NUR 265 EXAM 2 STUDY GUIDE 2026 | ADVANCED
MED-SURG UNITS 4-6 | MECHANICAL VENTILATION, ARDS,
ENDOCRINE, DKA & HHS | GALEN COLLEGE OF NURSING.
148 Questions with Answers and Detailed Rationales
100 PERCENT GUARANTEED PASS
INSTANT DOWNLOAD ANSWERS INCLUDED
IMPORTANCE OF THIS DOCUMENT
This comprehensive examination preparation guide has been meticulously developed to help you succeed in the
NUR 265 EXAM 2 STUDY GUIDE 2026 | ADVANCED MED-SURG UNITS 4-6 | MECHANICAL VENTILATION,
ARDS, ENDOCRINE, DKA & HHS | GALEN COLLEGE OF NURSING.. It contains 148 carefully selected
questions that reflect the most current exam content and testing strategies. Each question is accompanied by a
correct answer and a detailed rationale that explains the underlying pathophysiology, pharmacology, or clinical
reasoning.
Self-Assessment – Test your knowledge and Exam Preparation – Familiarize yourself with the
identify areas requiring further question format and content
study areas
Concept Reinforcement – Deepen your Confidence Building – Develop test-taking
understanding through strategies and reduce
evidence-based exam anxiety
rationales
Time Management – Practice answering
questions under simulated
exam conditions
Review Summary 148 Questions
Foundations - Application - NUR 265 2 Study Guide 2026 Advanced Med-surg Units 4 6 Mechanical
Ventilation ARDS Endocrine DKA & HHS Galen College OF Nursing Advanced Medical-surgical Nursing
Mechanical Ventilation ARDS Endocrine Disorders DKA & HHS Undergraduate YEAR 3 Prelicensure BSN
Advanced Medical-surgical Nursing
All answers with rationales
,Table of Contents
Content Area Questions Key Topics
Mechanical Ventilation 1-25 Serum, Ventilation, Syndrome, Finding, Mechanical
Modes Settings AND Nursing
Management
Acute Respiratory Distress 26-50 Ventilation, Finding, Serum, Priority, Receiving
Syndrome ARDS
Pathophysiology Diagnosis
AND Management
Endocrine Disorders 51-75 Glucose, Insulin, Receiving, Ventilation, Blood
Pituitary Thyroid Parathyroid
AND Adrenal Gland
Dysfunction
Diabetic Ketoacidosis DKA 76-100 Ventilation, Finding, Mechanical, Insulin, Serum
Pathophysiology Clinical
Manifestations AND
Treatment
Hyperglycemic 101-125 Ventilation, Finding, Receiving, Mechanical, Intervention
Hyperosmolar State HHS
Pathophysiology Clinical
Manifestations AND
Treatment
Diabetes Mellitus 126-148 Finding, Prone Position, Placed, Indicates, Ventilation
Pharmacologic Management
AND Insulin Therapy
TOTAL 148 All questions include answers and detailed rationales
,Section A - Mechanical Ventilation Modes Settings AND
Nursing Management
Q1.
A patient on volume-control mechanical ventilation has the following ABG: pH 7.28,
PaCO2 55 mm Hg, HCO3- 24 mEq/L. Which action should the nurse anticipate?
A. Increase the respiratory rate. B. Decrease the tidal volume.
C. Increase the FiO2. D. Administer sodium bicarbonate IV push.
Correct: A - Increase the respiratory rate.
Rationale:The ABG shows uncompensated respiratory acidosis (low pH, high PaCO2,
normal HCO3-), indicating hypoventilation. Increasing the respiratory rate enhances minute
ventilation and CO2 elimination. Decreasing tidal volume would worsen hypoventilation;
increasing FiO2 addresses oxygenation, not CO2; sodium bicarbonate is not first-line for
respiratory acidosis.
Why the other answers are wrong:
B. Decreasing tidal volume would reduce minute ventilation and worsen the respiratory
acidosis.
C. Increasing FiO2 improves oxygenation but does not correct the primary problem of CO2
retention.
D. Sodium bicarbonate is not indicated for respiratory acidosis unless severe acidosis persists
after optimizing ventilation.
Reference: Urden, L.D., Stacy, K.M., & Lough, M.E. (2022). Critical Care Nursing, 9th Ed., Ch. 14
Q2.
A patient with acute respiratory distress syndrome (ARDS) is being ventilated. Which
ventilator strategy best aligns with current evidence-based practice?
A. High tidal volumes (10-12 mL/kg) to B. Low tidal volumes (4-6 mL/kg) with
improve oxygenation. plateau pressure <30 cm H2O.
C. High positive end-expiratory pressure D. Permissive hypercapnia is
(PEEP) without regard to hemodynamics. contraindicated.
Correct: B - Low tidal volumes (4-6 mL/kg) with plateau pressure <30 cm H2O.
Rationale:Lung-protective ventilation with low tidal volumes (4-6 mL/kg predicted body
weight) and plateau pressure <30 cm H2O reduces ventilator-induced lung injury and
mortality in ARDS. High tidal volumes cause volutrauma; high PEEP must be balanced with
hemodynamic effects; permissive hypercapnia is often tolerated to minimize lung injury.
Why the other answers are wrong:
Page 3
, Section A - Mechanical Ventilation Modes Settings AND Nursing Management
A. High tidal volumes increase the risk of volutrauma and barotrauma and are associated with
higher mortality.
C. High PEEP can compromise cardiac output and is not applied without considering hemodynamic status.
D. Permissive hypercapnia is an accepted strategy to limit tidal volume and plateau pressure.
Reference: ARDSNet Protocol. (2023). Lower Tidal Volume Ventilation for Acute Lung Injury and ARDS.
NEJM.
Q3.
A patient with type 1 diabetes presents with Kussmaul respirations, fruity breath, and
blood glucose 480 mg/dL. Which additional finding is most consistent with diabetic
ketoacidosis (DKA)?
A. Serum bicarbonate of 28 mEq/L. B. Arterial pH of 7.48.
C. Positive serum ketones. D. Serum osmolality of 340 mOsm/kg.
Correct: C - Positive serum ketones.
Rationale:DKA is characterized by hyperglycemia, ketonemia, and metabolic acidosis.
Positive serum ketones are a hallmark. Bicarbonate would be low (not high) in DKA; pH would
be low (acidosis), not alkalotic; extreme osmolality is more typical of HHS.
Why the other answers are wrong:
A. Bicarbonate is typically low (<18 mEq/L) in DKA due to metabolic acidosis.
B. An elevated pH is inconsistent with DKA, which causes metabolic acidosis.
D. Osmolality >320 mOsm/kg is more characteristic of hyperosmolar hyperglycemic state
(HHS), not DKA.
Reference: American Diabetes Association. (2024). Hyperglycemic Crises in Adults with Diabetes: A
Consensus Report. Diabetes Care.
Q4.
A patient with suspected hyperosmolar hyperglycemic state (HHS) has a blood glucose of
1,200 mg/dL and serum osmolality of 350 mOsm/kg. Which nursing intervention is the
priority?
A. Administer regular insulin IV bolus. B. Initiate rapid fluid resuscitation with 0.9%
sodium chloride.
C. Restrict fluid intake to prevent cerebral D. Administer potassium-sparing diuretics.
edema.
Correct: B - Initiate rapid fluid resuscitation with 0.9% sodium chloride.
Rationale:HHS is characterized by severe dehydration and hyperosmolality; aggressive fluid
resuscitation with isotonic saline is the priority to restore intravascular volume and perfusion.
Insulin is given after initial fluid resuscitation to avoid precipitous drops in glucose and
osmolality; fluid restriction would worsen dehydration; diuretics are contraindicated.
Page 4
MED-SURG UNITS 4-6 | MECHANICAL VENTILATION, ARDS,
ENDOCRINE, DKA & HHS | GALEN COLLEGE OF NURSING.
148 Questions with Answers and Detailed Rationales
100 PERCENT GUARANTEED PASS
INSTANT DOWNLOAD ANSWERS INCLUDED
IMPORTANCE OF THIS DOCUMENT
This comprehensive examination preparation guide has been meticulously developed to help you succeed in the
NUR 265 EXAM 2 STUDY GUIDE 2026 | ADVANCED MED-SURG UNITS 4-6 | MECHANICAL VENTILATION,
ARDS, ENDOCRINE, DKA & HHS | GALEN COLLEGE OF NURSING.. It contains 148 carefully selected
questions that reflect the most current exam content and testing strategies. Each question is accompanied by a
correct answer and a detailed rationale that explains the underlying pathophysiology, pharmacology, or clinical
reasoning.
Self-Assessment – Test your knowledge and Exam Preparation – Familiarize yourself with the
identify areas requiring further question format and content
study areas
Concept Reinforcement – Deepen your Confidence Building – Develop test-taking
understanding through strategies and reduce
evidence-based exam anxiety
rationales
Time Management – Practice answering
questions under simulated
exam conditions
Review Summary 148 Questions
Foundations - Application - NUR 265 2 Study Guide 2026 Advanced Med-surg Units 4 6 Mechanical
Ventilation ARDS Endocrine DKA & HHS Galen College OF Nursing Advanced Medical-surgical Nursing
Mechanical Ventilation ARDS Endocrine Disorders DKA & HHS Undergraduate YEAR 3 Prelicensure BSN
Advanced Medical-surgical Nursing
All answers with rationales
,Table of Contents
Content Area Questions Key Topics
Mechanical Ventilation 1-25 Serum, Ventilation, Syndrome, Finding, Mechanical
Modes Settings AND Nursing
Management
Acute Respiratory Distress 26-50 Ventilation, Finding, Serum, Priority, Receiving
Syndrome ARDS
Pathophysiology Diagnosis
AND Management
Endocrine Disorders 51-75 Glucose, Insulin, Receiving, Ventilation, Blood
Pituitary Thyroid Parathyroid
AND Adrenal Gland
Dysfunction
Diabetic Ketoacidosis DKA 76-100 Ventilation, Finding, Mechanical, Insulin, Serum
Pathophysiology Clinical
Manifestations AND
Treatment
Hyperglycemic 101-125 Ventilation, Finding, Receiving, Mechanical, Intervention
Hyperosmolar State HHS
Pathophysiology Clinical
Manifestations AND
Treatment
Diabetes Mellitus 126-148 Finding, Prone Position, Placed, Indicates, Ventilation
Pharmacologic Management
AND Insulin Therapy
TOTAL 148 All questions include answers and detailed rationales
,Section A - Mechanical Ventilation Modes Settings AND
Nursing Management
Q1.
A patient on volume-control mechanical ventilation has the following ABG: pH 7.28,
PaCO2 55 mm Hg, HCO3- 24 mEq/L. Which action should the nurse anticipate?
A. Increase the respiratory rate. B. Decrease the tidal volume.
C. Increase the FiO2. D. Administer sodium bicarbonate IV push.
Correct: A - Increase the respiratory rate.
Rationale:The ABG shows uncompensated respiratory acidosis (low pH, high PaCO2,
normal HCO3-), indicating hypoventilation. Increasing the respiratory rate enhances minute
ventilation and CO2 elimination. Decreasing tidal volume would worsen hypoventilation;
increasing FiO2 addresses oxygenation, not CO2; sodium bicarbonate is not first-line for
respiratory acidosis.
Why the other answers are wrong:
B. Decreasing tidal volume would reduce minute ventilation and worsen the respiratory
acidosis.
C. Increasing FiO2 improves oxygenation but does not correct the primary problem of CO2
retention.
D. Sodium bicarbonate is not indicated for respiratory acidosis unless severe acidosis persists
after optimizing ventilation.
Reference: Urden, L.D., Stacy, K.M., & Lough, M.E. (2022). Critical Care Nursing, 9th Ed., Ch. 14
Q2.
A patient with acute respiratory distress syndrome (ARDS) is being ventilated. Which
ventilator strategy best aligns with current evidence-based practice?
A. High tidal volumes (10-12 mL/kg) to B. Low tidal volumes (4-6 mL/kg) with
improve oxygenation. plateau pressure <30 cm H2O.
C. High positive end-expiratory pressure D. Permissive hypercapnia is
(PEEP) without regard to hemodynamics. contraindicated.
Correct: B - Low tidal volumes (4-6 mL/kg) with plateau pressure <30 cm H2O.
Rationale:Lung-protective ventilation with low tidal volumes (4-6 mL/kg predicted body
weight) and plateau pressure <30 cm H2O reduces ventilator-induced lung injury and
mortality in ARDS. High tidal volumes cause volutrauma; high PEEP must be balanced with
hemodynamic effects; permissive hypercapnia is often tolerated to minimize lung injury.
Why the other answers are wrong:
Page 3
, Section A - Mechanical Ventilation Modes Settings AND Nursing Management
A. High tidal volumes increase the risk of volutrauma and barotrauma and are associated with
higher mortality.
C. High PEEP can compromise cardiac output and is not applied without considering hemodynamic status.
D. Permissive hypercapnia is an accepted strategy to limit tidal volume and plateau pressure.
Reference: ARDSNet Protocol. (2023). Lower Tidal Volume Ventilation for Acute Lung Injury and ARDS.
NEJM.
Q3.
A patient with type 1 diabetes presents with Kussmaul respirations, fruity breath, and
blood glucose 480 mg/dL. Which additional finding is most consistent with diabetic
ketoacidosis (DKA)?
A. Serum bicarbonate of 28 mEq/L. B. Arterial pH of 7.48.
C. Positive serum ketones. D. Serum osmolality of 340 mOsm/kg.
Correct: C - Positive serum ketones.
Rationale:DKA is characterized by hyperglycemia, ketonemia, and metabolic acidosis.
Positive serum ketones are a hallmark. Bicarbonate would be low (not high) in DKA; pH would
be low (acidosis), not alkalotic; extreme osmolality is more typical of HHS.
Why the other answers are wrong:
A. Bicarbonate is typically low (<18 mEq/L) in DKA due to metabolic acidosis.
B. An elevated pH is inconsistent with DKA, which causes metabolic acidosis.
D. Osmolality >320 mOsm/kg is more characteristic of hyperosmolar hyperglycemic state
(HHS), not DKA.
Reference: American Diabetes Association. (2024). Hyperglycemic Crises in Adults with Diabetes: A
Consensus Report. Diabetes Care.
Q4.
A patient with suspected hyperosmolar hyperglycemic state (HHS) has a blood glucose of
1,200 mg/dL and serum osmolality of 350 mOsm/kg. Which nursing intervention is the
priority?
A. Administer regular insulin IV bolus. B. Initiate rapid fluid resuscitation with 0.9%
sodium chloride.
C. Restrict fluid intake to prevent cerebral D. Administer potassium-sparing diuretics.
edema.
Correct: B - Initiate rapid fluid resuscitation with 0.9% sodium chloride.
Rationale:HHS is characterized by severe dehydration and hyperosmolality; aggressive fluid
resuscitation with isotonic saline is the priority to restore intravascular volume and perfusion.
Insulin is given after initial fluid resuscitation to avoid precipitous drops in glucose and
osmolality; fluid restriction would worsen dehydration; diuretics are contraindicated.
Page 4
