NUR 265 Exam 1
Medical-Surgical
Nursing (2026)
1. A 72-year-old patient with a history of heart failure is admitted with acute decompensated heart
failure (ADHF). The nurse administers intravenous furosemide as prescribed. Which assessment
finding best indicates that the medication is achieving its desired therapeutic effect?
A. Serum potassium level increases from 3.8 mEq/L to 4.2 mEq/L.
B. Patient reports a decrease in dyspnea and orthopnea.
C. Urine output increases to 250 mL over the past 4 hours.
D. Jugular venous distention (JVD) is no longer visible when the patient is supine.
Correct answer: B. The primary goal of furosemide in ADHF is to reduce preload and pulmonary
congestion. A decrease in dyspnea and orthopnea is a direct indicator of reduced fluid in the lungs,
reflecting a positive therapeutic response. While increased urine output (C) is the mechanism of action,
it is not the definitive clinical endpoint. Option A is a potential adverse effect. Option D is incorrect
because JVD is assessed with the patient at a 45-degree angle, not supine.
2. The nurse is caring for a patient with acute respiratory distress syndrome (ARDS) who is on a
mechanical ventilator with a low tidal volume (6 mL/kg) and high positive end-expiratory pressure
(PEEP). The nurse notes a sudden drop in the patient's oxygen saturation (SpO2) from 92% to 85% and
an increase in peak airway pressure. Which action should the nurse take FIRST?
A. Administer a prescribed sedative to improve patient-ventilator synchrony.
B. Perform a quick chest auscultation to assess for breath sounds.
C. Notify the healthcare provider immediately of the change in status.
D. Suction the patient's endotracheal tube to clear a potential mucus plug.
Correct answer: D. A sudden drop in SpO2 accompanied by an acute rise in peak airway pressure
in a patient with ARDS is highly suggestive of an airway occlusion, such as a mucus plug. Suctioning is the
immediate, priority nursing intervention to assess for and clear the obstruction and restore oxygenation.
The other actions are appropriate but are secondary to addressing the immediate life-threatening
airway issue.
,3. A patient is scheduled for a bronchoscopy with biopsy. Which of the following nursing actions is a
priority in the pre-procedural preparation?
A. Ensure the patient has been NPO for at least 8 hours.
B. Verify the patient has signed a valid informed consent form.
C. Administer the patient's usual morning dose of warfarin.
D. Provide the patient with a detailed explanation of the procedure.
Correct answer: B. While all options are important aspects of pre-procedural care, the priority is to
ensure that a signed, witnessed informed consent is on the chart. This is a legal and ethical requirement
before any invasive procedure. The nurse's role is to clarify facts, not to provide the primary explanation
(D). Holding anticoagulants (C) is a critical pre-op action, but verifying the consent is the priority before
any procedure. NPO status (A) is typically 4-6 hours, not 8.
4. The nurse is providing discharge teaching to a patient who has been diagnosed with chronic
obstructive pulmonary disease (COPD). The patient asks, "Why is it so important to use my oxygen
exactly as prescribed? I feel fine and don't think I need it all the time." What is the nurse's BEST
response?
A. "Using oxygen as prescribed will help prevent long-term damage to your heart muscle."
B. "If you don't use it, you may get dizzy and fall, which could cause a serious injury."
C. "You need it to maintain adequate tissue oxygenation and prevent organ damage."
D. "The main reason is to keep your oxygen saturation above 92% to prevent the need for
rehospitalization."
Correct answer: A. In COPD, chronic hypoxemia leads to pulmonary hypertension, which increases
the workload on the right ventricle and can eventually lead to right-sided heart failure (cor pulmonale).
This response provides a clear, specific, and logical rationale for adherence to oxygen therapy related to
long-term health outcomes.
5. A patient with active pulmonary tuberculosis (TB) is placed on a four-drug regimen (isoniazid,
rifampin, pyrazinamide, and ethambutol). Which finding requires the nurse's most immediate action?
A. The patient reports that their urine and tears have turned an orange-red color.
B. The patient complains of a mild, intermittent headache for the past two days.
C. The patient mentions they have not been sleeping well and feel nauseous.
D. The patient reports a new onset of blurred vision and pain in their eyes.
, Correct answer: D. Ethambutol is known to cause optic neuritis, which can lead to permanent
vision loss if not addressed. This is a serious adverse effect that requires immediate notification of the
healthcare provider to potentially discontinue the drug. Option A is a common and harmless side effect
of rifampin. Options B and C are less specific and urgent.
6. The nurse is monitoring a patient receiving a blood transfusion. Fifteen minutes after the
transfusion begins, the patient reports chills and low back pain. The nurse's immediate priority is to:
A. Slow the rate of the infusion and monitor vital signs.
B. Stop the transfusion and maintain intravenous access with normal saline.
C. Take the patient's temperature and administer an antipyretic.
D. Notify the healthcare provider and prepare to administer diphenhydramine.
Correct answer: B. Chills and low back pain are classic signs of a febrile (non-hemolytic) or a
hemolytic transfusion reaction. The immediate and priority action is to stop the transfusion to prevent
further infusion of the offending blood product. The IV line must be kept open with normal saline to
have access for any emergency medications. Notifying the provider and monitoring vitals are
subsequent steps.
7. A patient with chronic kidney disease (CKD) has a serum potassium level of 6.8 mEq/L. The nurse
anticipates which of the following changes on the cardiac monitor?
A. Flattened T waves and a prominent U wave.
B. Tall, peaked T waves and a widened QRS complex.
C. Prolonged PR interval and a depressed ST segment.
D. A shortened QT interval and bradycardia.
Correct answer: B. Hyperkalemia (elevated potassium) has characteristic ECG changes. The earliest
and most classic finding is tall, peaked (tented) T waves. As hyperkalemia worsens, the QRS complex
widens, the PR interval prolongs, and the P wave may flatten or disappear, leading to a sine wave
pattern and cardiac arrest. Option A describes hypokalemia, Option C describes hypocalcemia or
hypokalemia, and Option D is non-specific.
8. The nurse is preparing a patient for a pericardiocentesis. The patient is anxious and asks, "What
exactly is this procedure going to do?" Which statement by the nurse is most accurate?
A. "This procedure will help us determine if you have a bacterial or viral infection in the sac
around your heart."
Medical-Surgical
Nursing (2026)
1. A 72-year-old patient with a history of heart failure is admitted with acute decompensated heart
failure (ADHF). The nurse administers intravenous furosemide as prescribed. Which assessment
finding best indicates that the medication is achieving its desired therapeutic effect?
A. Serum potassium level increases from 3.8 mEq/L to 4.2 mEq/L.
B. Patient reports a decrease in dyspnea and orthopnea.
C. Urine output increases to 250 mL over the past 4 hours.
D. Jugular venous distention (JVD) is no longer visible when the patient is supine.
Correct answer: B. The primary goal of furosemide in ADHF is to reduce preload and pulmonary
congestion. A decrease in dyspnea and orthopnea is a direct indicator of reduced fluid in the lungs,
reflecting a positive therapeutic response. While increased urine output (C) is the mechanism of action,
it is not the definitive clinical endpoint. Option A is a potential adverse effect. Option D is incorrect
because JVD is assessed with the patient at a 45-degree angle, not supine.
2. The nurse is caring for a patient with acute respiratory distress syndrome (ARDS) who is on a
mechanical ventilator with a low tidal volume (6 mL/kg) and high positive end-expiratory pressure
(PEEP). The nurse notes a sudden drop in the patient's oxygen saturation (SpO2) from 92% to 85% and
an increase in peak airway pressure. Which action should the nurse take FIRST?
A. Administer a prescribed sedative to improve patient-ventilator synchrony.
B. Perform a quick chest auscultation to assess for breath sounds.
C. Notify the healthcare provider immediately of the change in status.
D. Suction the patient's endotracheal tube to clear a potential mucus plug.
Correct answer: D. A sudden drop in SpO2 accompanied by an acute rise in peak airway pressure
in a patient with ARDS is highly suggestive of an airway occlusion, such as a mucus plug. Suctioning is the
immediate, priority nursing intervention to assess for and clear the obstruction and restore oxygenation.
The other actions are appropriate but are secondary to addressing the immediate life-threatening
airway issue.
,3. A patient is scheduled for a bronchoscopy with biopsy. Which of the following nursing actions is a
priority in the pre-procedural preparation?
A. Ensure the patient has been NPO for at least 8 hours.
B. Verify the patient has signed a valid informed consent form.
C. Administer the patient's usual morning dose of warfarin.
D. Provide the patient with a detailed explanation of the procedure.
Correct answer: B. While all options are important aspects of pre-procedural care, the priority is to
ensure that a signed, witnessed informed consent is on the chart. This is a legal and ethical requirement
before any invasive procedure. The nurse's role is to clarify facts, not to provide the primary explanation
(D). Holding anticoagulants (C) is a critical pre-op action, but verifying the consent is the priority before
any procedure. NPO status (A) is typically 4-6 hours, not 8.
4. The nurse is providing discharge teaching to a patient who has been diagnosed with chronic
obstructive pulmonary disease (COPD). The patient asks, "Why is it so important to use my oxygen
exactly as prescribed? I feel fine and don't think I need it all the time." What is the nurse's BEST
response?
A. "Using oxygen as prescribed will help prevent long-term damage to your heart muscle."
B. "If you don't use it, you may get dizzy and fall, which could cause a serious injury."
C. "You need it to maintain adequate tissue oxygenation and prevent organ damage."
D. "The main reason is to keep your oxygen saturation above 92% to prevent the need for
rehospitalization."
Correct answer: A. In COPD, chronic hypoxemia leads to pulmonary hypertension, which increases
the workload on the right ventricle and can eventually lead to right-sided heart failure (cor pulmonale).
This response provides a clear, specific, and logical rationale for adherence to oxygen therapy related to
long-term health outcomes.
5. A patient with active pulmonary tuberculosis (TB) is placed on a four-drug regimen (isoniazid,
rifampin, pyrazinamide, and ethambutol). Which finding requires the nurse's most immediate action?
A. The patient reports that their urine and tears have turned an orange-red color.
B. The patient complains of a mild, intermittent headache for the past two days.
C. The patient mentions they have not been sleeping well and feel nauseous.
D. The patient reports a new onset of blurred vision and pain in their eyes.
, Correct answer: D. Ethambutol is known to cause optic neuritis, which can lead to permanent
vision loss if not addressed. This is a serious adverse effect that requires immediate notification of the
healthcare provider to potentially discontinue the drug. Option A is a common and harmless side effect
of rifampin. Options B and C are less specific and urgent.
6. The nurse is monitoring a patient receiving a blood transfusion. Fifteen minutes after the
transfusion begins, the patient reports chills and low back pain. The nurse's immediate priority is to:
A. Slow the rate of the infusion and monitor vital signs.
B. Stop the transfusion and maintain intravenous access with normal saline.
C. Take the patient's temperature and administer an antipyretic.
D. Notify the healthcare provider and prepare to administer diphenhydramine.
Correct answer: B. Chills and low back pain are classic signs of a febrile (non-hemolytic) or a
hemolytic transfusion reaction. The immediate and priority action is to stop the transfusion to prevent
further infusion of the offending blood product. The IV line must be kept open with normal saline to
have access for any emergency medications. Notifying the provider and monitoring vitals are
subsequent steps.
7. A patient with chronic kidney disease (CKD) has a serum potassium level of 6.8 mEq/L. The nurse
anticipates which of the following changes on the cardiac monitor?
A. Flattened T waves and a prominent U wave.
B. Tall, peaked T waves and a widened QRS complex.
C. Prolonged PR interval and a depressed ST segment.
D. A shortened QT interval and bradycardia.
Correct answer: B. Hyperkalemia (elevated potassium) has characteristic ECG changes. The earliest
and most classic finding is tall, peaked (tented) T waves. As hyperkalemia worsens, the QRS complex
widens, the PR interval prolongs, and the P wave may flatten or disappear, leading to a sine wave
pattern and cardiac arrest. Option A describes hypokalemia, Option C describes hypocalcemia or
hypokalemia, and Option D is non-specific.
8. The nurse is preparing a patient for a pericardiocentesis. The patient is anxious and asks, "What
exactly is this procedure going to do?" Which statement by the nurse is most accurate?
A. "This procedure will help us determine if you have a bacterial or viral infection in the sac
around your heart."
