NU 265 – Advanced Medical-Surgical Nursing / Exam V1
Questions, Verified Answers, and Clinical Rationales
2026/2027 Edition
Question 1
A client with acute respiratory distress syndrome is positioned prone. Which key
physiological mechanism justifies the use of this positioning strategy?
A. It improves ventilation-perfusion matching by recruiting collapsed posterior
alveoli and reducing weight of the heart on the lungs.
B. It completely eliminates the need for mechanical ventilation support.
C. It decreases systemic arterial blood pressure and reduces cardiac output.
D. It forces the diaphragm upward to reduce total lung capacity.
Correct Answer: A. It improves ventilation-perfusion matching by recruiting
collapsed posterior alveoli and reducing weight of the heart on the lungs.
Clinical Rationale: Prone positioning utilizes gravity to shift the heart away from
dependent lung regions, allowing recruitment of collapsed dorsal alveoli and
improving gas exchange in acute respiratory distress syndrome.
Question 2
The nurse hears a high-pressure ventilator alarm sound. What is the immediate
priority nursing action?
A. Quickly assess the client and ventilator tubing for kinks, excess secretions,
or biting on the endotracheal tube.
B. Immediately disconnect the client from the ventilator and leave the room to
find a respiratory therapist.
C. Silence the alarm permanently and decrease the oxygen concentration to
zero.
D. Increase the high-pressure limit ceiling on the control panel.
,Correct Answer: A. Quickly assess the client and ventilator tubing for kinks,
excess secretions, or biting on the endotracheal tube.
Clinical Rationale: High-pressure alarms indicate increased airway resistance or
decreased compliance. The nurse must first quickly assess for common, reversible
mechanical obstructions before taking further action.
Question 3
A client with a chest tube system experiences accidental disconnection of the tube
from the drainage unit. What is the immediate nursing priority?
A. Submerge the distal end of the chest tube in a sterile container of sterile
water to re-establish a temporary water seal.
B. Clamp the chest tube permanently using metal hemostats.
C. Leave the tube open to room air while preparing supplies.
D. Pull the chest tube out immediately.
Correct Answer: A. Submerge the distal end of the chest tube in a sterile
container of sterile water to re-establish a temporary water seal.
Clinical Rationale: Submerging the end in sterile water creates an instant water
seal that lets air escape from the pleural space while preventing environmental air
from entering and causing a tension pneumothorax.
Question 4
The nurse is monitoring a client post-lobectomy with a chest tube in place. Which
finding requires immediate reporting to the healthcare provider?
A. A large, sudden gush of bright red blood output from the mediastinal tube in
the immediate postoperative period.
B. Continuous gentle bubbling in the suction control chamber connected to wall
suction.
C. Fluctuations in the water-seal chamber during respiration.
, D. A small, non-progressive area of subcutaneous emphysema at the insertion
site.
Correct Answer: A. A large, sudden gush of bright red blood output from the
mediastinal tube in the immediate postoperative period.
Clinical Rationale: Excessive bright red bleeding indicates active postoperative
hemorrhage, which requires immediate surgical intervention.
Question 5
A client with a pulmonary embolism is receiving a continuous heparin infusion.
Laboratory clotting times are reported above the therapeutic range. What is the
appropriate nursing action?
A. Decrease the heparin infusion rate according to the hospital protocol and re-
check per schedule.
B. Stop the infusion permanently and administer protamine sulfate immediately
without an order.
C. Increase the infusion rate to reach maximum levels.
D. Continue the exact same rate without changes.
Correct Answer: A. Decrease the heparin infusion rate according to the
hospital protocol and re-check per schedule.
Clinical Rationale: When clotting times exceed the therapeutic range, the nurse
must decrease the infusion rate following established institutional protocols to
minimize bleeding risks.
Question 6
A client is admitted with severe pneumonia and respiratory distress. Arterial blood
gas results show elevated pH, low carbon dioxide, low oxygen, and normal
bicarbonate. How should the nurse interpret these findings?
A. Respiratory alkalosis with severe hypoxemia
B. Metabolic acidosis with compensation
, C. Respiratory acidosis with metabolic compensation
D. Normal acid-base balance
Correct Answer: A. Respiratory alkalosis with severe hypoxemia
Clinical Rationale: An elevated pH and low carbon dioxide level indicate primary
acute respiratory alkalosis driven by hyperventilation, paired with low oxygen
levels reflecting hypoxemia.
Question 7
A client in hypovolemic shock is being assessed by the nurse. Which physical
findings are expected manifestations of this condition?
A. Cool, pale, clammy skin with weak, thready peripheral pulses and delayed
capillary refill.
B. Warm, flushed skin with bounding pulses and slow heart rate.
C. Jaundiced sclera with wide pulse pressure and warm extremities.
D. Slow, bounding pulse with normal skin perfusion.
Correct Answer: A. Cool, pale, clammy skin with weak, thready peripheral
pulses and delayed capillary refill.
Clinical Rationale: Sympathetic nervous system activation in hypovolemic shock
causes intense peripheral vasoconstriction to prioritize blood flow to vital organs,
resulting in cool, clammy skin and weak pulses.
Question 8
A client in septic shock remains hypotensive despite initial fluid boluses. Which
vasopressor is recommended as the first-line pharmacologic agent?
A. Norepinephrine
B. Dopamine
C. Epinephrine
Questions, Verified Answers, and Clinical Rationales
2026/2027 Edition
Question 1
A client with acute respiratory distress syndrome is positioned prone. Which key
physiological mechanism justifies the use of this positioning strategy?
A. It improves ventilation-perfusion matching by recruiting collapsed posterior
alveoli and reducing weight of the heart on the lungs.
B. It completely eliminates the need for mechanical ventilation support.
C. It decreases systemic arterial blood pressure and reduces cardiac output.
D. It forces the diaphragm upward to reduce total lung capacity.
Correct Answer: A. It improves ventilation-perfusion matching by recruiting
collapsed posterior alveoli and reducing weight of the heart on the lungs.
Clinical Rationale: Prone positioning utilizes gravity to shift the heart away from
dependent lung regions, allowing recruitment of collapsed dorsal alveoli and
improving gas exchange in acute respiratory distress syndrome.
Question 2
The nurse hears a high-pressure ventilator alarm sound. What is the immediate
priority nursing action?
A. Quickly assess the client and ventilator tubing for kinks, excess secretions,
or biting on the endotracheal tube.
B. Immediately disconnect the client from the ventilator and leave the room to
find a respiratory therapist.
C. Silence the alarm permanently and decrease the oxygen concentration to
zero.
D. Increase the high-pressure limit ceiling on the control panel.
,Correct Answer: A. Quickly assess the client and ventilator tubing for kinks,
excess secretions, or biting on the endotracheal tube.
Clinical Rationale: High-pressure alarms indicate increased airway resistance or
decreased compliance. The nurse must first quickly assess for common, reversible
mechanical obstructions before taking further action.
Question 3
A client with a chest tube system experiences accidental disconnection of the tube
from the drainage unit. What is the immediate nursing priority?
A. Submerge the distal end of the chest tube in a sterile container of sterile
water to re-establish a temporary water seal.
B. Clamp the chest tube permanently using metal hemostats.
C. Leave the tube open to room air while preparing supplies.
D. Pull the chest tube out immediately.
Correct Answer: A. Submerge the distal end of the chest tube in a sterile
container of sterile water to re-establish a temporary water seal.
Clinical Rationale: Submerging the end in sterile water creates an instant water
seal that lets air escape from the pleural space while preventing environmental air
from entering and causing a tension pneumothorax.
Question 4
The nurse is monitoring a client post-lobectomy with a chest tube in place. Which
finding requires immediate reporting to the healthcare provider?
A. A large, sudden gush of bright red blood output from the mediastinal tube in
the immediate postoperative period.
B. Continuous gentle bubbling in the suction control chamber connected to wall
suction.
C. Fluctuations in the water-seal chamber during respiration.
, D. A small, non-progressive area of subcutaneous emphysema at the insertion
site.
Correct Answer: A. A large, sudden gush of bright red blood output from the
mediastinal tube in the immediate postoperative period.
Clinical Rationale: Excessive bright red bleeding indicates active postoperative
hemorrhage, which requires immediate surgical intervention.
Question 5
A client with a pulmonary embolism is receiving a continuous heparin infusion.
Laboratory clotting times are reported above the therapeutic range. What is the
appropriate nursing action?
A. Decrease the heparin infusion rate according to the hospital protocol and re-
check per schedule.
B. Stop the infusion permanently and administer protamine sulfate immediately
without an order.
C. Increase the infusion rate to reach maximum levels.
D. Continue the exact same rate without changes.
Correct Answer: A. Decrease the heparin infusion rate according to the
hospital protocol and re-check per schedule.
Clinical Rationale: When clotting times exceed the therapeutic range, the nurse
must decrease the infusion rate following established institutional protocols to
minimize bleeding risks.
Question 6
A client is admitted with severe pneumonia and respiratory distress. Arterial blood
gas results show elevated pH, low carbon dioxide, low oxygen, and normal
bicarbonate. How should the nurse interpret these findings?
A. Respiratory alkalosis with severe hypoxemia
B. Metabolic acidosis with compensation
, C. Respiratory acidosis with metabolic compensation
D. Normal acid-base balance
Correct Answer: A. Respiratory alkalosis with severe hypoxemia
Clinical Rationale: An elevated pH and low carbon dioxide level indicate primary
acute respiratory alkalosis driven by hyperventilation, paired with low oxygen
levels reflecting hypoxemia.
Question 7
A client in hypovolemic shock is being assessed by the nurse. Which physical
findings are expected manifestations of this condition?
A. Cool, pale, clammy skin with weak, thready peripheral pulses and delayed
capillary refill.
B. Warm, flushed skin with bounding pulses and slow heart rate.
C. Jaundiced sclera with wide pulse pressure and warm extremities.
D. Slow, bounding pulse with normal skin perfusion.
Correct Answer: A. Cool, pale, clammy skin with weak, thready peripheral
pulses and delayed capillary refill.
Clinical Rationale: Sympathetic nervous system activation in hypovolemic shock
causes intense peripheral vasoconstriction to prioritize blood flow to vital organs,
resulting in cool, clammy skin and weak pulses.
Question 8
A client in septic shock remains hypotensive despite initial fluid boluses. Which
vasopressor is recommended as the first-line pharmacologic agent?
A. Norepinephrine
B. Dopamine
C. Epinephrine
