NUR 265/NUR265: Exam 3
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 58-year-old patient is admitted with a traumatic brain injury following a fall from
scaffolding. The nurse is implementing interventions to reduce intracranial pressure. Which
action is the priority?
A. Suction the airway for 15 seconds as needed to maintain patency
B. Maintain the head of the bed at 30 degrees with the head in neutral alignment
C. Perform active range-of-motion exercises every 2 hours to prevent contractures
D. Cluster nursing activities to provide longer uninterrupted rest periods
Correct Answer: B
Rationale: Correct because elevating the head of the bed to 30 degrees promotes jugular venous
drainage and reduces cerebral blood volume, thereby lowering intracranial pressure according to
the Monroe-Kellie hypothesis. Neutral head alignment prevents jugular venous compression that
would otherwise impede cerebral outflow and acutely worsen ICP. Incorrect options either
increase intracranial pressure through prolonged suctioning or inappropriate activity clustering,
or address non-acute priorities.
Q2: A patient with septic shock has a temperature of 38.9°C, heart rate 128 bpm, and blood
pressure 82/50 mmHg after receiving 2 L of 0.9% sodium chloride. Which intervention is the
nurse's highest priority?
A. Initiate norepinephrine infusion to maintain MAP ≥65 mmHg
B. Administer broad-spectrum antibiotics after blood culture results return
C. Give an additional 500 mL crystalloid bolus and reassess in 4 hours
D. Start hydrocortisone immediately as first-line vasopressor therapy
,Correct Answer: A
Rationale: Correct because after adequate fluid resuscitation with 30 mL/kg crystalloids,
persistent hypotension indicates vasopressor-refractory septic shock requiring norepinephrine as
the first-line agent to maintain MAP ≥65 mmHg per Surviving Sepsis guidelines. Norepinephrine
restores vascular tone through alpha-1 adrenergic agonism counteracting the massive
vasodilation characteristic of septic shock. Incorrect options either delay definitive hemodynamic
support or violate sepsis bundle timing protocols.
Q3: A firefighter is rescued from a structural collapse and presents with facial burns and a hoarse
voice. Which findings indicate inhalation injury? Select all that apply.
A. Singed nasal hairs
B. Pink, moist oral mucosa
C. Sooty sputum
D. Clear breath sounds bilaterally
E. Hoarseness
F. Normal carboxyhemoglobin levels
Correct Answer(s): A, C, E
Rationale: Correct because singed nasal hairs, sooty sputum, and hoarseness are classic
indicators of upper airway thermal injury and smoke inhalation requiring immediate airway
protection. These findings suggest direct thermal damage to the respiratory mucosa and potential
progressive edema formation that can precipitate complete airway obstruction. Incorrect options
represent normal physiological findings or absence of injury rather than pathological inhalation
indicators.
Q4: A 24-year-old male is struck in the temporal region during an assault, loses consciousness
briefly, then becomes alert and conversant. Thirty minutes later he is unresponsive with a dilated
right pupil. What does the nurse suspect?
A. Concussion with post-traumatic amnesia
B. Subdural hematoma from venous bleeding
C. Diffuse axonal injury from rotational shearing forces
D. Epidural hematoma requiring emergency surgical evacuation
Correct Answer: D
Rationale: Correct because the classic lucid interval followed by rapid neurological deterioration
indicates an epidural hematoma, which is an arterial bleed most commonly from the middle
, meningeal artery requiring emergent neurosurgical evacuation. The unilateral dilated pupil
suggests uncal herniation with ipsilateral oculomotor nerve compression. Incorrect options
describe slower-onset venous bleeds or injuries without the characteristic temporal pattern of
epidural bleeding.
Q5: A 68-year-old patient arrives in the emergency department 3 hours after sudden onset of left-
sided weakness and aphasia. Non-contrast CT shows no hemorrhage, and blood pressure is
175/100 mmHg. What is the nurse's priority action?
A. Prepare for immediate tPA administration regardless of blood pressure
B. Administer sublingual nitroglycerin to rapidly lower the blood pressure
C. Anticipate antihypertensive therapy to achieve SBP <185 and DBP <110
D. Insert an indwelling urinary catheter before thrombolytic initiation
Correct Answer: C
Rationale: Correct because tPA eligibility requires strict blood pressure parameters with systolic
BP below 185 mmHg and diastolic BP below 110 mmHg prior to infusion, necessitating
antihypertensive management to meet absolute inclusion criteria. Uncontrolled hypertension
represents an absolute contraindication due to hemorrhagic transformation risk during
thrombolysis. Incorrect options either proceed without meeting safety thresholds or introduce
interventions that do not address the primary eligibility barrier.
Q6: A patient with a C6 spinal cord injury presents with hypotension and bradycardia. Which
findings differentiate neurogenic shock from hypovolemic, cardiogenic, and septic shock? Select
all that apply.
A. Tachycardia and weak, thready pulses
B. Bradycardia and hypotension without compensatory vasoconstriction
C. Warm, flushed skin above the level of injury
D. Poikilothermia with inability to regulate body temperature
E. Increased systemic vascular resistance and cool extremities
Correct Answer(s): B, D
Rationale: Correct because neurogenic shock uniquely presents with bradycardia and
hypotension due to loss of sympathetic nervous system tone below the level of spinal cord injury,
accompanied by poikilothermia as the patient loses thermoregulatory ability and assumes
ambient temperature. These findings contrast with all other shock states that demonstrate
compensatory tachycardia and vasoconstriction. Incorrect options describe physiological
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 58-year-old patient is admitted with a traumatic brain injury following a fall from
scaffolding. The nurse is implementing interventions to reduce intracranial pressure. Which
action is the priority?
A. Suction the airway for 15 seconds as needed to maintain patency
B. Maintain the head of the bed at 30 degrees with the head in neutral alignment
C. Perform active range-of-motion exercises every 2 hours to prevent contractures
D. Cluster nursing activities to provide longer uninterrupted rest periods
Correct Answer: B
Rationale: Correct because elevating the head of the bed to 30 degrees promotes jugular venous
drainage and reduces cerebral blood volume, thereby lowering intracranial pressure according to
the Monroe-Kellie hypothesis. Neutral head alignment prevents jugular venous compression that
would otherwise impede cerebral outflow and acutely worsen ICP. Incorrect options either
increase intracranial pressure through prolonged suctioning or inappropriate activity clustering,
or address non-acute priorities.
Q2: A patient with septic shock has a temperature of 38.9°C, heart rate 128 bpm, and blood
pressure 82/50 mmHg after receiving 2 L of 0.9% sodium chloride. Which intervention is the
nurse's highest priority?
A. Initiate norepinephrine infusion to maintain MAP ≥65 mmHg
B. Administer broad-spectrum antibiotics after blood culture results return
C. Give an additional 500 mL crystalloid bolus and reassess in 4 hours
D. Start hydrocortisone immediately as first-line vasopressor therapy
,Correct Answer: A
Rationale: Correct because after adequate fluid resuscitation with 30 mL/kg crystalloids,
persistent hypotension indicates vasopressor-refractory septic shock requiring norepinephrine as
the first-line agent to maintain MAP ≥65 mmHg per Surviving Sepsis guidelines. Norepinephrine
restores vascular tone through alpha-1 adrenergic agonism counteracting the massive
vasodilation characteristic of septic shock. Incorrect options either delay definitive hemodynamic
support or violate sepsis bundle timing protocols.
Q3: A firefighter is rescued from a structural collapse and presents with facial burns and a hoarse
voice. Which findings indicate inhalation injury? Select all that apply.
A. Singed nasal hairs
B. Pink, moist oral mucosa
C. Sooty sputum
D. Clear breath sounds bilaterally
E. Hoarseness
F. Normal carboxyhemoglobin levels
Correct Answer(s): A, C, E
Rationale: Correct because singed nasal hairs, sooty sputum, and hoarseness are classic
indicators of upper airway thermal injury and smoke inhalation requiring immediate airway
protection. These findings suggest direct thermal damage to the respiratory mucosa and potential
progressive edema formation that can precipitate complete airway obstruction. Incorrect options
represent normal physiological findings or absence of injury rather than pathological inhalation
indicators.
Q4: A 24-year-old male is struck in the temporal region during an assault, loses consciousness
briefly, then becomes alert and conversant. Thirty minutes later he is unresponsive with a dilated
right pupil. What does the nurse suspect?
A. Concussion with post-traumatic amnesia
B. Subdural hematoma from venous bleeding
C. Diffuse axonal injury from rotational shearing forces
D. Epidural hematoma requiring emergency surgical evacuation
Correct Answer: D
Rationale: Correct because the classic lucid interval followed by rapid neurological deterioration
indicates an epidural hematoma, which is an arterial bleed most commonly from the middle
, meningeal artery requiring emergent neurosurgical evacuation. The unilateral dilated pupil
suggests uncal herniation with ipsilateral oculomotor nerve compression. Incorrect options
describe slower-onset venous bleeds or injuries without the characteristic temporal pattern of
epidural bleeding.
Q5: A 68-year-old patient arrives in the emergency department 3 hours after sudden onset of left-
sided weakness and aphasia. Non-contrast CT shows no hemorrhage, and blood pressure is
175/100 mmHg. What is the nurse's priority action?
A. Prepare for immediate tPA administration regardless of blood pressure
B. Administer sublingual nitroglycerin to rapidly lower the blood pressure
C. Anticipate antihypertensive therapy to achieve SBP <185 and DBP <110
D. Insert an indwelling urinary catheter before thrombolytic initiation
Correct Answer: C
Rationale: Correct because tPA eligibility requires strict blood pressure parameters with systolic
BP below 185 mmHg and diastolic BP below 110 mmHg prior to infusion, necessitating
antihypertensive management to meet absolute inclusion criteria. Uncontrolled hypertension
represents an absolute contraindication due to hemorrhagic transformation risk during
thrombolysis. Incorrect options either proceed without meeting safety thresholds or introduce
interventions that do not address the primary eligibility barrier.
Q6: A patient with a C6 spinal cord injury presents with hypotension and bradycardia. Which
findings differentiate neurogenic shock from hypovolemic, cardiogenic, and septic shock? Select
all that apply.
A. Tachycardia and weak, thready pulses
B. Bradycardia and hypotension without compensatory vasoconstriction
C. Warm, flushed skin above the level of injury
D. Poikilothermia with inability to regulate body temperature
E. Increased systemic vascular resistance and cool extremities
Correct Answer(s): B, D
Rationale: Correct because neurogenic shock uniquely presents with bradycardia and
hypotension due to loss of sympathetic nervous system tone below the level of spinal cord injury,
accompanied by poikilothermia as the patient loses thermoregulatory ability and assumes
ambient temperature. These findings contrast with all other shock states that demonstrate
compensatory tachycardia and vasoconstriction. Incorrect options describe physiological
