NUR 265 Medical-Surgical Nursing Exam 3 Comprehensive Practice
2026 Galen College
1. A patient with a history of heart failure reports a sudden weight gain of 3 lbs
in 24 hours. What is the nurse’s priority action?
A. Monitor the patient’s daily intake and output
B. Auscultate the patient’s lung sounds for crackles
C. Educate the patient on a low-sodium diet
D. Check the patient’s peripheral edema status
Answer: B
Rationale: Sudden weight gain in heart failure suggests fluid volume overload;
auscultating lungs for crackles is the priority to assess for pulmonary edema.
2. Which laboratory value is the most specific indicator of myocardial infarction
(MI)?
A. Troponin I
B. Myoglobin
C. Creatine Kinase-MB (CK-MB)
D. C-reactive protein (CRP)
Answer: A
Rationale: Troponin I is the most specific and sensitive biomarker for myocardial injury
and remains elevated for several days.
,3. The nurse is caring for a patient in the ICU with an arterial line. Which action
ensures the accuracy of the blood pressure readings?
A. Keep the patient’s arm at the level of the head
B. Zero the system every 2 hours
C. Level the transducer to the phlebostatic axis
D. Use a soft-tipped catheter for the insertion
Answer: C
Rationale: The transducer must be leveled at the phlebostatic axis (4th intercostal space,
mid-axillary line) to provide accurate pressure readings.
4. A patient is admitted with a diagnosis of Acute Respiratory Distress Syndrome
(ARDS). What is a hallmark clinical manifestation of this condition?
A. Hypercapnia that improves with oxygen therapy
B. Hypoxemia that is refractory to supplemental oxygen
C. Increased lung compliance
D. Decreased pulmonary artery wedge pressure
Answer: B
Rationale: Refractory hypoxemia, where oxygen levels remain low despite high
concentrations of supplemental oxygen, is a hallmark of ARDS.
5. A nurse identifies a ‘high pressure’ alarm on a patient’s mechanical ventilator.
Which of the following could be the cause?
A. A leak in the ventilator circuit
B. The patient is disconnected from the ventilator
C. The endotracheal tube cuff is deflated
D. The patient is biting the endotracheal tube
Answer: D
Rationale: High pressure alarms are triggered by obstructions, such as biting the tube,
secretions, or kinks in the tubing. Leaks cause low pressure alarms.
, 6. Which ABG result is consistent with a patient in early stages of Acute
Respiratory Failure due to hyperventilation?
A. pH 7.30, PaCO2 50, HCO3 24
B. pH 7.48, PaCO2 45, HCO3 30
C. pH 7.35, PaCO2 40, HCO3 24
D. pH 7.50, PaCO2 30, HCO3 22
Answer: D
Rationale: Hyperventilation leads to excessive loss of CO2, resulting in respiratory
alkalosis (high pH, low PaCO2).
7. A patient with a chest tube has continuous bubbling in the water seal
chamber. How should the nurse interpret this finding?
A. There is an air leak in the system
B. This is a normal finding during expiration
C. The lung has fully re-expanded
D. The suction is turned up too high
Answer: A
Rationale: Continuous bubbling in the water seal chamber indicates an air leak between
the patient and the drainage system.
8. A patient with Acute Kidney Injury (AKI) has a potassium level of 6.5 mEq/L.
Which medication should the nurse prepare to administer first to protect the
heart?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Furosemide (Lasix)
C. Regular Insulin and D50
D. Calcium Gluconate
Answer: D
2026 Galen College
1. A patient with a history of heart failure reports a sudden weight gain of 3 lbs
in 24 hours. What is the nurse’s priority action?
A. Monitor the patient’s daily intake and output
B. Auscultate the patient’s lung sounds for crackles
C. Educate the patient on a low-sodium diet
D. Check the patient’s peripheral edema status
Answer: B
Rationale: Sudden weight gain in heart failure suggests fluid volume overload;
auscultating lungs for crackles is the priority to assess for pulmonary edema.
2. Which laboratory value is the most specific indicator of myocardial infarction
(MI)?
A. Troponin I
B. Myoglobin
C. Creatine Kinase-MB (CK-MB)
D. C-reactive protein (CRP)
Answer: A
Rationale: Troponin I is the most specific and sensitive biomarker for myocardial injury
and remains elevated for several days.
,3. The nurse is caring for a patient in the ICU with an arterial line. Which action
ensures the accuracy of the blood pressure readings?
A. Keep the patient’s arm at the level of the head
B. Zero the system every 2 hours
C. Level the transducer to the phlebostatic axis
D. Use a soft-tipped catheter for the insertion
Answer: C
Rationale: The transducer must be leveled at the phlebostatic axis (4th intercostal space,
mid-axillary line) to provide accurate pressure readings.
4. A patient is admitted with a diagnosis of Acute Respiratory Distress Syndrome
(ARDS). What is a hallmark clinical manifestation of this condition?
A. Hypercapnia that improves with oxygen therapy
B. Hypoxemia that is refractory to supplemental oxygen
C. Increased lung compliance
D. Decreased pulmonary artery wedge pressure
Answer: B
Rationale: Refractory hypoxemia, where oxygen levels remain low despite high
concentrations of supplemental oxygen, is a hallmark of ARDS.
5. A nurse identifies a ‘high pressure’ alarm on a patient’s mechanical ventilator.
Which of the following could be the cause?
A. A leak in the ventilator circuit
B. The patient is disconnected from the ventilator
C. The endotracheal tube cuff is deflated
D. The patient is biting the endotracheal tube
Answer: D
Rationale: High pressure alarms are triggered by obstructions, such as biting the tube,
secretions, or kinks in the tubing. Leaks cause low pressure alarms.
, 6. Which ABG result is consistent with a patient in early stages of Acute
Respiratory Failure due to hyperventilation?
A. pH 7.30, PaCO2 50, HCO3 24
B. pH 7.48, PaCO2 45, HCO3 30
C. pH 7.35, PaCO2 40, HCO3 24
D. pH 7.50, PaCO2 30, HCO3 22
Answer: D
Rationale: Hyperventilation leads to excessive loss of CO2, resulting in respiratory
alkalosis (high pH, low PaCO2).
7. A patient with a chest tube has continuous bubbling in the water seal
chamber. How should the nurse interpret this finding?
A. There is an air leak in the system
B. This is a normal finding during expiration
C. The lung has fully re-expanded
D. The suction is turned up too high
Answer: A
Rationale: Continuous bubbling in the water seal chamber indicates an air leak between
the patient and the drainage system.
8. A patient with Acute Kidney Injury (AKI) has a potassium level of 6.5 mEq/L.
Which medication should the nurse prepare to administer first to protect the
heart?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Furosemide (Lasix)
C. Regular Insulin and D50
D. Calcium Gluconate
Answer: D
