NUR 265 Exam 2 Practice Advanced Concepts In
Medical-Surgical Nursing 2026–2027 Questions And
Answers Verified Study Solutions
1. The nurse is caring for a client who has acute respiratory distress syndrome
(ARDS) and is receiving mechanical ventilation. Which finding indicates to the nurse
that positive end-expiratory pressure (PEEP) has been effective?
A. The client's respiratory rate has decreased from 28 to 24 breaths/min.
B. The client's PaO₂ has improved from 55 mm Hg to 88 mm Hg.
C. The client has developed subcutaneous emphysema around the neck and chest.
D. The client's peak inspiratory pressure has increased by 10 cm H₂O.
Correct Answer: B
Expert Rationale: The primary purpose of PEEP is to prevent alveolar collapse during
expiration, thereby improving oxygenation. The most direct indicator of PEEP
effectiveness is an improvement in arterial oxygenation, reflected by an increased PaO₂.
While a decreased respiratory rate may occur, it is not the most reliable indicator of
PEEP efficacy. Subcutaneous emphysema (Option C) and rising peak inspiratory
pressures (Option D) are complications of positive-pressure ventilation (barotrauma),
not indicators of successful therapy.
2. A client with ARDS is being treated with mechanical ventilation and high levels of
PEEP. Which finding obtained by the nurse indicates that a complication of ventilator
therapy is occurring?
A. The client has a sinus bradycardia with a rate of 52 beats/min.
B. The client's PaO₂ is 50 mm Hg and the SaO₂ is 88%.
C. The client has subcutaneous emphysema.
D. The client has bronchial breath sounds in both lung fields.
Correct Answer: C
Expert Rationale: Subcutaneous emphysema is a recognized complication of positive-
pressure ventilation and high PEEP, indicating barotrauma (air leak from the alveoli into
the subcutaneous tissues). While a PaO₂ of 50 mm Hg and SaO₂ of 88% indicate poor
,oxygenation, these are expected findings in ARDS before adequate PEEP is applied, not
a complication of the ventilator itself. Bradycardia and bronchial breath sounds are not
direct complications of PEEP.
3. The nurse is caring for a client with ARDS who is receiving oxygen by
nonrebreather mask. Arterial blood gas results still reveal poor oxygenation. Which
action should the nurse anticipate?
A. Begin continuous positive airway pressure (CPAP) via nose and mouth.
B. Perform endotracheal intubation and initiate mechanical ventilation.
C. Administer furosemide 100 mg IV push stat.
D. Call a code for impending respiratory arrest.
Correct Answer: B
Expert Rationale: ARDS is characterized by refractory hypoxemia that does not respond
to supplemental oxygen alone. When a client with ARDS continues to have poor
oxygenation despite high-flow oxygen via nonrebreather mask, the next step is
endotracheal intubation and mechanical ventilation, often with PEEP. CPAP (Option A) is
not appropriate for a client who is already failing on a nonrebreather mask. Furosemide
(Option C) would worsen the hypovolemia often seen in ARDS. A code (Option D) is
unnecessary at this stage if the client is still compensating.
4. When prone positioning is used for a client with ARDS, which finding indicates to
the nurse that the positioning is effective?
A. The skin on the client's back remains intact.
B. Sputum cultures show no bacterial growth after 24 hours.
C. The client's PaO₂ is 90 mm Hg and the SaO₂ is 92%.
D. Endotracheal suctioning results in minimal mucous return.
Correct Answer: C
,Expert Rationale: The primary goal of prone positioning in ARDS is to improve
ventilation-perfusion matching and oxygenation. The most direct evidence of
effectiveness is improvement in oxygenation parameters, specifically PaO₂ and SaO₂.
Skin integrity (Option A) is an important nursing consideration but does not indicate
therapeutic effectiveness. Sputum culture results (Option B) and suctioning returns
(Option D) are unrelated to the mechanism by which prone positioning improves
oxygenation.
5. A nurse is reviewing the plan of care for a client with ARDS. Which statement
about the fibrotic phase of ARDS is most accurate?
A. The fibrotic phase indicates that the client's lungs are healing and recovery is
expected.
B. The fibrotic phase is the initial stage of ARDS and is reversible with prompt treatment.
C. The chance for survival is poor because permanent damage to the alveoli has
occurred.
D. The fibrotic phase is characterized by massive pulmonary edema that responds well
to diuretics.
Correct Answer: C
Expert Rationale: The fibrotic phase of ARDS represents the final stage of the disease
process, characterized by diffuse pulmonary fibrosis and permanent structural damage
to the alveoli. This phase carries a grave prognosis because the lung architecture is
irreversibly altered. It does not indicate healing (Option A), nor is it the initial stage
(Option B). While pulmonary edema occurs in earlier phases, the fibrotic phase involves
scarring, not edema responsive to diuretics (Option D).
6. The nurse is caring for a client who has been diagnosed with ARDS. Which early
clinical manifestation should the nurse expect to find?
A. Cyanosis and apprehension
, B. Hypotension and tachycardia
C. Dyspnea and tachypnea
D. Respiratory distress and frothy pink sputum
Correct Answer: C
Expert Rationale: The earliest clinical manifestations of ARDS are dyspnea and
tachypnea, often occurring 12–24 hours after the initial insult. These reflect the body's
compensatory response to hypoxemia. Cyanosis and apprehension (Option A),
hypotension and tachycardia (Option B), and frothy sputum (Option D) are later findings
that indicate progression of the disease and decompensation.
7. The nurse is reviewing the chest X-ray of a client with ARDS. Which finding is
consistent with this disorder?
A. Unilateral infiltrates in the right lower lobe
B. Hyperinflation of the lungs with flattened diaphragms
C. Bilateral white-out infiltrates
D. A large pleural effusion on the left side
Correct Answer: C
Expert Rationale: ARDS is characterized radiographically by bilateral, diffuse, patchy, or
confluent ("white-out") infiltrates that resemble pulmonary edema. Unilateral infiltrates
(Option A) suggest pneumonia or atelectasis. Hyperinflation (Option B) is seen in COPD.
A large pleural effusion (Option D) is not a characteristic finding of ARDS.
8. The nurse is caring for a client who is on a volume-cycled ventilator. The nurse
understands that this client is at greatest risk for which complication?
A. Hypoventilation
B. Hypercapnia
C. Respiratory acidosis
D. Barotrauma
Medical-Surgical Nursing 2026–2027 Questions And
Answers Verified Study Solutions
1. The nurse is caring for a client who has acute respiratory distress syndrome
(ARDS) and is receiving mechanical ventilation. Which finding indicates to the nurse
that positive end-expiratory pressure (PEEP) has been effective?
A. The client's respiratory rate has decreased from 28 to 24 breaths/min.
B. The client's PaO₂ has improved from 55 mm Hg to 88 mm Hg.
C. The client has developed subcutaneous emphysema around the neck and chest.
D. The client's peak inspiratory pressure has increased by 10 cm H₂O.
Correct Answer: B
Expert Rationale: The primary purpose of PEEP is to prevent alveolar collapse during
expiration, thereby improving oxygenation. The most direct indicator of PEEP
effectiveness is an improvement in arterial oxygenation, reflected by an increased PaO₂.
While a decreased respiratory rate may occur, it is not the most reliable indicator of
PEEP efficacy. Subcutaneous emphysema (Option C) and rising peak inspiratory
pressures (Option D) are complications of positive-pressure ventilation (barotrauma),
not indicators of successful therapy.
2. A client with ARDS is being treated with mechanical ventilation and high levels of
PEEP. Which finding obtained by the nurse indicates that a complication of ventilator
therapy is occurring?
A. The client has a sinus bradycardia with a rate of 52 beats/min.
B. The client's PaO₂ is 50 mm Hg and the SaO₂ is 88%.
C. The client has subcutaneous emphysema.
D. The client has bronchial breath sounds in both lung fields.
Correct Answer: C
Expert Rationale: Subcutaneous emphysema is a recognized complication of positive-
pressure ventilation and high PEEP, indicating barotrauma (air leak from the alveoli into
the subcutaneous tissues). While a PaO₂ of 50 mm Hg and SaO₂ of 88% indicate poor
,oxygenation, these are expected findings in ARDS before adequate PEEP is applied, not
a complication of the ventilator itself. Bradycardia and bronchial breath sounds are not
direct complications of PEEP.
3. The nurse is caring for a client with ARDS who is receiving oxygen by
nonrebreather mask. Arterial blood gas results still reveal poor oxygenation. Which
action should the nurse anticipate?
A. Begin continuous positive airway pressure (CPAP) via nose and mouth.
B. Perform endotracheal intubation and initiate mechanical ventilation.
C. Administer furosemide 100 mg IV push stat.
D. Call a code for impending respiratory arrest.
Correct Answer: B
Expert Rationale: ARDS is characterized by refractory hypoxemia that does not respond
to supplemental oxygen alone. When a client with ARDS continues to have poor
oxygenation despite high-flow oxygen via nonrebreather mask, the next step is
endotracheal intubation and mechanical ventilation, often with PEEP. CPAP (Option A) is
not appropriate for a client who is already failing on a nonrebreather mask. Furosemide
(Option C) would worsen the hypovolemia often seen in ARDS. A code (Option D) is
unnecessary at this stage if the client is still compensating.
4. When prone positioning is used for a client with ARDS, which finding indicates to
the nurse that the positioning is effective?
A. The skin on the client's back remains intact.
B. Sputum cultures show no bacterial growth after 24 hours.
C. The client's PaO₂ is 90 mm Hg and the SaO₂ is 92%.
D. Endotracheal suctioning results in minimal mucous return.
Correct Answer: C
,Expert Rationale: The primary goal of prone positioning in ARDS is to improve
ventilation-perfusion matching and oxygenation. The most direct evidence of
effectiveness is improvement in oxygenation parameters, specifically PaO₂ and SaO₂.
Skin integrity (Option A) is an important nursing consideration but does not indicate
therapeutic effectiveness. Sputum culture results (Option B) and suctioning returns
(Option D) are unrelated to the mechanism by which prone positioning improves
oxygenation.
5. A nurse is reviewing the plan of care for a client with ARDS. Which statement
about the fibrotic phase of ARDS is most accurate?
A. The fibrotic phase indicates that the client's lungs are healing and recovery is
expected.
B. The fibrotic phase is the initial stage of ARDS and is reversible with prompt treatment.
C. The chance for survival is poor because permanent damage to the alveoli has
occurred.
D. The fibrotic phase is characterized by massive pulmonary edema that responds well
to diuretics.
Correct Answer: C
Expert Rationale: The fibrotic phase of ARDS represents the final stage of the disease
process, characterized by diffuse pulmonary fibrosis and permanent structural damage
to the alveoli. This phase carries a grave prognosis because the lung architecture is
irreversibly altered. It does not indicate healing (Option A), nor is it the initial stage
(Option B). While pulmonary edema occurs in earlier phases, the fibrotic phase involves
scarring, not edema responsive to diuretics (Option D).
6. The nurse is caring for a client who has been diagnosed with ARDS. Which early
clinical manifestation should the nurse expect to find?
A. Cyanosis and apprehension
, B. Hypotension and tachycardia
C. Dyspnea and tachypnea
D. Respiratory distress and frothy pink sputum
Correct Answer: C
Expert Rationale: The earliest clinical manifestations of ARDS are dyspnea and
tachypnea, often occurring 12–24 hours after the initial insult. These reflect the body's
compensatory response to hypoxemia. Cyanosis and apprehension (Option A),
hypotension and tachycardia (Option B), and frothy sputum (Option D) are later findings
that indicate progression of the disease and decompensation.
7. The nurse is reviewing the chest X-ray of a client with ARDS. Which finding is
consistent with this disorder?
A. Unilateral infiltrates in the right lower lobe
B. Hyperinflation of the lungs with flattened diaphragms
C. Bilateral white-out infiltrates
D. A large pleural effusion on the left side
Correct Answer: C
Expert Rationale: ARDS is characterized radiographically by bilateral, diffuse, patchy, or
confluent ("white-out") infiltrates that resemble pulmonary edema. Unilateral infiltrates
(Option A) suggest pneumonia or atelectasis. Hyperinflation (Option B) is seen in COPD.
A large pleural effusion (Option D) is not a characteristic finding of ARDS.
8. The nurse is caring for a client who is on a volume-cycled ventilator. The nurse
understands that this client is at greatest risk for which complication?
A. Hypoventilation
B. Hypercapnia
C. Respiratory acidosis
D. Barotrauma
