NUR 254 Exam 1 | (2026/2027 Update) Questions & Answer
Sheet Attached With Rationales | Galen College Of Nursing - 99
Questions and Answers Already Graded A+ Premium Exam
Tested And Verified
Subject Area Nursing (Medical-Surgical Nursing)
Description This exam assesses advanced concepts in medical-surgical nursing, including
hemodynamic monitoring, sepsis management, acute kidney injury, ventilatory
support, and evidence-based interventions for complex patient conditions.
Emphasis is on clinical reasoning, prioritization, and application of current
guidelines.
Expected Grade A+
Total Questions 99
Duration 3 hours
Learning Outcomes 1. Analyze hemodynamic parameters to guide fluid resuscitation in septic shock.
2. Interpret arterial blood gas results to adjust ventilator settings.
3. Differentiate between prerenal, intrarenal, and postrenal acute kidney injury
based on lab values.
4. Prioritize nursing interventions for patients with multiple system failures.
5. Apply evidence-based protocols for prevention of hospital-acquired infections.
Accreditation Accreditation Commission for Education in Nursing (ACEN) standards, aligned
with NCLEX-RN test plan.
Page 1
,1. A patient with septic shock has a mean arterial pressure (MAP) of 58 mm Hg
despite fluid resuscitation. Which hemodynamic parameter best indicates that the
patient would benefit from further fluid administration rather than initiating
vasopressors?
A. Central venous pressure (CVP) of 2 mm Hg
B. Systemic vascular resistance (SVR) of 1400 dynes/sec/cm-5
C. Cardiac output (CO) of 3.5 L/min
D. Pulmonary artery wedge pressure (PAWP) of 18 mm Hg
Answer: A. Central venous pressure (CVP) of 2 mm Hg
A low CVP (2 mm Hg) indicates hypovolemia, suggesting that further fluid
resuscitation may improve MAP. High SVR (B) suggests vasoconstriction, not
hypovolemia. Low CO (C) could be due to various causes. High PAWP (D) indicates
fluid overload, which would contraindicate further fluids.
2. A patient with acute respiratory distress syndrome (ARDS) is on
volume-controlled ventilation with a tidal volume of 8 mL/kg ideal body weight. The
plateau pressure is 32 cm H2O. Which adjustment should the nurse anticipate?
A. Increase tidal volume to 10 mL/kg to improve oxygenation
B. Decrease tidal volume to 6 mL/kg to reduce plateau pressure
C. Increase positive end-expiratory pressure (PEEP) to 20 cm H2O
D. Switch to pressure-controlled ventilation with a set peak pressure
Answer: B. Decrease tidal volume to 6 mL/kg to reduce plateau pressure
Lung-protective ventilation recommends tidal volumes of 6 mL/kg ideal body weight
and plateau pressure <30 cm H2O to prevent ventilator-induced lung injury. The
current tidal volume (8 mL/kg) and plateau pressure (32 cm H2O) exceed these
thresholds, so decreasing tidal volume is indicated.
Page 2
,3. Which combination of laboratory findings is most consistent with prerenal acute
kidney injury (AKI) in a patient with decompensated heart failure?
A. Urine sodium <20 mEq/L, fractional excretion of sodium (FeNa) <1%, BUN:creatinine
ratio >20:1
B. Urine sodium >40 mEq/L, FeNa >2%, BUN:creatinine ratio <10:1
C. Urine sodium <20 mEq/L, FeNa >2%, BUN:creatinine ratio <10:1
D. Urine sodium >40 mEq/L, FeNa <1%, BUN:creatinine ratio >20:1
Answer: A. Urine sodium <20 mEq/L, fractional excretion of sodium (FeNa) <1%,
BUN:creatinine ratio >20:1
Prerenal AKI results from decreased renal perfusion; the kidneys retain sodium and
concentrate urine, leading to low urine sodium, low FeNa, and elevated BUN:creatinine
ratio. Option B reflects intrinsic renal damage (acute tubular necrosis). Options C and
D have conflicting values.
4. A patient with cirrhosis and ascites develops acute kidney injury. The urine
sediment shows granular casts, and urine sodium is 10 mEq/L. Which type of AKI is
most likely?
A. Prerenal AKI due to hepatorenal syndrome
B. Intrinsic AKI due to acute tubular necrosis
C. Postrenal AKI due to obstructive uropathy
D. Prerenal AKI due to hypovolemia from diuretic use
Answer: A. Prerenal AKI due to hepatorenal syndrome
Hepatorenal syndrome (HRS) is a prerenal form of AKI in cirrhosis characterized by
low urine sodium (<20 mEq/L) and granular casts. Acute tubular necrosis (B) typically
has higher urine sodium. Postrenal AKI (C) would show anuria or hydronephrosis.
Hypovolemia (D) is possible but HRS is classic in this setting.
Page 3
, 5. A patient with diabetic ketoacidosis (DKA) has a serum potassium of 5.8 mEq/L
on admission. After initiation of insulin therapy, which potassium level warrants
immediate intervention?
A. 3.0 mEq/L
B. 3.5 mEq/L
C. 4.0 mEq/L
D. 5.0 mEq/L
Answer: A. 3.0 mEq/L
Insulin drives potassium into cells, causing hypokalemia. A level of 3.0 mEq/L is
critically low and increases risk of cardiac arrhythmias; replacement is needed. Levels
of 3.5-5.0 mEq/L are within acceptable range or mildly low but not immediately
dangerous.
6. A patient with a pulmonary embolism (PE) is receiving a heparin infusion. The
activated partial thromboplastin time (aPTT) is 45 seconds (therapeutic range 60-80
seconds). What is the nurse's priority action?
A. Increase the heparin infusion rate as per protocol
B. Administer a bolus of heparin as prescribed
C. Obtain a platelet count to check for heparin-induced thrombocytopenia (HIT)
D. Continue the infusion at the same rate and recheck aPTT in 6 hours
Answer: A. Increase the heparin infusion rate as per protocol
The aPTT is subtherapeutic, indicating insufficient anticoagulation. Increasing the
infusion rate is the standard response to achieve therapeutic range. A bolus (B) may be
prescribed but is not the priority without an order. HIT (C) is not indicated by a single
low aPTT. Continuing same rate (D) would delay treatment.
Page 4
Sheet Attached With Rationales | Galen College Of Nursing - 99
Questions and Answers Already Graded A+ Premium Exam
Tested And Verified
Subject Area Nursing (Medical-Surgical Nursing)
Description This exam assesses advanced concepts in medical-surgical nursing, including
hemodynamic monitoring, sepsis management, acute kidney injury, ventilatory
support, and evidence-based interventions for complex patient conditions.
Emphasis is on clinical reasoning, prioritization, and application of current
guidelines.
Expected Grade A+
Total Questions 99
Duration 3 hours
Learning Outcomes 1. Analyze hemodynamic parameters to guide fluid resuscitation in septic shock.
2. Interpret arterial blood gas results to adjust ventilator settings.
3. Differentiate between prerenal, intrarenal, and postrenal acute kidney injury
based on lab values.
4. Prioritize nursing interventions for patients with multiple system failures.
5. Apply evidence-based protocols for prevention of hospital-acquired infections.
Accreditation Accreditation Commission for Education in Nursing (ACEN) standards, aligned
with NCLEX-RN test plan.
Page 1
,1. A patient with septic shock has a mean arterial pressure (MAP) of 58 mm Hg
despite fluid resuscitation. Which hemodynamic parameter best indicates that the
patient would benefit from further fluid administration rather than initiating
vasopressors?
A. Central venous pressure (CVP) of 2 mm Hg
B. Systemic vascular resistance (SVR) of 1400 dynes/sec/cm-5
C. Cardiac output (CO) of 3.5 L/min
D. Pulmonary artery wedge pressure (PAWP) of 18 mm Hg
Answer: A. Central venous pressure (CVP) of 2 mm Hg
A low CVP (2 mm Hg) indicates hypovolemia, suggesting that further fluid
resuscitation may improve MAP. High SVR (B) suggests vasoconstriction, not
hypovolemia. Low CO (C) could be due to various causes. High PAWP (D) indicates
fluid overload, which would contraindicate further fluids.
2. A patient with acute respiratory distress syndrome (ARDS) is on
volume-controlled ventilation with a tidal volume of 8 mL/kg ideal body weight. The
plateau pressure is 32 cm H2O. Which adjustment should the nurse anticipate?
A. Increase tidal volume to 10 mL/kg to improve oxygenation
B. Decrease tidal volume to 6 mL/kg to reduce plateau pressure
C. Increase positive end-expiratory pressure (PEEP) to 20 cm H2O
D. Switch to pressure-controlled ventilation with a set peak pressure
Answer: B. Decrease tidal volume to 6 mL/kg to reduce plateau pressure
Lung-protective ventilation recommends tidal volumes of 6 mL/kg ideal body weight
and plateau pressure <30 cm H2O to prevent ventilator-induced lung injury. The
current tidal volume (8 mL/kg) and plateau pressure (32 cm H2O) exceed these
thresholds, so decreasing tidal volume is indicated.
Page 2
,3. Which combination of laboratory findings is most consistent with prerenal acute
kidney injury (AKI) in a patient with decompensated heart failure?
A. Urine sodium <20 mEq/L, fractional excretion of sodium (FeNa) <1%, BUN:creatinine
ratio >20:1
B. Urine sodium >40 mEq/L, FeNa >2%, BUN:creatinine ratio <10:1
C. Urine sodium <20 mEq/L, FeNa >2%, BUN:creatinine ratio <10:1
D. Urine sodium >40 mEq/L, FeNa <1%, BUN:creatinine ratio >20:1
Answer: A. Urine sodium <20 mEq/L, fractional excretion of sodium (FeNa) <1%,
BUN:creatinine ratio >20:1
Prerenal AKI results from decreased renal perfusion; the kidneys retain sodium and
concentrate urine, leading to low urine sodium, low FeNa, and elevated BUN:creatinine
ratio. Option B reflects intrinsic renal damage (acute tubular necrosis). Options C and
D have conflicting values.
4. A patient with cirrhosis and ascites develops acute kidney injury. The urine
sediment shows granular casts, and urine sodium is 10 mEq/L. Which type of AKI is
most likely?
A. Prerenal AKI due to hepatorenal syndrome
B. Intrinsic AKI due to acute tubular necrosis
C. Postrenal AKI due to obstructive uropathy
D. Prerenal AKI due to hypovolemia from diuretic use
Answer: A. Prerenal AKI due to hepatorenal syndrome
Hepatorenal syndrome (HRS) is a prerenal form of AKI in cirrhosis characterized by
low urine sodium (<20 mEq/L) and granular casts. Acute tubular necrosis (B) typically
has higher urine sodium. Postrenal AKI (C) would show anuria or hydronephrosis.
Hypovolemia (D) is possible but HRS is classic in this setting.
Page 3
, 5. A patient with diabetic ketoacidosis (DKA) has a serum potassium of 5.8 mEq/L
on admission. After initiation of insulin therapy, which potassium level warrants
immediate intervention?
A. 3.0 mEq/L
B. 3.5 mEq/L
C. 4.0 mEq/L
D. 5.0 mEq/L
Answer: A. 3.0 mEq/L
Insulin drives potassium into cells, causing hypokalemia. A level of 3.0 mEq/L is
critically low and increases risk of cardiac arrhythmias; replacement is needed. Levels
of 3.5-5.0 mEq/L are within acceptable range or mildly low but not immediately
dangerous.
6. A patient with a pulmonary embolism (PE) is receiving a heparin infusion. The
activated partial thromboplastin time (aPTT) is 45 seconds (therapeutic range 60-80
seconds). What is the nurse's priority action?
A. Increase the heparin infusion rate as per protocol
B. Administer a bolus of heparin as prescribed
C. Obtain a platelet count to check for heparin-induced thrombocytopenia (HIT)
D. Continue the infusion at the same rate and recheck aPTT in 6 hours
Answer: A. Increase the heparin infusion rate as per protocol
The aPTT is subtherapeutic, indicating insufficient anticoagulation. Increasing the
infusion rate is the standard response to achieve therapeutic range. A bolus (B) may be
prescribed but is not the priority without an order. HIT (C) is not indicated by a single
low aPTT. Continuing same rate (D) would delay treatment.
Page 4
