reports relief of shortness of breath when sitting upright but experiences distress when lying flat? A) Dyspnea on exertion B) Orthopnea C) Paroxysmal nocturnal dyspnea D) Platypnea Correct Answer: B) Orthopnea Rationale: Orthopnea is the sensation of breathlessness that occurs when the patient lies flat and is relieved by sitting or standing up. It is a classic symptom of heart failure due to fluid redistribution and increased preload in the supine position. Dyspnea on exertion occurs with activity, and paroxysmal nocturnal dyspnea occurs specifically at night during sleep.
2. A patient with chronic obstructive pulmonary disease (COPD) presents with a "barrel chest" appearance. What is the primary pathophysiologic cause of this physical finding? A) Fluid accumulation in the pleural space B) Hyperinflation of the lungs due to air trapping C) Collapse of the alveoli D) Enlargement of the heart Correct Answer: B) Hyperinflation of the lungs due to air trapping Rationale: Barrel chest occurs in COPD due to chronic hyperinflation of the lungs, a result of air trapping from loss of elastic recoil and airway obstruction. The anteroposterior (AP) diameter of the chest increases, giving it a barrel-like appearance. Pleural effusion, atelectasis, and cardiomegaly do not cause this structural change.

C) Febrile non-hemolytic reaction D) Bacterial contamination Correct Answer: C) Febrile non-hemolytic reaction Rationale: Febrile non-hemolytic reactions are the most common type of transfusion reaction, characterized by chills and a rise in temperature (≥1°C) without other significant symptoms. They are caused by recipient antibodies reacting against donor white blood cells. Allergic reactions present with urticaria and itching.

1. A patient with a urinary tract infection (UTI) reports dysuria, frequency, and urgency but denies any back pain or fever. The nurse suspects the infection is limited to which part of the urinary tract? A) Kidney B) Ureters C) Bladder D) Urethra only Correct Answer: C) Bladder Rationale: The classic symptoms of cystitis (bladder infection) are dysuria (painful urination), frequency, urgency, and suprapubic discomfort. The absence of systemic symptoms such as fever or back pain makes an upper UTI (pyelonephritis) less likely. Urethritis typically involves dysuria but may also be accompanied by discharge.
2. A nurse is caring for a patient with a new diagnosis of chronic kidney disease (CKD). The patient asks, "What does my GFR mean?" Which response by the nurse is most accurate? A) “It measures how much urine your kidneys produce each day.” B) “It is the percentage of blood that is filtered by the kidneys each minute.” C) “It determines the amount of sodium your kidneys can excrete.” D) “It is a direct measure of the number of nephrons you have left.” Correct Answer: B) “It is the percentage of blood that is filtered by the kidneys each minute.”

Rationale: The glomerular filtration rate (GFR) is the best measure of kidney function and indicates how much blood passes through the glomeruli each minute. A normal GFR is approximately 125 mL/min. It is an estimation, not a direct count of nephrons, but it reflects the overall function of the remaining nephrons.

1. A patient with chronic kidney disease (CKD) has a serum potassium level of 6.8 mEq/L. Which medication should the nurse anticipate administering to lower this potassium level quickly? A) Furosemide (Lasix) B) Sodium polystyrene sulfonate (Kayexalate) C) Epoetin alfa (Epogen) D) Sevelamer (Renagel) Correct Answer: B) Sodium polystyrene sulfonate (Kayexalate) Rationale: Sodium polystyrene sulfonate (Kayexalate) is a cation-exchange resin that works in the gut to exchange sodium for potassium, which is then eliminated in the stool. It is used to treat hyperkalemia. Furosemide may not be effective in renal failure, Epogen treats anemia, and Sevelamer is a phosphate binder.
2. A patient is in the oliguric phase of acute kidney injury (AKI). The nurse should monitor the patient most closely for which life-threatening electrolyte imbalance? A) Hyperkalemia B) Hypokalemia C) Hypernatremia D) Hypocalcemia Correct Answer: A) Hyperkalemia Rationale: In the oliguric phase of AKI, the kidneys cannot excrete potassium, leading to its retention and hyperkalemia. This is a medical emergency because hyperkalemia can cause fatal cardiac dysrhythmias (peaked T waves, wide QRS, and eventually asystole). Potassium levels must be

A) Increased production of albumin by the liver B) Decreased production of albumin by the damaged liver C) Excessive loss of protein in the urine D) Malabsorption of dietary protein Correct Answer: B) Decreased production of albumin by the damaged liver Rationale: Albumin is a protein synthesized exclusively by the liver. In cirrhosis, the liver's synthetic function is impaired, leading to decreased albumin production. This hypoalbuminemia reduces plasma oncotic pressure, contributing to the development of ascites (fluid accumulation in the peritoneal cavity).

1. A client with a nasogastric (NG) tube is reporting nausea and abdominal distention. The nurse checks the placement and finds the tube is in the correct position. What should the nurse do next? A) Remove the NG tube immediately. B) Increase the suction pressure. C) Irrigate the tube with 30 mL of water. D) Document the findings as normal. Correct Answer: C) Irrigate the tube with 30 mL of water. Rationale: Nausea and distension in a patient with an NG tube often indicate that the tube is not draining effectively, possibly due to a blockage. Irrigating the tube with a small amount of water is the appropriate first step to clear an obstruction and restore function. Increasing suction pressure could damage the gastric mucosa.
2. The nurse is teaching a client how to perform colostomy irrigation. Which statement by the client indicates a correct understanding of the procedure? A) “I will use 500 to 1000 mL of warm tap water.” B) “I will hang the irrigation bag 36 inches above my stoma.” C) “I will insert the cone ½ inch into the stoma.” D) “If I get cramping, I will open the irrigation clamp wider to flush it out.”

Correct Answer: A) “I will use 500 to 1000 mL of warm tap water.” Rationale: Warm tap water is the standard solution for colostomy irrigation, and a volume of 500- 1000 mL is typically recommended. The irrigation bag should be hung 18-24 inches above the stoma, not 36 inches, to avoid too rapid flow. The cone should be inserted 1-2 inches into the stoma, and cramping indicates the flow is too fast; the clamp should be closed or the flow slowed, not opened wider.

1. A nurse is caring for a patient with a new ileostomy who is 3 days post-operative for IBD. The nurse notices that the stoma is red and has a scant amount of blood on the surface. What is the nurse's most appropriate action? A) Apply a barrier ointment to the stoma. B) Clean the stoma with an alcohol wipe. C) Scrub the stoma to get the blood off. D) Document the findings, as they are normal. Correct Answer: D) Document the findings, as they are normal. Rationale: A healthy stoma should be shiny, moist, and beefy red. A small amount of bleeding when touched is normal because the tissue is highly vascular. The nurse should document this normal finding and continue routine care. The stoma should not be scrubbed, and barrier ointments or alcohol wipes should not be used on the stoma itself.
2. A client with new-onset diabetes insipidus (DI) is admitted to the unit. What is the priority nursing intervention? A) Administer insulin as ordered. B) Monitor intake and output and daily weight. C) Restrict all oral fluids. D) Place the patient on a low-sodium diet. Correct Answer: B) Monitor intake and output and daily weight.

1. A patient is receiving a continuous infusion of total parenteral nutrition (TPN). Which complication should the nurse monitor for most closely? A) Hypoglycemia B) Hyperglycemia C) Hypokalemia D) Hyponatremia Correct Answer: B) Hyperglycemia Rationale: TPN solutions are hypertonic and contain high concentrations of glucose. Hyperglycemia is the most common metabolic complication of TPN, especially if insulin is not added or if the rate is infused too quickly. Blood glucose levels must be monitored closely, and sliding-scale insulin may be required.
2. A nurse is teaching a patient with a new colostomy about diet. Which instruction should the nurse include to help prevent food blockages? A) “You will need to avoid all high - fiber foods for the rest of your life.” B) “Chew your food thoroughly and drink plenty of fluids to prevent blockages.” C) “You can eat normally, but take a stool softener with every meal.” D) “You will need to follow a pureed diet for the first 6 months.” Correct Answer: B) “Chew your food thoroughly and drink plenty of fluids to prevent blockages.” Rationale: Patients with an ostomy can eat most normal foods but should chew thoroughly to prevent food blockages. High-fiber foods should be introduced cautiously, not avoided entirely. Stool softeners are not a routine requirement, and a pureed diet is unnecessary.
3. A patient is admitted with a small bowel obstruction. Which assessment finding is most characteristic of this condition? A) Hypoactive bowel sounds in all four quadrants. B) Hard, palpable mass in the right upper quadrant.

C) High-pitched, tinkling bowel sounds. D) Severe, knife-like pain that is constant. Correct Answer: C) High-pitched, tinkling bowel sounds. Rationale: In the early stages of a small bowel obstruction, the bowel attempts to push contents past the obstruction, causing hyperactive, high-pitched, tinkling bowel sounds. As the obstruction progresses, bowel sounds may become absent. Hypoactive sounds are more typical of an ileus.

22. A client with Crohn’s di sease is prescribed sulfasalazine (Azulfidine). The nurse should teach the client to report which adverse effect immediately? A) Nausea and vomiting B) Headache C) Skin rash and sore throat D) Abdominal cramping Correct Answer: C) Skin rash and sore throat Rationale: Sulfasalazine can cause serious adverse effects, including agranulocytosis (a drop in white blood cells) and Stevens-Johnson syndrome. A sore throat, fever, and rash are early warning signs of these life-threatening reactions and should be reported immediately. Nausea and vomiting are common, milder side effects.

1. A nurse is caring for a patient with dumping syndrome. Which dietary modification is most appropriate to reduce the patient's symptoms? A) Encourage large, heavy meals to slow gastric emptying. B) Remove fluids from the meal tray and have the patient drink them 30-60 minutes after the meal. C) Ask the client to sit up for 1 hour after eating. D) Provide a diet high in simple carbohydrate foods. Correct Answer: B) Remove fluids from the meal tray and have the patient drink them 30-60 minutes after the meal.

1. A patient with chronic pancreatitis is being discharged. Which statement by the patient indicates a correct understanding of the discharge teaching? A) “I will need to take pancreatic enzymes with every meal and snack.” B) “I should take my pancreatic enzymes on an empty stomach for best absorption.” C) “I can drink alcohol, but only beer and wine.” D) “I will follow a high - fat diet to replace the calories I lost.” Correct Answer: A) “I will need to take pancreatic enzymes with every meal and snack.” Rationale: Patients with chronic pancreatitis often have exocrine insufficiency and require pancreatic enzyme replacement therapy with meals and snacks to digest fats and proteins. These enzymes must be taken with food, not on an empty stomach. Alcohol must be strictly avoided, and a low-fat diet is recommended.
2. The nurse is caring for a client with acute pancreatitis. Which assessment finding requires the most immediate intervention? A) The client's blood glucose level is 180 mg/dL. B) The client's temperature is 37.8°C (100.0°F). C) The client reports severe, unrelieved abdominal pain. D) The client's oxygen saturation drops to 88% on room air. Correct Answer: D) The client's oxygen saturation drops to 88% on room air. Rationale: Acute pancreatitis can lead to acute respiratory distress syndrome (ARDS) and significant hypoxemia. A drop in oxygen saturation to 88% is below the acceptable range and indicates a life- threatening respiratory complication requiring immediate intervention (supplemental oxygen and possibly mechanical ventilation). Airway and breathing are always the priority.
3. A patient has newly diagnosed type 1 diabetes mellitus. The nurse is teaching the patient about the pathophysiology of the disease. Which statement accurately describes type 1 diabetes? A) It is caused by insulin resistance and relative insulin deficiency.

B) It is caused by autoimmune destruction of the beta cells in the pancreas. C) It is caused by a high-calorie diet and sedentary lifestyle. D) It is a genetic disorder that always appears in the first year of life. Correct Answer: B) It is caused by autoimmune destruction of the beta cells in the pancreas. Rationale: Type 1 diabetes is an autoimmune disorder where the body's immune system attacks and destroys the insulin-producing beta cells in the pancreas. This leads to an absolute insulin deficiency, requiring lifelong exogenous insulin therapy. While genetics play a role, it is not solely a lifestyle disease, and onset can occur at any age.

1. A patient with diabetes is being treated for diabetic ketoacidosis (DKA). The patient is receiving an IV insulin infusion. Which serum laboratory value requires the nurse to take immediate action? A) Glucose: 250 mg/dL B) Potassium: 3.2 mEq/L C) Sodium: 135 mEq/L D) Chloride: 100 mEq/L Correct Answer: B) Potassium: 3.2 mEq/L Rationale: A potassium level of 3.2 mEq/L indicates hypokalemia. Insulin therapy drives potassium into the cells, which can rapidly worsen hypokalemia, leading to potentially fatal cardiac arrhythmias and respiratory muscle weakness. Potassium must be repleted before continuing the insulin infusion.
2. A patient is admitted with hyperosmolar hyperglycemic state (HHS). Which clinical finding is most characteristic of HHS? A) Fruity breath odor and Kussmaul respirations. B) Severe metabolic acidosis with a low pH. C) Extreme hyperglycemia with minimal or no ketones. D) Rapid onset of symptoms over a few hours.

1. A patient with a pulmonary embolism (PE) is receiving a continuous heparin infusion. The nurse notes the patient's aPTT is 45 seconds; the therapeutic range is 60-80 seconds. Which action should the nurse anticipate? A) The heparin infusion will be stopped. B) The heparin infusion rate will be increased. C) The heparin infusion rate will be decreased. D) A stat dose of protamine sulfate will be ordered. Correct Answer: B) The heparin infusion rate will be increased. Rationale: An aPTT of 45 seconds is subtherapeutic, meaning the patient is not adequately anticoagulated and remains at risk for thrombus extension. The nurse should anticipate an order to increase the infusion rate to achieve the therapeutic range. Protamine sulfate reverses heparin and would be used for a supratherapeutic level.
2. A patient is receiving a blood transfusion. The patient's temperature increases from 37.0°C to 38.5°C (98.6°F to 101.3°F), and the patient is shivering. What is the priority nursing action? A) Apply a cooling blanket to reduce the fever. B) Administer acetaminophen as ordered. C) Stop the transfusion and notify the provider. D) Slow the transfusion rate to 50 mL per hour. Correct Answer: C) Stop the transfusion and notify the provider. Rationale: Any fever or chills during a transfusion should be assumed to be a transfusion reaction. The transfusion must be stopped immediately to prevent a more serious reaction, such as a febrile non- hemolytic or, more critically, an acute hemolytic reaction. The provider should be notified after the transfusion is stopped.
3. The nurse is caring for a patient with a newly placed arteriovenous (AV) fistula for hemodialysis. Which finding should be reported to the provider immediately?

A) A palpable thrill and audible bruit over the fistula site. B) The patient reports mild pain at the fistula site. C) Absence of a palpable thrill or audible bruit. D) Slight edema of the hand on the side of the fistula. Correct Answer: C) Absence of a palpable thrill or audible bruit. Rationale: A palpable thrill (vibration) and audible bruit (whooshing sound) indicate patency of the AV fistula. Absence of these findings suggests thrombosis or stenosis, which is a surgical emergency requiring immediate intervention. The fistula may not be usable for dialysis if it is not patent.

1. A patient with chronic heart failure is being discharged. The nurse is teaching about daily weights. Which instruction is correct? A) “Weigh yourself before you go to bed at night.” B) “Wear the same type of clothing each time you weigh yourself.” C) “Weigh yourself daily, and report a gain of more than 2 pounds in 24 hours.” D) “It is only necessary to weigh yourself if you feel short of breath.” Correct Answer: C) “Weigh yourself daily, and report a gain of more than 2 pounds in 24 hours.” Rationale: Weight gain is an early sign of fluid retention. Clients should weigh themselves daily, in the morning, after voiding, and before eating, wearing the same amount of clothing. A gain of 2-3 pounds in 24 hours or 5 pounds in a week indicates worsening fluid overload and should be reported immediately.
2. A patient with a seizure disorder is prescribed levetiracetam (Keppra). Which statement by the patient indicates a need for further teaching? A) “I can stop this medication if I feel well for 6 months.” B) “I will need to have my blood drawn regularly to check the level of this medication.” C) “I should not drive until my seizures are controlled by the medication.” D) “I will take this medication with or without food, as it is well - absorbed.”

Rationale: Antiepileptic medications are typically taken for life. Discontinuing the medication abruptly, even after a period of being seizure-free, can precipitate status epilepticus. Patients must be taught never to stop or change the dose without consulting the healthcare provider.

1. A patient is suspected of having a subarachnoid hemorrhage (SAH). The initial non-contrast head CT is negative, but the patient's symptoms are highly suggestive. What is the most appropriate next diagnostic step? A) Magnetic resonance imaging (MRI) B) Cerebral angiography C) Repeat CT scan in 24 hours D) Lumbar puncture Correct Answer: D) Lumbar puncture Rationale: If CT is negative but suspicion for SAH remains high, a lumbar puncture should be performed to look for xanthochromia (yellowish discoloration of CSF indicating the presence of bilirubin from lysed red blood cells). This can detect a bleed that may not be visible on CT, especially several hours after the onset.
2. A patient with a brain tumor is receiving dexamethasone (Decadron) to decrease cerebral edema. The nurse should monitor the patient for which common side effect of this medication? A) Hypoglycemia B) Hyperkalemia C) Hyperglycemia D) Hypotension Correct Answer: C) Hyperglycemia. Rationale: Dexamethasone is a corticosteroid that can cause hyperglycemia, even in patients without diabetes. Blood glucose levels should be monitored regularly, and insulin may be required. Other side effects include hypertension, fluid retention, and hypokalemia.

1. A patient with myasthenia gravis is being discharged. Which instruction should the nurse include in the teaching plan? A) “Schedule your most demanding activities for the late afternoon.” B) “Take your anticholinesterase medication immediately before eating.” C) “Monitor your weight weekly for signs of fluid retention.” D) “Avoid stress, which can exacerbate muscle weakness.” Correct Answer: D) “Avoid stress, which can exacerbate muscle weakness.” Rationale: In myasthenia gravis, muscle weakness is exacerbated by stress, illness, fatigue, and certain medications. Patients should be taught to manage stress and conserve energy. Activities should be scheduled for times when the patient is strongest (typically morning). Anticholinesterase medications should be taken 30-60 minutes before meals.
2. The nurse is assessing a patient with a new diagnosis of multiple sclerosis (MS). Which finding is most characteristic of the motor symptoms of this disease? A) Muscle hypertrophy and increased strength. B) Tremors at rest and muscle rigidity. C) Weakness, spasticity, and hyperreflexia. D) Flaccid paralysis and areflexia. Correct Answer: C) Weakness, spasticity, and hyperreflexia. Rationale: MS is a demyelinating disease affecting the central nervous system, leading to upper motor neuron signs. Common motor findings include muscle weakness, spasticity (increased muscle tone), hyperreflexia, and clonus. Tremors at rest and rigidity are more typical of Parkinson's disease, while flaccid paralysis and areflexia suggest a lower motor neuron disorder. 44. A patient with a history of migraines reports a new onset of a “thunderclap” headache that reached maximal intensity within seconds. The patient has never had a headache like this before. What is the priority nursing action? A) Administer the patient's prescribed triptan medication.