NUR 265 Exam 1 V1 V2 V3 Actual Exam
2026/2027 – 100% Verified | Detailed Rationales
Pass Guaranteed – A+ Graded
Content Area Overview: This actual examination reflects the real clinical knowledge and advanced
reasoning required for success in NUR 265. It is designed to evaluate the student's ability to apply
evidence-based practice, prioritize complex patient care, and demonstrate clinical judgment across
multiple organ systems. Questions are structured to assess recall of pathophysiology, application of
nursing interventions, and analysis of complex clinical scenarios. This authentic question bank
represents the real exams used in the course and serves as a comprehensive resource for students
demonstrating mastery of advanced medical-surgical nursing content.
Content Domains Covered:
1. Complex Cardiovascular Disorders: Actual assessment and management of heart failure, acute
coronary syndrome, cardiac dysrhythmias, shock states, hypertensive crisis, peripheral vascular
disease, aortic aneurysm, and valvular heart disease. Includes hemodynamic monitoring,
pharmacological interventions, and priority nursing care.
2. Critical Respiratory Disorders: Real-world management of acute respiratory failure, ARDS,
pulmonary embolism, COPD exacerbation, status asthmaticus, pneumonia, respiratory acidosis,
and mechanical ventilation. Includes interpretation of ABGs, oxygen therapy, and priority
interventions.
3. Renal, Fluid, & Electrolyte Disorders: Complex fluid and electrolyte imbalances
(hyper/hyponatremia, hyper/hypokalemia, acid-base disturbances), acute kidney injury (AKI),
chronic kidney disease (CKD), and management of renal replacement therapies. Includes lab
interpretation and pharmacological management.
4. Gastrointestinal & Hepatic Disorders: Actual management of GI bleeding, pancreatitis,
hepatitis, cirrhosis, hepatic encephalopathy, inflammatory bowel disease, and bowel
obstructions. Includes nutritional support, medication management, and complication
monitoring.
5. Endocrine & Metabolic Emergencies: Real clinical management of diabetic emergencies (DKA,
HHS), thyroid disorders (thyroid storm, myxedema coma), and adrenal crisis. Includes insulin
management, fluid resuscitation, and symptom management.
, 6. Multisystem & Complex Care: Sepsis and septic shock, multiple organ dysfunction syndrome
(MODS), critical care prioritization, end-of-life care, and advanced clinical judgment across
complex patient presentations. Includes NGN-style clinical reasoning and prioritization.
Section 1: Complex Cardiovascular Disorders (Questions 1–9)
Q1: A 72-year-old patient with a history of chronic heart failure is admitted with worsening dyspnea,
orthopnea, and a 6-pound weight gain over four days. Vital signs: BP 152/94, HR 112, RR 28, SpO₂ 88%
on room air. Lung auscultation reveals bilateral crackles to the mid-lung fields, and jugular venous
distention is present at 45 degrees. Which intervention should the nurse implement first?
A. Administer digoxin 0.25 mg IV to improve cardiac contractility
B. Place the patient in high Fowler's position and administer supplemental oxygen [CORRECT]
C. Start an IV nitroglycerin infusion to reduce afterload
D. Insert a Foley catheter to monitor hourly urine output
Correct Answer: B
Rationale: The best answer is B. This patient is in acute pulmonary edema with severe hypoxemia—
positioning upright and giving oxygen are the immediate priorities to improve ventilation and
oxygenation before any other interventions. Digoxin, nitroglycerin, and monitoring devices all have their
place, but none matter if the patient can't oxygenate. High Fowler's uses gravity to reduce venous return
to the heart and ease breathing effort.
Correct Answer: B
Q2: A patient with acute ST-elevation myocardial infarction (STEMI) is being prepared for emergent
percutaneous coronary intervention (PCI). The nurse notes the patient's potassium is 3.2 mEq/L. Which
action is most appropriate?
A. Proceed with PCI and address the potassium after the procedure
B. Administer IV potassium replacement per protocol before PCI [CORRECT]
C. Hold the procedure until the potassium reaches 5.0 mEq/L
D. Start a potassium-sparing diuretic immediately
Correct Answer: B
Rationale: The best answer is B. Hypokalemia increases the risk of ventricular arrhythmias during
cardiac catheterization and reperfusion—correcting it to at least 3.5–4.0 mEq/L before PCI is standard
practice. Waiting for 5.0 is unnecessary and risks hyperkalemia, while proceeding without correction or
starting a diureticon a hypokalemic patient would be dangerous.
Correct Answer: B
, Q3: A patient in the cardiac unit develops a new irregularly irregular rhythm at a rate of 150 bpm. The
patient is alert, BP 118/76, and denies chest pain or dyspnea. Which intervention should the nurse
anticipate?
A. Immediate synchronized cardioversion
B. IV adenosine 6 mg rapid push
C. IV diltiazem or beta-blocker for rate control, plus anticoagulation assessment [CORRECT]
D. Immediate transcutaneous pacing
Correct Answer: C
Rationale: The best answer is C. This patient has new-onset atrial fibrillation with rapid ventricular
response but is hemodynamically stable—rate control with calcium channel blockers or beta-blockers is
the appropriate first step, along with evaluating stroke risk for anticoagulation. Cardioversion is reserved
for unstable patients, adenosine is for SVT not AFib, and pacing is for bradycardia, not tachycardia.
Correct Answer: C
Q4: A patient with an abdominal aortic aneurysm measuring 5.5 cm reports sudden, severe, tearing back
pain. Vital signs: BP 78/50, HR 136, RR 28. The abdomen is rigid and tender. Which is the priority nursing
action?
A. Administer IV morphine for pain control
B. Obtain a CT scan of the abdomen for definitive diagnosis
C. Activate the rapid response team and prepare for emergent surgery [CORRECT]
D. Insert a nasogastric tube for gastric decompression
Correct Answer: C
Rationale: The best answer is C. Sudden tearing back pain with hypotension and tachycardia in a patient
with a known large AAA is a ruptured aneurysm until proven otherwise—this is a surgical emergency
with minutes to hours of survivability. Pain control and imaging are secondary to getting the patient to
the OR; every minute of delay increases mortality exponentially.
Correct Answer: C
Q5: A patient with hypertensive emergency has a BP of 240/130 with headache and blurred vision. The
provider orders IV nicardipine. Fifteen minutes after starting the infusion, the BP is 200/110. Which is
the most appropriate nursing response?
A. Increase the nicardipine infusion rate to achieve normotension faster
B. Continue the current rate and monitor; a gradual reduction is the goal [CORRECT]
C. Switch to IV hydralazine for more aggressive control
D. Place the patient in Trendelenburg position to improve cerebral perfusion
Correct Answer: B
Rationale: The best answer is B. In hypertensive emergency, the goal is a controlled reduction of mean
2026/2027 – 100% Verified | Detailed Rationales
Pass Guaranteed – A+ Graded
Content Area Overview: This actual examination reflects the real clinical knowledge and advanced
reasoning required for success in NUR 265. It is designed to evaluate the student's ability to apply
evidence-based practice, prioritize complex patient care, and demonstrate clinical judgment across
multiple organ systems. Questions are structured to assess recall of pathophysiology, application of
nursing interventions, and analysis of complex clinical scenarios. This authentic question bank
represents the real exams used in the course and serves as a comprehensive resource for students
demonstrating mastery of advanced medical-surgical nursing content.
Content Domains Covered:
1. Complex Cardiovascular Disorders: Actual assessment and management of heart failure, acute
coronary syndrome, cardiac dysrhythmias, shock states, hypertensive crisis, peripheral vascular
disease, aortic aneurysm, and valvular heart disease. Includes hemodynamic monitoring,
pharmacological interventions, and priority nursing care.
2. Critical Respiratory Disorders: Real-world management of acute respiratory failure, ARDS,
pulmonary embolism, COPD exacerbation, status asthmaticus, pneumonia, respiratory acidosis,
and mechanical ventilation. Includes interpretation of ABGs, oxygen therapy, and priority
interventions.
3. Renal, Fluid, & Electrolyte Disorders: Complex fluid and electrolyte imbalances
(hyper/hyponatremia, hyper/hypokalemia, acid-base disturbances), acute kidney injury (AKI),
chronic kidney disease (CKD), and management of renal replacement therapies. Includes lab
interpretation and pharmacological management.
4. Gastrointestinal & Hepatic Disorders: Actual management of GI bleeding, pancreatitis,
hepatitis, cirrhosis, hepatic encephalopathy, inflammatory bowel disease, and bowel
obstructions. Includes nutritional support, medication management, and complication
monitoring.
5. Endocrine & Metabolic Emergencies: Real clinical management of diabetic emergencies (DKA,
HHS), thyroid disorders (thyroid storm, myxedema coma), and adrenal crisis. Includes insulin
management, fluid resuscitation, and symptom management.
, 6. Multisystem & Complex Care: Sepsis and septic shock, multiple organ dysfunction syndrome
(MODS), critical care prioritization, end-of-life care, and advanced clinical judgment across
complex patient presentations. Includes NGN-style clinical reasoning and prioritization.
Section 1: Complex Cardiovascular Disorders (Questions 1–9)
Q1: A 72-year-old patient with a history of chronic heart failure is admitted with worsening dyspnea,
orthopnea, and a 6-pound weight gain over four days. Vital signs: BP 152/94, HR 112, RR 28, SpO₂ 88%
on room air. Lung auscultation reveals bilateral crackles to the mid-lung fields, and jugular venous
distention is present at 45 degrees. Which intervention should the nurse implement first?
A. Administer digoxin 0.25 mg IV to improve cardiac contractility
B. Place the patient in high Fowler's position and administer supplemental oxygen [CORRECT]
C. Start an IV nitroglycerin infusion to reduce afterload
D. Insert a Foley catheter to monitor hourly urine output
Correct Answer: B
Rationale: The best answer is B. This patient is in acute pulmonary edema with severe hypoxemia—
positioning upright and giving oxygen are the immediate priorities to improve ventilation and
oxygenation before any other interventions. Digoxin, nitroglycerin, and monitoring devices all have their
place, but none matter if the patient can't oxygenate. High Fowler's uses gravity to reduce venous return
to the heart and ease breathing effort.
Correct Answer: B
Q2: A patient with acute ST-elevation myocardial infarction (STEMI) is being prepared for emergent
percutaneous coronary intervention (PCI). The nurse notes the patient's potassium is 3.2 mEq/L. Which
action is most appropriate?
A. Proceed with PCI and address the potassium after the procedure
B. Administer IV potassium replacement per protocol before PCI [CORRECT]
C. Hold the procedure until the potassium reaches 5.0 mEq/L
D. Start a potassium-sparing diuretic immediately
Correct Answer: B
Rationale: The best answer is B. Hypokalemia increases the risk of ventricular arrhythmias during
cardiac catheterization and reperfusion—correcting it to at least 3.5–4.0 mEq/L before PCI is standard
practice. Waiting for 5.0 is unnecessary and risks hyperkalemia, while proceeding without correction or
starting a diureticon a hypokalemic patient would be dangerous.
Correct Answer: B
, Q3: A patient in the cardiac unit develops a new irregularly irregular rhythm at a rate of 150 bpm. The
patient is alert, BP 118/76, and denies chest pain or dyspnea. Which intervention should the nurse
anticipate?
A. Immediate synchronized cardioversion
B. IV adenosine 6 mg rapid push
C. IV diltiazem or beta-blocker for rate control, plus anticoagulation assessment [CORRECT]
D. Immediate transcutaneous pacing
Correct Answer: C
Rationale: The best answer is C. This patient has new-onset atrial fibrillation with rapid ventricular
response but is hemodynamically stable—rate control with calcium channel blockers or beta-blockers is
the appropriate first step, along with evaluating stroke risk for anticoagulation. Cardioversion is reserved
for unstable patients, adenosine is for SVT not AFib, and pacing is for bradycardia, not tachycardia.
Correct Answer: C
Q4: A patient with an abdominal aortic aneurysm measuring 5.5 cm reports sudden, severe, tearing back
pain. Vital signs: BP 78/50, HR 136, RR 28. The abdomen is rigid and tender. Which is the priority nursing
action?
A. Administer IV morphine for pain control
B. Obtain a CT scan of the abdomen for definitive diagnosis
C. Activate the rapid response team and prepare for emergent surgery [CORRECT]
D. Insert a nasogastric tube for gastric decompression
Correct Answer: C
Rationale: The best answer is C. Sudden tearing back pain with hypotension and tachycardia in a patient
with a known large AAA is a ruptured aneurysm until proven otherwise—this is a surgical emergency
with minutes to hours of survivability. Pain control and imaging are secondary to getting the patient to
the OR; every minute of delay increases mortality exponentially.
Correct Answer: C
Q5: A patient with hypertensive emergency has a BP of 240/130 with headache and blurred vision. The
provider orders IV nicardipine. Fifteen minutes after starting the infusion, the BP is 200/110. Which is
the most appropriate nursing response?
A. Increase the nicardipine infusion rate to achieve normotension faster
B. Continue the current rate and monitor; a gradual reduction is the goal [CORRECT]
C. Switch to IV hydralazine for more aggressive control
D. Place the patient in Trendelenburg position to improve cerebral perfusion
Correct Answer: B
Rationale: The best answer is B. In hypertensive emergency, the goal is a controlled reduction of mean
