NUR 265 EXAM 2 (2 VERSIONS) GALEN MED-
SURG NURSING – ACTUAL QUESTIONS &
ANSWERS 100% PASS GUARANTEE
This premium practice exam pack delivers actual NCLEX-style questions
and comprehensive rationales designed to ensure a 100% guarantee pass
on advanced medical-surgical nursing concepts. It features rigorous, high-
yield scenarios covering critical care respiratory management, mechanical
ventilation, and complex endocrine crises like DKA, HHS, SIADH, and
Diabetes Insipidus. Perfectly formatted with italicized answers and bolded
rationales, this high-traffic study guide is the ultimate resource for students
aiming to ace their second major nursing curriculum exam.
Question 1
A nurse is caring for a client with Acute Respiratory
Distress Syndrome (ARDS) who is on mechanical
ventilation with High-Frequency Oscillatory
Ventilation (HFOV). The client's arterial blood gas
(ABG) results show severe respiratory acidosis.
Which ventilator setting adjustment should the nurse
anticipate?
A. Increase the fraction of inspired oxygen (FiO2).
B. Decrease the positive end-expiratory pressure
(PEEP).
C. Increase the oscillatory amplitude (Power).
D. Decrease the oscillatory frequency (Hertz).
Answer: C. Increase the oscillatory amplitude
(Power).
Rationale: In HFOV, carbon dioxide clearance
,(ventilation) is primarily controlled by the
oscillatory amplitude (Power) and the frequency
(Hertz). Increasing the amplitude increases tidal
volume and enhances CO2 elimination, which
directly corrects respiratory acidosis.
Decreasing the frequency (Hertz) also increases
tidal volume and CO2 clearance, but increasing
power is typically the primary intervention.
Adjusting FiO2 and PEEP targets oxygenation,
not ventilation (CO2 clearance).
Question 2
A client admitted with a massive acute pulmonary
embolism (PE) is hemodynamically unstable with a
blood pressure of 82/44 mmHg despite aggressive
fluid resuscitation. Which immediate medical
management should the nurse anticipate?
A. Initiation of a continuous unfractionated heparin
infusion.
B. Administration of systemic tissue plasminogen
activator (tPA).
C. Urgent subcutaneous administration of low-
molecular-weight heparin.
D. Insertion of a greenfield inferior vena cava (IVC)
filter.
,Answer: B. Administration of systemic tissue
plasminogen activator (tPA).
Rationale: Systemic fibrinolytic therapy, such as
tPA, is indicated for clients with massive acute
PE who demonstrate hemodynamic instability
(hypotension, shock) without high bleeding
risks. Heparin and low-molecular-weight heparin
prevent new clot formation but do not dissolve
existing clots causing hemodynamic collapse.
An IVC filter prevents future emboli but does not
resolve the acute obstruction.
Question 3
The nurse notes a continuous bubbling in the water-
seal chamber of a chest drainage system attached
to a client who is 24 hours postoperative following a
left lower lobectomy. What is the priority nursing
action?
A. Clamp the chest tube close to the client's chest
wall to check for a client-centered leak.
B. Turn down the wall suction to reduce the
excessive bubbling.
C. Document this as an expected finding during the
early postoperative period.
D. Check all connections from the insertion site to
the drainage system for loose seals.
, Answer: D. Check all connections from the insertion
site to the drainage system for loose seals.
Rationale: Continuous bubbling in the water-seal
chamber indicates an air leak within the system
or from the client's pleural space. The nurse
should first check all external connections to
ensure they are tight. Clamping the tube should
only be done briefly if troubleshooting from the
insertion site downward, as clamping poses a
risk of tension pneumothorax. Intermittent
bubbling with coughing or expiration is
expected, but continuous bubbling signifies an
active leak requiring intervention.
Question 4
A nurse is managing a client with Syndrome of
Inappropriate Antidiuretic Hormone (SIADH)
secondary to small cell lung cancer. The client's
morning serum sodium is 114 mEq/L, and they are
exhibiting confusion and lethargy. Which prescription
should the nurse question?
A. Infusion of 3% hypertonic saline at 30 mL/hr.
B. Oral fluid restriction of 500 mL/24 hours.
C. Administration of Tolvaptan 15 mg orally daily.
D. Continuous infusion of 0.45% half-normal saline
at 100 mL/hr.
SURG NURSING – ACTUAL QUESTIONS &
ANSWERS 100% PASS GUARANTEE
This premium practice exam pack delivers actual NCLEX-style questions
and comprehensive rationales designed to ensure a 100% guarantee pass
on advanced medical-surgical nursing concepts. It features rigorous, high-
yield scenarios covering critical care respiratory management, mechanical
ventilation, and complex endocrine crises like DKA, HHS, SIADH, and
Diabetes Insipidus. Perfectly formatted with italicized answers and bolded
rationales, this high-traffic study guide is the ultimate resource for students
aiming to ace their second major nursing curriculum exam.
Question 1
A nurse is caring for a client with Acute Respiratory
Distress Syndrome (ARDS) who is on mechanical
ventilation with High-Frequency Oscillatory
Ventilation (HFOV). The client's arterial blood gas
(ABG) results show severe respiratory acidosis.
Which ventilator setting adjustment should the nurse
anticipate?
A. Increase the fraction of inspired oxygen (FiO2).
B. Decrease the positive end-expiratory pressure
(PEEP).
C. Increase the oscillatory amplitude (Power).
D. Decrease the oscillatory frequency (Hertz).
Answer: C. Increase the oscillatory amplitude
(Power).
Rationale: In HFOV, carbon dioxide clearance
,(ventilation) is primarily controlled by the
oscillatory amplitude (Power) and the frequency
(Hertz). Increasing the amplitude increases tidal
volume and enhances CO2 elimination, which
directly corrects respiratory acidosis.
Decreasing the frequency (Hertz) also increases
tidal volume and CO2 clearance, but increasing
power is typically the primary intervention.
Adjusting FiO2 and PEEP targets oxygenation,
not ventilation (CO2 clearance).
Question 2
A client admitted with a massive acute pulmonary
embolism (PE) is hemodynamically unstable with a
blood pressure of 82/44 mmHg despite aggressive
fluid resuscitation. Which immediate medical
management should the nurse anticipate?
A. Initiation of a continuous unfractionated heparin
infusion.
B. Administration of systemic tissue plasminogen
activator (tPA).
C. Urgent subcutaneous administration of low-
molecular-weight heparin.
D. Insertion of a greenfield inferior vena cava (IVC)
filter.
,Answer: B. Administration of systemic tissue
plasminogen activator (tPA).
Rationale: Systemic fibrinolytic therapy, such as
tPA, is indicated for clients with massive acute
PE who demonstrate hemodynamic instability
(hypotension, shock) without high bleeding
risks. Heparin and low-molecular-weight heparin
prevent new clot formation but do not dissolve
existing clots causing hemodynamic collapse.
An IVC filter prevents future emboli but does not
resolve the acute obstruction.
Question 3
The nurse notes a continuous bubbling in the water-
seal chamber of a chest drainage system attached
to a client who is 24 hours postoperative following a
left lower lobectomy. What is the priority nursing
action?
A. Clamp the chest tube close to the client's chest
wall to check for a client-centered leak.
B. Turn down the wall suction to reduce the
excessive bubbling.
C. Document this as an expected finding during the
early postoperative period.
D. Check all connections from the insertion site to
the drainage system for loose seals.
, Answer: D. Check all connections from the insertion
site to the drainage system for loose seals.
Rationale: Continuous bubbling in the water-seal
chamber indicates an air leak within the system
or from the client's pleural space. The nurse
should first check all external connections to
ensure they are tight. Clamping the tube should
only be done briefly if troubleshooting from the
insertion site downward, as clamping poses a
risk of tension pneumothorax. Intermittent
bubbling with coughing or expiration is
expected, but continuous bubbling signifies an
active leak requiring intervention.
Question 4
A nurse is managing a client with Syndrome of
Inappropriate Antidiuretic Hormone (SIADH)
secondary to small cell lung cancer. The client's
morning serum sodium is 114 mEq/L, and they are
exhibiting confusion and lethargy. Which prescription
should the nurse question?
A. Infusion of 3% hypertonic saline at 30 mL/hr.
B. Oral fluid restriction of 500 mL/24 hours.
C. Administration of Tolvaptan 15 mg orally daily.
D. Continuous infusion of 0.45% half-normal saline
at 100 mL/hr.
