Advanced Medical-Surgical Nursing Final Exam Prep 2026
|Galen College UPDATED ACTUAL Questions and CORRECT
Answers
1. A patient with a major burn injury is in the emergent phase. Which laboratory
value should the nurse expect to find?
A. Hypokalemia
B. Hyperkalemia
C. Hypernatremia
D. Decreased Hematocrit
Answer: B
Rationale: In the emergent phase of a burn, massive cell destruction releases potassium
into the extracellular fluid, leading to hyperkalemia.
2. Which assessment finding is most characteristic of the compensatory stage of
shock?
A. Cold, clammy skin
B. Anuria
C. Lethargy and confusion
D. Heart rate of 115 bpm
Answer: D
Rationale: In the compensatory stage, the body activates the sympathetic nervous system,
leading to tachycardia and increased respiratory rate to maintain cardiac output.
,3. A patient is admitted with Acute Respiratory Distress Syndrome (ARDS).
Which ventilator setting is specifically designed to keep the alveoli open at the
end of expiration?
A. Tidal Volume
B. Fraction of Inspired Oxygen (FiO2)
C. Inspiratory Rate
D. Positive End-Expiratory Pressure (PEEP)
Answer: D
Rationale: PEEP provides positive pressure at the end of expiration to prevent alveolar
collapse and improve oxygenation in ARDS.
4. A nurse is caring for a patient with a Mean Arterial Pressure (MAP) of 55
mmHg. What is the priority intervention?
A. Decrease the IV fluid rate
B. Notify the provider and prepare for vasopressors
C. Check the patient’s temperature
D. Assess for bowel sounds
Answer: B
Rationale: A MAP below 60-65 mmHg indicates inadequate organ perfusion. Interventions
like fluid resuscitation or vasopressors are required immediately.
5. Which rhythm is characterized by a ‘sawtooth’ pattern on an ECG?
A. Atrial Fibrillation
B. Ventricular Tachycardia
C. Sinus Bradycardia
D. Atrial Flutter
Answer: D
Rationale: Atrial flutter is recognized by rapid, regular sawtooth-shaped waves (F-waves).
,6. A patient with chronic kidney disease (CKD) has a potassium level of 6.8
mEq/L. Which medication should the nurse expect to administer first to protect
the heart?
A. Calcium Gluconate
B. Sodium Polystyrene Sulfonate
C. Insulin and D50W
D. Furosemide
Answer: A
Rationale: While other meds lower potassium, Calcium Gluconate is administered first to
stabilize the myocardial cell membrane and prevent lethal dysrhythmias.
7. A patient is experiencing Autonomic Dysreflexia. Which is the first action the
nurse should take?
A. Raise the head of the bed to a high-Fowler’s position
B. Check for a full bladder or fecal impaction
C. Administer antihypertensive medication
D. Call a Rapid Response Team
Answer: A
Rationale: The first action is to sit the patient up to utilize orthostatic pressure to help
lower the blood pressure before looking for the cause.
8. What is a classic sign of Neurogenic Shock following a spinal cord injury?
A. Tachycardia and Hypertension
B. Bradycardia and Hypotension
C. Fever and Chills
D. Tachypnea and Diaphoresis
Answer: B
Rationale: Neurogenic shock results in the loss of sympathetic tone, leading to the unique
combination of bradycardia and hypotension.
, 9. A patient with Acute Pancreatitis has a positive Cullen’s sign. This indicates:
A. Intra-abdominal hemorrhage
B. Hypocalcemia
C. Biliary obstruction
D. Pancreatic pseudocyst
Answer: A
Rationale: Cullen’s sign is bluish discoloration around the umbilicus, signifying
retroperitoneal or intra-abdominal bleeding.
10. When assessing a patient with a chest tube, the nurse notes continuous
bubbling in the water-seal chamber. This indicates:
A. Normal functioning
B. The lung has fully re-expanded
C. Suction is set too high
D. An air leak in the system
Answer: D
Rationale: Intermittent bubbling is normal in a patient with a pneumothorax, but
continuous bubbling indicates a leak in the drainage system.
11. Which Glasgow Coma Scale (GCS) score would indicate a patient is in a coma
and requires intubation?
A. 15
B. 8
C. 12
D. 10
Answer: B
Rationale: A GCS score of 8 or less is generally the threshold for indicating a coma and the
need for airway protection.
|Galen College UPDATED ACTUAL Questions and CORRECT
Answers
1. A patient with a major burn injury is in the emergent phase. Which laboratory
value should the nurse expect to find?
A. Hypokalemia
B. Hyperkalemia
C. Hypernatremia
D. Decreased Hematocrit
Answer: B
Rationale: In the emergent phase of a burn, massive cell destruction releases potassium
into the extracellular fluid, leading to hyperkalemia.
2. Which assessment finding is most characteristic of the compensatory stage of
shock?
A. Cold, clammy skin
B. Anuria
C. Lethargy and confusion
D. Heart rate of 115 bpm
Answer: D
Rationale: In the compensatory stage, the body activates the sympathetic nervous system,
leading to tachycardia and increased respiratory rate to maintain cardiac output.
,3. A patient is admitted with Acute Respiratory Distress Syndrome (ARDS).
Which ventilator setting is specifically designed to keep the alveoli open at the
end of expiration?
A. Tidal Volume
B. Fraction of Inspired Oxygen (FiO2)
C. Inspiratory Rate
D. Positive End-Expiratory Pressure (PEEP)
Answer: D
Rationale: PEEP provides positive pressure at the end of expiration to prevent alveolar
collapse and improve oxygenation in ARDS.
4. A nurse is caring for a patient with a Mean Arterial Pressure (MAP) of 55
mmHg. What is the priority intervention?
A. Decrease the IV fluid rate
B. Notify the provider and prepare for vasopressors
C. Check the patient’s temperature
D. Assess for bowel sounds
Answer: B
Rationale: A MAP below 60-65 mmHg indicates inadequate organ perfusion. Interventions
like fluid resuscitation or vasopressors are required immediately.
5. Which rhythm is characterized by a ‘sawtooth’ pattern on an ECG?
A. Atrial Fibrillation
B. Ventricular Tachycardia
C. Sinus Bradycardia
D. Atrial Flutter
Answer: D
Rationale: Atrial flutter is recognized by rapid, regular sawtooth-shaped waves (F-waves).
,6. A patient with chronic kidney disease (CKD) has a potassium level of 6.8
mEq/L. Which medication should the nurse expect to administer first to protect
the heart?
A. Calcium Gluconate
B. Sodium Polystyrene Sulfonate
C. Insulin and D50W
D. Furosemide
Answer: A
Rationale: While other meds lower potassium, Calcium Gluconate is administered first to
stabilize the myocardial cell membrane and prevent lethal dysrhythmias.
7. A patient is experiencing Autonomic Dysreflexia. Which is the first action the
nurse should take?
A. Raise the head of the bed to a high-Fowler’s position
B. Check for a full bladder or fecal impaction
C. Administer antihypertensive medication
D. Call a Rapid Response Team
Answer: A
Rationale: The first action is to sit the patient up to utilize orthostatic pressure to help
lower the blood pressure before looking for the cause.
8. What is a classic sign of Neurogenic Shock following a spinal cord injury?
A. Tachycardia and Hypertension
B. Bradycardia and Hypotension
C. Fever and Chills
D. Tachypnea and Diaphoresis
Answer: B
Rationale: Neurogenic shock results in the loss of sympathetic tone, leading to the unique
combination of bradycardia and hypotension.
, 9. A patient with Acute Pancreatitis has a positive Cullen’s sign. This indicates:
A. Intra-abdominal hemorrhage
B. Hypocalcemia
C. Biliary obstruction
D. Pancreatic pseudocyst
Answer: A
Rationale: Cullen’s sign is bluish discoloration around the umbilicus, signifying
retroperitoneal or intra-abdominal bleeding.
10. When assessing a patient with a chest tube, the nurse notes continuous
bubbling in the water-seal chamber. This indicates:
A. Normal functioning
B. The lung has fully re-expanded
C. Suction is set too high
D. An air leak in the system
Answer: D
Rationale: Intermittent bubbling is normal in a patient with a pneumothorax, but
continuous bubbling indicates a leak in the drainage system.
11. Which Glasgow Coma Scale (GCS) score would indicate a patient is in a coma
and requires intubation?
A. 15
B. 8
C. 12
D. 10
Answer: B
Rationale: A GCS score of 8 or less is generally the threshold for indicating a coma and the
need for airway protection.
