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 patient is being evaluated for brain death following a catastrophic traumatic brain injury.
Which assessment findings are consistent with brain death? Select all that apply.
A. Positive pupillary constriction to light
B. Absent pupillary light reflex
C. Intact oculocephalic reflex
D. Apnea during formal apnea testing
E. Absent corneal reflex
F. Purposeful withdrawal from painful stimuli
Correct Answer(s): B, D, E
Rationale: Correct because brain death requires the irreversible absence of all brainstem
reflexes, including pupillary light reflexes, corneal reflexes, and documented apnea during
standardized testing with appropriate preoxygenation. The nurse must ensure that confounding
factors such as hypothermia, sedative medications, or metabolic disturbances are excluded prior
to testing. Purposeful movement or any preserved brainstem reflex indicates retained
neurological function and is incompatible with brain death determination.
Q2: A patient in the emergency department is diagnosed with septic shock. Which intervention is
the priority according to the Surviving Sepsis Bundle?
A. Wait for blood culture results before initiating antibiotics
B. Administer vasopressors before fluid resuscitation
C. Initiate broad-spectrum antibiotics within 1 hour of recognition
D. Delay fluid administration until a central venous catheter is placed
Correct Answer: C
Rationale: Correct because the Surviving Sepsis Campaign mandates administration of broad-
spectrum antibiotics within 1 hour of sepsis recognition to reduce mortality, as each hour of
delay increases the risk of death. Blood cultures must be obtained prior to antibiotic
,administration whenever possible, but antibiotics should never be delayed pending culture
results. Fluid resuscitation with 30 mL/kg of crystalloids and vasopressor initiation follow
antibiotic administration in the resuscitation sequence.
Q3: A patient is rescued from a house fire with facial burns, singed nasal hairs, and hoarseness.
Which is the priority nursing action during the emergent phase?
A. Assess and protect the airway
B. Calculate the Parkland formula for fluid resuscitation
C. Apply silver sulfadiazine to facial burns
D. Initiate passive range of motion exercises
Correct Answer: A
Rationale: Correct because airway protection is the highest priority in the emergent phase of
burn care, as inhalation injury can rapidly progress to airway obstruction from progressive
edema. Singed nasal hairs, hoarseness, and facial burns are classic indicators of upper airway
thermal injury that may necessitate immediate intubation. Fluid resuscitation, topical
antimicrobials, and rehabilitation exercises are initiated only after the airway is secured and the
patient is hemodynamically stable.
Q4: A patient with a traumatic brain injury is diagnosed with an epidural hematoma. Which
statement accurately describes this condition?
A. It is caused by venous bleeding from bridging veins
B. It is typically caused by arterial bleeding and may present with a lucid interval
C. It is most common in elderly patients with cerebral atrophy
D. It develops slowly over several days to weeks
Correct Answer: B
Rationale: Correct because epidural hematomas are typically arterial bleeds from the middle
meningeal artery and classically present with a brief lucid interval followed by rapid
neurological deterioration. This neurosurgical emergency requires immediate evacuation to
prevent uncal herniation and death. Venous bleeding from bridging veins and slower onset are
characteristic of subdural hematomas, which are more common in elderly and anticoagulated
patients.
, Q5: A patient develops generalized urticaria, angioedema of the tongue, and hypotension within
minutes of receiving intravenous penicillin. Which interventions are appropriate? Select all that
apply.
A. Administer intramuscular epinephrine immediately
B. Administer oral antihistamines as first-line therapy
C. Initiate high-flow oxygen and monitor airway patency
D. Observe the patient without intervention if symptoms appear mild
E. Delay corticosteroid administration until blood pressure stabilizes
Correct Answer(s): A, C
Rationale: Correct because intramuscular epinephrine is the first-line life-saving treatment for
anaphylactic shock, rapidly reversing bronchospasm and vasodilation through alpha and beta-
adrenergic receptor activation. High-flow oxygen and vigilant airway monitoring are essential
adjuncts to prevent hypoxic brain injury from laryngeal edema. Oral antihistamines and
corticosteroids are secondary therapies that do not address the immediate cardiovascular collapse
and airway compromise.
Q6: A patient with a tibial fracture has a long-leg cast applied and reports severe pain unrelieved
by intravenous morphine. The toes are pale, cool, and capillary refill is 4 seconds. Which action
is the priority?
A. Elevate the extremity above heart level
B. Apply ice packs to reduce swelling
C. Administer additional opioid analgesic
D. Notify the provider and prepare for fasciotomy
Correct Answer: D
Rationale: Correct because pain disproportionate to the injury and unrelieved by narcotics,
combined with pallor and delayed capillary refill, are hallmark signs of compartment syndrome
requiring immediate surgical intervention. Compartment syndrome is a limb-threatening
emergency caused by increased pressure within a closed fascial compartment that compromises
perfusion and leads to irreversible muscle necrosis. Elevation and ice application are
contraindicated because they further reduce arterial perfusion pressure and exacerbate tissue
ischemia.
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 patient is being evaluated for brain death following a catastrophic traumatic brain injury.
Which assessment findings are consistent with brain death? Select all that apply.
A. Positive pupillary constriction to light
B. Absent pupillary light reflex
C. Intact oculocephalic reflex
D. Apnea during formal apnea testing
E. Absent corneal reflex
F. Purposeful withdrawal from painful stimuli
Correct Answer(s): B, D, E
Rationale: Correct because brain death requires the irreversible absence of all brainstem
reflexes, including pupillary light reflexes, corneal reflexes, and documented apnea during
standardized testing with appropriate preoxygenation. The nurse must ensure that confounding
factors such as hypothermia, sedative medications, or metabolic disturbances are excluded prior
to testing. Purposeful movement or any preserved brainstem reflex indicates retained
neurological function and is incompatible with brain death determination.
Q2: A patient in the emergency department is diagnosed with septic shock. Which intervention is
the priority according to the Surviving Sepsis Bundle?
A. Wait for blood culture results before initiating antibiotics
B. Administer vasopressors before fluid resuscitation
C. Initiate broad-spectrum antibiotics within 1 hour of recognition
D. Delay fluid administration until a central venous catheter is placed
Correct Answer: C
Rationale: Correct because the Surviving Sepsis Campaign mandates administration of broad-
spectrum antibiotics within 1 hour of sepsis recognition to reduce mortality, as each hour of
delay increases the risk of death. Blood cultures must be obtained prior to antibiotic
,administration whenever possible, but antibiotics should never be delayed pending culture
results. Fluid resuscitation with 30 mL/kg of crystalloids and vasopressor initiation follow
antibiotic administration in the resuscitation sequence.
Q3: A patient is rescued from a house fire with facial burns, singed nasal hairs, and hoarseness.
Which is the priority nursing action during the emergent phase?
A. Assess and protect the airway
B. Calculate the Parkland formula for fluid resuscitation
C. Apply silver sulfadiazine to facial burns
D. Initiate passive range of motion exercises
Correct Answer: A
Rationale: Correct because airway protection is the highest priority in the emergent phase of
burn care, as inhalation injury can rapidly progress to airway obstruction from progressive
edema. Singed nasal hairs, hoarseness, and facial burns are classic indicators of upper airway
thermal injury that may necessitate immediate intubation. Fluid resuscitation, topical
antimicrobials, and rehabilitation exercises are initiated only after the airway is secured and the
patient is hemodynamically stable.
Q4: A patient with a traumatic brain injury is diagnosed with an epidural hematoma. Which
statement accurately describes this condition?
A. It is caused by venous bleeding from bridging veins
B. It is typically caused by arterial bleeding and may present with a lucid interval
C. It is most common in elderly patients with cerebral atrophy
D. It develops slowly over several days to weeks
Correct Answer: B
Rationale: Correct because epidural hematomas are typically arterial bleeds from the middle
meningeal artery and classically present with a brief lucid interval followed by rapid
neurological deterioration. This neurosurgical emergency requires immediate evacuation to
prevent uncal herniation and death. Venous bleeding from bridging veins and slower onset are
characteristic of subdural hematomas, which are more common in elderly and anticoagulated
patients.
, Q5: A patient develops generalized urticaria, angioedema of the tongue, and hypotension within
minutes of receiving intravenous penicillin. Which interventions are appropriate? Select all that
apply.
A. Administer intramuscular epinephrine immediately
B. Administer oral antihistamines as first-line therapy
C. Initiate high-flow oxygen and monitor airway patency
D. Observe the patient without intervention if symptoms appear mild
E. Delay corticosteroid administration until blood pressure stabilizes
Correct Answer(s): A, C
Rationale: Correct because intramuscular epinephrine is the first-line life-saving treatment for
anaphylactic shock, rapidly reversing bronchospasm and vasodilation through alpha and beta-
adrenergic receptor activation. High-flow oxygen and vigilant airway monitoring are essential
adjuncts to prevent hypoxic brain injury from laryngeal edema. Oral antihistamines and
corticosteroids are secondary therapies that do not address the immediate cardiovascular collapse
and airway compromise.
Q6: A patient with a tibial fracture has a long-leg cast applied and reports severe pain unrelieved
by intravenous morphine. The toes are pale, cool, and capillary refill is 4 seconds. Which action
is the priority?
A. Elevate the extremity above heart level
B. Apply ice packs to reduce swelling
C. Administer additional opioid analgesic
D. Notify the provider and prepare for fasciotomy
Correct Answer: D
Rationale: Correct because pain disproportionate to the injury and unrelieved by narcotics,
combined with pallor and delayed capillary refill, are hallmark signs of compartment syndrome
requiring immediate surgical intervention. Compartment syndrome is a limb-threatening
emergency caused by increased pressure within a closed fascial compartment that compromises
perfusion and leads to irreversible muscle necrosis. Elevation and ice application are
contraindicated because they further reduce arterial perfusion pressure and exacerbate tissue
ischemia.
