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 patient with acute lymphoblastic leukemia begins initial chemotherapy. Six hours after the
first infusion, the nurse reviews the laboratory results. Which finding requires the most
immediate intervention?
A. Serum phosphate 4.5 mg/dL
B. Serum potassium 6.8 mEq/L
C. Serum uric acid 8.2 mg/dL
D. Serum calcium 8.8 mg/dL
Correct Answer: B
Rationale: Correct because hyperkalemia is the most immediately life-threatening electrolyte
imbalance in tumor lysis syndrome due to its potential to cause fatal cardiac arrhythmias, and
levels exceeding 6.5 mEq/L require urgent intervention with calcium gluconate and cardiac
monitoring. Elevated uric acid and phosphate are incorrect as priority interventions because,
while serious, they do not pose an immediate risk of cardiac arrest. Hypocalcemia is incorrect
because it typically manifests secondary to hyperphosphatemia and is treated only if
symptomatic or in conjunction with severe hyperkalemia.
Q2: A patient with AIDS presents to the emergency department with a productive cough, night
sweats, and fever. The CD4+ count is 120 cells/mm³. Which nursing action is the priority?
A. Initiate Airborne Precautions and place the patient in a negative pressure room
B. Begin Contact Precautions for Cryptosporidiosis
C. Administer trimethoprim-sulfamethoxazole prophylaxis
D. Prepare for immediate bronchoscopy
Correct Answer: A
,Rationale: Correct because a patient with AIDS, productive cough, night sweats, and fever must
be placed under Airborne Precautions in a negative pressure room until tuberculosis is ruled out,
as TB is a highly contagious and lethal opportunistic infection in immunocompromised patients.
Contact isolation for cryptosporidiosis is incorrect because the presentation is respiratory, not
diarrheal. Initiating PJP prophylaxis is incorrect because the patient already has active symptoms
requiring diagnostic workup rather than prophylaxis.
Q3: A mass casualty incident occurs at a local factory. The triage nurse assesses multiple victims.
Which patients would be classified as Red (Emergent/Immediate)? Select all that apply.
A. A patient with a stable ankle fracture and no other injuries
B. A patient with a tension pneumothorax and tracheal deviation to the right
C. A patient with a minor laceration who is fully oriented and ambulatory
D. A patient in hemorrhagic shock with a weak, thready pulse
E. A patient with an obstructed airway requiring immediate intubation
F. A patient with full-thickness burns covering 95% of total body surface area
Correct Answer(s): B, D, E
Rationale: Correct because tension pneumothorax with tracheal deviation, hemorrhagic shock,
and airway obstruction are all immediately life-threatening conditions that require emergent
intervention to prevent death within minutes. Stable ankle fracture and minor laceration are
incorrect because these represent minor or delayed injuries that can wait for treatment. Burns
exceeding 90% TBSA are incorrect because they are classified as Black/Expectant due to
unsurvivable injuries in a mass casualty setting where resources must be allocated to salvageable
patients.
Q4: A patient with systemic lupus erythematosus calls the clinic reporting a new facial rash, joint
swelling in both knees, and foamy urine for the past three days. Which instruction from the nurse
is most appropriate?
A. Increase the daily dose of ibuprofen until the rash resolves
B. Apply topical hydrocortisone cream to the joints and face
C. Come to the clinic today for a urinalysis and provider evaluation
D. Avoid all sun exposure and monitor symptoms for two weeks
Correct Answer: C
Rationale: Correct because foamy urine indicates proteinuria, which is a sign of lupus nephritis
and active disease flare requiring immediate evaluation, urinalysis, and possible adjustment of
, immunosuppressive therapy. Increasing ibuprofen is incorrect because NSAIDs can worsen renal
function and do not address potential nephritis. Topical hydrocortisone is incorrect because it
treats superficial skin manifestations but not systemic organ involvement. Delaying evaluation
for two weeks is incorrect because lupus nephritis can rapidly progress to renal failure without
prompt intervention.
Q5: A hiker presents with an expanding erythematous rash with central clearing on the left thigh,
fever, and joint pain. The patient reports removing a tick two weeks ago. Which statement by the
nurse is most accurate regarding diagnostic testing?
A. A polymerase chain reaction test is immediately sensitive and specific for Lyme disease
B. Serologic testing will be positive within 48 hours of symptom onset
C. The rash alone is insufficient to diagnose Lyme disease without laboratory confirmation
D. Blood testing is only reliable 4 to 6 weeks after the tick bite because antibodies take time
to develop
Correct Answer: D
Rationale: Correct because serologic blood tests for Lyme disease rely on antibody detection,
which requires 4 to 6 weeks after the initial tick bite to develop reliable titers, making early
testing potentially false-negative. PCR testing is incorrect because it is not the standard
immediate diagnostic method and has limited availability. Serologic testing within 48 hours is
incorrect because antibodies have not yet formed in sufficient quantities. Relying solely on rash
is incorrect because erythema migrans is a clinical hallmark that actually permits empiric
treatment without laboratory confirmation in endemic areas.
Q6: A patient with sepsis develops oozing from the intravenous catheter site, petechiae on the
upper extremities, and a dropping platelet count. The nurse suspects disseminated intravascular
coagulation. Which laboratory finding best supports this diagnosis?
A. Elevated hematocrit and hemoglobin levels
B. Elevated D-dimer with low fibrinogen and thrombocytopenia
C. Prolonged activated partial thromboplastin time with normal platelet count
D. Elevated international normalized ratio with elevated platelet count
Correct Answer: B
Rationale: Correct because DIC is characterized by widespread activation of coagulation leading
to consumption of platelets and clotting factors, resulting in elevated D-dimer from fibrin
degradation, low fibrinogen from consumption, and thrombocytopenia. Elevated hematocrit is
incorrect because DIC causes bleeding and hemodilution from fluid resuscitation, not
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 with acute lymphoblastic leukemia begins initial chemotherapy. Six hours after the
first infusion, the nurse reviews the laboratory results. Which finding requires the most
immediate intervention?
A. Serum phosphate 4.5 mg/dL
B. Serum potassium 6.8 mEq/L
C. Serum uric acid 8.2 mg/dL
D. Serum calcium 8.8 mg/dL
Correct Answer: B
Rationale: Correct because hyperkalemia is the most immediately life-threatening electrolyte
imbalance in tumor lysis syndrome due to its potential to cause fatal cardiac arrhythmias, and
levels exceeding 6.5 mEq/L require urgent intervention with calcium gluconate and cardiac
monitoring. Elevated uric acid and phosphate are incorrect as priority interventions because,
while serious, they do not pose an immediate risk of cardiac arrest. Hypocalcemia is incorrect
because it typically manifests secondary to hyperphosphatemia and is treated only if
symptomatic or in conjunction with severe hyperkalemia.
Q2: A patient with AIDS presents to the emergency department with a productive cough, night
sweats, and fever. The CD4+ count is 120 cells/mm³. Which nursing action is the priority?
A. Initiate Airborne Precautions and place the patient in a negative pressure room
B. Begin Contact Precautions for Cryptosporidiosis
C. Administer trimethoprim-sulfamethoxazole prophylaxis
D. Prepare for immediate bronchoscopy
Correct Answer: A
,Rationale: Correct because a patient with AIDS, productive cough, night sweats, and fever must
be placed under Airborne Precautions in a negative pressure room until tuberculosis is ruled out,
as TB is a highly contagious and lethal opportunistic infection in immunocompromised patients.
Contact isolation for cryptosporidiosis is incorrect because the presentation is respiratory, not
diarrheal. Initiating PJP prophylaxis is incorrect because the patient already has active symptoms
requiring diagnostic workup rather than prophylaxis.
Q3: A mass casualty incident occurs at a local factory. The triage nurse assesses multiple victims.
Which patients would be classified as Red (Emergent/Immediate)? Select all that apply.
A. A patient with a stable ankle fracture and no other injuries
B. A patient with a tension pneumothorax and tracheal deviation to the right
C. A patient with a minor laceration who is fully oriented and ambulatory
D. A patient in hemorrhagic shock with a weak, thready pulse
E. A patient with an obstructed airway requiring immediate intubation
F. A patient with full-thickness burns covering 95% of total body surface area
Correct Answer(s): B, D, E
Rationale: Correct because tension pneumothorax with tracheal deviation, hemorrhagic shock,
and airway obstruction are all immediately life-threatening conditions that require emergent
intervention to prevent death within minutes. Stable ankle fracture and minor laceration are
incorrect because these represent minor or delayed injuries that can wait for treatment. Burns
exceeding 90% TBSA are incorrect because they are classified as Black/Expectant due to
unsurvivable injuries in a mass casualty setting where resources must be allocated to salvageable
patients.
Q4: A patient with systemic lupus erythematosus calls the clinic reporting a new facial rash, joint
swelling in both knees, and foamy urine for the past three days. Which instruction from the nurse
is most appropriate?
A. Increase the daily dose of ibuprofen until the rash resolves
B. Apply topical hydrocortisone cream to the joints and face
C. Come to the clinic today for a urinalysis and provider evaluation
D. Avoid all sun exposure and monitor symptoms for two weeks
Correct Answer: C
Rationale: Correct because foamy urine indicates proteinuria, which is a sign of lupus nephritis
and active disease flare requiring immediate evaluation, urinalysis, and possible adjustment of
, immunosuppressive therapy. Increasing ibuprofen is incorrect because NSAIDs can worsen renal
function and do not address potential nephritis. Topical hydrocortisone is incorrect because it
treats superficial skin manifestations but not systemic organ involvement. Delaying evaluation
for two weeks is incorrect because lupus nephritis can rapidly progress to renal failure without
prompt intervention.
Q5: A hiker presents with an expanding erythematous rash with central clearing on the left thigh,
fever, and joint pain. The patient reports removing a tick two weeks ago. Which statement by the
nurse is most accurate regarding diagnostic testing?
A. A polymerase chain reaction test is immediately sensitive and specific for Lyme disease
B. Serologic testing will be positive within 48 hours of symptom onset
C. The rash alone is insufficient to diagnose Lyme disease without laboratory confirmation
D. Blood testing is only reliable 4 to 6 weeks after the tick bite because antibodies take time
to develop
Correct Answer: D
Rationale: Correct because serologic blood tests for Lyme disease rely on antibody detection,
which requires 4 to 6 weeks after the initial tick bite to develop reliable titers, making early
testing potentially false-negative. PCR testing is incorrect because it is not the standard
immediate diagnostic method and has limited availability. Serologic testing within 48 hours is
incorrect because antibodies have not yet formed in sufficient quantities. Relying solely on rash
is incorrect because erythema migrans is a clinical hallmark that actually permits empiric
treatment without laboratory confirmation in endemic areas.
Q6: A patient with sepsis develops oozing from the intravenous catheter site, petechiae on the
upper extremities, and a dropping platelet count. The nurse suspects disseminated intravascular
coagulation. Which laboratory finding best supports this diagnosis?
A. Elevated hematocrit and hemoglobin levels
B. Elevated D-dimer with low fibrinogen and thrombocytopenia
C. Prolonged activated partial thromboplastin time with normal platelet count
D. Elevated international normalized ratio with elevated platelet count
Correct Answer: B
Rationale: Correct because DIC is characterized by widespread activation of coagulation leading
to consumption of platelets and clotting factors, resulting in elevated D-dimer from fibrin
degradation, low fibrinogen from consumption, and thrombocytopenia. Elevated hematocrit is
incorrect because DIC causes bleeding and hemodilution from fluid resuscitation, not
