NUR 265 Medical-Surgical Nursing Exams 1-3 &
Final | Galen College of Nursing | 2026/2027 |
Nursing | with Complete Solutions
Document Information
Course: NUR 265 - Medical-Surgical Nursing
Institution: Galen College of Nursing
Academic Year: 2026/2027
Total Questions: 250
Format: Multiple Choice with Correct Answers and Rationales
NUR 265 EXAM 1: Cardiovascular, Respiratory, and Critical
Care
,Question 1
A 68-year-old client with a history of chronic heart failure is admitted to the telemetry
unit with worsening dyspnea and weight gain of 4.5 kg over the past week. The nurse
notes crackles in both lung bases and jugular venous distention. Which assessment
finding would the nurse expect to see in this client?
A. Bounding peripheral pulses and warm, flushed skin
B. Decreased pulmonary capillary wedge pressure and dry lung sounds
C. S3 heart sound and hepatomegaly on abdominal palpation
D. Narrow pulse pressure and delayed capillary refill
Correct Answer: C. S3 heart sound and hepatomegaly on abdominal palpation
Rationale: An S3 heart sound and hepatomegaly are classic findings in left-sided and
right-sided heart failure, respectively. The S3 sound indicates ventricular volume overload,
while hepatomegaly reflects hepatic congestion from right-sided failure. Bounding pulses
and warm skin suggest high-output states, not heart failure. Decreased wedge pressure
and dry lungs would indicate dehydration, not fluid overload.
Question 2
A 54-year-old male is postoperative day 2 after coronary artery bypass grafting (CABG)
using the left internal mammary artery. The nurse is monitoring the chest tube drainage
and notes 175 mL of bright red blood in the past hour. Which action by the nurse is the
priority?
A. Clamp the chest tube to prevent excessive blood loss
B. Assess the client's hemodynamic status and notify the surgeon immediately
,C. Reposition the client to the affected side to promote drainage
D. Increase the suction pressure on the chest drainage system
Correct Answer: B. Assess the client's hemodynamic status and notify the surgeon
immediately
Rationale: Bright red drainage exceeding 100-150 mL per hour indicates active
hemorrhage and requires immediate assessment of hemodynamic stability and surgeon
notification. Clamping the chest tube can cause a tension pneumothorax. Repositioning
does not address the underlying bleeding. Increasing suction may worsen bleeding and is
not the priority intervention .
Question 3
A client with atrial fibrillation is prescribed warfarin 5 mg daily. The nurse reviews the
client's INR result of 3.8. Which nursing intervention is most appropriate at this time?
A. Administer the scheduled dose and schedule a repeat INR in one week
B. Hold the dose, notify the provider, and assess for signs of bleeding
C. Administer vitamin K 10 mg subcutaneously and continue the warfarin
D. Increase the dose to 7.5 mg to maintain therapeutic anticoagulation
Correct Answer: B. Hold the dose, notify the provider, and assess for signs of
bleeding
, Rationale: An INR of 3.8 exceeds the therapeutic range of 2.0-3.0 for atrial fibrillation and
increases bleeding risk. The nurse should hold the dose and notify the provider.
Administering the dose or increasing it would further elevate the INR. Vitamin K is
reserved for INR greater than 10 or active bleeding and should not be given without
provider orders .
Question 4
A 72-year-old client with peripheral arterial disease (PAD) reports severe pain in the
right foot that worsens with elevation and improves when the leg is dependent. The
nurse notes non-healing ulcers on the toes and absent pedal pulses. Which nursing
intervention should be included in the plan of care?
A. Apply warm compresses to the affected foot to promote circulation
B. Elevate the legs above heart level for 30 minutes every 2 hours
C. Keep the legs in a dependent position and avoid pressure on the heels
D. Perform range-of-motion exercises aggressively to improve blood flow
Correct Answer: C. Keep the legs in a dependent position and avoid pressure on the
heels
Rationale: In PAD, dependent positioning improves blood flow to the extremity and
reduces ischemic pain. Elevation worsens ischemia. Warm compresses can cause thermal
injury in ischemic tissue with impaired sensation. Aggressive ROM can damage fragile
tissue and is contraindicated.
Final | Galen College of Nursing | 2026/2027 |
Nursing | with Complete Solutions
Document Information
Course: NUR 265 - Medical-Surgical Nursing
Institution: Galen College of Nursing
Academic Year: 2026/2027
Total Questions: 250
Format: Multiple Choice with Correct Answers and Rationales
NUR 265 EXAM 1: Cardiovascular, Respiratory, and Critical
Care
,Question 1
A 68-year-old client with a history of chronic heart failure is admitted to the telemetry
unit with worsening dyspnea and weight gain of 4.5 kg over the past week. The nurse
notes crackles in both lung bases and jugular venous distention. Which assessment
finding would the nurse expect to see in this client?
A. Bounding peripheral pulses and warm, flushed skin
B. Decreased pulmonary capillary wedge pressure and dry lung sounds
C. S3 heart sound and hepatomegaly on abdominal palpation
D. Narrow pulse pressure and delayed capillary refill
Correct Answer: C. S3 heart sound and hepatomegaly on abdominal palpation
Rationale: An S3 heart sound and hepatomegaly are classic findings in left-sided and
right-sided heart failure, respectively. The S3 sound indicates ventricular volume overload,
while hepatomegaly reflects hepatic congestion from right-sided failure. Bounding pulses
and warm skin suggest high-output states, not heart failure. Decreased wedge pressure
and dry lungs would indicate dehydration, not fluid overload.
Question 2
A 54-year-old male is postoperative day 2 after coronary artery bypass grafting (CABG)
using the left internal mammary artery. The nurse is monitoring the chest tube drainage
and notes 175 mL of bright red blood in the past hour. Which action by the nurse is the
priority?
A. Clamp the chest tube to prevent excessive blood loss
B. Assess the client's hemodynamic status and notify the surgeon immediately
,C. Reposition the client to the affected side to promote drainage
D. Increase the suction pressure on the chest drainage system
Correct Answer: B. Assess the client's hemodynamic status and notify the surgeon
immediately
Rationale: Bright red drainage exceeding 100-150 mL per hour indicates active
hemorrhage and requires immediate assessment of hemodynamic stability and surgeon
notification. Clamping the chest tube can cause a tension pneumothorax. Repositioning
does not address the underlying bleeding. Increasing suction may worsen bleeding and is
not the priority intervention .
Question 3
A client with atrial fibrillation is prescribed warfarin 5 mg daily. The nurse reviews the
client's INR result of 3.8. Which nursing intervention is most appropriate at this time?
A. Administer the scheduled dose and schedule a repeat INR in one week
B. Hold the dose, notify the provider, and assess for signs of bleeding
C. Administer vitamin K 10 mg subcutaneously and continue the warfarin
D. Increase the dose to 7.5 mg to maintain therapeutic anticoagulation
Correct Answer: B. Hold the dose, notify the provider, and assess for signs of
bleeding
, Rationale: An INR of 3.8 exceeds the therapeutic range of 2.0-3.0 for atrial fibrillation and
increases bleeding risk. The nurse should hold the dose and notify the provider.
Administering the dose or increasing it would further elevate the INR. Vitamin K is
reserved for INR greater than 10 or active bleeding and should not be given without
provider orders .
Question 4
A 72-year-old client with peripheral arterial disease (PAD) reports severe pain in the
right foot that worsens with elevation and improves when the leg is dependent. The
nurse notes non-healing ulcers on the toes and absent pedal pulses. Which nursing
intervention should be included in the plan of care?
A. Apply warm compresses to the affected foot to promote circulation
B. Elevate the legs above heart level for 30 minutes every 2 hours
C. Keep the legs in a dependent position and avoid pressure on the heels
D. Perform range-of-motion exercises aggressively to improve blood flow
Correct Answer: C. Keep the legs in a dependent position and avoid pressure on the
heels
Rationale: In PAD, dependent positioning improves blood flow to the extremity and
reduces ischemic pain. Elevation worsens ischemia. Warm compresses can cause thermal
injury in ischemic tissue with impaired sensation. Aggressive ROM can damage fragile
tissue and is contraindicated.
