NU 265 – Advanced Medical-Surgical Nursing / Final
Exam Questions, Verified Answers, and Clinical
Rationales 2026/2027 Edition
Question 1
The nurse working in the emergency department (ED) has triaged a client who
presented with chest pain, shortness of breath, a productive cough, and reports of
night sweats. The client’s health history includes acquired immune deficiency
syndrome (AIDS) and recent laboratory results that reveal a low CD4+ count.
Which of the following actions should the nurse take next?
A. Obtain a sputum culture for bacterial analysis
B. Initiate airborne precautions
C. Administer supplemental oxygen at 2 L/min
D. Prepare the client for chest X-ray
Correct Answer: B. Initiate airborne precautions
Clinical Rationale: Presentation with a productive cough, night sweats, weight
loss, and a compromised immune system (AIDS with low CD4+ count) strongly
suggests active pulmonary tuberculosis (TB). TB is an airborne pathogen requiring
immediate implementation of airborne precautions (negative pressure room, N95
respirator use) to prevent nosocomial transmission before diagnostic confirmation.
Question 2
The nurse attended a conference about kidney transplantations. Which of the
following clients who have end-stage renal disease (ESRD) does the nurse
recognize as being an optimal candidate for transplantation?
A. A 35-year-old client who is reporting burning with urination and is receiving
abdominal radiation
B. A 60-year-old diabetic client with active, untreated coronary artery disease
C. A 45-year-old client with no active infection and good psychosocial support
, D. A 50-year-old client with a documented history of chronic noncompliance
with medications
Correct Answer: C. A 45-year-old client with no active infection and good
psychosocial support
Clinical Rationale: Optimal renal transplant candidates must be free of active
infections, malignant disease, and severe extrarenal complications, while
demonstrating strong psychosocial support and the capacity to comply with
complex lifetime immunosuppressive therapy. Active infections, recent radiation,
and chronic noncompliance are absolute or relative contraindications.
Question 3
The nurse is reviewing laboratory results for assigned clients on a medical-surgical
unit. Which of the following clients requires priority follow-up with the primary
healthcare provider (PHCP)?
A. Client with chronic, stable stage 3 chronic kidney disease and a serum
creatinine of 2.2 mg/dL
B. Client 2 days post-abdominal aortic aneurysm (AAA) repair with serum
creatinine increasing from 0.9 to 2.5 mg/dL
C. Client with Type 2 diabetes mellitus and a morning fasting blood glucose of
145 mg/dL
D. Client receiving loop diuretics with a serum potassium level of 3.6 mEq/L
Correct Answer: B. Client 2 days post-abdominal aortic aneurysm (AAA)
repair with serum creatinine increasing from 0.9 to 2.5 mg/dL
Clinical Rationale: A rapid, sharp elevation in serum creatinine following major
vascular surgery like an AAA repair strongly indicates acute kidney injury
(AKI)—frequently secondary to transient renal ischemia, hemorrhage, or
atheroembolism. This requires immediate intervention to preserve remaining renal
function.
Question 4
,The nurse is caring for a client who is 4 days postoperative following a major
cardiothoracic surgery and suddenly develops severe, sharp chest pain and acute
dyspnea. Vital signs show tachycardia and tachypnea, and pulse oximetry reads
88% on room air. After raising the head of the bed, what is the next best nursing
action?
A. Order an immediate stat chest X-ray
B. Obtain a blood specimen for arterial blood gases (ABGs)
C. Administer supplemental oxygen therapy
D. Encourage deep breathing and coughing exercises
Correct Answer: C. Administer supplemental oxygen therapy
Clinical Rationale: Utilizing the ABC (Airway, Breathing, Circulation)
framework and emergency nursing protocols, correcting acute hypoxemia via
supplemental oxygen is the immediate priority when a client displays signs of a
massive pulmonary event or acute respiratory distress. Diagnostic orders (ABGs,
X-rays) follow stabilization of oxygenation.
Question 5
The nurse is caring for a client who had an orthotopic liver transplant 48 hours ago.
It is a priority for the nurse to notify the primary healthcare provider (PHCP) if the
client exhibits which of the following findings?
A. Increasing total bilirubin and serum liver enzymes
B. Mild, localized surgical incision discomfort
C. Decreased appetite and early morning fatigue
D. Slightly elevated body temperature of 99.2°F (37.3°C)
Correct Answer: A. Increasing total bilirubin and serum liver enzymes
Clinical Rationale: Rising bilirubin, ALT, and AST levels within the immediate
postoperative window following a liver transplant serve as early biochemical
indicators of acute graft rejection or primary graft non-function, demanding
, immediate clinical evaluation. Mild incisional pain or low-grade sub-febrile
temperatures can be common early postoperative findings.
Question 6
The nurse is assessing a client with acute pancreatitis. Which of the following
clinical manifestations is expected regarding the client's pain profile?
A. Lower right quadrant cramping pain relieved by defecation
B. Severe, constant epigastric and back pain that is aggravated when lying
supine
C. Sharp, intermittent chest pain radiating down the left inner arm
D. Right upper quadrant colicky pain triggered by high-fat meals
Correct Answer: B. Severe, constant epigastric and back pain that is
aggravated when lying supine
Clinical Rationale: Acute pancreatitis classically presents with severe, boring
epigastric pain that frequently radiates straight through to the back. The pain is
characteristically worsened by lying flat in a supine position due to retroperitoneal
inflammation of the pancreas, and it is often slightly alleviated by leaning forward
or assuming a fetal position.
Question 7
The newly hired nurse is developing a plan of care for a client who has acquired
immune deficiency syndrome (AIDS) and was just diagnosed with Pneumocystis
jiroveci pneumonia (PJP). Which of the following nursing interventions should the
nurse preceptor question?
A. Wearing clean gloves when performing oral care
B. Wearing a standard surgical mask when standing within 3 feet of the client
C. Encouraging adequate oral fluid intake
D. Administering prescribed prophylactic or therapeutic antibiotics
Exam Questions, Verified Answers, and Clinical
Rationales 2026/2027 Edition
Question 1
The nurse working in the emergency department (ED) has triaged a client who
presented with chest pain, shortness of breath, a productive cough, and reports of
night sweats. The client’s health history includes acquired immune deficiency
syndrome (AIDS) and recent laboratory results that reveal a low CD4+ count.
Which of the following actions should the nurse take next?
A. Obtain a sputum culture for bacterial analysis
B. Initiate airborne precautions
C. Administer supplemental oxygen at 2 L/min
D. Prepare the client for chest X-ray
Correct Answer: B. Initiate airborne precautions
Clinical Rationale: Presentation with a productive cough, night sweats, weight
loss, and a compromised immune system (AIDS with low CD4+ count) strongly
suggests active pulmonary tuberculosis (TB). TB is an airborne pathogen requiring
immediate implementation of airborne precautions (negative pressure room, N95
respirator use) to prevent nosocomial transmission before diagnostic confirmation.
Question 2
The nurse attended a conference about kidney transplantations. Which of the
following clients who have end-stage renal disease (ESRD) does the nurse
recognize as being an optimal candidate for transplantation?
A. A 35-year-old client who is reporting burning with urination and is receiving
abdominal radiation
B. A 60-year-old diabetic client with active, untreated coronary artery disease
C. A 45-year-old client with no active infection and good psychosocial support
, D. A 50-year-old client with a documented history of chronic noncompliance
with medications
Correct Answer: C. A 45-year-old client with no active infection and good
psychosocial support
Clinical Rationale: Optimal renal transplant candidates must be free of active
infections, malignant disease, and severe extrarenal complications, while
demonstrating strong psychosocial support and the capacity to comply with
complex lifetime immunosuppressive therapy. Active infections, recent radiation,
and chronic noncompliance are absolute or relative contraindications.
Question 3
The nurse is reviewing laboratory results for assigned clients on a medical-surgical
unit. Which of the following clients requires priority follow-up with the primary
healthcare provider (PHCP)?
A. Client with chronic, stable stage 3 chronic kidney disease and a serum
creatinine of 2.2 mg/dL
B. Client 2 days post-abdominal aortic aneurysm (AAA) repair with serum
creatinine increasing from 0.9 to 2.5 mg/dL
C. Client with Type 2 diabetes mellitus and a morning fasting blood glucose of
145 mg/dL
D. Client receiving loop diuretics with a serum potassium level of 3.6 mEq/L
Correct Answer: B. Client 2 days post-abdominal aortic aneurysm (AAA)
repair with serum creatinine increasing from 0.9 to 2.5 mg/dL
Clinical Rationale: A rapid, sharp elevation in serum creatinine following major
vascular surgery like an AAA repair strongly indicates acute kidney injury
(AKI)—frequently secondary to transient renal ischemia, hemorrhage, or
atheroembolism. This requires immediate intervention to preserve remaining renal
function.
Question 4
,The nurse is caring for a client who is 4 days postoperative following a major
cardiothoracic surgery and suddenly develops severe, sharp chest pain and acute
dyspnea. Vital signs show tachycardia and tachypnea, and pulse oximetry reads
88% on room air. After raising the head of the bed, what is the next best nursing
action?
A. Order an immediate stat chest X-ray
B. Obtain a blood specimen for arterial blood gases (ABGs)
C. Administer supplemental oxygen therapy
D. Encourage deep breathing and coughing exercises
Correct Answer: C. Administer supplemental oxygen therapy
Clinical Rationale: Utilizing the ABC (Airway, Breathing, Circulation)
framework and emergency nursing protocols, correcting acute hypoxemia via
supplemental oxygen is the immediate priority when a client displays signs of a
massive pulmonary event or acute respiratory distress. Diagnostic orders (ABGs,
X-rays) follow stabilization of oxygenation.
Question 5
The nurse is caring for a client who had an orthotopic liver transplant 48 hours ago.
It is a priority for the nurse to notify the primary healthcare provider (PHCP) if the
client exhibits which of the following findings?
A. Increasing total bilirubin and serum liver enzymes
B. Mild, localized surgical incision discomfort
C. Decreased appetite and early morning fatigue
D. Slightly elevated body temperature of 99.2°F (37.3°C)
Correct Answer: A. Increasing total bilirubin and serum liver enzymes
Clinical Rationale: Rising bilirubin, ALT, and AST levels within the immediate
postoperative window following a liver transplant serve as early biochemical
indicators of acute graft rejection or primary graft non-function, demanding
, immediate clinical evaluation. Mild incisional pain or low-grade sub-febrile
temperatures can be common early postoperative findings.
Question 6
The nurse is assessing a client with acute pancreatitis. Which of the following
clinical manifestations is expected regarding the client's pain profile?
A. Lower right quadrant cramping pain relieved by defecation
B. Severe, constant epigastric and back pain that is aggravated when lying
supine
C. Sharp, intermittent chest pain radiating down the left inner arm
D. Right upper quadrant colicky pain triggered by high-fat meals
Correct Answer: B. Severe, constant epigastric and back pain that is
aggravated when lying supine
Clinical Rationale: Acute pancreatitis classically presents with severe, boring
epigastric pain that frequently radiates straight through to the back. The pain is
characteristically worsened by lying flat in a supine position due to retroperitoneal
inflammation of the pancreas, and it is often slightly alleviated by leaning forward
or assuming a fetal position.
Question 7
The newly hired nurse is developing a plan of care for a client who has acquired
immune deficiency syndrome (AIDS) and was just diagnosed with Pneumocystis
jiroveci pneumonia (PJP). Which of the following nursing interventions should the
nurse preceptor question?
A. Wearing clean gloves when performing oral care
B. Wearing a standard surgical mask when standing within 3 feet of the client
C. Encouraging adequate oral fluid intake
D. Administering prescribed prophylactic or therapeutic antibiotics
