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 nurse is providing community education on Lyme disease prevention in an endemic area.
Which statement by the nurse is correct?
A. Apply DEET insect repellent at 50% concentration for optimal protection
B. Burn attached ticks with a match to facilitate removal
C. Wear dark-colored clothing to make ticks more visible
D. Tuck pants into boots when hiking in wooded or grassy areas
Correct Answer: D
Rationale: Correct because tucking pants into boots creates a physical barrier that prevents ticks
from accessing the skin, which is a primary prevention strategy for Lyme disease. Dark clothing
actually makes ticks harder to spot, and DEET should be used at 20–30% concentration, not
50%. Burning ticks with a match is contraindicated because it can cause the tick to regurgitate
infectious organisms into the bite wound.
Q2: A patient with newly diagnosed HIV infection has a CD4+ T-cell count of 180 cells/mm³.
Which clinical implication is most appropriate for the nurse to consider?
A. The patient requires prophylaxis for Mycobacterium avium complex
B. The patient is at risk for Pneumocystis jirovecii pneumonia and requires TMP-SMX
prophylaxis
C. The patient meets the immunological criteria for an AIDS diagnosis
D. The patient has a normal CD4+ count and requires no immediate intervention
Correct Answer: C
Rationale: Correct because an AIDS diagnosis is established when the CD4+ T-cell count falls
below 200 cells/mm³, which significantly increases susceptibility to opportunistic infections.
While PJP prophylaxis with TMP-SMX is indeed indicated at this threshold, the question focuses
on the diagnostic implication of the CD4+ count itself. MAC prophylaxis is initiated when CD4+
,drops below 50 cells/mm³, and a count of 180 is not within the normal range of 500–1,500
cells/mm³.
Q3: A patient with systemic lupus erythematosus is being evaluated in the clinic. Which finding
indicates an active disease flare?
A. Resolution of previous malar rash and stable joint function
B. New-onset malar rash, bilateral knee arthritis, and 2+ proteinuria on urinalysis
C. Blood pressure of 118/76 mmHg and absence of oral ulcers
D. Improved energy levels and normal complement levels
Correct Answer: B
Rationale: Correct because a malar rash, arthritis, and proteinuria are hallmark clinical
indicators of an active SLE flare involving the skin, joints, and kidneys. The nurse must
recognize these manifestations promptly to initiate appropriate immunosuppressive therapy and
prevent progressive organ damage. Resolution of symptoms, normal blood pressure, and
improved energy levels are consistent with disease remission rather than active flare.
Q4: A patient with acute lymphoblastic leukemia is beginning induction chemotherapy. The
nurse monitors for tumor lysis syndrome. Which laboratory findings are consistent with this
oncologic emergency? Select all that apply.
A. Hypokalemia
B. Hyperuricemia
C. Hypophosphatemia
D. Hypercalcemia
E. Hyperkalemia
Correct Answer(s): B, E
Rationale: Correct because tumor lysis syndrome results from rapid malignant cell destruction
that releases intracellular potassium and uric acid into the bloodstream, producing hyperkalemia
and hyperuricemia. Hyperkalemia places the patient at immediate risk for fatal cardiac
arrhythmias, while hyperuricemia can precipitate in renal tubules and cause acute kidney injury.
Hypophosphatemia and hypercalcemia are incorrect because TLS causes hyperphosphatemia and
secondary hypocalcemia due to calcium-phosphate binding.
Q5: A post-operative liver transplant patient had a urine output of 65 mL/hr for the first 8 hours.
On hour 10, the urine output drops to 45 mL/hr, and the nurse notes a slight increase in bilirubin.
Which action is the priority?
, A. Report the findings to the transplant team immediately
B. Document the findings and continue routine monitoring
C. Administer a diuretic to increase urine output
D. Decrease immunosuppressant dosing to improve renal perfusion
Correct Answer: A
Rationale: Correct because a sudden drop in urine output combined with rising bilirubin in a
post-operative liver transplant patient are early warning signs of acute rejection or hepatic artery
thrombosis, requiring immediate provider notification. The transplanted liver is highly
vulnerable to ischemic injury and immunological attack during the immediate post-operative
period. Delayed reporting or independent medication adjustments could result in irreversible
graft loss.
Q6: During a mass casualty incident, emergency medical services bring multiple patients to the
triage area. Which patient should be assigned the Black triage category?
A. A conscious patient with a stable femur fracture and intact distal pulses
B. A patient with partial-thickness burns covering 20% TBSA without airway involvement
C. A patient with a sprained ankle who is ambulatory and alert
D. A patient with decapitation and no spontaneous respirations
Correct Answer: D
Rationale: Correct because the Black category designates expectant or deceased patients with
unsurvivable injuries such as decapitation, major trauma with agonal breathing, or severe burns
exceeding 90% TBSA. Triage protocols prioritize limited resources toward patients who have
life-threatening but survivable conditions. Assigning the Black category allows responders to
direct critical interventions to Red and Yellow category patients who will benefit from immediate
care.
Q7: A patient with HIV/AIDS presents with a dry, nonproductive cough, fever of 101.8°F,
dyspnea on exertion, and an oxygen saturation of 89% on room air. The CD4+ count is 160
cells/mm³. Which condition should the nurse suspect?
A. Tuberculosis with Airborne Precautions required indefinitely
B. Disseminated Mycobacterium avium complex infection
C. Pneumocystis jirovecii pneumonia
D. Cryptosporidiosis with pulmonary involvement
Correct Answer: C
Rationale: Correct because Pneumocystis jirovecii pneumonia is the most common
opportunistic infection in patients with CD4+ counts below 200 cells/mm³, presenting with
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 nurse is providing community education on Lyme disease prevention in an endemic area.
Which statement by the nurse is correct?
A. Apply DEET insect repellent at 50% concentration for optimal protection
B. Burn attached ticks with a match to facilitate removal
C. Wear dark-colored clothing to make ticks more visible
D. Tuck pants into boots when hiking in wooded or grassy areas
Correct Answer: D
Rationale: Correct because tucking pants into boots creates a physical barrier that prevents ticks
from accessing the skin, which is a primary prevention strategy for Lyme disease. Dark clothing
actually makes ticks harder to spot, and DEET should be used at 20–30% concentration, not
50%. Burning ticks with a match is contraindicated because it can cause the tick to regurgitate
infectious organisms into the bite wound.
Q2: A patient with newly diagnosed HIV infection has a CD4+ T-cell count of 180 cells/mm³.
Which clinical implication is most appropriate for the nurse to consider?
A. The patient requires prophylaxis for Mycobacterium avium complex
B. The patient is at risk for Pneumocystis jirovecii pneumonia and requires TMP-SMX
prophylaxis
C. The patient meets the immunological criteria for an AIDS diagnosis
D. The patient has a normal CD4+ count and requires no immediate intervention
Correct Answer: C
Rationale: Correct because an AIDS diagnosis is established when the CD4+ T-cell count falls
below 200 cells/mm³, which significantly increases susceptibility to opportunistic infections.
While PJP prophylaxis with TMP-SMX is indeed indicated at this threshold, the question focuses
on the diagnostic implication of the CD4+ count itself. MAC prophylaxis is initiated when CD4+
,drops below 50 cells/mm³, and a count of 180 is not within the normal range of 500–1,500
cells/mm³.
Q3: A patient with systemic lupus erythematosus is being evaluated in the clinic. Which finding
indicates an active disease flare?
A. Resolution of previous malar rash and stable joint function
B. New-onset malar rash, bilateral knee arthritis, and 2+ proteinuria on urinalysis
C. Blood pressure of 118/76 mmHg and absence of oral ulcers
D. Improved energy levels and normal complement levels
Correct Answer: B
Rationale: Correct because a malar rash, arthritis, and proteinuria are hallmark clinical
indicators of an active SLE flare involving the skin, joints, and kidneys. The nurse must
recognize these manifestations promptly to initiate appropriate immunosuppressive therapy and
prevent progressive organ damage. Resolution of symptoms, normal blood pressure, and
improved energy levels are consistent with disease remission rather than active flare.
Q4: A patient with acute lymphoblastic leukemia is beginning induction chemotherapy. The
nurse monitors for tumor lysis syndrome. Which laboratory findings are consistent with this
oncologic emergency? Select all that apply.
A. Hypokalemia
B. Hyperuricemia
C. Hypophosphatemia
D. Hypercalcemia
E. Hyperkalemia
Correct Answer(s): B, E
Rationale: Correct because tumor lysis syndrome results from rapid malignant cell destruction
that releases intracellular potassium and uric acid into the bloodstream, producing hyperkalemia
and hyperuricemia. Hyperkalemia places the patient at immediate risk for fatal cardiac
arrhythmias, while hyperuricemia can precipitate in renal tubules and cause acute kidney injury.
Hypophosphatemia and hypercalcemia are incorrect because TLS causes hyperphosphatemia and
secondary hypocalcemia due to calcium-phosphate binding.
Q5: A post-operative liver transplant patient had a urine output of 65 mL/hr for the first 8 hours.
On hour 10, the urine output drops to 45 mL/hr, and the nurse notes a slight increase in bilirubin.
Which action is the priority?
, A. Report the findings to the transplant team immediately
B. Document the findings and continue routine monitoring
C. Administer a diuretic to increase urine output
D. Decrease immunosuppressant dosing to improve renal perfusion
Correct Answer: A
Rationale: Correct because a sudden drop in urine output combined with rising bilirubin in a
post-operative liver transplant patient are early warning signs of acute rejection or hepatic artery
thrombosis, requiring immediate provider notification. The transplanted liver is highly
vulnerable to ischemic injury and immunological attack during the immediate post-operative
period. Delayed reporting or independent medication adjustments could result in irreversible
graft loss.
Q6: During a mass casualty incident, emergency medical services bring multiple patients to the
triage area. Which patient should be assigned the Black triage category?
A. A conscious patient with a stable femur fracture and intact distal pulses
B. A patient with partial-thickness burns covering 20% TBSA without airway involvement
C. A patient with a sprained ankle who is ambulatory and alert
D. A patient with decapitation and no spontaneous respirations
Correct Answer: D
Rationale: Correct because the Black category designates expectant or deceased patients with
unsurvivable injuries such as decapitation, major trauma with agonal breathing, or severe burns
exceeding 90% TBSA. Triage protocols prioritize limited resources toward patients who have
life-threatening but survivable conditions. Assigning the Black category allows responders to
direct critical interventions to Red and Yellow category patients who will benefit from immediate
care.
Q7: A patient with HIV/AIDS presents with a dry, nonproductive cough, fever of 101.8°F,
dyspnea on exertion, and an oxygen saturation of 89% on room air. The CD4+ count is 160
cells/mm³. Which condition should the nurse suspect?
A. Tuberculosis with Airborne Precautions required indefinitely
B. Disseminated Mycobacterium avium complex infection
C. Pneumocystis jirovecii pneumonia
D. Cryptosporidiosis with pulmonary involvement
Correct Answer: C
Rationale: Correct because Pneumocystis jirovecii pneumonia is the most common
opportunistic infection in patients with CD4+ counts below 200 cells/mm³, presenting with
