https://www.stuvia.com/user/performance
NUR 265 Exam 4 Practice Questions & Answers (2026–2027
Update) – Galen College
Exam Format: multiple-choice questions | 60 minutes
Content Focus: Advanced Medical-Surgical Nursing / Acute Care
Key Topics: Shock states, AKI, transplant rejection, anaphylaxis,
HIV/AIDS, SLE, oncology emergencies, and disaster triage
Section 1: Critical Care & Shock Management
1. A patient in septic shock has a lactate of 4.8 mmol/L, MAP
58 mmHg despite 30 mL/kg crystalloid, and is started on
norepinephrine. According to Surviving Sepsis guidelines,
what is the nurse's priority action?
A. Add vasopressin immediately
B. Obtain blood cultures if not already done
C. Start hydrocortisone
D. Assess for source control (e.g., remove infected line)
Answer: D
Rationale: Source control is a cornerstone of sepsis
management. While cultures, fluids, antibiotics, and
vasopressors are critical, persistent hypotension requires rapid
identification and elimination of the infection source.
,https://www.stuvia.com/user/performance
Vasopressin is added as a second-line agent; steroids are
considered only in refractory shock .
2. A client with severe pancreatitis has hypotension,
tachycardia, and low urine output. What is the priority?
A. Restrict oral intake
B. Administer IV fluids
C. Give analgesics
D. Encourage ambulation
Answer: B
Rationale: Fluid resuscitation prevents hypovolemic shock and
organ failure in severe pancreatitis .
3. A client post-abdominal surgery has HR 132, BP 86/54, and
distended abdomen. What is the priority?
A. Monitor vital signs
B. Notify provider
C. Encourage ambulation
D. Give analgesics
Answer: B
Rationale: These signs indicate possible internal bleeding
requiring urgent provider assessment and intervention .
4. A client with pulmonary embolism has sudden dyspnea,
chest pain, and hypotension. What is the priority?
,https://www.stuvia.com/user/performance
A. Administer oxygen
B. Prepare for thrombolytic therapy
C. Give anticoagulants subcutaneously
D. Monitor ABG
Answer: B
Rationale: Massive PE with hypotension requires urgent
thrombolytic therapy to restore perfusion .
5. A client with acute myocardial infarction develops
hypotension, JVD, and muffled heart sounds. What is the
priority?
A. Administer morphine
B. Prepare for pericardiocentesis
C. Give oxygen
D. Start nitroglycerin
Answer: B
Rationale: These findings indicate cardiac tamponade, which
requires urgent intervention .
6. A client with hyperthyroidism presents with agitation, fever
103°F, and HR 160. What is the priority?
A. Give acetaminophen
B. Administer propranolol
C. Encourage fluids
D. Obtain ECG
, https://www.stuvia.com/user/performance
Answer: B
Rationale: Propranolol controls tachycardia and decreases
cardiac complications in thyroid storm .
7. Which finding is expected in anaphylactic shock?
A. Hypertension
B. Bradycardia
C. Bronchoconstriction
D. Hyperglycemia
Answer: C
Rationale: Airway narrowing and bronchospasm are classic
manifestations of anaphylaxis .
Section 2: Acute Kidney Injury (AKI)
8. Which finding indicates the patient with AKI has progressed
to the oliguric phase?
A. Urine output 0.3 mL/kg/hr for 18 hours, rising
BUN/creatinine, hyperkalemia
B. Sudden increase in urine output with falling creatinine
C. Normal urine output but elevated creatinine
D. Anuria with normal electrolytes
Answer: A
Rationale: Oliguric phase of AKI is defined as urine output <0.5
mL/kg/hr for ≥6–12 hours (KDIGO), fluid overload, rising
BUN/Cr, and electrolyte imbalances—especially hyperkalemia
NUR 265 Exam 4 Practice Questions & Answers (2026–2027
Update) – Galen College
Exam Format: multiple-choice questions | 60 minutes
Content Focus: Advanced Medical-Surgical Nursing / Acute Care
Key Topics: Shock states, AKI, transplant rejection, anaphylaxis,
HIV/AIDS, SLE, oncology emergencies, and disaster triage
Section 1: Critical Care & Shock Management
1. A patient in septic shock has a lactate of 4.8 mmol/L, MAP
58 mmHg despite 30 mL/kg crystalloid, and is started on
norepinephrine. According to Surviving Sepsis guidelines,
what is the nurse's priority action?
A. Add vasopressin immediately
B. Obtain blood cultures if not already done
C. Start hydrocortisone
D. Assess for source control (e.g., remove infected line)
Answer: D
Rationale: Source control is a cornerstone of sepsis
management. While cultures, fluids, antibiotics, and
vasopressors are critical, persistent hypotension requires rapid
identification and elimination of the infection source.
,https://www.stuvia.com/user/performance
Vasopressin is added as a second-line agent; steroids are
considered only in refractory shock .
2. A client with severe pancreatitis has hypotension,
tachycardia, and low urine output. What is the priority?
A. Restrict oral intake
B. Administer IV fluids
C. Give analgesics
D. Encourage ambulation
Answer: B
Rationale: Fluid resuscitation prevents hypovolemic shock and
organ failure in severe pancreatitis .
3. A client post-abdominal surgery has HR 132, BP 86/54, and
distended abdomen. What is the priority?
A. Monitor vital signs
B. Notify provider
C. Encourage ambulation
D. Give analgesics
Answer: B
Rationale: These signs indicate possible internal bleeding
requiring urgent provider assessment and intervention .
4. A client with pulmonary embolism has sudden dyspnea,
chest pain, and hypotension. What is the priority?
,https://www.stuvia.com/user/performance
A. Administer oxygen
B. Prepare for thrombolytic therapy
C. Give anticoagulants subcutaneously
D. Monitor ABG
Answer: B
Rationale: Massive PE with hypotension requires urgent
thrombolytic therapy to restore perfusion .
5. A client with acute myocardial infarction develops
hypotension, JVD, and muffled heart sounds. What is the
priority?
A. Administer morphine
B. Prepare for pericardiocentesis
C. Give oxygen
D. Start nitroglycerin
Answer: B
Rationale: These findings indicate cardiac tamponade, which
requires urgent intervention .
6. A client with hyperthyroidism presents with agitation, fever
103°F, and HR 160. What is the priority?
A. Give acetaminophen
B. Administer propranolol
C. Encourage fluids
D. Obtain ECG
, https://www.stuvia.com/user/performance
Answer: B
Rationale: Propranolol controls tachycardia and decreases
cardiac complications in thyroid storm .
7. Which finding is expected in anaphylactic shock?
A. Hypertension
B. Bradycardia
C. Bronchoconstriction
D. Hyperglycemia
Answer: C
Rationale: Airway narrowing and bronchospasm are classic
manifestations of anaphylaxis .
Section 2: Acute Kidney Injury (AKI)
8. Which finding indicates the patient with AKI has progressed
to the oliguric phase?
A. Urine output 0.3 mL/kg/hr for 18 hours, rising
BUN/creatinine, hyperkalemia
B. Sudden increase in urine output with falling creatinine
C. Normal urine output but elevated creatinine
D. Anuria with normal electrolytes
Answer: A
Rationale: Oliguric phase of AKI is defined as urine output <0.5
mL/kg/hr for ≥6–12 hours (KDIGO), fluid overload, rising
BUN/Cr, and electrolyte imbalances—especially hyperkalemia
