NUR 265 - Exam 1: Critical Care & Medical-Surgical
Nursing Actual Exam 2026/2027 Update | 200 Verified
Questions - 190 Questions with Answers
NUR 265 Exam 1 Critical Care & Medical-Surgical Nursing 2026-190 QUESTIONS AND ANSWERS ALREADY
GRADED A+. 100% Verified Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive exam prep document for NUR 265 Exam 1 focuses on critical care and
medical-surgical nursing, reflecting the 2026/2027 curriculum updates. It includes 200 verified
questions that cover essential concepts, clinical scenarios, and evidence-based practices. Designed to
reinforce key knowledge and test-taking skills, this resource is ideal for nursing students seeking to
excel in their exam and clinical practice.
Key Features:
Critical care nursing principles and interventions
Medical-surgical nursing management of acute and chronic conditions
Pharmacology and safe medication administration in critical care
Patient assessment, monitoring, and hemodynamic parameters
Ethical and legal considerations in critical care settings
Interdisciplinary collaboration and patient education
Updates for 2026:
- Revised to align with 2026/2027 AACN and QSEN competencies
- Incorporated latest evidence-based guidelines for sepsis, shock, and cardiac care
- Updated pharmacology content to reflect new drug approvals and safety alerts
- Enhanced rationales with current research and clinical pearls
- Added new questions on COVID-19 and post-ICU syndrome
Abstract:
This exam preparation document is meticulously crafted for nursing students enrolled in NUR 265, focusing on
critical care and medical-surgical nursing. The 2026/2027 edition integrates the latest clinical guidelines and
educational standards, ensuring that students are well-prepared for both the exam and real-world practice. The
200 questions are designed to challenge students' critical thinking and clinical reasoning, covering a wide array of
topics including hemodynamic monitoring, ventilator management, acute kidney injury, and multi-organ
dysfunction. Each question is accompanied by detailed rationales that explain the correct answer and why the
distractors are incorrect, fostering a deeper understanding of the material. The content is organized by system and
complexity, allowing for systematic review and self-assessment. This document serves as an invaluable tool for
achieving a high score and demonstrating competence in critical care nursing.
Keywords:
Critical care nursing, Medical-surgical nursing, NCLEX-style questions, Hemodynamic monitoring, Ventilator
management, Sepsis, Acute kidney injury, Pharmacology
Answer Format:
Each question is presented in NCLEX-style format with four answer choices. The correct answer is indicated,
followed by a comprehensive rationale explaining the underlying pathophysiology, nursing interventions, and
evidence-based rationale. Distractor explanations are provided to clarify common misconceptions and reinforce key
concepts.
Compliance Checklist:
Page 1
, Aligned with 2026/2027 NUR 265 course objectives
Incorporates latest AACN, QSEN, and NCLEX-RN test plan
All answers verified by subject matter experts
Includes rationales for correct and incorrect options
Updated to reflect current clinical practice guidelines
Suitable for self-study and group review
Content Area Overview:
Content Area Questions Key Topics Weight
Critical Care Foundations 1-40 Hemodynamic monitoring, shock, sepsis, 20%
ARDS
Cardiovascular 41-80 Acute coronary syndrome, heart failure, 20%
dysrhythmias, cardiac surgery
Respiratory 81-120 Mechanical ventilation, tracheostomy care, 20%
pneumonia, pulmonary embolism
Renal & Fluid/Electrolytes 121-150 Acute kidney injury, continuous renal 15%
replacement therapy, electrolyte imbalances
Neurological 151-170 Increased ICP, stroke, traumatic brain injury, 10%
seizure management
Gastrointestinal & Endocrine 171-190 GI bleeding, liver failure, pancreatitis, 10%
DKA/HHS
Hematology & Multisystem 191-200 DIC, multiple organ dysfunction syndrome, 5%
transfusion reactions
Page 2
,Q1. A patient with septic shock has a pulmonary artery catheter in place. Which set
of values is most consistent with hyperdynamic septic shock?
A. CO 4.2 L/min, SVR 1450 dyne-sec/cm, CVP 12 mm Hg
B. CO 8.9 L/min, SVR 680 dyne-sec/cm, CVP 6 mm Hg
C. CO 6.1 L/min, SVR 1100 dyne-sec/cm, CVP 14 mm Hg
D. CO 3.8 L/min, SVR 1800 dyne-sec/cm, CVP 2 mm Hg
Correct Answer: B. CO 8.9 L/min, SVR 680 dyne-sec/cm, CVP 6 mm Hg
Rationale: Septic shock initially presents with high cardiac output (CO) and low systemic
vascular resistance (SVR) due to vasodilation and distributive shock. Option B reflects this
hyperdynamic state. Low CVP may indicate relative hypovolemia, but the key is high CO
and low SVR.
Why Wrong:
A - Low CO with high SVR suggests cardiogenic or hypovolemic shock, not septic.
C - SVR is normal, not low, and CO is not elevated; this is not typical of septic shock.
D - Low CO and high SVR are consistent with hypovolemic or cardiogenic shock.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 27; AACN
Essentials of Critical Care Nursing, 5th Ed.
Q2. A patient on volume-controlled ventilation has the following waveform: a sudden
decrease in peak pressure with unchanged plateau pressure. Which condition is most
likely?
A. Bronchospasm
B. Tension pneumothorax
C. Leak in the ventilator circuit
D. Pulmonary edema
Correct Answer: C. Leak in the ventilator circuit
Rationale: A leak in the circuit causes loss of delivered volume, reducing peak pressure
while plateau pressure (measured after inspiratory hold) remains unchanged because the
leak occurs during delivery, not during the hold. Bronchospasm and pulmonary edema
increase both peak and plateau pressures; tension pneumothorax increases both as well.
Why Wrong:
A - Bronchospasm increases airway resistance, raising peak pressure while plateau
may be normal or increased.
B - Tension pneumothorax increases both peak and plateau pressures due to decreased
compliance.
D - Pulmonary edema decreases compliance, increasing both peak and plateau
pressures.
Reference: Pilbeam, S.P. & Cairo, J.M. (2026). Mechanical Ventilation: Physiological and
Clinical Applications, 8th Ed., Ch. 5.
Page 3
, Q3. In a patient with acute respiratory distress syndrome (ARDS), which ventilator
strategy has been shown to reduce mortality?
A. Tidal volume 12 mL/kg ideal body weight with plateau pressure < 30 cm HO
B. Tidal volume 6 mL/kg ideal body weight with plateau pressure 30 cm HO
C. Tidal volume 10 mL/kg actual body weight with permissive hypercapnia
D. Tidal volume 8 mL/kg ideal body weight with PEEP adjusted to FiO
Correct Answer: B. Tidal volume 6 mL/kg ideal body weight with plateau pressure
30 cm HO
Rationale: The ARDSNet trial demonstrated that low tidal volume ventilation (6 mL/kg
ideal body weight) with plateau pressure 30 cm HO reduces mortality compared to higher
tidal volumes. This lung-protective strategy minimizes ventilator-induced lung injury.
Why Wrong:
A - 12 mL/kg is high and increases mortality in ARDS.
C - 10 mL/kg actual body weight is not lung-protective; actual weight overestimates
lung size.
D - 8 mL/kg is not the evidence-based target; 6 mL/kg is recommended.
Reference: ARDSNet (2000). NEJM; updated in ARDS Clinical Practice Guidelines
(2024).
Q4. A patient with a Glasgow Coma Scale score of 6 has an absent oculocephalic
reflex. Which additional finding would confirm brain death?
A. Spontaneous respirations at 20/min
B. Presence of decerebrate posturing
C. Negative apnea test with PaCO > 60 mm Hg
D. Pupils equal and reactive to light
Correct Answer: C. Negative apnea test with PaCO > 60 mm Hg
Rationale: Brain death requires absence of brainstem reflexes, including no respiratory
drive. A negative apnea test (no respiratory effort despite PaCO > 60 mm Hg) confirms the
absence of respiratory drive, a critical criterion. Other findings like spontaneous
respirations, posturing, or reactive pupils indicate brainstem function.
Why Wrong:
A - Spontaneous respirations indicate brainstem function, ruling out brain death.
B - Decerebrate posturing is a reflex mediated by brainstem, so it's incompatible with
brain death.
D - Reactive pupils indicate intact midbrain function, ruling out brain death.
Reference: Wijdicks, E.F.M. (2025). Brain Death Guidelines, AAN.
Page 4
Nursing Actual Exam 2026/2027 Update | 200 Verified
Questions - 190 Questions with Answers
NUR 265 Exam 1 Critical Care & Medical-Surgical Nursing 2026-190 QUESTIONS AND ANSWERS ALREADY
GRADED A+. 100% Verified Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive exam prep document for NUR 265 Exam 1 focuses on critical care and
medical-surgical nursing, reflecting the 2026/2027 curriculum updates. It includes 200 verified
questions that cover essential concepts, clinical scenarios, and evidence-based practices. Designed to
reinforce key knowledge and test-taking skills, this resource is ideal for nursing students seeking to
excel in their exam and clinical practice.
Key Features:
Critical care nursing principles and interventions
Medical-surgical nursing management of acute and chronic conditions
Pharmacology and safe medication administration in critical care
Patient assessment, monitoring, and hemodynamic parameters
Ethical and legal considerations in critical care settings
Interdisciplinary collaboration and patient education
Updates for 2026:
- Revised to align with 2026/2027 AACN and QSEN competencies
- Incorporated latest evidence-based guidelines for sepsis, shock, and cardiac care
- Updated pharmacology content to reflect new drug approvals and safety alerts
- Enhanced rationales with current research and clinical pearls
- Added new questions on COVID-19 and post-ICU syndrome
Abstract:
This exam preparation document is meticulously crafted for nursing students enrolled in NUR 265, focusing on
critical care and medical-surgical nursing. The 2026/2027 edition integrates the latest clinical guidelines and
educational standards, ensuring that students are well-prepared for both the exam and real-world practice. The
200 questions are designed to challenge students' critical thinking and clinical reasoning, covering a wide array of
topics including hemodynamic monitoring, ventilator management, acute kidney injury, and multi-organ
dysfunction. Each question is accompanied by detailed rationales that explain the correct answer and why the
distractors are incorrect, fostering a deeper understanding of the material. The content is organized by system and
complexity, allowing for systematic review and self-assessment. This document serves as an invaluable tool for
achieving a high score and demonstrating competence in critical care nursing.
Keywords:
Critical care nursing, Medical-surgical nursing, NCLEX-style questions, Hemodynamic monitoring, Ventilator
management, Sepsis, Acute kidney injury, Pharmacology
Answer Format:
Each question is presented in NCLEX-style format with four answer choices. The correct answer is indicated,
followed by a comprehensive rationale explaining the underlying pathophysiology, nursing interventions, and
evidence-based rationale. Distractor explanations are provided to clarify common misconceptions and reinforce key
concepts.
Compliance Checklist:
Page 1
, Aligned with 2026/2027 NUR 265 course objectives
Incorporates latest AACN, QSEN, and NCLEX-RN test plan
All answers verified by subject matter experts
Includes rationales for correct and incorrect options
Updated to reflect current clinical practice guidelines
Suitable for self-study and group review
Content Area Overview:
Content Area Questions Key Topics Weight
Critical Care Foundations 1-40 Hemodynamic monitoring, shock, sepsis, 20%
ARDS
Cardiovascular 41-80 Acute coronary syndrome, heart failure, 20%
dysrhythmias, cardiac surgery
Respiratory 81-120 Mechanical ventilation, tracheostomy care, 20%
pneumonia, pulmonary embolism
Renal & Fluid/Electrolytes 121-150 Acute kidney injury, continuous renal 15%
replacement therapy, electrolyte imbalances
Neurological 151-170 Increased ICP, stroke, traumatic brain injury, 10%
seizure management
Gastrointestinal & Endocrine 171-190 GI bleeding, liver failure, pancreatitis, 10%
DKA/HHS
Hematology & Multisystem 191-200 DIC, multiple organ dysfunction syndrome, 5%
transfusion reactions
Page 2
,Q1. A patient with septic shock has a pulmonary artery catheter in place. Which set
of values is most consistent with hyperdynamic septic shock?
A. CO 4.2 L/min, SVR 1450 dyne-sec/cm, CVP 12 mm Hg
B. CO 8.9 L/min, SVR 680 dyne-sec/cm, CVP 6 mm Hg
C. CO 6.1 L/min, SVR 1100 dyne-sec/cm, CVP 14 mm Hg
D. CO 3.8 L/min, SVR 1800 dyne-sec/cm, CVP 2 mm Hg
Correct Answer: B. CO 8.9 L/min, SVR 680 dyne-sec/cm, CVP 6 mm Hg
Rationale: Septic shock initially presents with high cardiac output (CO) and low systemic
vascular resistance (SVR) due to vasodilation and distributive shock. Option B reflects this
hyperdynamic state. Low CVP may indicate relative hypovolemia, but the key is high CO
and low SVR.
Why Wrong:
A - Low CO with high SVR suggests cardiogenic or hypovolemic shock, not septic.
C - SVR is normal, not low, and CO is not elevated; this is not typical of septic shock.
D - Low CO and high SVR are consistent with hypovolemic or cardiogenic shock.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 27; AACN
Essentials of Critical Care Nursing, 5th Ed.
Q2. A patient on volume-controlled ventilation has the following waveform: a sudden
decrease in peak pressure with unchanged plateau pressure. Which condition is most
likely?
A. Bronchospasm
B. Tension pneumothorax
C. Leak in the ventilator circuit
D. Pulmonary edema
Correct Answer: C. Leak in the ventilator circuit
Rationale: A leak in the circuit causes loss of delivered volume, reducing peak pressure
while plateau pressure (measured after inspiratory hold) remains unchanged because the
leak occurs during delivery, not during the hold. Bronchospasm and pulmonary edema
increase both peak and plateau pressures; tension pneumothorax increases both as well.
Why Wrong:
A - Bronchospasm increases airway resistance, raising peak pressure while plateau
may be normal or increased.
B - Tension pneumothorax increases both peak and plateau pressures due to decreased
compliance.
D - Pulmonary edema decreases compliance, increasing both peak and plateau
pressures.
Reference: Pilbeam, S.P. & Cairo, J.M. (2026). Mechanical Ventilation: Physiological and
Clinical Applications, 8th Ed., Ch. 5.
Page 3
, Q3. In a patient with acute respiratory distress syndrome (ARDS), which ventilator
strategy has been shown to reduce mortality?
A. Tidal volume 12 mL/kg ideal body weight with plateau pressure < 30 cm HO
B. Tidal volume 6 mL/kg ideal body weight with plateau pressure 30 cm HO
C. Tidal volume 10 mL/kg actual body weight with permissive hypercapnia
D. Tidal volume 8 mL/kg ideal body weight with PEEP adjusted to FiO
Correct Answer: B. Tidal volume 6 mL/kg ideal body weight with plateau pressure
30 cm HO
Rationale: The ARDSNet trial demonstrated that low tidal volume ventilation (6 mL/kg
ideal body weight) with plateau pressure 30 cm HO reduces mortality compared to higher
tidal volumes. This lung-protective strategy minimizes ventilator-induced lung injury.
Why Wrong:
A - 12 mL/kg is high and increases mortality in ARDS.
C - 10 mL/kg actual body weight is not lung-protective; actual weight overestimates
lung size.
D - 8 mL/kg is not the evidence-based target; 6 mL/kg is recommended.
Reference: ARDSNet (2000). NEJM; updated in ARDS Clinical Practice Guidelines
(2024).
Q4. A patient with a Glasgow Coma Scale score of 6 has an absent oculocephalic
reflex. Which additional finding would confirm brain death?
A. Spontaneous respirations at 20/min
B. Presence of decerebrate posturing
C. Negative apnea test with PaCO > 60 mm Hg
D. Pupils equal and reactive to light
Correct Answer: C. Negative apnea test with PaCO > 60 mm Hg
Rationale: Brain death requires absence of brainstem reflexes, including no respiratory
drive. A negative apnea test (no respiratory effort despite PaCO > 60 mm Hg) confirms the
absence of respiratory drive, a critical criterion. Other findings like spontaneous
respirations, posturing, or reactive pupils indicate brainstem function.
Why Wrong:
A - Spontaneous respirations indicate brainstem function, ruling out brain death.
B - Decerebrate posturing is a reflex mediated by brainstem, so it's incompatible with
brain death.
D - Reactive pupils indicate intact midbrain function, ruling out brain death.
Reference: Wijdicks, E.F.M. (2025). Brain Death Guidelines, AAN.
Page 4
