NUR 265 MEDICAL-SURGICAL NURSING EXAMS 1-3 & FINAL ACTUAL
2026/2027 - COMPLETE QUESTIONS WITH DETAILED RATIONALES 100%
VERIFIED ANSWERS - PASS GUARANTEED - A+ GRADED
180 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Analyze pathophysiological alterations to formulate nursing diagnoses and prioritize care
2 Integrate pharmacological, laboratory, and diagnostic data to guide clinical decisions
3 Evaluate patient responses to interventions and modify care plans in dynamic situations
4 Apply safety and infection control principles in high-acuity medical-surgical settings
5 NUR 265 Medical
6 Surgical Nursing Exams 1
7 3 & Final Actual 2026
8 2027
9 Complete Questions with Detailed Rationales 100% Verified Answers
10 Pass Guaranteed
11 A+ Graded
12 Foundations of Medical-Surgical Nursing
13 Applied Medical-Surgical Nursing
14 Advanced Medical-Surgical Nursing
15 Medical-Surgical Nursing Review
Page 1
,Q1 ANALYZE PATHOPHYSIOLOGICAL ALTERATIONS TO FORMULATE NURSING DIAGNOSES
AND PRIORITIZE CARE
A patient with septic shock develops acute respiratory distress syndrome (ARDS).
The ventilator is set to assist-control mode with a tidal volume of 6 mL/kg ideal
body weight and positive end-expiratory pressure (PEEP) of 10 cm H2O. Arterial
blood gas reveals pH 7.31, PaCO2 48 mm Hg, PaO2 58 mm Hg, HCO3- 24 mEq/L.
Which intervention should the nurse anticipate next?
A. Increase PEEP to 15 cm H2O and reassess oxygenation CORRECT
B. Increase tidal volume to 8 mL/kg to correct PaCO2
C. Decrease respiratory rate to allow permissive hypercapnia
D. Administer sodium bicarbonate to correct metabolic acidosis
RATIONALE: In ARDS, lung-protective ventilation includes low tidal volumes and adequate
PEEP to improve oxygenation. Increasing PEEP is appropriate for refractory hypoxemia.
Increasing tidal volume would cause ventilator-induced lung injury. Permissive hypercapnia is
acceptable but not the priority when PaO2 is critically low; bicarbonate is not indicated for
respiratory acidosis.
Q2 ANALYZE PATHOPHYSIOLOGICAL ALTERATIONS TO FORMULATE NURSING DIAGNOSES
AND PRIORITIZE CARE
A patient with chronic kidney disease (CKD) stage 5 is scheduled for creation of
an arteriovenous (AV) fistula. Which preoperative action is essential for the nurse
to implement?
A. Avoid venipuncture and blood pressure measurements on the nondominant arm CORRECT
B. Encourage high-protein diet to promote healing
C. Administer erythropoietin to increase red blood cell count
D. Apply warm compresses to the selected arm to dilate vessels
RATIONALE: Preserving veins in the arm designated for AV fistula is critical to ensure vessel
suitability. Venipuncture and blood pressure measurements can cause venous damage and
compromise fistula maturation. High-protein diet is not specifically indicated preoperatively;
erythropoietin is for anemia management but not immediate preoperative priority; warm
compresses are not standard.
Page 2
,Q3 ANALYZE PATHOPHYSIOLOGICAL ALTERATIONS TO FORMULATE NURSING DIAGNOSES
AND PRIORITIZE CARE
A patient with type 2 diabetes mellitus is prescribed metformin and is scheduled
for a computed tomography (CT) scan with intravenous iodinated contrast. Which
nursing action is most appropriate?
A. Hold metformin on the day of the procedure and for 48 hours afterward CORRECT
B. Administer metformin with a small sip of water before the scan
C. Increase metformin dose to maintain glycemic control during fasting
D. Switch metformin to insulin for 24 hours before the scan
RATIONALE: Metformin carries a risk of lactic acidosis with iodinated contrast, especially in
patients with renal impairment. Current guidelines recommend withholding metformin at the time
of contrast administration and for 48 hours afterward, resuming only after renal function is
re-evaluated. Other options are incorrect and potentially harmful.
Q4 ANALYZE PATHOPHYSIOLOGICAL ALTERATIONS TO FORMULATE NURSING DIAGNOSES
AND PRIORITIZE CARE
A patient with a large pulmonary embolism develops hypotension and hypoxemia.
The nurse prepares to administer a thrombolytic. Which assessment finding is a
contraindication to thrombolytic therapy?
A. Recent surgery 2 weeks ago
B. Systolic blood pressure 90 mm Hg
C. Active peptic ulcer disease CORRECT
D. Age 75 years
RATIONALE: Active bleeding, including peptic ulcer disease, is an absolute contraindication to
thrombolytic therapy. Recent surgery within 2 weeks is a relative contraindication but may be
acceptable in life-threatening PE. Hypotension is an indication, not a contraindication. Age >75 is
a relative contraindication but not absolute.
Page 3
, Q5 ANALYZE PATHOPHYSIOLOGICAL ALTERATIONS TO FORMULATE NURSING DIAGNOSES
AND PRIORITIZE CARE
A patient with cirrhosis and ascites develops confusion, asterixis, and elevated
serum ammonia. Which dietary intervention should the nurse implement first?
A. Restrict protein to 0.8 g/kg/day
B. Increase dietary protein to 1.2 g/kg/day
C. Administer lactulose to reduce ammonia production CORRECT
D. Encourage high-fiber foods to promote ammonia excretion
RATIONALE: Hepatic encephalopathy is treated with lactulose to acidify the colon and trap
ammonia, reducing its absorption. Dietary protein restriction is no longer routinely recommended;
current guidelines suggest maintaining adequate protein. High-fiber is not effective. The priority is
pharmacologic intervention to lower ammonia.
Q6 ANALYZE PATHOPHYSIOLOGICAL ALTERATIONS TO FORMULATE NURSING DIAGNOSES
AND PRIORITIZE CARE
A patient with heart failure and a left ventricular assist device (LVAD) presents with
low-flow alarms and mean arterial pressure (MAP) of 55 mm Hg. Which
intervention should the nurse perform first?
A. Administer intravenous normal saline bolus
B. Decrease afterload by administering nitroprusside
C. Check the driveline for disconnection or kinking CORRECT
D. Increase the pump speed to improve cardiac output
RATIONALE: Low-flow alarms in LVAD patients often result from mechanical issues such as
kinked driveline, disconnection, or inadequate preload. The nurse should first assess the device
and driveline integrity. Administering fluids or adjusting speed without assessing the cause could
be harmful. Nitroprusside may worsen hypotension.
Page 4
2026/2027 - COMPLETE QUESTIONS WITH DETAILED RATIONALES 100%
VERIFIED ANSWERS - PASS GUARANTEED - A+ GRADED
180 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Analyze pathophysiological alterations to formulate nursing diagnoses and prioritize care
2 Integrate pharmacological, laboratory, and diagnostic data to guide clinical decisions
3 Evaluate patient responses to interventions and modify care plans in dynamic situations
4 Apply safety and infection control principles in high-acuity medical-surgical settings
5 NUR 265 Medical
6 Surgical Nursing Exams 1
7 3 & Final Actual 2026
8 2027
9 Complete Questions with Detailed Rationales 100% Verified Answers
10 Pass Guaranteed
11 A+ Graded
12 Foundations of Medical-Surgical Nursing
13 Applied Medical-Surgical Nursing
14 Advanced Medical-Surgical Nursing
15 Medical-Surgical Nursing Review
Page 1
,Q1 ANALYZE PATHOPHYSIOLOGICAL ALTERATIONS TO FORMULATE NURSING DIAGNOSES
AND PRIORITIZE CARE
A patient with septic shock develops acute respiratory distress syndrome (ARDS).
The ventilator is set to assist-control mode with a tidal volume of 6 mL/kg ideal
body weight and positive end-expiratory pressure (PEEP) of 10 cm H2O. Arterial
blood gas reveals pH 7.31, PaCO2 48 mm Hg, PaO2 58 mm Hg, HCO3- 24 mEq/L.
Which intervention should the nurse anticipate next?
A. Increase PEEP to 15 cm H2O and reassess oxygenation CORRECT
B. Increase tidal volume to 8 mL/kg to correct PaCO2
C. Decrease respiratory rate to allow permissive hypercapnia
D. Administer sodium bicarbonate to correct metabolic acidosis
RATIONALE: In ARDS, lung-protective ventilation includes low tidal volumes and adequate
PEEP to improve oxygenation. Increasing PEEP is appropriate for refractory hypoxemia.
Increasing tidal volume would cause ventilator-induced lung injury. Permissive hypercapnia is
acceptable but not the priority when PaO2 is critically low; bicarbonate is not indicated for
respiratory acidosis.
Q2 ANALYZE PATHOPHYSIOLOGICAL ALTERATIONS TO FORMULATE NURSING DIAGNOSES
AND PRIORITIZE CARE
A patient with chronic kidney disease (CKD) stage 5 is scheduled for creation of
an arteriovenous (AV) fistula. Which preoperative action is essential for the nurse
to implement?
A. Avoid venipuncture and blood pressure measurements on the nondominant arm CORRECT
B. Encourage high-protein diet to promote healing
C. Administer erythropoietin to increase red blood cell count
D. Apply warm compresses to the selected arm to dilate vessels
RATIONALE: Preserving veins in the arm designated for AV fistula is critical to ensure vessel
suitability. Venipuncture and blood pressure measurements can cause venous damage and
compromise fistula maturation. High-protein diet is not specifically indicated preoperatively;
erythropoietin is for anemia management but not immediate preoperative priority; warm
compresses are not standard.
Page 2
,Q3 ANALYZE PATHOPHYSIOLOGICAL ALTERATIONS TO FORMULATE NURSING DIAGNOSES
AND PRIORITIZE CARE
A patient with type 2 diabetes mellitus is prescribed metformin and is scheduled
for a computed tomography (CT) scan with intravenous iodinated contrast. Which
nursing action is most appropriate?
A. Hold metformin on the day of the procedure and for 48 hours afterward CORRECT
B. Administer metformin with a small sip of water before the scan
C. Increase metformin dose to maintain glycemic control during fasting
D. Switch metformin to insulin for 24 hours before the scan
RATIONALE: Metformin carries a risk of lactic acidosis with iodinated contrast, especially in
patients with renal impairment. Current guidelines recommend withholding metformin at the time
of contrast administration and for 48 hours afterward, resuming only after renal function is
re-evaluated. Other options are incorrect and potentially harmful.
Q4 ANALYZE PATHOPHYSIOLOGICAL ALTERATIONS TO FORMULATE NURSING DIAGNOSES
AND PRIORITIZE CARE
A patient with a large pulmonary embolism develops hypotension and hypoxemia.
The nurse prepares to administer a thrombolytic. Which assessment finding is a
contraindication to thrombolytic therapy?
A. Recent surgery 2 weeks ago
B. Systolic blood pressure 90 mm Hg
C. Active peptic ulcer disease CORRECT
D. Age 75 years
RATIONALE: Active bleeding, including peptic ulcer disease, is an absolute contraindication to
thrombolytic therapy. Recent surgery within 2 weeks is a relative contraindication but may be
acceptable in life-threatening PE. Hypotension is an indication, not a contraindication. Age >75 is
a relative contraindication but not absolute.
Page 3
, Q5 ANALYZE PATHOPHYSIOLOGICAL ALTERATIONS TO FORMULATE NURSING DIAGNOSES
AND PRIORITIZE CARE
A patient with cirrhosis and ascites develops confusion, asterixis, and elevated
serum ammonia. Which dietary intervention should the nurse implement first?
A. Restrict protein to 0.8 g/kg/day
B. Increase dietary protein to 1.2 g/kg/day
C. Administer lactulose to reduce ammonia production CORRECT
D. Encourage high-fiber foods to promote ammonia excretion
RATIONALE: Hepatic encephalopathy is treated with lactulose to acidify the colon and trap
ammonia, reducing its absorption. Dietary protein restriction is no longer routinely recommended;
current guidelines suggest maintaining adequate protein. High-fiber is not effective. The priority is
pharmacologic intervention to lower ammonia.
Q6 ANALYZE PATHOPHYSIOLOGICAL ALTERATIONS TO FORMULATE NURSING DIAGNOSES
AND PRIORITIZE CARE
A patient with heart failure and a left ventricular assist device (LVAD) presents with
low-flow alarms and mean arterial pressure (MAP) of 55 mm Hg. Which
intervention should the nurse perform first?
A. Administer intravenous normal saline bolus
B. Decrease afterload by administering nitroprusside
C. Check the driveline for disconnection or kinking CORRECT
D. Increase the pump speed to improve cardiac output
RATIONALE: Low-flow alarms in LVAD patients often result from mechanical issues such as
kinked driveline, disconnection, or inadequate preload. The nurse should first assess the device
and driveline integrity. Administering fluids or adjusting speed without assessing the cause could
be harmful. Nitroprusside may worsen hypotension.
Page 4
