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GALEN NUR 265 EXAM 3 – MEDICAL-SURGICAL
NURSING QUESTIONS AND VERIFIED ANSWERS WITH
RATIONALES JUST RELEASED
# GALEN NUR 265 EXAM 3 – MEDICAL-SURGICAL NURSING
EXAM COVERAGE AREAS (MOST TESTED)
1. Neurological Disorders – Traumatic brain injury, increased ICP, Cushing's triad, GCS, spinal cord injury,
autonomic dysreflexia, meningitis, stroke, seizures
2. Respiratory Disorders – ARDS, COPD, chest tubes, pneumonia, TB, mechanical ventilation
3. Cardiovascular Disorders – Heart failure, MI, dysrhythmias, pericarditis, endocarditis, DVT/PE
4. Renal Disorders – AKI, CKD, dialysis, electrolyte management
5. GI & Hepatic Disorders – Esophageal varices, pancreatitis, cirrhosis, hepatic encephalopathy,
ulcerative colitis, Crohn's disease
6. Burn Injury & Shock – Rule of Nines, Parkland formula, emergent phase, burn shock, sepsis
7. Musculoskeletal & Integumentary – Fractures, pressure injuries, wound care
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8. Endocrine Disorders – Diabetes insipidus, SIADH, Cushing's disease, myasthenia gravis, Parkinson's
disease
9. Multisystem Trauma & Emergencies – Triage, mass casualty, shock states
10. Pain Management & Critical Care – Pain assessment, sedation, ventilator management
1. A client with a traumatic brain injury has a Glasgow Coma Scale (GCS) score of 6. Which nursing action
is the priority for this client based on their GCS score?
A) Obtain a CT scan of the head to evaluate for any intracranial bleeding
B) Prepare for immediate intubation and mechanical ventilation to protect the airway
C) Administer hypertonic saline to reduce intracranial pressure effectively
D) Place the client in a dark, quiet room to minimize stimulation and agitation
Answer: B - A GCS of 8 or less indicates a severe brain injury with an inability to protect the airway.
Securing the airway via intubation is the priority per the ABCs (Airway, Breathing, Circulation) to prevent
hypoxia and secondary brain injury .
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2. A client with a C5 spinal cord injury develops a severe headache, hypertension (BP 210/110 mm Hg),
and bradycardia. What condition is suspected, and what is the priority nursing action?
A) Orthostatic hypotension; place the client in Trendelenburg position
B) Autonomic dysreflexia; sit the client upright and check for bladder distention
C) Pulmonary embolism; administer oxygen and prepare for anticoagulation
D) Neurogenic shock; administer IV fluids and vasopressors immediately
Answer: B - Autonomic dysreflexia occurs in spinal cord injuries at T6 or above due to an unopposed
sympathetic response to noxious stimuli (e.g., full bladder, fecal impaction). Symptoms include severe
hypertension, bradycardia, headache, and flushing above the lesion. The priority is to sit the client
upright and check for bladder distention or bowel impaction .
3. A client with a fractured femur suddenly becomes dyspneic, tachycardic, and hypoxic 48 hours after
the injury. What is the most likely cause of these symptoms?
A) Pulmonary embolism from a deep vein thrombosis
B) Fat embolism syndrome causing acute respiratory distress
C) Acute myocardial infarction from stress on the heart
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D) Pneumothorax from a rib fracture during the initial trauma
Answer: B - Fat embolism syndrome typically occurs 24-72 hours after long bone fractures (especially
femur fractures). The classic triad includes respiratory distress, petechiae, and mental status changes.
Hypoxia and tachycardia are early signs .
4. A client in septic shock has a MAP of 58 mm Hg despite adequate fluid resuscitation. Which
vasopressor is the first-line treatment according to the Surviving Sepsis Guidelines?
A) Dopamine infusion to increase cardiac output
B) Norepinephrine to achieve a MAP of 65 mm Hg or greater
C) Epinephrine for its potent vasoconstrictive effects
D) Phenylephrine as a pure alpha-agonist vasopressor
Answer: B - Norepinephrine is the first-line vasopressor in septic shock to achieve a MAP of 65 mm Hg or
greater. It primarily causes vasoconstriction with minimal cardiac stimulation. Dopamine is less
preferred due to arrhythmia risk .
GALEN NUR 265 EXAM 3 – MEDICAL-SURGICAL
NURSING QUESTIONS AND VERIFIED ANSWERS WITH
RATIONALES JUST RELEASED
# GALEN NUR 265 EXAM 3 – MEDICAL-SURGICAL NURSING
EXAM COVERAGE AREAS (MOST TESTED)
1. Neurological Disorders – Traumatic brain injury, increased ICP, Cushing's triad, GCS, spinal cord injury,
autonomic dysreflexia, meningitis, stroke, seizures
2. Respiratory Disorders – ARDS, COPD, chest tubes, pneumonia, TB, mechanical ventilation
3. Cardiovascular Disorders – Heart failure, MI, dysrhythmias, pericarditis, endocarditis, DVT/PE
4. Renal Disorders – AKI, CKD, dialysis, electrolyte management
5. GI & Hepatic Disorders – Esophageal varices, pancreatitis, cirrhosis, hepatic encephalopathy,
ulcerative colitis, Crohn's disease
6. Burn Injury & Shock – Rule of Nines, Parkland formula, emergent phase, burn shock, sepsis
7. Musculoskeletal & Integumentary – Fractures, pressure injuries, wound care
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8. Endocrine Disorders – Diabetes insipidus, SIADH, Cushing's disease, myasthenia gravis, Parkinson's
disease
9. Multisystem Trauma & Emergencies – Triage, mass casualty, shock states
10. Pain Management & Critical Care – Pain assessment, sedation, ventilator management
1. A client with a traumatic brain injury has a Glasgow Coma Scale (GCS) score of 6. Which nursing action
is the priority for this client based on their GCS score?
A) Obtain a CT scan of the head to evaluate for any intracranial bleeding
B) Prepare for immediate intubation and mechanical ventilation to protect the airway
C) Administer hypertonic saline to reduce intracranial pressure effectively
D) Place the client in a dark, quiet room to minimize stimulation and agitation
Answer: B - A GCS of 8 or less indicates a severe brain injury with an inability to protect the airway.
Securing the airway via intubation is the priority per the ABCs (Airway, Breathing, Circulation) to prevent
hypoxia and secondary brain injury .
, Page 3 of 153
2. A client with a C5 spinal cord injury develops a severe headache, hypertension (BP 210/110 mm Hg),
and bradycardia. What condition is suspected, and what is the priority nursing action?
A) Orthostatic hypotension; place the client in Trendelenburg position
B) Autonomic dysreflexia; sit the client upright and check for bladder distention
C) Pulmonary embolism; administer oxygen and prepare for anticoagulation
D) Neurogenic shock; administer IV fluids and vasopressors immediately
Answer: B - Autonomic dysreflexia occurs in spinal cord injuries at T6 or above due to an unopposed
sympathetic response to noxious stimuli (e.g., full bladder, fecal impaction). Symptoms include severe
hypertension, bradycardia, headache, and flushing above the lesion. The priority is to sit the client
upright and check for bladder distention or bowel impaction .
3. A client with a fractured femur suddenly becomes dyspneic, tachycardic, and hypoxic 48 hours after
the injury. What is the most likely cause of these symptoms?
A) Pulmonary embolism from a deep vein thrombosis
B) Fat embolism syndrome causing acute respiratory distress
C) Acute myocardial infarction from stress on the heart
, Page 4 of 153
D) Pneumothorax from a rib fracture during the initial trauma
Answer: B - Fat embolism syndrome typically occurs 24-72 hours after long bone fractures (especially
femur fractures). The classic triad includes respiratory distress, petechiae, and mental status changes.
Hypoxia and tachycardia are early signs .
4. A client in septic shock has a MAP of 58 mm Hg despite adequate fluid resuscitation. Which
vasopressor is the first-line treatment according to the Surviving Sepsis Guidelines?
A) Dopamine infusion to increase cardiac output
B) Norepinephrine to achieve a MAP of 65 mm Hg or greater
C) Epinephrine for its potent vasoconstrictive effects
D) Phenylephrine as a pure alpha-agonist vasopressor
Answer: B - Norepinephrine is the first-line vasopressor in septic shock to achieve a MAP of 65 mm Hg or
greater. It primarily causes vasoconstriction with minimal cardiac stimulation. Dopamine is less
preferred due to arrhythmia risk .
