NUR 265/NUR265: Exam 2
Advanced Concepts in Medical-Surgical Nursing
2026-2028 Testing Cycle | Complete Guide
50 Questions With Answers & Expert Rationales.
Guaranteed Pass | Graded A+ | Galen
Q1: A nurse is caring for a patient with severe acute respiratory distress syndrome (ARDS) who
is mechanically ventilated. The provider orders prone positioning. The nurse understands that the
primary rationale for this intervention is which of the following?
A. To reduce the risk of ventilator-associated pneumonia by improving secretion clearance
B. To facilitate dependent drainage of protein-rich fluid from the alveoli
C. To decrease the work of breathing by reducing airway resistance and compliance
D. To improve oxygenation by recruiting dorsal alveoli and matching ventilation to perfusion
Correct Answer: D
Rationale: Correct because prone positioning in ARDS improves oxygenation by allowing
recruitment of collapsed dorsal alveoli and reducing the compressive effects of the heart and
mediastinum on the lungs. This repositioning creates a more favorable ventilation-to-perfusion
match across the posterior lung fields where perfusion is greatest. In ARDS, the inflammatory
cascade damages the alveolar-capillary membrane, and prone positioning is an evidence-based
intervention to address refractory hypoxemia when conventional ventilation strategies are
insufficient.
Q2: A nurse is assessing a patient with a suspected pulmonary embolism. Which findings are
consistent with this diagnosis? Select all that apply.
A. Sudden onset of dyspnea at rest
B. Bilateral crackles throughout all lung fields
C. Sharp pleuritic chest pain that worsens with inspiration
D. Pink, frothy sputum production
E. Tachycardia with anxiety
F. Bradypnea and bradycardia
,Correct Answer(s): A, C, E
Rationale: Correct because sudden dyspnea is the most common presenting symptom of
pulmonary embolism as the clot obstructs pulmonary blood flow and creates a ventilation-
perfusion mismatch. Pleuritic chest pain that intensifies with inspiration occurs when the
embolism causes pulmonary infarction or irritation of the pleural lining. Tachycardia and anxiety
are compensatory responses to hypoxia and the release of catecholamines; the heart rate
increases to maintain cardiac output despite obstructed pulmonary vasculature. Pink frothy
sputum indicates cardiogenic pulmonary edema, not PE, and bradypnea is inconsistent with the
tachypneic response characteristic of embolic events.
Q3: A patient on mechanical ventilation suddenly develops a high-pressure alarm. Which action
should the nurse take first?
A. Increase the tidal volume to overcome the resistance
B. Assess the patient for tube obstruction, secretions, and kinking
C. Administer sedation immediately to prevent the patient from fighting the ventilator
D. Disconnect the ventilator and manually ventilate with an Ambu bag
Correct Answer: B
Rationale: Correct because the nurse must first assess the patient and the circuit to identify the
cause of the high-pressure alarm before implementing any intervention. Common causes of high-
pressure alarms include tube obstruction from secretions or mucus plugs, kinking of the tubing,
patient coughing or biting the tube, pneumothorax, and bronchospasm. The nursing priority is
systematic assessment using the DOPE mnemonic framework, beginning with visual inspection
of the circuit and auscultation of breath sounds to differentiate between patient-related and
equipment-related causes.
Q4: A nurse is caring for a patient with a three-chamber chest tube drainage system. The nurse
notes continuous bubbling in the water seal chamber. What is the nurse's priority action?
A. Assess the entire system for an air leak, beginning at the insertion site
B. Increase the suction pressure to compensate for the air leak
C. Clamp the chest tube immediately to prevent further air entry
D. Notify the provider that the chest tube is ready for removal
Correct Answer: A
Rationale: Correct because continuous bubbling in the water seal chamber indicates an air leak
somewhere in the system, which requires immediate systematic assessment starting at the
patient's chest and moving toward the drainage unit. The nurse should check the insertion site,
tubing connections, and the drainage system itself to locate and correct the source of the leak.
, Expected tidaling with respirations is normal, but continuous bubbling represents abnormal air
entry that compromises the water seal's ability to maintain negative intrathoracic pressure.
Q5: Which interventions are included in the evidence-based ventilator-associated pneumonia
(VAP) bundle? Select all that apply.
A. Oral care with normal saline every 8 hours
B. Head of bed elevated 30–45 degrees
C. Daily routine chest x-ray for all ventilated patients
D. Daily sedation vacation to assess readiness to wean
E. Prophylactic broad-spectrum antibiotics
F. Deep vein thrombosis prophylaxis
Correct Answer(s): B, D, F
Rationale: Correct because elevating the head of the bed 30–45 degrees uses gravity to prevent
aspiration of oropharyngeal secretions into the lungs, which is a primary mechanism for VAP
development. Daily sedation vacations allow the nurse to assess the patient's neurological status
and spontaneous breathing effort, facilitating earlier extubation and reducing ventilator days.
DVT prophylaxis is a standard VAP bundle component because immobility and critical illness
increase thrombotic risk, and comprehensive critical care bundles address multiple complication
preventions simultaneously. Oral care should be performed with chlorhexidine every 2–4 hours,
not saline, and prophylactic antibiotics are not recommended due to resistance concerns.
Q6: A patient presents to the emergency department with blood glucose of 780 mg/dL, serum
osmolality of 340 mOsm/L, arterial pH of 7.38, and absent ketones in the urine. The nurse
recognizes that these findings are most consistent with which condition?
A. Diabetic ketoacidosis
B. Addisonian crisis
C. Hyperosmolar hyperglycemic state
D. Thyroid storm
Correct Answer: C
Rationale: Correct because hyperosmolar hyperglycemic state (HHS) is characterized by severe
hyperglycemia greater than 600 mg/dL, profound hyperosmolality exceeding 320 mOsm/L, and
the absence of significant ketosis with a near-normal arterial pH. This condition typically occurs
in older patients with type 2 diabetes and develops gradually over days, leading to severe
dehydration and neurological changes. Unlike diabetic ketoacidosis, HHS does not involve
metabolic acidosis or ketone production because sufficient insulin is present to prevent lipolysis
and ketogenesis.
Advanced Concepts in Medical-Surgical Nursing
2026-2028 Testing Cycle | Complete Guide
50 Questions With Answers & Expert Rationales.
Guaranteed Pass | Graded A+ | Galen
Q1: A nurse is caring for a patient with severe acute respiratory distress syndrome (ARDS) who
is mechanically ventilated. The provider orders prone positioning. The nurse understands that the
primary rationale for this intervention is which of the following?
A. To reduce the risk of ventilator-associated pneumonia by improving secretion clearance
B. To facilitate dependent drainage of protein-rich fluid from the alveoli
C. To decrease the work of breathing by reducing airway resistance and compliance
D. To improve oxygenation by recruiting dorsal alveoli and matching ventilation to perfusion
Correct Answer: D
Rationale: Correct because prone positioning in ARDS improves oxygenation by allowing
recruitment of collapsed dorsal alveoli and reducing the compressive effects of the heart and
mediastinum on the lungs. This repositioning creates a more favorable ventilation-to-perfusion
match across the posterior lung fields where perfusion is greatest. In ARDS, the inflammatory
cascade damages the alveolar-capillary membrane, and prone positioning is an evidence-based
intervention to address refractory hypoxemia when conventional ventilation strategies are
insufficient.
Q2: A nurse is assessing a patient with a suspected pulmonary embolism. Which findings are
consistent with this diagnosis? Select all that apply.
A. Sudden onset of dyspnea at rest
B. Bilateral crackles throughout all lung fields
C. Sharp pleuritic chest pain that worsens with inspiration
D. Pink, frothy sputum production
E. Tachycardia with anxiety
F. Bradypnea and bradycardia
,Correct Answer(s): A, C, E
Rationale: Correct because sudden dyspnea is the most common presenting symptom of
pulmonary embolism as the clot obstructs pulmonary blood flow and creates a ventilation-
perfusion mismatch. Pleuritic chest pain that intensifies with inspiration occurs when the
embolism causes pulmonary infarction or irritation of the pleural lining. Tachycardia and anxiety
are compensatory responses to hypoxia and the release of catecholamines; the heart rate
increases to maintain cardiac output despite obstructed pulmonary vasculature. Pink frothy
sputum indicates cardiogenic pulmonary edema, not PE, and bradypnea is inconsistent with the
tachypneic response characteristic of embolic events.
Q3: A patient on mechanical ventilation suddenly develops a high-pressure alarm. Which action
should the nurse take first?
A. Increase the tidal volume to overcome the resistance
B. Assess the patient for tube obstruction, secretions, and kinking
C. Administer sedation immediately to prevent the patient from fighting the ventilator
D. Disconnect the ventilator and manually ventilate with an Ambu bag
Correct Answer: B
Rationale: Correct because the nurse must first assess the patient and the circuit to identify the
cause of the high-pressure alarm before implementing any intervention. Common causes of high-
pressure alarms include tube obstruction from secretions or mucus plugs, kinking of the tubing,
patient coughing or biting the tube, pneumothorax, and bronchospasm. The nursing priority is
systematic assessment using the DOPE mnemonic framework, beginning with visual inspection
of the circuit and auscultation of breath sounds to differentiate between patient-related and
equipment-related causes.
Q4: A nurse is caring for a patient with a three-chamber chest tube drainage system. The nurse
notes continuous bubbling in the water seal chamber. What is the nurse's priority action?
A. Assess the entire system for an air leak, beginning at the insertion site
B. Increase the suction pressure to compensate for the air leak
C. Clamp the chest tube immediately to prevent further air entry
D. Notify the provider that the chest tube is ready for removal
Correct Answer: A
Rationale: Correct because continuous bubbling in the water seal chamber indicates an air leak
somewhere in the system, which requires immediate systematic assessment starting at the
patient's chest and moving toward the drainage unit. The nurse should check the insertion site,
tubing connections, and the drainage system itself to locate and correct the source of the leak.
, Expected tidaling with respirations is normal, but continuous bubbling represents abnormal air
entry that compromises the water seal's ability to maintain negative intrathoracic pressure.
Q5: Which interventions are included in the evidence-based ventilator-associated pneumonia
(VAP) bundle? Select all that apply.
A. Oral care with normal saline every 8 hours
B. Head of bed elevated 30–45 degrees
C. Daily routine chest x-ray for all ventilated patients
D. Daily sedation vacation to assess readiness to wean
E. Prophylactic broad-spectrum antibiotics
F. Deep vein thrombosis prophylaxis
Correct Answer(s): B, D, F
Rationale: Correct because elevating the head of the bed 30–45 degrees uses gravity to prevent
aspiration of oropharyngeal secretions into the lungs, which is a primary mechanism for VAP
development. Daily sedation vacations allow the nurse to assess the patient's neurological status
and spontaneous breathing effort, facilitating earlier extubation and reducing ventilator days.
DVT prophylaxis is a standard VAP bundle component because immobility and critical illness
increase thrombotic risk, and comprehensive critical care bundles address multiple complication
preventions simultaneously. Oral care should be performed with chlorhexidine every 2–4 hours,
not saline, and prophylactic antibiotics are not recommended due to resistance concerns.
Q6: A patient presents to the emergency department with blood glucose of 780 mg/dL, serum
osmolality of 340 mOsm/L, arterial pH of 7.38, and absent ketones in the urine. The nurse
recognizes that these findings are most consistent with which condition?
A. Diabetic ketoacidosis
B. Addisonian crisis
C. Hyperosmolar hyperglycemic state
D. Thyroid storm
Correct Answer: C
Rationale: Correct because hyperosmolar hyperglycemic state (HHS) is characterized by severe
hyperglycemia greater than 600 mg/dL, profound hyperosmolality exceeding 320 mOsm/L, and
the absence of significant ketosis with a near-normal arterial pH. This condition typically occurs
in older patients with type 2 diabetes and develops gradually over days, leading to severe
dehydration and neurological changes. Unlike diabetic ketoacidosis, HHS does not involve
metabolic acidosis or ketone production because sufficient insulin is present to prevent lipolysis
and ketogenesis.
