1|P a g e
NUR 265 EXAM 1 MEDICAL-SURGICAL
NURSING (2026/2027) PDF | NURSING |
GALEN COLLEGE — PRACTICE
QUESTION BANK
INTRODUCTION
NUR 265 Exam 1 Medical-Surgical Nursing is designed to evaluate a nursing student's ability to
apply foundational medical-surgical nursing concepts to complex clinical situations. Success
requires more than memorizing disease definitions or interventio ns; students must recognize
clinical deterioration, prioritize competing patient needs, interpret assessment findings, apply
nursing-process principles, and select safe evidence-based interventions. This practice question
bank is designed for nursing students preparing for an examination covering core medical-
surgical concepts. The questions emphasize clinical judgment, prioritization, safety, assessment,
pharmacologic considerations, patient education, and recognition of complications. Each
question contains four answer choices with one best answer followed by a detailed rationale
explaining the clinical reasoning behind the correct response and why the alternatives are less
appropriate. Working through these questions can help students identify knowledge gaps,
strengthen prioritization skills, and become more comfortable with application- level examination
questions. Students should use this resource alongside their Galen College course materials,
assigned textbook, instructor guidance, and official learning objectives rather than treating it as a
reproduction of a proprietary examination.
CONTENT AREA OVERVIEW
Content Area Questions Key Topics Weight
Nursing Assessment & Clinical Assessment, prioritization, ABCs,
1–15 10%
Judgment deterioration, reassessment
Fluid, Electrolyte & Acid-Base Sodium, potassium, calcium, magnesium,
16–30 10%
Balance ABGs, IV therapy
Infection Prevention & Standard precautions, transmission, sepsis,
31–43 9%
Immune Response inflammation
Perioperative & Postoperative Preoperative assessment, complications,
44–55 8%
Nursing wound care, recovery
Oxygenation, COPD, pneumonia,
Respiratory Disorders 56–70 10%
respiratory failure
Heart failure, dysrhythmias, hypertension,
Cardiovascular Disorders 71–85 10%
perfusion
AKI, CKD, fluid balance, urinary
Renal & Urinary Disorders 86–97 8%
complications
,2|P a g e
GI bleeding, obstruction, liver disease,
GI & Hepatobiliary Disorders 98–110 8%
nutrition
Endocrine & Metabolic Diabetes, thyroid, adrenal disorders,
111–123 8%
Disorders glucose regulation
Stroke, seizures, increased ICP, neurologic
Neurologic Disorders 124–135 8%
assessment
Hematologic & Oncologic Anemia, bleeding, neutropenia, cancer-
136–143 6%
Concepts related complications
Safety, Education & Discharge Medication safety, teaching, delegation,
144–150 5%
Planning continuity of care
Note: The weighting above is an instructional practice distribution, not a claim about the
confidential weighting of a Galen College examination.
QUESTIONS 1–150
Q1
A postoperative patient becomes restless and confused. The respiratory rate is 30/min, oxygen
saturation is 88% on room air, and the patient is using accessory muscles. Which action should
the nurse take first?
A) Obtain a complete medication history
B) Apply supplemental oxygen and immediately assess airway and breathing
C) Encourage the patient to ambulate
D) Administer the prescribed opioid analgesic
Rationale: B is correct because acute restlessness and confusion can indicate cerebral hypoxia,
while tachypnea, low oxygen saturation, and accessory-muscle use indicate impaired
oxygenation. Airway and breathing take priority. A is important but should not delay
stabilization. C could worsen oxygen demand. D could further depress respirations and worsen
hypoxemia.
Q2
A client with suspected sepsis has a temperature of 39.2°C, heart rate 128/min, blood pressure
84/48 mm Hg, and altered mental status. Which finding is the nurse most concerned about?
A) Temperature of 39.2°C
B) Heart rate of 128/min
C) Blood pressure of 84/48 mm Hg with altered mental status
D) Chills and diaphoresis
,3|P a g e
Rationale: C is correct because hypotension accompanied by altered mentation indicates
inadequate tissue perfusion and possible septic shock. Fever, tachycardia, and chills are
significant but do not demonstrate compromised perfusion as directly as hypotension with
neurologic changes. Immediate escalation and hemodynamic management are required.
Q3
A patient with heart failure suddenly develops severe dyspnea, bilateral crackles, and pink frothy
sputum. Which intervention has the highest priority?
A) Place the patient flat
B) Encourage oral fluids
C) Position the patient upright and administer prescribed oxygen
D) Encourage coughing and deep breathing only
Rationale: C is correct because the findings are consistent with acute pulmonary edema. Upright
positioning reduces venous return and improves lung expansion, while oxygen supports gas
exchange. A worsens pulmonary congestion. B increases fluid burden. D alone is inadequate for
acute pulmonary edema.
Q4
A patient receiving IV potassium chloride reports burning at the IV site. The nurse notes
erythema and swelling. What should the nurse do first?
A) Increase the infusion rate
B) Apply a heating pad and continue the infusion
C) Stop the infusion and assess the IV site for infiltration or phlebitis
D) Flush the catheter rapidly
Rationale: C is correct because potassium is irritating and extravasation or infiltration can
cause tissue injury. The infusion should be stopped and the site assessed. Increasing the rate or
flushing the line may worsen tissue injury. Heat may be appropriate in selected situations after
assessment, but continuing the infusion is unsafe.
Q5
A patient with COPD receiving oxygen at 6 L/min by nasal cannula becomes increasingly
somnolent. Which explanation is most clinically concerning?
A) The oxygen flow is too low
B) The patient has developed metabolic alkalosis
C) Excessive oxygen administration may worsen carbon-dioxide retention in a susceptible
patient
D) Oxygen causes immediate bronchoconstriction in COPD
, 4|P a g e
Rationale: C is correct because some patients with severe COPD and chronic CO₂ retention can
experience worsening hypercapnia with excessive oxygen administration. Oxygen should not be
withheld from a hypoxemic patient, but it should be titrated to the prescribed target. A does not
explain somnolence. B is not the most likely explanation. D is incorrect.
Q6
A patient has a potassium level of 6.7 mEq/L and reports muscle weakness. Which finding
requires immediate attention?
A) Mild nausea
B) Decreased appetite
C) Peaked T waves on the ECG
D) Generalized fatigue
Rationale: C is correct because severe hyperkalemia can produce life-threatening cardiac
dysrhythmias. Peaked T waves are an important ECG manifestation and require urgent
intervention. Weakness and gastrointestinal symptoms can occur but are less immediately
dangerous than electrical instability.
Q7
A patient with vomiting and diarrhea has a blood pressure of 88/54 mm Hg, heart rate of
124/min, and urine output of 15 mL/hr. Which complication should the nurse suspect?
A) Fluid overload
B) Hypovolemic shock
C) Increased intracranial pressure
D) Neurogenic shock
Rationale: B is correct because gastrointestinal fluid losses combined with hypotension,
tachycardia, and oliguria strongly indicate significant intravascular-volume depletion. Fluid
overload would typically produce findings such as edema and pulmonary congestion. Increased
intracranial pressure does not explain the overall pattern, and neurogenic shock is associated
with loss of sympathetic vascular tone rather than major GI losses.
Q8
A client with pneumonia has an oxygen saturation of 89% despite prescribed oxygen. The patient
is increasingly confused. What should the nurse do?
A) Reassess in 30 minutes
B) Encourage oral fluids
C) Immediately reassess respiratory status and escalate care for persistent hypoxemia
D) Administer a sedative
NUR 265 EXAM 1 MEDICAL-SURGICAL
NURSING (2026/2027) PDF | NURSING |
GALEN COLLEGE — PRACTICE
QUESTION BANK
INTRODUCTION
NUR 265 Exam 1 Medical-Surgical Nursing is designed to evaluate a nursing student's ability to
apply foundational medical-surgical nursing concepts to complex clinical situations. Success
requires more than memorizing disease definitions or interventio ns; students must recognize
clinical deterioration, prioritize competing patient needs, interpret assessment findings, apply
nursing-process principles, and select safe evidence-based interventions. This practice question
bank is designed for nursing students preparing for an examination covering core medical-
surgical concepts. The questions emphasize clinical judgment, prioritization, safety, assessment,
pharmacologic considerations, patient education, and recognition of complications. Each
question contains four answer choices with one best answer followed by a detailed rationale
explaining the clinical reasoning behind the correct response and why the alternatives are less
appropriate. Working through these questions can help students identify knowledge gaps,
strengthen prioritization skills, and become more comfortable with application- level examination
questions. Students should use this resource alongside their Galen College course materials,
assigned textbook, instructor guidance, and official learning objectives rather than treating it as a
reproduction of a proprietary examination.
CONTENT AREA OVERVIEW
Content Area Questions Key Topics Weight
Nursing Assessment & Clinical Assessment, prioritization, ABCs,
1–15 10%
Judgment deterioration, reassessment
Fluid, Electrolyte & Acid-Base Sodium, potassium, calcium, magnesium,
16–30 10%
Balance ABGs, IV therapy
Infection Prevention & Standard precautions, transmission, sepsis,
31–43 9%
Immune Response inflammation
Perioperative & Postoperative Preoperative assessment, complications,
44–55 8%
Nursing wound care, recovery
Oxygenation, COPD, pneumonia,
Respiratory Disorders 56–70 10%
respiratory failure
Heart failure, dysrhythmias, hypertension,
Cardiovascular Disorders 71–85 10%
perfusion
AKI, CKD, fluid balance, urinary
Renal & Urinary Disorders 86–97 8%
complications
,2|P a g e
GI bleeding, obstruction, liver disease,
GI & Hepatobiliary Disorders 98–110 8%
nutrition
Endocrine & Metabolic Diabetes, thyroid, adrenal disorders,
111–123 8%
Disorders glucose regulation
Stroke, seizures, increased ICP, neurologic
Neurologic Disorders 124–135 8%
assessment
Hematologic & Oncologic Anemia, bleeding, neutropenia, cancer-
136–143 6%
Concepts related complications
Safety, Education & Discharge Medication safety, teaching, delegation,
144–150 5%
Planning continuity of care
Note: The weighting above is an instructional practice distribution, not a claim about the
confidential weighting of a Galen College examination.
QUESTIONS 1–150
Q1
A postoperative patient becomes restless and confused. The respiratory rate is 30/min, oxygen
saturation is 88% on room air, and the patient is using accessory muscles. Which action should
the nurse take first?
A) Obtain a complete medication history
B) Apply supplemental oxygen and immediately assess airway and breathing
C) Encourage the patient to ambulate
D) Administer the prescribed opioid analgesic
Rationale: B is correct because acute restlessness and confusion can indicate cerebral hypoxia,
while tachypnea, low oxygen saturation, and accessory-muscle use indicate impaired
oxygenation. Airway and breathing take priority. A is important but should not delay
stabilization. C could worsen oxygen demand. D could further depress respirations and worsen
hypoxemia.
Q2
A client with suspected sepsis has a temperature of 39.2°C, heart rate 128/min, blood pressure
84/48 mm Hg, and altered mental status. Which finding is the nurse most concerned about?
A) Temperature of 39.2°C
B) Heart rate of 128/min
C) Blood pressure of 84/48 mm Hg with altered mental status
D) Chills and diaphoresis
,3|P a g e
Rationale: C is correct because hypotension accompanied by altered mentation indicates
inadequate tissue perfusion and possible septic shock. Fever, tachycardia, and chills are
significant but do not demonstrate compromised perfusion as directly as hypotension with
neurologic changes. Immediate escalation and hemodynamic management are required.
Q3
A patient with heart failure suddenly develops severe dyspnea, bilateral crackles, and pink frothy
sputum. Which intervention has the highest priority?
A) Place the patient flat
B) Encourage oral fluids
C) Position the patient upright and administer prescribed oxygen
D) Encourage coughing and deep breathing only
Rationale: C is correct because the findings are consistent with acute pulmonary edema. Upright
positioning reduces venous return and improves lung expansion, while oxygen supports gas
exchange. A worsens pulmonary congestion. B increases fluid burden. D alone is inadequate for
acute pulmonary edema.
Q4
A patient receiving IV potassium chloride reports burning at the IV site. The nurse notes
erythema and swelling. What should the nurse do first?
A) Increase the infusion rate
B) Apply a heating pad and continue the infusion
C) Stop the infusion and assess the IV site for infiltration or phlebitis
D) Flush the catheter rapidly
Rationale: C is correct because potassium is irritating and extravasation or infiltration can
cause tissue injury. The infusion should be stopped and the site assessed. Increasing the rate or
flushing the line may worsen tissue injury. Heat may be appropriate in selected situations after
assessment, but continuing the infusion is unsafe.
Q5
A patient with COPD receiving oxygen at 6 L/min by nasal cannula becomes increasingly
somnolent. Which explanation is most clinically concerning?
A) The oxygen flow is too low
B) The patient has developed metabolic alkalosis
C) Excessive oxygen administration may worsen carbon-dioxide retention in a susceptible
patient
D) Oxygen causes immediate bronchoconstriction in COPD
, 4|P a g e
Rationale: C is correct because some patients with severe COPD and chronic CO₂ retention can
experience worsening hypercapnia with excessive oxygen administration. Oxygen should not be
withheld from a hypoxemic patient, but it should be titrated to the prescribed target. A does not
explain somnolence. B is not the most likely explanation. D is incorrect.
Q6
A patient has a potassium level of 6.7 mEq/L and reports muscle weakness. Which finding
requires immediate attention?
A) Mild nausea
B) Decreased appetite
C) Peaked T waves on the ECG
D) Generalized fatigue
Rationale: C is correct because severe hyperkalemia can produce life-threatening cardiac
dysrhythmias. Peaked T waves are an important ECG manifestation and require urgent
intervention. Weakness and gastrointestinal symptoms can occur but are less immediately
dangerous than electrical instability.
Q7
A patient with vomiting and diarrhea has a blood pressure of 88/54 mm Hg, heart rate of
124/min, and urine output of 15 mL/hr. Which complication should the nurse suspect?
A) Fluid overload
B) Hypovolemic shock
C) Increased intracranial pressure
D) Neurogenic shock
Rationale: B is correct because gastrointestinal fluid losses combined with hypotension,
tachycardia, and oliguria strongly indicate significant intravascular-volume depletion. Fluid
overload would typically produce findings such as edema and pulmonary congestion. Increased
intracranial pressure does not explain the overall pattern, and neurogenic shock is associated
with loss of sympathetic vascular tone rather than major GI losses.
Q8
A client with pneumonia has an oxygen saturation of 89% despite prescribed oxygen. The patient
is increasingly confused. What should the nurse do?
A) Reassess in 30 minutes
B) Encourage oral fluids
C) Immediately reassess respiratory status and escalate care for persistent hypoxemia
D) Administer a sedative
