NUR 265 Exam 2 | Advanced Medical-Surgical Nursing | Galen | 2023/2024
Exam 2: NUR265 Advanced Concepts of
Medical-Surgical Nursing
Latest 2023/2024 Update | Grade A | 100% Correct | Galen College of Nursing
40 Questions | 100 Points Total
Table of Contents
SECTION 1: Advanced Cardiovascular & Respiratory Disorders (Q1–Q10)
SECTION 2: Endocrine, Renal, & Fluid/Electrolyte Imbalances (Q11–Q20)
SECTION 3: Neurological, Gastrointestinal, & Hepatic Disorders (Q21–Q30)
SECTION 4: Perioperative Care, Infectious Diseases, & Clinical Prioritization
(Q31–Q40)
Grading Rubric & Answer Key
SECTION 1: Advanced Cardiovascular & Respiratory Disorders
(Q1–Q10)
1. A nurse is caring for a client with systolic heart failure (HFrEF). Which assessment
finding indicates the client is experiencing fluid overload?
A. Bradycardia with regular rhythm
B. Weight gain of 2 kg in 2 days, bilateral crackles, and jugular venous distention
[CORRECT]
C. Decreased blood pressure and cool extremities
D. Dry cough and clear lung sounds
Correct Answer: B
Rationale: In HFrEF, fluid overload manifests as rapid weight gain (1 kg/day indicates retention),
crackles from pulmonary congestion, and JVD from increased central venous pressure.
2. A client with heart failure is prescribed furosemide (Lasix). Which laboratory value
requires the nurse to hold the medication and notify the provider?
A. Potassium 3.1 mEq/L [CORRECT]
B. Sodium 138 mEq/L
C. Calcium 9.0 mg/dL
D. Magnesium 2.0 mg/dL
Correct Answer: A
Rationale: Furosemide causes potassium wasting; administering it with hypokalemia (normal
3.5-5.0) increases risk of lethal arrhythmias. Hold and notify.
Page 1
, 3. A client arrives in the ED with acute coronary syndrome (ACS). The nurse should
NUR 265 Exam
anticipate 2 | Advanced
which Medical-Surgical
FIRST medication to beNursing | Galen | 2023/2024
administered?
A. Metoprolol (Lopressor)
B. Aspirin 325 mg chewed [CORRECT]
C. Heparin IV infusion
D. Morphine sulfate
Correct Answer: B
Rationale: Per AHA/ACC guidelines, aspirin 162-325 mg chewed is the first medication administered
for suspected ACS to inhibit platelet aggregation.
4. A nurse is monitoring a client on a mechanical ventilator. Which finding requires
IMMEDIATE intervention?
A. Peak inspiratory pressure of 35 cm H2O
B. High-pressure alarm sounding with absent breath sounds on the right side
[CORRECT]
C. Oxygen saturation of 94% on FiO2 of 40%
D. Tidal volume of 450 mL on a 6 mL/kg setting
Correct Answer: B
Rationale: A high-pressure alarm with absent breath sounds suggests a pneumothorax or
endotracheal tube displacement, requiring immediate intervention to prevent death.
5. A client with COPD is prescribed home oxygen therapy. Which teaching is MOST
important?
A. “Use oxygen only when you feel short of breath”
B. “Your oxygen flow rate should be maintained at 1-2 L/min to prevent suppressing
your hypoxic drive” [CORRECT]
C. “You can safely increase your oxygen to 5-6 L/min during episodes of severe dyspnea”
D. “Oxygen therapy will cure your COPD over time”
Correct Answer: B
Rationale: In COPD, the respiratory center becomes adapted to chronic hypercapnia; administering
high-flow oxygen eliminates the hypoxic drive, leading to respiratory depression.
6. A nurse is caring for a client with a new diagnosis of atrial fibrillation. The nurse should
prioritize assessment for which complication?
A. Pulmonary embolism
B. Stroke due to thrombus formation from atrial stasis [CORRECT]
C. Myocardial infarction
D. Heart failure from increased cardiac output
Correct Answer: B
Rationale: Atrial fibrillation causes stasis of blood in the atria (loss of atrial kick), promoting thrombus
formation that can embolize to the brain causing stroke.
Page 2
Exam 2: NUR265 Advanced Concepts of
Medical-Surgical Nursing
Latest 2023/2024 Update | Grade A | 100% Correct | Galen College of Nursing
40 Questions | 100 Points Total
Table of Contents
SECTION 1: Advanced Cardiovascular & Respiratory Disorders (Q1–Q10)
SECTION 2: Endocrine, Renal, & Fluid/Electrolyte Imbalances (Q11–Q20)
SECTION 3: Neurological, Gastrointestinal, & Hepatic Disorders (Q21–Q30)
SECTION 4: Perioperative Care, Infectious Diseases, & Clinical Prioritization
(Q31–Q40)
Grading Rubric & Answer Key
SECTION 1: Advanced Cardiovascular & Respiratory Disorders
(Q1–Q10)
1. A nurse is caring for a client with systolic heart failure (HFrEF). Which assessment
finding indicates the client is experiencing fluid overload?
A. Bradycardia with regular rhythm
B. Weight gain of 2 kg in 2 days, bilateral crackles, and jugular venous distention
[CORRECT]
C. Decreased blood pressure and cool extremities
D. Dry cough and clear lung sounds
Correct Answer: B
Rationale: In HFrEF, fluid overload manifests as rapid weight gain (1 kg/day indicates retention),
crackles from pulmonary congestion, and JVD from increased central venous pressure.
2. A client with heart failure is prescribed furosemide (Lasix). Which laboratory value
requires the nurse to hold the medication and notify the provider?
A. Potassium 3.1 mEq/L [CORRECT]
B. Sodium 138 mEq/L
C. Calcium 9.0 mg/dL
D. Magnesium 2.0 mg/dL
Correct Answer: A
Rationale: Furosemide causes potassium wasting; administering it with hypokalemia (normal
3.5-5.0) increases risk of lethal arrhythmias. Hold and notify.
Page 1
, 3. A client arrives in the ED with acute coronary syndrome (ACS). The nurse should
NUR 265 Exam
anticipate 2 | Advanced
which Medical-Surgical
FIRST medication to beNursing | Galen | 2023/2024
administered?
A. Metoprolol (Lopressor)
B. Aspirin 325 mg chewed [CORRECT]
C. Heparin IV infusion
D. Morphine sulfate
Correct Answer: B
Rationale: Per AHA/ACC guidelines, aspirin 162-325 mg chewed is the first medication administered
for suspected ACS to inhibit platelet aggregation.
4. A nurse is monitoring a client on a mechanical ventilator. Which finding requires
IMMEDIATE intervention?
A. Peak inspiratory pressure of 35 cm H2O
B. High-pressure alarm sounding with absent breath sounds on the right side
[CORRECT]
C. Oxygen saturation of 94% on FiO2 of 40%
D. Tidal volume of 450 mL on a 6 mL/kg setting
Correct Answer: B
Rationale: A high-pressure alarm with absent breath sounds suggests a pneumothorax or
endotracheal tube displacement, requiring immediate intervention to prevent death.
5. A client with COPD is prescribed home oxygen therapy. Which teaching is MOST
important?
A. “Use oxygen only when you feel short of breath”
B. “Your oxygen flow rate should be maintained at 1-2 L/min to prevent suppressing
your hypoxic drive” [CORRECT]
C. “You can safely increase your oxygen to 5-6 L/min during episodes of severe dyspnea”
D. “Oxygen therapy will cure your COPD over time”
Correct Answer: B
Rationale: In COPD, the respiratory center becomes adapted to chronic hypercapnia; administering
high-flow oxygen eliminates the hypoxic drive, leading to respiratory depression.
6. A nurse is caring for a client with a new diagnosis of atrial fibrillation. The nurse should
prioritize assessment for which complication?
A. Pulmonary embolism
B. Stroke due to thrombus formation from atrial stasis [CORRECT]
C. Myocardial infarction
D. Heart failure from increased cardiac output
Correct Answer: B
Rationale: Atrial fibrillation causes stasis of blood in the atria (loss of atrial kick), promoting thrombus
formation that can embolize to the brain causing stroke.
Page 2
