NUR 265 ADVANCED MEDICAL-
SURGICAL NURSING FINAL EXAM
PREP QUESTIONS AND ANSWERS | 2026
UPDATE | 100% CORRECT - GALEN
COLLEGE OF NURSING.
1. A patient with septic shock has a MAP of 55 mmHg and a CVP of 2 mmHg. Which
intervention should the nurse prioritize first?
A. Start a Norepinephrine drip at 2 mcg/min
B. Administer a 30 mL/kg bolus of Normal Saline
C. Obtain blood cultures from two different sites
D. Administer broad-spectrum antibiotics
Answer: B
Conceptual Explanation: According to Surviving Sepsis guidelines, the priority is to
restore volume (fluid resuscitation) for a low CVP and MAP before starting vasopressors.
2. A patient presents with pH 7.28, PaCO2 50 mmHg, and HCO3 24 mEq/L. How should the
nurse interpret these ABG results?
A. Uncompensated Respiratory Acidosis
B. Compensated Metabolic Acidosis
,C. Partially Compensated Respiratory Acidosis
D. Uncompensated Metabolic Acidosis
Answer: A
Conceptual Explanation: The pH is acidic, the PaCO2 is high (acidic), and the HCO3 is
normal, indicating no compensation has occurred yet for the respiratory cause.
3. Which clinical finding is most indicative of the ‘hyperdynamic’ phase of septic shock?
A. Cool, clammy skin
B. Warm, flushed skin and bounding pulses
C. Increased systemic vascular resistance (SVR)
D. Bradypnea and bradycardia
Answer: B
Conceptual Explanation: Early or hyperdynamic septic shock is characterized by
vasodilation, resulting in warm, flushed skin and a high cardiac output.
4. A patient with a T4 spinal cord injury reports a severe headache and has a BP of 190/110.
What is the nurse’s priority action?
A. Check the patient for bladder distension
B. Administer PRN Hydralazine
C. Lower the head of the bed to a flat position
, D. Perform a neurological assessment
Answer: A
Conceptual Explanation: These are signs of Autonomic Dysreflexia. The priority is to
identify and remove the noxious stimulus, most commonly a full bladder or impacted
bowel.
5. Using the Parkland Formula, calculate the fluid requirements for the first 8 hours for a 70kg
patient with 40% TBSA burns.
A. 5,600 mL
B. 11,200 mL
C. 2,800 mL
D. 700 mL
Answer: A
Conceptual Explanation: Total fluid = 4mL x 70kg x 40 = 11,200 mL. Half is given in the
first 8 hours: 11, = 5,600 mL.
6. A patient on a ventilator has a sudden drop in SpO2 and the high-pressure alarm is
sounding. What is the nurse’s first action?
A. Check for a leak in the ventilator circuit
B. Call the respiratory therapist to adjust settings
C. Increase the FiO2 to 100%
SURGICAL NURSING FINAL EXAM
PREP QUESTIONS AND ANSWERS | 2026
UPDATE | 100% CORRECT - GALEN
COLLEGE OF NURSING.
1. A patient with septic shock has a MAP of 55 mmHg and a CVP of 2 mmHg. Which
intervention should the nurse prioritize first?
A. Start a Norepinephrine drip at 2 mcg/min
B. Administer a 30 mL/kg bolus of Normal Saline
C. Obtain blood cultures from two different sites
D. Administer broad-spectrum antibiotics
Answer: B
Conceptual Explanation: According to Surviving Sepsis guidelines, the priority is to
restore volume (fluid resuscitation) for a low CVP and MAP before starting vasopressors.
2. A patient presents with pH 7.28, PaCO2 50 mmHg, and HCO3 24 mEq/L. How should the
nurse interpret these ABG results?
A. Uncompensated Respiratory Acidosis
B. Compensated Metabolic Acidosis
,C. Partially Compensated Respiratory Acidosis
D. Uncompensated Metabolic Acidosis
Answer: A
Conceptual Explanation: The pH is acidic, the PaCO2 is high (acidic), and the HCO3 is
normal, indicating no compensation has occurred yet for the respiratory cause.
3. Which clinical finding is most indicative of the ‘hyperdynamic’ phase of septic shock?
A. Cool, clammy skin
B. Warm, flushed skin and bounding pulses
C. Increased systemic vascular resistance (SVR)
D. Bradypnea and bradycardia
Answer: B
Conceptual Explanation: Early or hyperdynamic septic shock is characterized by
vasodilation, resulting in warm, flushed skin and a high cardiac output.
4. A patient with a T4 spinal cord injury reports a severe headache and has a BP of 190/110.
What is the nurse’s priority action?
A. Check the patient for bladder distension
B. Administer PRN Hydralazine
C. Lower the head of the bed to a flat position
, D. Perform a neurological assessment
Answer: A
Conceptual Explanation: These are signs of Autonomic Dysreflexia. The priority is to
identify and remove the noxious stimulus, most commonly a full bladder or impacted
bowel.
5. Using the Parkland Formula, calculate the fluid requirements for the first 8 hours for a 70kg
patient with 40% TBSA burns.
A. 5,600 mL
B. 11,200 mL
C. 2,800 mL
D. 700 mL
Answer: A
Conceptual Explanation: Total fluid = 4mL x 70kg x 40 = 11,200 mL. Half is given in the
first 8 hours: 11, = 5,600 mL.
6. A patient on a ventilator has a sudden drop in SpO2 and the high-pressure alarm is
sounding. What is the nurse’s first action?
A. Check for a leak in the ventilator circuit
B. Call the respiratory therapist to adjust settings
C. Increase the FiO2 to 100%
