NUR 265/NUR265: Exam 4
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 42-year-old patient returns from a camping trip in an endemic area and reports an
expanding red rash on the thigh. Which finding is the early hallmark of Lyme disease?
A. Arthritis involving the knees
B. Facial palsy and meningismus
C. Bullseye rash with central clearing
D. Third-degree atrioventricular block
Correct Answer: C
Rationale: Correct because erythema migrans, the pathognomonic bullseye rash with central
clearing, is the earliest and most characteristic sign of localized Lyme disease appearing 3 to 30
days after tick transmission. Early recognition of this target-shaped lesion allows for prompt
initiation of doxycycline therapy and prevents progression to disseminated disease. Incorrect
options describe late manifestations involving the musculoskeletal, neurologic, or cardiac
systems that occur weeks to months after initial infection.
Q2: A patient with AIDS presents with a dry cough, low-grade fever, and progressive dyspnea
over two weeks. The CD4+ count is 160 cells/mm³. Which findings are consistent with
Pneumocystis jirovecii pneumonia? Select all that apply.
A. Bilateral interstitial infiltrates on chest X-ray
B. Productive cough with blood-tinged sputum
C. Tachypnea and hypoxemia at rest
D. CD4+ count greater than 300 cells/mm³
E. Night sweats and fatigue
Correct Answer(s): A, C, E
,Rationale: Correct because PJP characteristically presents with subacute onset of dry cough,
tachypnea, hypoxemia, bilateral interstitial infiltrates on chest radiography, and systemic
symptoms including night sweats and profound fatigue in patients with CD4+ counts below 200
cells/mm³. These findings reflect the diffuse alveolar damage and inflammatory response caused
by this opportunistic fungal pathogen. Incorrect options describe tuberculosis presentation or a
CD4+ threshold inconsistent with PJP risk stratification.
Q3: A patient with newly diagnosed high-grade Burkitt lymphoma begins chemotherapy and
develops muscle weakness and cardiac arrhythmias. Which tumor lysis syndrome metabolic
abnormality is the priority concern?
A. Hyperuricemia
B. Hyperkalemia
C. Hyperphosphatemia
D. Hypocalcemia
Correct Answer: B
Rationale: Correct because hyperkalemia resulting from massive tumor cell lysis poses the most
immediate life-threatening risk by causing ventricular arrhythmias, peaked T waves, and cardiac
arrest requiring emergent ECG monitoring and intervention. Rapid potassium release into the
extracellular compartment overwhelms renal excretion capacity during cytolytic therapy.
Incorrect options, while serious, do not produce the same acutely lethal cardiac conduction
disturbances.
Q4: A patient with systemic lupus erythematosus is being evaluated for disease activity. Which
finding most specifically indicates active lupus nephritis?
A. Proteinuria with red blood cell casts
B. Photosensitive malar rash
C. Non-erosive polyarthritis of the hands
D. Oral ulcers
Correct Answer: A
Rationale: Correct because proteinuria with active urinary sediment including red blood cell
casts represents immune complex-mediated glomerulonephritis, which is the most serious
manifestation of SLE requiring immediate nephrology involvement and possible renal biopsy.
This finding reflects ongoing antibody deposition and complement activation within the renal
parenchyma. Incorrect options describe other diagnostic criteria for SLE but do not specifically
indicate renal involvement or active nephritis.
, Q5: A patient with HIV infection has a CD4+ count of 150 cells/mm³ and an undetectable viral
load. Which prophylactic intervention is indicated?
A. Ganciclovir for cytomegalovirus retinitis
B. Clarithromycin for Mycobacterium avium complex
C. Fluconazole for esophageal candidiasis
D. Trimethoprim-sulfamethoxazole for Pneumocystis jirovecii pneumonia
Correct Answer: D
Rationale: Correct because primary prophylaxis against PJP is initiated when the CD4+ count
falls below 200 cells/mm³ regardless of viral load status, as this threshold represents the greatest
risk period for this potentially fatal opportunistic pneumonia. Trimethoprim-sulfamethoxazole
remains the first-line prophylactic agent with excellent efficacy against Pneumocystis. Incorrect
options target opportunistic infections associated with much lower CD4+ thresholds or are not
standard prophylactic indications.
Q6: During a mass casualty incident, the triage officer must categorize multiple patients. Which
patients are classified as Yellow (Delayed)? Select all that apply.
A. Tension pneumothorax with tracheal deviation
B. Stable open fracture of the tibia with controlled bleeding
C. Agonal respirations with absent carotid pulse
D. Second-degree burns covering 8% TBSA without airway involvement
Correct Answer(s): B, D
Rationale: Correct because Yellow (Delayed) triage category includes patients with serious but
not immediately life-threatening injuries such as stable fractures without active hemorrhage and
minor burns without inhalation injury, who can safely wait for definitive care after Red priority
patients are treated. These conditions require medical intervention but do not deteriorate rapidly
within the immediate timeframe. Incorrect options describe either an immediate life threat
requiring Red categorization or an unsurvivable injury warranting Black (Expectant) designation.
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 42-year-old patient returns from a camping trip in an endemic area and reports an
expanding red rash on the thigh. Which finding is the early hallmark of Lyme disease?
A. Arthritis involving the knees
B. Facial palsy and meningismus
C. Bullseye rash with central clearing
D. Third-degree atrioventricular block
Correct Answer: C
Rationale: Correct because erythema migrans, the pathognomonic bullseye rash with central
clearing, is the earliest and most characteristic sign of localized Lyme disease appearing 3 to 30
days after tick transmission. Early recognition of this target-shaped lesion allows for prompt
initiation of doxycycline therapy and prevents progression to disseminated disease. Incorrect
options describe late manifestations involving the musculoskeletal, neurologic, or cardiac
systems that occur weeks to months after initial infection.
Q2: A patient with AIDS presents with a dry cough, low-grade fever, and progressive dyspnea
over two weeks. The CD4+ count is 160 cells/mm³. Which findings are consistent with
Pneumocystis jirovecii pneumonia? Select all that apply.
A. Bilateral interstitial infiltrates on chest X-ray
B. Productive cough with blood-tinged sputum
C. Tachypnea and hypoxemia at rest
D. CD4+ count greater than 300 cells/mm³
E. Night sweats and fatigue
Correct Answer(s): A, C, E
,Rationale: Correct because PJP characteristically presents with subacute onset of dry cough,
tachypnea, hypoxemia, bilateral interstitial infiltrates on chest radiography, and systemic
symptoms including night sweats and profound fatigue in patients with CD4+ counts below 200
cells/mm³. These findings reflect the diffuse alveolar damage and inflammatory response caused
by this opportunistic fungal pathogen. Incorrect options describe tuberculosis presentation or a
CD4+ threshold inconsistent with PJP risk stratification.
Q3: A patient with newly diagnosed high-grade Burkitt lymphoma begins chemotherapy and
develops muscle weakness and cardiac arrhythmias. Which tumor lysis syndrome metabolic
abnormality is the priority concern?
A. Hyperuricemia
B. Hyperkalemia
C. Hyperphosphatemia
D. Hypocalcemia
Correct Answer: B
Rationale: Correct because hyperkalemia resulting from massive tumor cell lysis poses the most
immediate life-threatening risk by causing ventricular arrhythmias, peaked T waves, and cardiac
arrest requiring emergent ECG monitoring and intervention. Rapid potassium release into the
extracellular compartment overwhelms renal excretion capacity during cytolytic therapy.
Incorrect options, while serious, do not produce the same acutely lethal cardiac conduction
disturbances.
Q4: A patient with systemic lupus erythematosus is being evaluated for disease activity. Which
finding most specifically indicates active lupus nephritis?
A. Proteinuria with red blood cell casts
B. Photosensitive malar rash
C. Non-erosive polyarthritis of the hands
D. Oral ulcers
Correct Answer: A
Rationale: Correct because proteinuria with active urinary sediment including red blood cell
casts represents immune complex-mediated glomerulonephritis, which is the most serious
manifestation of SLE requiring immediate nephrology involvement and possible renal biopsy.
This finding reflects ongoing antibody deposition and complement activation within the renal
parenchyma. Incorrect options describe other diagnostic criteria for SLE but do not specifically
indicate renal involvement or active nephritis.
, Q5: A patient with HIV infection has a CD4+ count of 150 cells/mm³ and an undetectable viral
load. Which prophylactic intervention is indicated?
A. Ganciclovir for cytomegalovirus retinitis
B. Clarithromycin for Mycobacterium avium complex
C. Fluconazole for esophageal candidiasis
D. Trimethoprim-sulfamethoxazole for Pneumocystis jirovecii pneumonia
Correct Answer: D
Rationale: Correct because primary prophylaxis against PJP is initiated when the CD4+ count
falls below 200 cells/mm³ regardless of viral load status, as this threshold represents the greatest
risk period for this potentially fatal opportunistic pneumonia. Trimethoprim-sulfamethoxazole
remains the first-line prophylactic agent with excellent efficacy against Pneumocystis. Incorrect
options target opportunistic infections associated with much lower CD4+ thresholds or are not
standard prophylactic indications.
Q6: During a mass casualty incident, the triage officer must categorize multiple patients. Which
patients are classified as Yellow (Delayed)? Select all that apply.
A. Tension pneumothorax with tracheal deviation
B. Stable open fracture of the tibia with controlled bleeding
C. Agonal respirations with absent carotid pulse
D. Second-degree burns covering 8% TBSA without airway involvement
Correct Answer(s): B, D
Rationale: Correct because Yellow (Delayed) triage category includes patients with serious but
not immediately life-threatening injuries such as stable fractures without active hemorrhage and
minor burns without inhalation injury, who can safely wait for definitive care after Red priority
patients are treated. These conditions require medical intervention but do not deteriorate rapidly
within the immediate timeframe. Incorrect options describe either an immediate life threat
requiring Red categorization or an unsurvivable injury warranting Black (Expectant) designation.
