NUR 265 EXAM 3 – MEDICAL-SURGICAL NURSING | 2
VERSIONS | NEWEST QUESTIONS & ANSWERS
COMPLETE STUDY GUIDE – GALEN COLLEGE OF
NURSING | LATEST 2026-2028 | 100% VERIFIED.
Core Domains
• Cardiovascular Disorders and Interventions
• Respiratory Pathophysiology and Care
• Gastrointestinal and Hepatic Disorders
• Renal and Genitourinary Conditions
• Neurological Emergencies and Critical Care
• Endocrine and Hematologic Disorders
• Fluid, Electrolyte, and Acid-Base Imbalances
• Shock, Sepsis, and Multisystem Failure
• Emergency, Trauma, and Disaster Nursing
Introduction
The NUR 265 Exam 3 assesses advanced medical-surgical nursing knowledge and clinical reasoning
for students at Galen College of Nursing. This comprehensive evaluation covers critical concepts
essential for safe patient care across cardiovascular, respiratory, gastrointestinal, renal,
neurological, and endocrine systems. The exam employs multiple-choice and scenario-based
questions to test prioritization, evidence-based practice, and clinical decision-making. Emphasis is
placed on recognizing life-threatening complications, implementing appropriate nursing
interventions, and applying the nursing process to complex patient situations.
Question 1
A patient with cirrhosis and hepatic encephalopathy has an elevated serum ammonia level. Which
medication should the nurse prioritize?
A. Furosemide
B. Spironolactone
C. Lactulose
D. Omeprazole
, Correct answer: C. Lactulose
RATIONALE: Lactulose is used to lower ammonia levels by promoting its excretion through the
gastrointestinal tract. It acidifies the bowel contents, converting ammonia to ammonium which is
trapped and excreted in stool .
Question 2
The nurse is caring for a patient with acute pancreatitis. Which laboratory result most specifically
indicates this diagnosis?
A. Elevated serum bilirubin
B. Elevated serum amylase and lipase
C. Decreased white blood cell count
D. Elevated serum calcium
Correct answer: B. Elevated serum amylase and lipase
RATIONALE: Amylase and lipase are digestive enzymes released by the pancreas; their
elevation is hallmark for acute pancreatitis .
Question 3
A patient diagnosed with Ulcerative Colitis is admitted. Which clinical manifestation is most
characteristic of this condition?
A. Steatorrhea
B. Constipation with hard stools
C. Frequent bloody diarrhea
D. Right lower quadrant pain
Correct answer: C. Frequent bloody diarrhea
RATIONALE: Ulcerative colitis primarily affects the colon and rectum, leading to inflammation
and frequent bloody stools .
Question 4
What is the priority nursing intervention for a patient immediately following a liver biopsy?
A. Monitor for signs of infection
B. Position the patient on the right side
,C. Encourage early ambulation
D. Maintain NPO status for 12 hours
Correct answer: B. Position the patient on the right side
RATIONALE: Positioning the patient on the right side provides pressure on the biopsy site to
prevent hemorrhage .
Question 5
A nurse is assessing a patient with a suspected small bowel obstruction. Which finding should the
nurse expect?
A. Rigid, board-like abdomen
B. Lower abdominal distension and ribbon-like stools
C. Increased appetite and thirst
D. Visible peristaltic waves and high-pitched bowel sounds
Correct answer: D. Visible peristaltic waves and high-pitched bowel sounds
RATIONALE: In early bowel obstruction, bowel sounds are often hyperactive or high-pitched as
the intestine attempts to push past the blockage .
Question 6
A patient receiving Total Parenteral Nutrition (TPN) has their bag run out before the next one is
ready. What should the nurse hang in the meantime?
A. 0.9% Normal Saline
B. Lactated Ringer's
C. 10% Dextrose in water
D. 5% Dextrose in Normal Saline
Correct answer: C. 10% Dextrose in water
RATIONALE: TPN contains high concentrations of glucose; hanging 10% dextrose prevents
sudden hypoglycemia when the TPN bag is empty .
Question 7
Which assessment finding in a patient with Crohn's disease would require immediate notification
of the healthcare provider?
, A. Three semi-formed stools in 24 hours
B. A rigid, board-like abdomen with severe pain
C. Abdominal pain relieved by defecation
D. Weight loss of 2 pounds in one week
Correct answer: B. A rigid, board-like abdomen with severe pain
RATIONALE: A rigid, board-like abdomen is a sign of peritonitis, which may occur due to
bowel perforation, a surgical emergency .
Question 8
The nurse is educating a patient with Chronic Kidney Disease (CKD) about diet. Which nutrient
should usually be restricted?
A. Protein
B. Fiber
C. Vitamin C
D. Potassium
Correct answer: D. Potassium
RATIONALE: In CKD, the kidneys cannot effectively excrete potassium, leading to life-
threatening hyperkalemia .
Question 9
A 68-year-old client with a history of chronic heart failure is admitted to the telemetry unit with
worsening dyspnea and weight gain of 4.5 kg over the past week. The nurse notes crackles in both
lung bases and jugular venous distention. Which assessment finding would the nurse expect to see
in this client?
A. Bounding peripheral pulses and warm, flushed skin
B. Decreased pulmonary capillary wedge pressure and dry lung sounds
C. S3 heart sound and hepatomegaly on abdominal palpation
D. Narrow pulse pressure and delayed capillary refill
Correct answer: C. S3 heart sound and hepatomegaly on abdominal palpation
RATIONALE: An S3 heart sound and hepatomegaly are classic findings in left-sided and right-
sided heart failure, respectively. The S3 sound indicates ventricular volume overload, while
hepatomegaly reflects hepatic congestion from right-sided failure .
VERSIONS | NEWEST QUESTIONS & ANSWERS
COMPLETE STUDY GUIDE – GALEN COLLEGE OF
NURSING | LATEST 2026-2028 | 100% VERIFIED.
Core Domains
• Cardiovascular Disorders and Interventions
• Respiratory Pathophysiology and Care
• Gastrointestinal and Hepatic Disorders
• Renal and Genitourinary Conditions
• Neurological Emergencies and Critical Care
• Endocrine and Hematologic Disorders
• Fluid, Electrolyte, and Acid-Base Imbalances
• Shock, Sepsis, and Multisystem Failure
• Emergency, Trauma, and Disaster Nursing
Introduction
The NUR 265 Exam 3 assesses advanced medical-surgical nursing knowledge and clinical reasoning
for students at Galen College of Nursing. This comprehensive evaluation covers critical concepts
essential for safe patient care across cardiovascular, respiratory, gastrointestinal, renal,
neurological, and endocrine systems. The exam employs multiple-choice and scenario-based
questions to test prioritization, evidence-based practice, and clinical decision-making. Emphasis is
placed on recognizing life-threatening complications, implementing appropriate nursing
interventions, and applying the nursing process to complex patient situations.
Question 1
A patient with cirrhosis and hepatic encephalopathy has an elevated serum ammonia level. Which
medication should the nurse prioritize?
A. Furosemide
B. Spironolactone
C. Lactulose
D. Omeprazole
, Correct answer: C. Lactulose
RATIONALE: Lactulose is used to lower ammonia levels by promoting its excretion through the
gastrointestinal tract. It acidifies the bowel contents, converting ammonia to ammonium which is
trapped and excreted in stool .
Question 2
The nurse is caring for a patient with acute pancreatitis. Which laboratory result most specifically
indicates this diagnosis?
A. Elevated serum bilirubin
B. Elevated serum amylase and lipase
C. Decreased white blood cell count
D. Elevated serum calcium
Correct answer: B. Elevated serum amylase and lipase
RATIONALE: Amylase and lipase are digestive enzymes released by the pancreas; their
elevation is hallmark for acute pancreatitis .
Question 3
A patient diagnosed with Ulcerative Colitis is admitted. Which clinical manifestation is most
characteristic of this condition?
A. Steatorrhea
B. Constipation with hard stools
C. Frequent bloody diarrhea
D. Right lower quadrant pain
Correct answer: C. Frequent bloody diarrhea
RATIONALE: Ulcerative colitis primarily affects the colon and rectum, leading to inflammation
and frequent bloody stools .
Question 4
What is the priority nursing intervention for a patient immediately following a liver biopsy?
A. Monitor for signs of infection
B. Position the patient on the right side
,C. Encourage early ambulation
D. Maintain NPO status for 12 hours
Correct answer: B. Position the patient on the right side
RATIONALE: Positioning the patient on the right side provides pressure on the biopsy site to
prevent hemorrhage .
Question 5
A nurse is assessing a patient with a suspected small bowel obstruction. Which finding should the
nurse expect?
A. Rigid, board-like abdomen
B. Lower abdominal distension and ribbon-like stools
C. Increased appetite and thirst
D. Visible peristaltic waves and high-pitched bowel sounds
Correct answer: D. Visible peristaltic waves and high-pitched bowel sounds
RATIONALE: In early bowel obstruction, bowel sounds are often hyperactive or high-pitched as
the intestine attempts to push past the blockage .
Question 6
A patient receiving Total Parenteral Nutrition (TPN) has their bag run out before the next one is
ready. What should the nurse hang in the meantime?
A. 0.9% Normal Saline
B. Lactated Ringer's
C. 10% Dextrose in water
D. 5% Dextrose in Normal Saline
Correct answer: C. 10% Dextrose in water
RATIONALE: TPN contains high concentrations of glucose; hanging 10% dextrose prevents
sudden hypoglycemia when the TPN bag is empty .
Question 7
Which assessment finding in a patient with Crohn's disease would require immediate notification
of the healthcare provider?
, A. Three semi-formed stools in 24 hours
B. A rigid, board-like abdomen with severe pain
C. Abdominal pain relieved by defecation
D. Weight loss of 2 pounds in one week
Correct answer: B. A rigid, board-like abdomen with severe pain
RATIONALE: A rigid, board-like abdomen is a sign of peritonitis, which may occur due to
bowel perforation, a surgical emergency .
Question 8
The nurse is educating a patient with Chronic Kidney Disease (CKD) about diet. Which nutrient
should usually be restricted?
A. Protein
B. Fiber
C. Vitamin C
D. Potassium
Correct answer: D. Potassium
RATIONALE: In CKD, the kidneys cannot effectively excrete potassium, leading to life-
threatening hyperkalemia .
Question 9
A 68-year-old client with a history of chronic heart failure is admitted to the telemetry unit with
worsening dyspnea and weight gain of 4.5 kg over the past week. The nurse notes crackles in both
lung bases and jugular venous distention. Which assessment finding would the nurse expect to see
in this client?
A. Bounding peripheral pulses and warm, flushed skin
B. Decreased pulmonary capillary wedge pressure and dry lung sounds
C. S3 heart sound and hepatomegaly on abdominal palpation
D. Narrow pulse pressure and delayed capillary refill
Correct answer: C. S3 heart sound and hepatomegaly on abdominal palpation
RATIONALE: An S3 heart sound and hepatomegaly are classic findings in left-sided and right-
sided heart failure, respectively. The S3 sound indicates ventricular volume overload, while
hepatomegaly reflects hepatic congestion from right-sided failure .
