Galen ColleGe nUR 265 Final exam Set 1 2026/2027 – mediCal-SURG PdF Q&a

Galen ColleGe nUR 265 Final exam
Set 1 2026/2027 – mediCal-SURG PdF
Q&a
When turning an immobile bedridden client without assistance, which action by
the nurse best ensures client safety?
A. Securely grasp the client's arm and leg.
B. Put bed rails up on the side of bed opposite from the nurse.
C. Correctly position and use a turn sheet.
D. Lower the head of the client's bed slowly. - Answer-B
Rationale: Because the nurse can only stand on one side of the bed, bed rails
should be up on the opposite side to ensure that the client does not fall out of
bed. Option A can cause client injury to the skin or joint. Options C and D are
useful techniques while turning a client but have less priority in terms of safety
than use of the bed rails.


The nurse identifies a potential for infection in a client with partial-thickness
(second-degree) and full-thickness (third-degree) burns. What intervention has
the highest priority in decreasing the client's risk of infection?
A. Administration of plasma expanders
B. Use of careful handwashing technique
C. Application of a topical antibacterial cream
D. Limiting visitors to the client with burns - Answer-B
Rationale: Careful handwashing technique is the single most effective intervention
for the prevention of contamination to all clients. Option A reverses the
hypovolemia that initially accompanies burn trauma but is not related to

,decreasing the proliferation of infective organisms. Options C and D are
recommended by various burn centers as possible ways to reduce the chance of
infection. Option B is a proven technique to prevent infection.


The nurse is aware that malnutrition is a common problem among clients served
by a community health clinic for the homeless. Which laboratory value is the most
reliable indicator of chronic protein malnutrition?
A. Low serum albumin level
B. Low serum transferrin level
C. High hemoglobin level
D. High cholesterol level - Answer-A
Rationale: Long-term protein deficiency is required to cause significantly lowered
serum albumin levels. Albumin is made by the liver only when adequate amounts
of amino acids (from protein breakdown) are available. Albumin has a long half-
life, so acute protein loss does not significantly alter serum levels. Option B is a
serum protein with a half-life of only 8 to 10 days, so it will drop with an acute
protein deficiency. Options C and D are not clinical measures of protein
malnutrition.
The health care provider has changed a client's prescription from the PO to the IV
route of administration. The nurse should anticipate which change in the
pharmacokinetic properties of the medication?
A. The client will experience increased tolerance to the drug's effects and may
need a higher dose.
B. The onset of action of the drug will occur more rapidly, resulting in a more rapid
effect.
C. The medication will be more highly protein-bound, increasing the duration of
action.

,D. The therapeutic index will be increased, placing the client at greater risk for
toxicity. - Answer-B
Rationale: Because the absorptive process is eliminated when medications are
administered via the IV route, the onset of action is more rapid, resulting in a
more immediate effect. Drug tolerance, protein binding, and the drug's
therapeutic index are not affected by the change in route from PO to IV. In
addition, an increased therapeutic index reduces the risk of drug toxicity.


An older client who had abdominal surgery 3 days earlier was given a barbiturate
for sleep and is now requesting to go to the bathroom. Which action should the
nurse implement?
A. Assist the client to walk to the bathroom and do not leave the client alone.
B. Request that the UAP assist the client onto a bedpan.
C. Ask if the client needs to have a bowel movement or void.
D. Assess the client's bladder to determine if the client needs to urinate. - Answer-
A
Rationale: Barbiturates cause central nervous system (CNS) depression, and
individuals taking these medications are at greater risk for falls. The nurse should
assist the client to the bathroom. A bedpan is not necessary as long as safety is
ensured. Whether the client needs to void or have a bowel movement, option C is
irrelevant in terms of meeting this client's safety needs. There is no indication that
this client cannot voice her or his needs, so assessment of the bladder is not
needed.


By rolling contaminated gloves inside-out, the nurse is affecting which step in the
chain of infection?
A. Mode of transmission
B. Portal of entry

, C. Reservoir
D. Portal of exit - Answer-A
Rationale: The contaminated gloves serve as the mode of transmission from the
portal of exit of the reservoir to a portal of entry.


Which instruction is most important for the nurse to include when teaching a
client with limited mobility strategies to prevent venous thrombosis?
A. Perform cough and deep breathing exercises hourly.
B. Turn from side to side in bed at least every 2 hours.
C. Dorsiflex and plantarflex the feet 10 times each hour.
D. Drink approximately 4 ounces of water every hour. - Answer-C
Rationale: To reduce the risk of venous thrombosis, the nurse should instruct the
client in measures that promote venous return, such as dorsiflexion and plantar
flexion. Options A, B, and D are helpful to prevent other complications of
immobility but are less effective in preventing venous thrombus formation than
option C.


In assisting an older adult client prepare to take a tub bath, which nursing action is
most important?
A. Check the bath water temperature.
B. Shut the bathroom door.
C. Ensure that the client has voided.
D. Provide extra towels. - Answer-A
Rationale: To prevent burns or excessive chilling, the nurse must check the bath
water temperature. Options B, C, and D promote comfort and privacy and are
important interventions but are of less priority than promoting safety.