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NUR 265 EXAM 3 PRACTICE EXAM GALEN COLLEGE OF
NURSING — ADVANCED MEDICAL-SURGICAL NURSING
2026/2027 COMPLETE (100) CURRENT TESTING
QUESTIONS AND CORRECT ANSWERS WITH DETAILED
RATIONALES.
NURSING
Prepare for the NUR 265 Exam 3 – Galen College with a focused study resource
designed to reinforce high-priority medical-surgical nursing concepts. It supports
review of neurological disorders, burns and shock, complex patient assessment,
emergency interventions, prioritization, and evidence-based nursing care. Use the
material to strengthen clinical reasoning, reinforce key concepts, and identify areas
that may require additional review before the exam. This resource is best suited for
Galen College of Nursing NUR 265 students preparing for Exam 3 and reviewing
advanced medical-surgical nursing concepts.
MULTIPLE CHOICE.
SHOCK & HEMODYNAMICS
1. A patient in septic shock has a mean arterial pressure (MAP) of 58
mmHg despite fluid resuscitation. Which vasopressor is the first-line
choice?
• A) Dobutamine
• B) Norepinephrine
• C) Epinephrine
• D) Vasopressin
Answer: B) Norepinephrine
Rationale: Norepinephrine is the first-line vasopressor for septic shock. It
increases MAP through vasoconstriction with minimal effect on heart
rate. Dobutamine is an inotrope used for cardiogenic shock. Epinephrine
and vasopressin are second-line agents.
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2. Which hemodynamic finding is typically expected in the early
(hyperdynamic) phase of septic shock?
• A) Low cardiac output
• B) High Systemic Vascular Resistance (SVR)
• C) Cool, clammy skin
• D) Increased Cardiac Index
Answer: D) Increased Cardiac Index
Rationale: In the early (hyperdynamic) phase of septic shock, there is
vasodilation with increased cardiac output (warm shock). Cardiac index is
elevated. SVR is decreased, and skin is warm and flushed.
3. A patient is in the compensatory stage of hypovolemic shock. Which
assessment finding would the nurse expect?
• A) Hypotension
• B) Bradycardia
• C) Tachycardia with narrowing pulse pressure
• D) Cool, clammy skin with mottling
Answer: C) Tachycardia with narrowing pulse pressure
Rationale: In the compensatory stage of hypovolemic shock, the body
attempts to maintain perfusion through sympathetic activation. Findings
include tachycardia, tachypnea, and narrowing pulse pressure.
Hypotension and cool, clammy skin are signs of progressive or
irreversible shock.
4. A client with a C5 spinal cord injury develops severe headache,
hypertension (BP 210/110 mmHg), and bradycardia. What is the priority
nursing action?
, Page 3 of 44
• A) Administer PRN antihypertensives
• B) Check for bladder distension or fecal impaction
• C) Lower the head of the bed to the supine position
• D) Notify the physician immediately without assessment
Answer: B) Check for bladder distension or fecal impaction
Rationale: This is autonomic dysreflexia, a life-threatening emergency in
patients with spinal cord injury at or above T6. The priority is to sit the
patient upright and identify/remove the triggering stimulus, most
commonly a distended bladder or fecal impaction.
5. Which type of shock is characterized by a loss of sympathetic tone
resulting in hypotension and bradycardia?
• A) Hypovolemic shock
• B) Septic shock
• C) Neurogenic shock
• D) Anaphylactic shock
Answer: C) Neurogenic shock
Rationale: Neurogenic shock occurs after spinal cord injury above T6,
resulting in loss of sympathetic nervous system tone. This causes
massive vasodilation, hypotension, and bradycardia. It is treated with
fluid resuscitation and vasopressors.
6. A patient in septic shock has a serum lactate level of 4.2 mmol/L. What
does this finding indicate?
• A) Adequate tissue perfusion
• B) Tissue hypoxia and anaerobic metabolism
• C) Liver failure
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• D) Renal failure
Answer: B) Tissue hypoxia and anaerobic metabolism
Rationale: Elevated serum lactate (> 2.0 mmol/L) indicates tissue hypoxia
and anaerobic metabolism due to inadequate perfusion in shock states.
Lactate is a marker of severity and is used to guide resuscitation.
7. Which medication is used to treat hyperkalemia by exchanging sodium
ions for potassium ions in the intestine?
• A) Sodium Bicarbonate
• B) Insulin with Dextrose
• C) Sodium Polystyrene Sulfonate (Kayexalate)
• D) Calcium Gluconate
Answer: C) Sodium Polystyrene Sulfonate (Kayexalate)
Rationale: Kayexalate is a cation-exchange resin that removes potassium
from the body via the gastrointestinal tract. It is used for hyperkalemia but
is slower-acting than insulin with dextrose.
8. A patient with acute kidney injury (AKI) enters the oliguric phase. The
nurse should expect which finding?
• A) Metabolic Alkalosis
• B) Increased GFR
• C) Hypokalemia
• D) Urine output < 400 mL/day
Answer: D) Urine output < 400 mL/day
Rationale: The oliguric phase of AKI is characterized by a significant drop
in urine output (usually less than 400 mL in 24 hours). This phase is
associated with fluid overload, hyperkalemia, metabolic acidosis, and
elevated BUN/creatinine.
NUR 265 EXAM 3 PRACTICE EXAM GALEN COLLEGE OF
NURSING — ADVANCED MEDICAL-SURGICAL NURSING
2026/2027 COMPLETE (100) CURRENT TESTING
QUESTIONS AND CORRECT ANSWERS WITH DETAILED
RATIONALES.
NURSING
Prepare for the NUR 265 Exam 3 – Galen College with a focused study resource
designed to reinforce high-priority medical-surgical nursing concepts. It supports
review of neurological disorders, burns and shock, complex patient assessment,
emergency interventions, prioritization, and evidence-based nursing care. Use the
material to strengthen clinical reasoning, reinforce key concepts, and identify areas
that may require additional review before the exam. This resource is best suited for
Galen College of Nursing NUR 265 students preparing for Exam 3 and reviewing
advanced medical-surgical nursing concepts.
MULTIPLE CHOICE.
SHOCK & HEMODYNAMICS
1. A patient in septic shock has a mean arterial pressure (MAP) of 58
mmHg despite fluid resuscitation. Which vasopressor is the first-line
choice?
• A) Dobutamine
• B) Norepinephrine
• C) Epinephrine
• D) Vasopressin
Answer: B) Norepinephrine
Rationale: Norepinephrine is the first-line vasopressor for septic shock. It
increases MAP through vasoconstriction with minimal effect on heart
rate. Dobutamine is an inotrope used for cardiogenic shock. Epinephrine
and vasopressin are second-line agents.
, Page 2 of 44
2. Which hemodynamic finding is typically expected in the early
(hyperdynamic) phase of septic shock?
• A) Low cardiac output
• B) High Systemic Vascular Resistance (SVR)
• C) Cool, clammy skin
• D) Increased Cardiac Index
Answer: D) Increased Cardiac Index
Rationale: In the early (hyperdynamic) phase of septic shock, there is
vasodilation with increased cardiac output (warm shock). Cardiac index is
elevated. SVR is decreased, and skin is warm and flushed.
3. A patient is in the compensatory stage of hypovolemic shock. Which
assessment finding would the nurse expect?
• A) Hypotension
• B) Bradycardia
• C) Tachycardia with narrowing pulse pressure
• D) Cool, clammy skin with mottling
Answer: C) Tachycardia with narrowing pulse pressure
Rationale: In the compensatory stage of hypovolemic shock, the body
attempts to maintain perfusion through sympathetic activation. Findings
include tachycardia, tachypnea, and narrowing pulse pressure.
Hypotension and cool, clammy skin are signs of progressive or
irreversible shock.
4. A client with a C5 spinal cord injury develops severe headache,
hypertension (BP 210/110 mmHg), and bradycardia. What is the priority
nursing action?
, Page 3 of 44
• A) Administer PRN antihypertensives
• B) Check for bladder distension or fecal impaction
• C) Lower the head of the bed to the supine position
• D) Notify the physician immediately without assessment
Answer: B) Check for bladder distension or fecal impaction
Rationale: This is autonomic dysreflexia, a life-threatening emergency in
patients with spinal cord injury at or above T6. The priority is to sit the
patient upright and identify/remove the triggering stimulus, most
commonly a distended bladder or fecal impaction.
5. Which type of shock is characterized by a loss of sympathetic tone
resulting in hypotension and bradycardia?
• A) Hypovolemic shock
• B) Septic shock
• C) Neurogenic shock
• D) Anaphylactic shock
Answer: C) Neurogenic shock
Rationale: Neurogenic shock occurs after spinal cord injury above T6,
resulting in loss of sympathetic nervous system tone. This causes
massive vasodilation, hypotension, and bradycardia. It is treated with
fluid resuscitation and vasopressors.
6. A patient in septic shock has a serum lactate level of 4.2 mmol/L. What
does this finding indicate?
• A) Adequate tissue perfusion
• B) Tissue hypoxia and anaerobic metabolism
• C) Liver failure
, Page 4 of 44
• D) Renal failure
Answer: B) Tissue hypoxia and anaerobic metabolism
Rationale: Elevated serum lactate (> 2.0 mmol/L) indicates tissue hypoxia
and anaerobic metabolism due to inadequate perfusion in shock states.
Lactate is a marker of severity and is used to guide resuscitation.
7. Which medication is used to treat hyperkalemia by exchanging sodium
ions for potassium ions in the intestine?
• A) Sodium Bicarbonate
• B) Insulin with Dextrose
• C) Sodium Polystyrene Sulfonate (Kayexalate)
• D) Calcium Gluconate
Answer: C) Sodium Polystyrene Sulfonate (Kayexalate)
Rationale: Kayexalate is a cation-exchange resin that removes potassium
from the body via the gastrointestinal tract. It is used for hyperkalemia but
is slower-acting than insulin with dextrose.
8. A patient with acute kidney injury (AKI) enters the oliguric phase. The
nurse should expect which finding?
• A) Metabolic Alkalosis
• B) Increased GFR
• C) Hypokalemia
• D) Urine output < 400 mL/day
Answer: D) Urine output < 400 mL/day
Rationale: The oliguric phase of AKI is characterized by a significant drop
in urine output (usually less than 400 mL in 24 hours). This phase is
associated with fluid overload, hyperkalemia, metabolic acidosis, and
elevated BUN/creatinine.
