NUR 257 FINAL EXAM PREP -
ADVANCED MEDICAL-SURGICAL
NURSING QUESTIONS AND ANSWERS |
2026/2027 UPDATE | 100% CORRECT-
GALEN.
1. A client in the ICU has a Pulmonary Artery Wedge Pressure (PAWP) of 22 mmHg. Which
assessment finding should the nurse anticipate?
A. Jugular venous distention and bilateral crackles
B. Flat neck veins and dry mucous membranes
C. Tachycardia and poor skin turgor
D. Increased urinary output and hypertension
Answer: A
Conceptual Explanation: The normal PAWP range is 6-12 mmHg. An elevation to 22
mmHg indicates left-sided heart failure or fluid volume overload, which manifests as
pulmonary congestion (crackles) and systemic backup (JVD).
2. A patient with ARDS is being mechanically ventilated with a PEEP of 15 cm H2O. Which
complication is the nurse primarily monitoring for?
A. Respiratory alkalosis
,B. Barotrauma and decreased cardiac output
C. Increased intracranial pressure
D. Oxygen toxicity
Answer: B
Conceptual Explanation: High levels of Positive End-Expiratory Pressure (PEEP) increase
intrathoracic pressure, which can lead to barotrauma (pneumothorax) and compress the
heart, decreasing venous return and cardiac output.
3. Which assessment finding best differentiates neurogenic shock from other types of shock?
A. Hypotension
B. Bradycardia
C. Tachycardia
D. Cool, clammy skin
Answer: B
Conceptual Explanation: Neurogenic shock is unique because the loss of sympathetic tone
leads to bradycardia and skin that is usually warm and dry, whereas most other shocks
feature compensatory tachycardia and cool skin.
4. A client with a T6 spinal cord injury reports a severe pounding headache and is found to be
hypertensive (190/100). What is the nurse’s priority action?
A. Administer prescribed antihypertensives
, B. Place the client in a supine position
C. Check the client’s bladder for distention
D. Notify the healthcare provider immediately
Answer: C
Conceptual Explanation: These are classic signs of autonomic dysreflexia. The priority is
to identify and remove the stimulus, most commonly a distended bladder or fecal
impaction, while sitting the patient upright.
5. Which laboratory result is most indicative of Disseminated Intravascular Coagulation (DIC)?
A. Decreased D-dimer and increased platelets
B. Increased D-dimer and decreased fibrinogen
C. Decreased Prothrombin Time (PT)
D. Increased hemoglobin and hematocrit
Answer: B
Conceptual Explanation: DIC is characterized by the consumption of clotting factors and
activation of the fibrinolytic system, leading to elevated D-dimer (clot breakdown
products) and low fibrinogen/platelets.
6. A nurse is caring for a patient in the oliguric phase of Acute Kidney Injury (AKI). Which
electrolyte imbalance is the greatest threat to the patient?
A. Hypokalemia
ADVANCED MEDICAL-SURGICAL
NURSING QUESTIONS AND ANSWERS |
2026/2027 UPDATE | 100% CORRECT-
GALEN.
1. A client in the ICU has a Pulmonary Artery Wedge Pressure (PAWP) of 22 mmHg. Which
assessment finding should the nurse anticipate?
A. Jugular venous distention and bilateral crackles
B. Flat neck veins and dry mucous membranes
C. Tachycardia and poor skin turgor
D. Increased urinary output and hypertension
Answer: A
Conceptual Explanation: The normal PAWP range is 6-12 mmHg. An elevation to 22
mmHg indicates left-sided heart failure or fluid volume overload, which manifests as
pulmonary congestion (crackles) and systemic backup (JVD).
2. A patient with ARDS is being mechanically ventilated with a PEEP of 15 cm H2O. Which
complication is the nurse primarily monitoring for?
A. Respiratory alkalosis
,B. Barotrauma and decreased cardiac output
C. Increased intracranial pressure
D. Oxygen toxicity
Answer: B
Conceptual Explanation: High levels of Positive End-Expiratory Pressure (PEEP) increase
intrathoracic pressure, which can lead to barotrauma (pneumothorax) and compress the
heart, decreasing venous return and cardiac output.
3. Which assessment finding best differentiates neurogenic shock from other types of shock?
A. Hypotension
B. Bradycardia
C. Tachycardia
D. Cool, clammy skin
Answer: B
Conceptual Explanation: Neurogenic shock is unique because the loss of sympathetic tone
leads to bradycardia and skin that is usually warm and dry, whereas most other shocks
feature compensatory tachycardia and cool skin.
4. A client with a T6 spinal cord injury reports a severe pounding headache and is found to be
hypertensive (190/100). What is the nurse’s priority action?
A. Administer prescribed antihypertensives
, B. Place the client in a supine position
C. Check the client’s bladder for distention
D. Notify the healthcare provider immediately
Answer: C
Conceptual Explanation: These are classic signs of autonomic dysreflexia. The priority is
to identify and remove the stimulus, most commonly a distended bladder or fecal
impaction, while sitting the patient upright.
5. Which laboratory result is most indicative of Disseminated Intravascular Coagulation (DIC)?
A. Decreased D-dimer and increased platelets
B. Increased D-dimer and decreased fibrinogen
C. Decreased Prothrombin Time (PT)
D. Increased hemoglobin and hematocrit
Answer: B
Conceptual Explanation: DIC is characterized by the consumption of clotting factors and
activation of the fibrinolytic system, leading to elevated D-dimer (clot breakdown
products) and low fibrinogen/platelets.
6. A nurse is caring for a patient in the oliguric phase of Acute Kidney Injury (AKI). Which
electrolyte imbalance is the greatest threat to the patient?
A. Hypokalemia
