NUR 265 Medical-Surgical Nursing - Final Exam Ultimate
Practice Exam | 2026/2027 Edition | 200+ Verified Questions -
170 Questions with Answers
NUR 265 Medical-Surgical Nursing Final Exam 2026-170 QUESTIONS AND ANSWERS ALREADY GRADED
A+. 100% Verified Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive practice exam is meticulously designed to prepare nursing students for the NUR
265 Medical-Surgical Nursing final examination. Featuring over 200 verified questions with detailed
answers and rationales, it covers essential topics in adult health nursing, including cardiovascular,
respiratory, neurological, and gastrointestinal systems. Each question is aligned with current
evidence-based practice and national nursing standards, ensuring a thorough review of critical
concepts. This resource is an indispensable tool for achieving a high score and demonstrating clinical
competence.
Key Features:
Comprehensive coverage of medical-surgical nursing concepts
200+ multiple-choice questions with detailed rationales
Focus on high-yield topics for the final exam
Includes pharmacology and prioritization questions
Aligned with NCLEX-RN and HESI exam blueprints
Updated to reflect 2026-2027 clinical guidelines
Updates for 2026:
- Revised to incorporate the latest evidence-based practice guidelines
- Added new questions on emerging infectious diseases and immunology
- Updated pharmacology content to reflect current drug classifications
- Enhanced rationales with step-by-step explanations for correct and incorrect options
- Aligned with the most recent NUR 265 course objectives and exam blueprint
Abstract:
This practice examination serves as a definitive resource for nursing students enrolled in NUR 265
Medical-Surgical Nursing, offering an extensive array of 200+ questions that mirror the format and complexity of
the final exam. The content is systematically organized to address the core competencies required for safe and
effective nursing practice, with a strong emphasis on clinical reasoning, patient-centered care, and
interprofessional collaboration. Each question is accompanied by a thorough rationale that not only explains the
correct answer but also analyzes why the distractors are incorrect, thereby reinforcing critical thinking and
knowledge retention. The examination covers a broad spectrum of medical-surgical conditions, including acute
and chronic illnesses, perioperative care, and emergency situations, with a focus on nursing interventions,
diagnostic tests, and pharmacological management. Additionally, the practice exam integrates priority-setting
frameworks, safety principles, and ethical considerations, ensuring a holistic review. By engaging with this
material, students will enhance their ability to apply theoretical knowledge to clinical scenarios, ultimately
improving their performance on the final examination and their readiness for professional nursing practice.
Keywords:
Medical-Surgical Nursing, NUR 265, Final Exam, Practice Questions, NCLEX-RN, Nursing Rationales, Adult
Health, Evidence-Based Practice
Answer Format:
Each question is presented in a multiple-choice format with four options. The correct answer is clearly indicated,
Page 1
,followed by a comprehensive rationale explaining the underlying pathophysiological and nursing principles.
Additionally, each incorrect option is analyzed to clarify why it is not the best choice, facilitating a deeper
understanding of the subject matter.
Compliance Checklist:
Aligned with the latest NCLEX-RN test plan
Incorporates QSEN competencies
References current clinical practice guidelines
Includes culturally competent care scenarios
Emphasizes patient safety and quality improvement
Reflects the NUR 265 course syllabus and learning outcomes
Content Area Overview:
Content Area Questions Key Topics Weight
Cardiovascular Disorders 1-30 Heart failure, Myocardial infarction, 15%
Hypertension, Arrhythmias, Cardiac
medications
Respiratory Disorders 31-60 COPD, Asthma, Pneumonia, Pulmonary 15%
embolism, Oxygen therapy
Neurological Disorders 61-90 Stroke, Seizures, Parkinson's disease, 15%
Increased intracranial pressure, Neuro
assessments
Gastrointestinal Disorders 91-120 Peptic ulcer disease, Inflammatory bowel 15%
disease, Pancreatitis, Liver cirrhosis, GI
bleeding
Renal and Urinary Disorders 121-150 Acute kidney injury, Chronic kidney 15%
disease, Urinary tract infections, Dialysis,
Fluid and electrolytes
Endocrine Disorders 151-180 Diabetes mellitus, Thyroid disorders, 15%
Adrenal insufficiency, SIADH, Diabetes
insipidus
Perioperative and Emergency 181-200 Preoperative care, Postoperative 10%
Nursing complications, Shock, Sepsis, Triage
Page 2
,Q1. In a patient with septic shock and acute respiratory distress syndrome (ARDS),
which ventilator strategy best balances oxygenation and prevention of further lung
injury?
A. High tidal volume (10-12 mL/kg) with low PEEP to minimize barotrauma
B. Low tidal volume (6 mL/kg ideal body weight) with adequate PEEP to recruit
alveoli
C. Pressure-controlled ventilation with high inspiratory pressures to maximize
oxygenation
D. Volume-assured pressure support with permissive hypercapnia only if pH < 7.10
Correct Answer: B. Low tidal volume (6 mL/kg ideal body weight) with adequate
PEEP to recruit alveoli
Rationale: Low tidal volume ventilation (6 mL/kg) with appropriate PEEP is the
evidence-based strategy for ARDS, reducing ventilator-induced lung injury and mortality.
High tidal volumes exacerbate alveolar overdistension, while high pressures increase
barotrauma. Permissive hypercapnia is accepted but not the primary strategy.
Why Wrong:
A - High tidal volumes are harmful in ARDS due to volutrauma and are not
recommended.
C - High inspiratory pressures increase the risk of barotrauma without proven benefit.
D - Permissive hypercapnia is a component but not the defining strategy; low tidal
volume is key.
Reference: Urden, L.D., Stacy, K.M., & Lough, M.E. (2025). Critical Care Nursing, 9th
Ed., Ch. 12
Q2. Which finding most reliably indicates that a patient with syndrome of
inappropriate antidiuretic hormone (SIADH) is responding to fluid restriction?
A. Urine sodium concentration drops below 20 mEq/L
B. Serum sodium increases toward normal range
C. Urine osmolality falls below serum osmolality
D. Daily weight decreases by 0.5 kg over 24 hours
Correct Answer: B. Serum sodium increases toward normal range
Rationale: The primary goal in SIADH is to correct hyponatremia; a rising serum sodium
indicates effective treatment. Urine sodium may remain high initially, urine osmolality
may stay elevated, and weight loss reflects fluid removal but not necessarily sodium
correction.
Why Wrong:
A - Urine sodium may remain high due to continued ADH effect; it is not a reliable
early indicator.
C - Urine osmolality typically remains inappropriately high despite fluid restriction.
Page 3
, D - Weight loss indicates fluid loss but does not directly confirm serum sodium
improvement.
Reference: Ignatavicius, D.D., Workman, M.L., et al. (2025). Medical-Surgical Nursing,
10th Ed., Ch. 11
Q3. A patient with hyperkalemia (K+ 6.8 mEq/L) and ECG changes is being treated.
Which medication sequence demonstrates the correct priority of interventions?
A. Calcium gluconate IV, then insulin with dextrose, then sodium polystyrene sulfonate
B. Insulin with dextrose, then calcium gluconate IV, then albuterol nebulization
C. Sodium bicarbonate IV, then furosemide, then calcium gluconate
D. Albuterol nebulization, then insulin with dextrose, then dialysis preparation
Correct Answer: A. Calcium gluconate IV, then insulin with dextrose, then sodium
polystyrene sulfonate
Rationale: In hyperkalemia with ECG changes, calcium gluconate is given first to stabilize
cardiac membranes, then insulin/dextrose shifts potassium intracellularly, and a binding
resin removes total body potassium. Sodium bicarbonate is not first-line, and dialysis is
reserved for refractory cases.
Why Wrong:
B - Calcium gluconate should precede insulin to prevent cardiac arrest during
potassium shift.
C - Sodium bicarbonate is not first-line and calcium should be given immediately for
ECG changes.
D - Albuterol is an adjunct but not the initial priority when ECG changes are present.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 52
Q4. Which assessment finding is most indicative of malignant hyperthermia in a
patient who received succinylcholine during surgery?
A. Postoperative temperature of 38.2°C (100.8°F) and mild tachycardia
B. Rising end-tidal CO2 with muscle rigidity and mixed respiratory/metabolic acidosis
C. Prolonged neuromuscular blockade with absent deep tendon reflexes
D. Sudden hypotension and bradycardia unresponsive to atropine
Correct Answer: B. Rising end-tidal CO2 with muscle rigidity and mixed
respiratory/metabolic acidosis
Rationale: Malignant hyperthermia presents with a hypermetabolic state: rising ETCO2,
muscle rigidity, and mixed acidosis due to uncontrolled calcium release. Fever is a late
sign, and early signs include tachycardia and hypercarbia.
Why Wrong:
A - Mild fever alone is nonspecific and not the earliest or most indicative sign.
C - Prolonged blockade is not typical; rigidity is a hallmark, but acidosis is key.
Page 4
Practice Exam | 2026/2027 Edition | 200+ Verified Questions -
170 Questions with Answers
NUR 265 Medical-Surgical Nursing Final Exam 2026-170 QUESTIONS AND ANSWERS ALREADY GRADED
A+. 100% Verified Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive practice exam is meticulously designed to prepare nursing students for the NUR
265 Medical-Surgical Nursing final examination. Featuring over 200 verified questions with detailed
answers and rationales, it covers essential topics in adult health nursing, including cardiovascular,
respiratory, neurological, and gastrointestinal systems. Each question is aligned with current
evidence-based practice and national nursing standards, ensuring a thorough review of critical
concepts. This resource is an indispensable tool for achieving a high score and demonstrating clinical
competence.
Key Features:
Comprehensive coverage of medical-surgical nursing concepts
200+ multiple-choice questions with detailed rationales
Focus on high-yield topics for the final exam
Includes pharmacology and prioritization questions
Aligned with NCLEX-RN and HESI exam blueprints
Updated to reflect 2026-2027 clinical guidelines
Updates for 2026:
- Revised to incorporate the latest evidence-based practice guidelines
- Added new questions on emerging infectious diseases and immunology
- Updated pharmacology content to reflect current drug classifications
- Enhanced rationales with step-by-step explanations for correct and incorrect options
- Aligned with the most recent NUR 265 course objectives and exam blueprint
Abstract:
This practice examination serves as a definitive resource for nursing students enrolled in NUR 265
Medical-Surgical Nursing, offering an extensive array of 200+ questions that mirror the format and complexity of
the final exam. The content is systematically organized to address the core competencies required for safe and
effective nursing practice, with a strong emphasis on clinical reasoning, patient-centered care, and
interprofessional collaboration. Each question is accompanied by a thorough rationale that not only explains the
correct answer but also analyzes why the distractors are incorrect, thereby reinforcing critical thinking and
knowledge retention. The examination covers a broad spectrum of medical-surgical conditions, including acute
and chronic illnesses, perioperative care, and emergency situations, with a focus on nursing interventions,
diagnostic tests, and pharmacological management. Additionally, the practice exam integrates priority-setting
frameworks, safety principles, and ethical considerations, ensuring a holistic review. By engaging with this
material, students will enhance their ability to apply theoretical knowledge to clinical scenarios, ultimately
improving their performance on the final examination and their readiness for professional nursing practice.
Keywords:
Medical-Surgical Nursing, NUR 265, Final Exam, Practice Questions, NCLEX-RN, Nursing Rationales, Adult
Health, Evidence-Based Practice
Answer Format:
Each question is presented in a multiple-choice format with four options. The correct answer is clearly indicated,
Page 1
,followed by a comprehensive rationale explaining the underlying pathophysiological and nursing principles.
Additionally, each incorrect option is analyzed to clarify why it is not the best choice, facilitating a deeper
understanding of the subject matter.
Compliance Checklist:
Aligned with the latest NCLEX-RN test plan
Incorporates QSEN competencies
References current clinical practice guidelines
Includes culturally competent care scenarios
Emphasizes patient safety and quality improvement
Reflects the NUR 265 course syllabus and learning outcomes
Content Area Overview:
Content Area Questions Key Topics Weight
Cardiovascular Disorders 1-30 Heart failure, Myocardial infarction, 15%
Hypertension, Arrhythmias, Cardiac
medications
Respiratory Disorders 31-60 COPD, Asthma, Pneumonia, Pulmonary 15%
embolism, Oxygen therapy
Neurological Disorders 61-90 Stroke, Seizures, Parkinson's disease, 15%
Increased intracranial pressure, Neuro
assessments
Gastrointestinal Disorders 91-120 Peptic ulcer disease, Inflammatory bowel 15%
disease, Pancreatitis, Liver cirrhosis, GI
bleeding
Renal and Urinary Disorders 121-150 Acute kidney injury, Chronic kidney 15%
disease, Urinary tract infections, Dialysis,
Fluid and electrolytes
Endocrine Disorders 151-180 Diabetes mellitus, Thyroid disorders, 15%
Adrenal insufficiency, SIADH, Diabetes
insipidus
Perioperative and Emergency 181-200 Preoperative care, Postoperative 10%
Nursing complications, Shock, Sepsis, Triage
Page 2
,Q1. In a patient with septic shock and acute respiratory distress syndrome (ARDS),
which ventilator strategy best balances oxygenation and prevention of further lung
injury?
A. High tidal volume (10-12 mL/kg) with low PEEP to minimize barotrauma
B. Low tidal volume (6 mL/kg ideal body weight) with adequate PEEP to recruit
alveoli
C. Pressure-controlled ventilation with high inspiratory pressures to maximize
oxygenation
D. Volume-assured pressure support with permissive hypercapnia only if pH < 7.10
Correct Answer: B. Low tidal volume (6 mL/kg ideal body weight) with adequate
PEEP to recruit alveoli
Rationale: Low tidal volume ventilation (6 mL/kg) with appropriate PEEP is the
evidence-based strategy for ARDS, reducing ventilator-induced lung injury and mortality.
High tidal volumes exacerbate alveolar overdistension, while high pressures increase
barotrauma. Permissive hypercapnia is accepted but not the primary strategy.
Why Wrong:
A - High tidal volumes are harmful in ARDS due to volutrauma and are not
recommended.
C - High inspiratory pressures increase the risk of barotrauma without proven benefit.
D - Permissive hypercapnia is a component but not the defining strategy; low tidal
volume is key.
Reference: Urden, L.D., Stacy, K.M., & Lough, M.E. (2025). Critical Care Nursing, 9th
Ed., Ch. 12
Q2. Which finding most reliably indicates that a patient with syndrome of
inappropriate antidiuretic hormone (SIADH) is responding to fluid restriction?
A. Urine sodium concentration drops below 20 mEq/L
B. Serum sodium increases toward normal range
C. Urine osmolality falls below serum osmolality
D. Daily weight decreases by 0.5 kg over 24 hours
Correct Answer: B. Serum sodium increases toward normal range
Rationale: The primary goal in SIADH is to correct hyponatremia; a rising serum sodium
indicates effective treatment. Urine sodium may remain high initially, urine osmolality
may stay elevated, and weight loss reflects fluid removal but not necessarily sodium
correction.
Why Wrong:
A - Urine sodium may remain high due to continued ADH effect; it is not a reliable
early indicator.
C - Urine osmolality typically remains inappropriately high despite fluid restriction.
Page 3
, D - Weight loss indicates fluid loss but does not directly confirm serum sodium
improvement.
Reference: Ignatavicius, D.D., Workman, M.L., et al. (2025). Medical-Surgical Nursing,
10th Ed., Ch. 11
Q3. A patient with hyperkalemia (K+ 6.8 mEq/L) and ECG changes is being treated.
Which medication sequence demonstrates the correct priority of interventions?
A. Calcium gluconate IV, then insulin with dextrose, then sodium polystyrene sulfonate
B. Insulin with dextrose, then calcium gluconate IV, then albuterol nebulization
C. Sodium bicarbonate IV, then furosemide, then calcium gluconate
D. Albuterol nebulization, then insulin with dextrose, then dialysis preparation
Correct Answer: A. Calcium gluconate IV, then insulin with dextrose, then sodium
polystyrene sulfonate
Rationale: In hyperkalemia with ECG changes, calcium gluconate is given first to stabilize
cardiac membranes, then insulin/dextrose shifts potassium intracellularly, and a binding
resin removes total body potassium. Sodium bicarbonate is not first-line, and dialysis is
reserved for refractory cases.
Why Wrong:
B - Calcium gluconate should precede insulin to prevent cardiac arrest during
potassium shift.
C - Sodium bicarbonate is not first-line and calcium should be given immediately for
ECG changes.
D - Albuterol is an adjunct but not the initial priority when ECG changes are present.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 52
Q4. Which assessment finding is most indicative of malignant hyperthermia in a
patient who received succinylcholine during surgery?
A. Postoperative temperature of 38.2°C (100.8°F) and mild tachycardia
B. Rising end-tidal CO2 with muscle rigidity and mixed respiratory/metabolic acidosis
C. Prolonged neuromuscular blockade with absent deep tendon reflexes
D. Sudden hypotension and bradycardia unresponsive to atropine
Correct Answer: B. Rising end-tidal CO2 with muscle rigidity and mixed
respiratory/metabolic acidosis
Rationale: Malignant hyperthermia presents with a hypermetabolic state: rising ETCO2,
muscle rigidity, and mixed acidosis due to uncontrolled calcium release. Fever is a late
sign, and early signs include tachycardia and hypercarbia.
Why Wrong:
A - Mild fever alone is nonspecific and not the earliest or most indicative sign.
C - Prolonged blockade is not typical; rigidity is a hallmark, but acidosis is key.
Page 4
