NUR 265 Medical-Surgical Nursing Final Exam Practice 2026 Galen
College
1. A patient is admitted with septic shock. Which of the following clinical
findings indicates the compensatory stage of shock?
A. Blood pressure 80/40 mmHg and lethargy
B. Petechiae and mottled skin
C. Anuria and metabolic acidosis
D. Tachycardia and narrowed pulse pressure
Answer: D
Rationale: In the compensatory stage of shock, the body uses the sympathetic nervous
system to maintain cardiac output, leading to tachycardia and vasoconstriction, which
narrows the pulse pressure.
2. A nurse is caring for a patient with Acute Respiratory Distress Syndrome
(ARDS) on a ventilator. What is the primary purpose of Positive End-Expiratory
Pressure (PEEP)?
A. To decrease the risk of barotrauma
B. To prevent alveolar collapse at the end of expiration
C. To increase the fraction of inspired oxygen (FiO2)
D. To suction secretions from the lower airway
Answer: B
Rationale: PEEP provides pressure at the end of expiration to keep the alveoli open,
improving gas exchange and preventing atelectasis.
,3. Which assessment finding is most indicative of increased intracranial pressure
(ICP) in a patient with a traumatic brain injury?
A. Hyperactivity and increased appetite
B. Decrease in systolic blood pressure
C. Narrowing pulse pressure
D. Change in the level of consciousness
Answer: D
Rationale: A change in the level of consciousness (LOC) is the earliest and most sensitive
indicator of increasing intracranial pressure.
4. A patient with a T4 spinal cord injury reports a sudden, severe headache and
has a BP of 190/100 mmHg. What is the priority nursing action?
A. Administer PRN pain medication
B. Check the patient’s bladder for distension
C. Lower the head of the bed to a flat position
D. Perform a neurological assessment
Answer: B
Rationale: These are signs of autonomic dysreflexia. The priority is to identify and remove
the stimulus, often a distended bladder or impacted bowel, while sitting the patient up.
5. In the Emergency Department, a triage nurse uses the START method. Which
patient should receive a Red Tag?
A. A patient with a simple fracture of the arm
B. A patient with a respiratory rate of 35 breaths per minute
C. A patient with no respirations after airway repositioning
D. A patient who follows commands but has a deep laceration
Answer: B
Rationale: In START triage, a respiratory rate over 30 bpm is a criterion for an immediate
(Red Tag) classification.
, 6. A patient with chronic kidney disease (CKD) has a potassium level of 6.8
mEq/L. Which medication should the nurse anticipate administering first to
protect the heart?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Furosemide (Lasix)
C. Calcium Gluconate
D. Regular Insulin and Dextrose
Answer: C
Rationale: Calcium gluconate is administered to stabilize the myocardial cell membrane
and prevent life-threatening dysrhythmias caused by hyperkalemia.
7. What is the primary goal of the ‘emergent’ phase of burn care?
A. Wound grafting and closure
B. Physical therapy and rehabilitation
C. Fluid resuscitation and airway management
D. Prevention of hypertrophic scarring
Answer: C
Rationale: The emergent (resuscitative) phase focuses on maintaining an airway and
replacing fluids lost due to increased capillary permeability.
8. A nurse notes a patient’s EKG shows a sawtooth pattern with a regular atrial
rhythm. This rhythm is identified as:
A. Atrial Fibrillation
B. Ventricular Tachycardia
C. First-degree AV block
D. Atrial Flutter
Answer: D
Rationale: Atrial flutter is characterized by a ‘sawtooth’ appearance of P waves (F-waves).
College
1. A patient is admitted with septic shock. Which of the following clinical
findings indicates the compensatory stage of shock?
A. Blood pressure 80/40 mmHg and lethargy
B. Petechiae and mottled skin
C. Anuria and metabolic acidosis
D. Tachycardia and narrowed pulse pressure
Answer: D
Rationale: In the compensatory stage of shock, the body uses the sympathetic nervous
system to maintain cardiac output, leading to tachycardia and vasoconstriction, which
narrows the pulse pressure.
2. A nurse is caring for a patient with Acute Respiratory Distress Syndrome
(ARDS) on a ventilator. What is the primary purpose of Positive End-Expiratory
Pressure (PEEP)?
A. To decrease the risk of barotrauma
B. To prevent alveolar collapse at the end of expiration
C. To increase the fraction of inspired oxygen (FiO2)
D. To suction secretions from the lower airway
Answer: B
Rationale: PEEP provides pressure at the end of expiration to keep the alveoli open,
improving gas exchange and preventing atelectasis.
,3. Which assessment finding is most indicative of increased intracranial pressure
(ICP) in a patient with a traumatic brain injury?
A. Hyperactivity and increased appetite
B. Decrease in systolic blood pressure
C. Narrowing pulse pressure
D. Change in the level of consciousness
Answer: D
Rationale: A change in the level of consciousness (LOC) is the earliest and most sensitive
indicator of increasing intracranial pressure.
4. A patient with a T4 spinal cord injury reports a sudden, severe headache and
has a BP of 190/100 mmHg. What is the priority nursing action?
A. Administer PRN pain medication
B. Check the patient’s bladder for distension
C. Lower the head of the bed to a flat position
D. Perform a neurological assessment
Answer: B
Rationale: These are signs of autonomic dysreflexia. The priority is to identify and remove
the stimulus, often a distended bladder or impacted bowel, while sitting the patient up.
5. In the Emergency Department, a triage nurse uses the START method. Which
patient should receive a Red Tag?
A. A patient with a simple fracture of the arm
B. A patient with a respiratory rate of 35 breaths per minute
C. A patient with no respirations after airway repositioning
D. A patient who follows commands but has a deep laceration
Answer: B
Rationale: In START triage, a respiratory rate over 30 bpm is a criterion for an immediate
(Red Tag) classification.
, 6. A patient with chronic kidney disease (CKD) has a potassium level of 6.8
mEq/L. Which medication should the nurse anticipate administering first to
protect the heart?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Furosemide (Lasix)
C. Calcium Gluconate
D. Regular Insulin and Dextrose
Answer: C
Rationale: Calcium gluconate is administered to stabilize the myocardial cell membrane
and prevent life-threatening dysrhythmias caused by hyperkalemia.
7. What is the primary goal of the ‘emergent’ phase of burn care?
A. Wound grafting and closure
B. Physical therapy and rehabilitation
C. Fluid resuscitation and airway management
D. Prevention of hypertrophic scarring
Answer: C
Rationale: The emergent (resuscitative) phase focuses on maintaining an airway and
replacing fluids lost due to increased capillary permeability.
8. A nurse notes a patient’s EKG shows a sawtooth pattern with a regular atrial
rhythm. This rhythm is identified as:
A. Atrial Fibrillation
B. Ventricular Tachycardia
C. First-degree AV block
D. Atrial Flutter
Answer: D
Rationale: Atrial flutter is characterized by a ‘sawtooth’ appearance of P waves (F-waves).
