NUR 265 Medical-Surgical Nursing - Exam 2 (2026/2027) 100 Questions | 100 Points | 150 Minutes
GALEN COLLEGE OF NURSING
NUR 265 Exam 2 (2026/2027)
Medical-Surgical Nursing | Comprehensive Examination Preparation with Rationales
100 Questions | Total: 100 Points (1 point each) | Suggested Time: 150 Minutes | Format: Multiple Choice (A-D) | Cognitive
Levels: 30% Recall, 50% Application, 20% Analysis
DIRECTIONS: Each question presents a clinical scenario or a single-concept item followed by four options (A-D). Select
the ONE best answer; the correct answer is marked [CORRECT] and a rationale explaining why the correct option is right
and why the distractors are wrong follows every item. Content is aligned to the NUR 265 Medical-Surgical Nursing Exam 2
course objectives for the 2026/2027 cycle: cardiovascular, vascular/hematologic, respiratory, neurological,
sensory/musculoskeletal, and emergency/critical-care nursing, with prioritization guided by the ABCs, Maslow, and safety
frameworks.
SECTION 1 | CARDIOVASCULAR SYSTEM - ADVANCED CONCEPTS (Questions 1-20)
Heart Failure (Left vs. Right, Systolic vs. Diastolic) - Dysrhythmias - Valvular Disease - Inflammatory Cardiac Disorders
Q1: A nurse auscultates fine crackles in the bilateral lung bases of a client admitted with an acute
exacerbation of heart failure. Which additional assessment finding is consistent with LEFT-sided heart
failure?
A. Dependent bilateral ankle edema and hepatomegaly
B. Jugular venous distension and ascites
C. Orthopnea and paroxysmal nocturnal dyspnea [CORRECT]
D. Right upper quadrant tenderness with hepatic congestion
Correct Answer: C
Rationale: Left-sided heart failure causes blood to back up into the pulmonary circulation, producing pulmonary
congestion manifested as crackles, orthopnea, and paroxysmal nocturnal dyspnea. Options A, B, and D describe
systemic venous congestion (jugular distension, ascites, peripheral edema, hepatomegaly) caused by RIGHT-sided
heart failure, in which the right ventricle fails to pump blood forward into the pulmonary circulation. Distinguishing
the two sides guides diuretic and preload-reduction therapies.
Galen College of Nursing - NUR 265 Exam 2 Preparation 1
,NUR 265 Medical-Surgical Nursing - Exam 2 (2026/2027) 100 Questions | 100 Points | 150 Minutes
Q2: A client is admitted with a diagnosis of right-sided heart failure following a large right ventricular
infarction. Which assessment finding should the nurse expect to find on examination?
A. Distended neck veins and pitting edema of the lower extremities [CORRECT]
B. Coarse crackles bilaterally and frothy pink-tinged sputum
C. Orthopnea requiring three pillows for sleep
D. Bibasilar dullness with increased tactile fremitus
Correct Answer: A
Rationale: Right-sided heart failure produces systemic venous congestion because the failing right ventricle cannot
accommodate venous return, so pressure rises in the vena cava, jugular veins, and peripheral capillary beds, causing
JVD, dependent edema, ascites, and hepatomegaly. Crackles, orthopnea, and pink-tinged sputum (options B, C, and
D) reflect pulmonary venous congestion from LEFT-sided failure. Right ventricular infarction is a classic cause of
isolated right-sided failure.
Q3: A client has an ejection fraction of 60% on echocardiogram yet presents with pulmonary congestion,
dyspnea on exertion, and an S4 heart sound. How should the nurse interpret these findings?
A. The ejection fraction was miscalculated because congestion requires a low ejection fraction
B. This presentation is inconsistent with any form of heart failure
C. This is right-sided heart failure caused by volume overload
D. This is diastolic heart failure (HFpEF) caused by impaired ventricular filling [CORRECT]
Correct Answer: D
Rationale: Diastolic heart failure (heart failure with preserved ejection fraction) occurs when a stiff, noncompliant
ventricle cannot relax and fill properly, so congestion develops despite a normal ejection fraction of 50% or higher.
In systolic heart failure the ejection fraction is reduced (typically below 40%) from impaired contractility. The S4
sound reflects blood being forced into a stiff, hypertrophied ventricle during atrial contraction, which supports the
diagnosis of diastolic dysfunction.
Q4: A client who arrived at the emergency department with acute dyspnea has a B-type natriuretic peptide
(BNP) of 1,450 pg/mL. How should the nurse interpret this laboratory result?
A. The value is normal and the dyspnea is most likely anxiety related
B. The result strongly supports heart failure as the cause of the dyspnea [CORRECT]
C. The result confirms a bacterial pneumonia as the source of dyspnea
D. The elevation reflects renal impairment and has no cardiac significance
Correct Answer: B
Rationale: BNP is released by stretched ventricular myocardium in response to volume and pressure overload;
values above 400 pg/mL strongly support heart failure, and 1,450 pg/mL indicates significant cardiac
decompensation. A normal BNP (below 100 pg/mL) makes heart failure an unlikely cause of dyspnea and helps
differentiate cardiac from pulmonary dyspnea. Pneumonia and anxiety do not produce BNP elevations of this
magnitude, although renal disease can modestly raise the value.
Galen College of Nursing - NUR 265 Exam 2 Preparation 2
,NUR 265 Medical-Surgical Nursing - Exam 2 (2026/2027) 100 Questions | 100 Points | 150 Minutes
Q5: A client receiving digoxin 0.25 mg daily for heart failure reports nausea and states that lights now appear
to have yellow halos. The apical pulse is 58 beats per minute. What is the priority nursing action?
A. Administer the dose with an antacid to reduce gastric irritation
B. Document the findings as expected therapeutic effects of digoxin
C. Withhold the dose and notify the provider, anticipating a serum digoxin level [CORRECT]
D. Reassure the client and administer the next scheduled dose on time
Correct Answer: C
Rationale: Gastrointestinal upset, yellow-green visual disturbances, and a pulse below 60 beats per minute are
hallmark manifestations of digoxin toxicity, so the nurse must hold the dose and obtain a serum level and
electrolytes. Hypokalemia potentiates digoxin toxicity, so the potassium level should also be evaluated. Options A, B,
and D ignore the signs of toxicity and could allow the serum level to rise to a dangerous degree.
Q6: The nurse is teaching a client with newly diagnosed heart failure about self-monitoring at home. Which
client statement indicates correct understanding of the teaching?
A. I will weigh myself every Friday evening after dinner for consistency
B. I will call the clinic if I gain 3 pounds in one day or 5 pounds in one week [CORRECT]
C. I will skip my diuretic on days when my ankles do not look swollen
D. A 2-pound weight gain overnight is expected from the fluids I drink
Correct Answer: B
Rationale: A gain of 2 to 3 pounds in 24 hours or 5 pounds in a week signals fluid retention before visible edema
appears, so early reporting allows adjustment of diuretics and prevents readmission. Weights must be taken daily, in
the morning after voiding, in similar clothing. Skipping diuretics (option C) and dismissing rapid overnight gains
(option D) reflect misconceptions that allow insidious volume overload to accumulate.
Q7: A client on telemetry has newly diagnosed atrial fibrillation with a ventricular rate of 128 and an
irregularly irregular rhythm. Which complication is the nurse's greatest concern when planning this client's
care?
A. Sudden progression to complete asystole
B. Ineffective breathing pattern from loss of the atrial kick
C. Development of a hypertensive crisis
D. Thromboembolic stroke from stasis of blood in the atria [CORRECT]
Correct Answer: D
Rationale: In atrial fibrillation the atria quiver rather than contract, eliminating the atrial kick and allowing blood to
stagnate in the atrial appendages, where mural thrombi form and can embolize to the brain. This is why
anticoagulation is a cornerstone of atrial fibrillation management along with rate or rhythm control. Asystole (option
A) is not the typical progression of atrial fibrillation, and while the atrial kick contributes up to 30% of cardiac
output, its loss causes fatigue rather than primary breathing failure.
Galen College of Nursing - NUR 265 Exam 2 Preparation 3
, NUR 265 Medical-Surgical Nursing - Exam 2 (2026/2027) 100 Questions | 100 Points | 150 Minutes
Q8: A nurse finds a client unresponsive with no palpable pulse, and the monitor displays chaotic, irregular
undulations without identifiable QRS complexes. What is the first action the nurse should take?
A. Defibrillate the client immediately at the prescribed energy setting [CORRECT]
B. Administer IV epinephrine before any electrical intervention
C. Prepare for synchronized cardioversion
D. Insert an oropharyngeal airway and begin oxygen by face mask
Correct Answer: A
Rationale: The rhythm is ventricular fibrillation, a pulseless lethal dysrhythmia in which the ventricles quiver
without effective contraction, so immediate UNSYNCHRONIZED defibrillation is the definitive treatment because
it simultaneously depolarizes all myocardial cells and allows the sinus node to resume control. Epinephrine is
administered after initial defibrillation attempts during CPR. Synchronized cardioversion (option C) is used for
unstable tachydysrhythmias in clients WITH a pulse, and airway measures never take priority over stopping a
shockable rhythm.
Q9: A client is admitted with sustained monomorphic ventricular tachycardia at 160 beats per minute. The
client is alert and oriented, has a palpable radial pulse, and has a blood pressure of 104/68 mm Hg without
chest pain. Which intervention should the nurse anticipate?
A. Immediate unsynchronized defibrillation
B. IV administration of amiodarone as prescribed [CORRECT]
C. Unsynchronized cardioversion during sedation
D. Carotid sinus massage at the bedside
Correct Answer: B
Rationale: Because this client is hemodynamically stable (adequate blood pressure, palpable pulse, no altered
mentation or chest pain), the initial treatment of stable sustained ventricular tachycardia is an IV antiarrhythmic such
as amiodarone. Unsynchronized defibrillation is reserved for pulseless ventricular tachycardia or ventricular
fibrillation, and synchronized cardioversion is indicated only when the client becomes unstable. Carotid massage is a
vagal maneuver for certain supraventricular tachycardias and is dangerous in ventricular rhythms.
Q10: A client with dizziness and hypotension is found to have a heart rate of 34, with P waves occurring
independently and completely dissociated from the QRS complexes on the rhythm strip. Which intervention
should the nurse anticipate first?
A. Rapid IV push of adenosine
B. Synchronized cardioversion at 100 joules
C. Transcutaneous pacing until a permanent pacing system can be placed [CORRECT]
D. Unsynchronized defibrillation at maximal energy
Correct Answer: C
Rationale: Complete (third-degree) AV block is identified by AV dissociation, in which atrial and ventricular
activity are entirely independent, producing an extremely slow rate and poor perfusion that require electrical pacing.
Transcutaneous pacing is the fastest temporizing method, followed by transvenous pacing and permanent pacemaker
implantation. Adenosine treats paroxysmal supraventricular tachycardia, cardioversion is ineffective when there is
no coordinated conduction to synchronize with, and defibrillation applies only to pulseless ventricular rhythms.
Galen College of Nursing - NUR 265 Exam 2 Preparation 4
GALEN COLLEGE OF NURSING
NUR 265 Exam 2 (2026/2027)
Medical-Surgical Nursing | Comprehensive Examination Preparation with Rationales
100 Questions | Total: 100 Points (1 point each) | Suggested Time: 150 Minutes | Format: Multiple Choice (A-D) | Cognitive
Levels: 30% Recall, 50% Application, 20% Analysis
DIRECTIONS: Each question presents a clinical scenario or a single-concept item followed by four options (A-D). Select
the ONE best answer; the correct answer is marked [CORRECT] and a rationale explaining why the correct option is right
and why the distractors are wrong follows every item. Content is aligned to the NUR 265 Medical-Surgical Nursing Exam 2
course objectives for the 2026/2027 cycle: cardiovascular, vascular/hematologic, respiratory, neurological,
sensory/musculoskeletal, and emergency/critical-care nursing, with prioritization guided by the ABCs, Maslow, and safety
frameworks.
SECTION 1 | CARDIOVASCULAR SYSTEM - ADVANCED CONCEPTS (Questions 1-20)
Heart Failure (Left vs. Right, Systolic vs. Diastolic) - Dysrhythmias - Valvular Disease - Inflammatory Cardiac Disorders
Q1: A nurse auscultates fine crackles in the bilateral lung bases of a client admitted with an acute
exacerbation of heart failure. Which additional assessment finding is consistent with LEFT-sided heart
failure?
A. Dependent bilateral ankle edema and hepatomegaly
B. Jugular venous distension and ascites
C. Orthopnea and paroxysmal nocturnal dyspnea [CORRECT]
D. Right upper quadrant tenderness with hepatic congestion
Correct Answer: C
Rationale: Left-sided heart failure causes blood to back up into the pulmonary circulation, producing pulmonary
congestion manifested as crackles, orthopnea, and paroxysmal nocturnal dyspnea. Options A, B, and D describe
systemic venous congestion (jugular distension, ascites, peripheral edema, hepatomegaly) caused by RIGHT-sided
heart failure, in which the right ventricle fails to pump blood forward into the pulmonary circulation. Distinguishing
the two sides guides diuretic and preload-reduction therapies.
Galen College of Nursing - NUR 265 Exam 2 Preparation 1
,NUR 265 Medical-Surgical Nursing - Exam 2 (2026/2027) 100 Questions | 100 Points | 150 Minutes
Q2: A client is admitted with a diagnosis of right-sided heart failure following a large right ventricular
infarction. Which assessment finding should the nurse expect to find on examination?
A. Distended neck veins and pitting edema of the lower extremities [CORRECT]
B. Coarse crackles bilaterally and frothy pink-tinged sputum
C. Orthopnea requiring three pillows for sleep
D. Bibasilar dullness with increased tactile fremitus
Correct Answer: A
Rationale: Right-sided heart failure produces systemic venous congestion because the failing right ventricle cannot
accommodate venous return, so pressure rises in the vena cava, jugular veins, and peripheral capillary beds, causing
JVD, dependent edema, ascites, and hepatomegaly. Crackles, orthopnea, and pink-tinged sputum (options B, C, and
D) reflect pulmonary venous congestion from LEFT-sided failure. Right ventricular infarction is a classic cause of
isolated right-sided failure.
Q3: A client has an ejection fraction of 60% on echocardiogram yet presents with pulmonary congestion,
dyspnea on exertion, and an S4 heart sound. How should the nurse interpret these findings?
A. The ejection fraction was miscalculated because congestion requires a low ejection fraction
B. This presentation is inconsistent with any form of heart failure
C. This is right-sided heart failure caused by volume overload
D. This is diastolic heart failure (HFpEF) caused by impaired ventricular filling [CORRECT]
Correct Answer: D
Rationale: Diastolic heart failure (heart failure with preserved ejection fraction) occurs when a stiff, noncompliant
ventricle cannot relax and fill properly, so congestion develops despite a normal ejection fraction of 50% or higher.
In systolic heart failure the ejection fraction is reduced (typically below 40%) from impaired contractility. The S4
sound reflects blood being forced into a stiff, hypertrophied ventricle during atrial contraction, which supports the
diagnosis of diastolic dysfunction.
Q4: A client who arrived at the emergency department with acute dyspnea has a B-type natriuretic peptide
(BNP) of 1,450 pg/mL. How should the nurse interpret this laboratory result?
A. The value is normal and the dyspnea is most likely anxiety related
B. The result strongly supports heart failure as the cause of the dyspnea [CORRECT]
C. The result confirms a bacterial pneumonia as the source of dyspnea
D. The elevation reflects renal impairment and has no cardiac significance
Correct Answer: B
Rationale: BNP is released by stretched ventricular myocardium in response to volume and pressure overload;
values above 400 pg/mL strongly support heart failure, and 1,450 pg/mL indicates significant cardiac
decompensation. A normal BNP (below 100 pg/mL) makes heart failure an unlikely cause of dyspnea and helps
differentiate cardiac from pulmonary dyspnea. Pneumonia and anxiety do not produce BNP elevations of this
magnitude, although renal disease can modestly raise the value.
Galen College of Nursing - NUR 265 Exam 2 Preparation 2
,NUR 265 Medical-Surgical Nursing - Exam 2 (2026/2027) 100 Questions | 100 Points | 150 Minutes
Q5: A client receiving digoxin 0.25 mg daily for heart failure reports nausea and states that lights now appear
to have yellow halos. The apical pulse is 58 beats per minute. What is the priority nursing action?
A. Administer the dose with an antacid to reduce gastric irritation
B. Document the findings as expected therapeutic effects of digoxin
C. Withhold the dose and notify the provider, anticipating a serum digoxin level [CORRECT]
D. Reassure the client and administer the next scheduled dose on time
Correct Answer: C
Rationale: Gastrointestinal upset, yellow-green visual disturbances, and a pulse below 60 beats per minute are
hallmark manifestations of digoxin toxicity, so the nurse must hold the dose and obtain a serum level and
electrolytes. Hypokalemia potentiates digoxin toxicity, so the potassium level should also be evaluated. Options A, B,
and D ignore the signs of toxicity and could allow the serum level to rise to a dangerous degree.
Q6: The nurse is teaching a client with newly diagnosed heart failure about self-monitoring at home. Which
client statement indicates correct understanding of the teaching?
A. I will weigh myself every Friday evening after dinner for consistency
B. I will call the clinic if I gain 3 pounds in one day or 5 pounds in one week [CORRECT]
C. I will skip my diuretic on days when my ankles do not look swollen
D. A 2-pound weight gain overnight is expected from the fluids I drink
Correct Answer: B
Rationale: A gain of 2 to 3 pounds in 24 hours or 5 pounds in a week signals fluid retention before visible edema
appears, so early reporting allows adjustment of diuretics and prevents readmission. Weights must be taken daily, in
the morning after voiding, in similar clothing. Skipping diuretics (option C) and dismissing rapid overnight gains
(option D) reflect misconceptions that allow insidious volume overload to accumulate.
Q7: A client on telemetry has newly diagnosed atrial fibrillation with a ventricular rate of 128 and an
irregularly irregular rhythm. Which complication is the nurse's greatest concern when planning this client's
care?
A. Sudden progression to complete asystole
B. Ineffective breathing pattern from loss of the atrial kick
C. Development of a hypertensive crisis
D. Thromboembolic stroke from stasis of blood in the atria [CORRECT]
Correct Answer: D
Rationale: In atrial fibrillation the atria quiver rather than contract, eliminating the atrial kick and allowing blood to
stagnate in the atrial appendages, where mural thrombi form and can embolize to the brain. This is why
anticoagulation is a cornerstone of atrial fibrillation management along with rate or rhythm control. Asystole (option
A) is not the typical progression of atrial fibrillation, and while the atrial kick contributes up to 30% of cardiac
output, its loss causes fatigue rather than primary breathing failure.
Galen College of Nursing - NUR 265 Exam 2 Preparation 3
, NUR 265 Medical-Surgical Nursing - Exam 2 (2026/2027) 100 Questions | 100 Points | 150 Minutes
Q8: A nurse finds a client unresponsive with no palpable pulse, and the monitor displays chaotic, irregular
undulations without identifiable QRS complexes. What is the first action the nurse should take?
A. Defibrillate the client immediately at the prescribed energy setting [CORRECT]
B. Administer IV epinephrine before any electrical intervention
C. Prepare for synchronized cardioversion
D. Insert an oropharyngeal airway and begin oxygen by face mask
Correct Answer: A
Rationale: The rhythm is ventricular fibrillation, a pulseless lethal dysrhythmia in which the ventricles quiver
without effective contraction, so immediate UNSYNCHRONIZED defibrillation is the definitive treatment because
it simultaneously depolarizes all myocardial cells and allows the sinus node to resume control. Epinephrine is
administered after initial defibrillation attempts during CPR. Synchronized cardioversion (option C) is used for
unstable tachydysrhythmias in clients WITH a pulse, and airway measures never take priority over stopping a
shockable rhythm.
Q9: A client is admitted with sustained monomorphic ventricular tachycardia at 160 beats per minute. The
client is alert and oriented, has a palpable radial pulse, and has a blood pressure of 104/68 mm Hg without
chest pain. Which intervention should the nurse anticipate?
A. Immediate unsynchronized defibrillation
B. IV administration of amiodarone as prescribed [CORRECT]
C. Unsynchronized cardioversion during sedation
D. Carotid sinus massage at the bedside
Correct Answer: B
Rationale: Because this client is hemodynamically stable (adequate blood pressure, palpable pulse, no altered
mentation or chest pain), the initial treatment of stable sustained ventricular tachycardia is an IV antiarrhythmic such
as amiodarone. Unsynchronized defibrillation is reserved for pulseless ventricular tachycardia or ventricular
fibrillation, and synchronized cardioversion is indicated only when the client becomes unstable. Carotid massage is a
vagal maneuver for certain supraventricular tachycardias and is dangerous in ventricular rhythms.
Q10: A client with dizziness and hypotension is found to have a heart rate of 34, with P waves occurring
independently and completely dissociated from the QRS complexes on the rhythm strip. Which intervention
should the nurse anticipate first?
A. Rapid IV push of adenosine
B. Synchronized cardioversion at 100 joules
C. Transcutaneous pacing until a permanent pacing system can be placed [CORRECT]
D. Unsynchronized defibrillation at maximal energy
Correct Answer: C
Rationale: Complete (third-degree) AV block is identified by AV dissociation, in which atrial and ventricular
activity are entirely independent, producing an extremely slow rate and poor perfusion that require electrical pacing.
Transcutaneous pacing is the fastest temporizing method, followed by transvenous pacing and permanent pacemaker
implantation. Adenosine treats paroxysmal supraventricular tachycardia, cardioversion is ineffective when there is
no coordinated conduction to synchronize with, and defibrillation applies only to pulseless ventricular rhythms.
Galen College of Nursing - NUR 265 Exam 2 Preparation 4
