NUR 265 Exam – Medical-Surgical Nursing
**1. A patient with a pheochromocytoma is admitted for surgery. Which symptom is the hallmark of
this condition and requires careful monitoring?**
A) Hypotension
B) Hypertension
C) Bradycardia
D) Hypoglycemia
**Answer: B**
*Rationale:* Pheochromocytoma is a catecholamine-producing tumor of the adrenal medulla. The
hallmark symptom is hypertension due to excessive release of epinephrine and norepinephrine .
**2. The nurse is caring for a patient with a chest tube. Is there supposed to be continuous bubbling
in the water seal chamber?**
A) Yes, continuous bubbling indicates normal function
B) No, bubbling in the water seal chamber indicates an air leak
C) Yes, bubbling is expected in the water seal chamber
D) No, bubbling should only occur in the suction control chamber
**Answer: B**
*Rationale:* Bubbling in the water seal chamber indicates an air leak. Bubbling should be present
only in the suction control chamber .
**3. A patient is on a mechanical ventilator. Which ventilator mode delivers a set number of breaths
per minute and does all the work for the patient?**
A) SIMV (Synchronized Intermittent Mandatory Ventilation)
B) CPAP (Continuous Positive Airway Pressure)
C) A/C (Assist-Control)
D) Pressure Support
**Answer: C**
*Rationale:* Assist-Control (A/C) mode delivers a set tidal volume and rate for every breath, meaning
the ventilator does all the work for the patient .
,**4. Which assessment finding indicates that endotracheal (ET) tube placement has been
confirmed?**
A) Absent breath sounds on the right side
B) ETCO2 reading of 15 mmHg
C) Chest X-ray showing tube above the carina
D) ETCO2 reading of 20-40 mmHg
**Answer: D**
*Rationale:* ETCO2 levels between 20-40 mmHg, along with chest X-ray confirmation and bilateral
breath sounds, confirm proper ET tube placement .
**5. What is the primary function of PEEP (Positive End-Expiratory Pressure) on a ventilator?**
A) To increase the patient's respiratory rate
B) To keep the alveoli open a little longer and improve gas exchange
C) To decrease the patient's tidal volume
D) To wean the patient from the ventilator
**Answer: B**
*Rationale:* PEEP provides positive pressure that keeps alveoli open longer, which improves gas
exchange and oxygenation .
**6. A patient on a ventilator has a high-pressure alarm sounding. The nurse assesses the patient and
finds they are anxious and coughing. What is the priority nursing action?**
A) Silence the alarm and assess the ventilator settings
B) Sedate the patient and turn off the alarm
C) Assess the patient, not the monitor, and identify the cause
D) Increase the tidal volume and reset the alarm
**Answer: C**
*Rationale:* The priority is to assess the patient first. High-pressure alarms can be caused by
coughing, kinked tubing, pneumothorax, or anxiety. The nurse should assess the patient to identify
and address the cause .
**7. What are the three buttons on a ventilator that the nurse is permitted to touch?**
,A) Alarm, Mode, and Rate
B) Silence, Restart, and 100% Oxygen
C) FiO2, PEEP, and Tidal Volume
D) Rate, Tidal Volume, and FiO2
**Answer: B**
*Rationale:* The nurse may touch the Silence, Restart, and 100% Oxygen buttons. The 100% Oxygen
button is pressed before suctioning the patient .
**8. Which statement is true regarding the suction control chamber on a chest tube drainage
system?**
A) Bubbling in the suction control chamber indicates an air leak
B) Bubbling in the suction control chamber is expected
C) The suction control chamber should always be empty
D) Bubbling in the suction control chamber indicates a tension pneumothorax
**Answer: B**
*Rationale:* Bubbling in the suction control chamber is expected and indicates that suction is being
applied .
**9. A patient with Cushing's disease is at increased risk for infection. The nurse understands this is
primarily due to which effect of the disease?**
A) Increased production of ACTH
B) The steroids break down lymphocytes
C) Decreased production of cortisol
D) Increased production of aldosterone
**Answer: B**
*Rationale:* Cushing's disease involves excess cortisol, which suppresses the immune system by
breaking down lymphocytes, increasing infection risk .
**10. Which patient with a head injury is at highest risk for a chronic subdural hematoma?**
A) A 25-year-old with a sports injury
B) An elderly patient with brain atrophy
C) A child with a fall from a bike
, D) A teenager with a motor vehicle accident
**Answer: B**
*Rationale:* Chronic subdural hematoma is most common in older adults and alcoholics because
brain atrophy causes stretching of the bridging veins, making them more susceptible to injury .
**11. A patient has a subdural hematoma evacuated. Postoperatively, the patient is placed flat in bed.
What is the rationale for this intervention?**
A) To decrease cerebral edema
B) To allow the brain to re-expand and fill the cranial cavity
C) To prevent bleeding at the surgical site
D) To increase cerebral perfusion pressure
**Answer: B**
*Rationale:* Flat positioning allows the brain to re-expand to fill the cranial cavity after evacuation of
the hematoma .
**12. What is the normal range for intracranial pressure (ICP)?**
A) 0-5 mmHg
B) 5-15 mmHg
C) 15-20 mmHg
D) 20-30 mmHg
**Answer: B**
*Rationale:* Normal ICP is 5-15 mmHg. ICP greater than 20 mmHg is considered elevated .
**13. Which finding differentiates an intracerebral hemorrhage from other types of brain injuries?**
A) Brief loss of consciousness followed by confusion
B) Hemiplegia
C) Pupillary dilation
D) Decorticate posturing
**Answer: B**
*Rationale:* Hemiplegia is a key distinguishing feature of intracerebral hemorrhage .
**1. A patient with a pheochromocytoma is admitted for surgery. Which symptom is the hallmark of
this condition and requires careful monitoring?**
A) Hypotension
B) Hypertension
C) Bradycardia
D) Hypoglycemia
**Answer: B**
*Rationale:* Pheochromocytoma is a catecholamine-producing tumor of the adrenal medulla. The
hallmark symptom is hypertension due to excessive release of epinephrine and norepinephrine .
**2. The nurse is caring for a patient with a chest tube. Is there supposed to be continuous bubbling
in the water seal chamber?**
A) Yes, continuous bubbling indicates normal function
B) No, bubbling in the water seal chamber indicates an air leak
C) Yes, bubbling is expected in the water seal chamber
D) No, bubbling should only occur in the suction control chamber
**Answer: B**
*Rationale:* Bubbling in the water seal chamber indicates an air leak. Bubbling should be present
only in the suction control chamber .
**3. A patient is on a mechanical ventilator. Which ventilator mode delivers a set number of breaths
per minute and does all the work for the patient?**
A) SIMV (Synchronized Intermittent Mandatory Ventilation)
B) CPAP (Continuous Positive Airway Pressure)
C) A/C (Assist-Control)
D) Pressure Support
**Answer: C**
*Rationale:* Assist-Control (A/C) mode delivers a set tidal volume and rate for every breath, meaning
the ventilator does all the work for the patient .
,**4. Which assessment finding indicates that endotracheal (ET) tube placement has been
confirmed?**
A) Absent breath sounds on the right side
B) ETCO2 reading of 15 mmHg
C) Chest X-ray showing tube above the carina
D) ETCO2 reading of 20-40 mmHg
**Answer: D**
*Rationale:* ETCO2 levels between 20-40 mmHg, along with chest X-ray confirmation and bilateral
breath sounds, confirm proper ET tube placement .
**5. What is the primary function of PEEP (Positive End-Expiratory Pressure) on a ventilator?**
A) To increase the patient's respiratory rate
B) To keep the alveoli open a little longer and improve gas exchange
C) To decrease the patient's tidal volume
D) To wean the patient from the ventilator
**Answer: B**
*Rationale:* PEEP provides positive pressure that keeps alveoli open longer, which improves gas
exchange and oxygenation .
**6. A patient on a ventilator has a high-pressure alarm sounding. The nurse assesses the patient and
finds they are anxious and coughing. What is the priority nursing action?**
A) Silence the alarm and assess the ventilator settings
B) Sedate the patient and turn off the alarm
C) Assess the patient, not the monitor, and identify the cause
D) Increase the tidal volume and reset the alarm
**Answer: C**
*Rationale:* The priority is to assess the patient first. High-pressure alarms can be caused by
coughing, kinked tubing, pneumothorax, or anxiety. The nurse should assess the patient to identify
and address the cause .
**7. What are the three buttons on a ventilator that the nurse is permitted to touch?**
,A) Alarm, Mode, and Rate
B) Silence, Restart, and 100% Oxygen
C) FiO2, PEEP, and Tidal Volume
D) Rate, Tidal Volume, and FiO2
**Answer: B**
*Rationale:* The nurse may touch the Silence, Restart, and 100% Oxygen buttons. The 100% Oxygen
button is pressed before suctioning the patient .
**8. Which statement is true regarding the suction control chamber on a chest tube drainage
system?**
A) Bubbling in the suction control chamber indicates an air leak
B) Bubbling in the suction control chamber is expected
C) The suction control chamber should always be empty
D) Bubbling in the suction control chamber indicates a tension pneumothorax
**Answer: B**
*Rationale:* Bubbling in the suction control chamber is expected and indicates that suction is being
applied .
**9. A patient with Cushing's disease is at increased risk for infection. The nurse understands this is
primarily due to which effect of the disease?**
A) Increased production of ACTH
B) The steroids break down lymphocytes
C) Decreased production of cortisol
D) Increased production of aldosterone
**Answer: B**
*Rationale:* Cushing's disease involves excess cortisol, which suppresses the immune system by
breaking down lymphocytes, increasing infection risk .
**10. Which patient with a head injury is at highest risk for a chronic subdural hematoma?**
A) A 25-year-old with a sports injury
B) An elderly patient with brain atrophy
C) A child with a fall from a bike
, D) A teenager with a motor vehicle accident
**Answer: B**
*Rationale:* Chronic subdural hematoma is most common in older adults and alcoholics because
brain atrophy causes stretching of the bridging veins, making them more susceptible to injury .
**11. A patient has a subdural hematoma evacuated. Postoperatively, the patient is placed flat in bed.
What is the rationale for this intervention?**
A) To decrease cerebral edema
B) To allow the brain to re-expand and fill the cranial cavity
C) To prevent bleeding at the surgical site
D) To increase cerebral perfusion pressure
**Answer: B**
*Rationale:* Flat positioning allows the brain to re-expand to fill the cranial cavity after evacuation of
the hematoma .
**12. What is the normal range for intracranial pressure (ICP)?**
A) 0-5 mmHg
B) 5-15 mmHg
C) 15-20 mmHg
D) 20-30 mmHg
**Answer: B**
*Rationale:* Normal ICP is 5-15 mmHg. ICP greater than 20 mmHg is considered elevated .
**13. Which finding differentiates an intracerebral hemorrhage from other types of brain injuries?**
A) Brief loss of consciousness followed by confusion
B) Hemiplegia
C) Pupillary dilation
D) Decorticate posturing
**Answer: B**
*Rationale:* Hemiplegia is a key distinguishing feature of intracerebral hemorrhage .
