NUR 265 Medical-Surgical Nursing Final Exam Practice 2026 Galen
College
1. A patient in the ICU is showing signs of early septic shock. Which of the
following hemodynamic findings is most consistent with the early
(hyperdynamic) phase?
A. Decreased cardiac output and increased systemic vascular resistance
B. Increased cardiac output and decreased systemic vascular resistance
C. Decreased heart rate and increased mean arterial pressure
D. Normal cardiac output and high pulmonary artery wedge pressure
Answer: B
Rationale: In the early or ‘warm’ phase of septic shock, the body compensates with a
hyperdynamic state characterized by high cardiac output and vasodilation (low SVR).
2. Using the Parkland Formula, calculate the total fluid resuscitation needed in
the first 24 hours for a 70 kg patient with 40% Total Body Surface Area (TBSA)
burns.
A. 5,600 mL
B. 11,200 mL
C. 2,800 mL
D. 8,400 mL
Answer: B
Rationale: The Parkland Formula is 4 mL x kg x %TBSA. So, 4 x 70 x 40 = 11,200 mL.
,3. A nurse is caring for a patient on a mechanical ventilator. The high-pressure
alarm sounds. Which action should the nurse take first?
A. Assess the patient’s breath sounds and respiratory status
B. Manually bag the patient with 100% oxygen
C. Suction the patient’s airway
D. Check for a kink in the ventilator tubing
Answer: A
Rationale: Assessment is always the priority. The nurse must check the patient first to
determine if the cause is physiological (e.g., bronchospasm, coughing) or mechanical.
4. Which clinical manifestation is a hallmark sign of Acute Respiratory Distress
Syndrome (ARDS)?
A. Hypoxemia that does not respond to supplemental oxygen (refractory hypoxemia)
B. Hypercapnia with a low respiratory rate
C. Clearing of lung fields on X-ray within 24 hours
D. Increased lung compliance
Answer: A
Rationale: Refractory hypoxemia, where the PaO2 remains low despite high levels of FiO2,
is a classic sign of ARDS due to significant shunting.
5. A patient with Acute Kidney Injury (AKI) enters the oliguric phase. Which
electrolyte imbalance is the nurse most concerned about?
A. Hypokalemia
B. Hyperkalemia
C. Hypernatremia
D. Hypocalcemia
Answer: B
Rationale: In the oliguric phase, the kidneys fail to excrete potassium, leading to
hyperkalemia, which can cause life-threatening cardiac arrhythmias.
, 6. What is the primary goal of administering a vasopressor like Norepinephrine
in a patient with distributive shock?
A. To decrease the heart rate
B. To increase systemic vascular resistance and blood pressure
C. To increase the stroke volume by decreasing afterload
D. To promote diuresis
Answer: B
Rationale: Vasopressors cause vasoconstriction, which increases SVR and MAP in patients
whose shock is caused by massive vasodilation.
7. A patient is admitted with a suspected Cervical Spinal Cord Injury (C3-C4).
What is the priority nursing assessment?
A. Monitoring for autonomic dysreflexia
B. Monitoring respiratory effort and rate
C. Assessing lower extremity motor strength
D. Checking for bladder distension
Answer: B
Rationale: Injuries at C3-C5 affect the phrenic nerve, which controls the diaphragm.
Respiratory failure is a major risk and the highest priority.
8. Which of the following is an early sign of increased intracranial pressure
(ICP)?
A. Altered level of consciousness (LOC)
B. Fixed and dilated pupils
C. Cushing’s Triad
D. Decerebrate posturing
Answer: A
Rationale: A change in LOC is the most sensitive and earliest indicator of neurological
deterioration and increased ICP.
College
1. A patient in the ICU is showing signs of early septic shock. Which of the
following hemodynamic findings is most consistent with the early
(hyperdynamic) phase?
A. Decreased cardiac output and increased systemic vascular resistance
B. Increased cardiac output and decreased systemic vascular resistance
C. Decreased heart rate and increased mean arterial pressure
D. Normal cardiac output and high pulmonary artery wedge pressure
Answer: B
Rationale: In the early or ‘warm’ phase of septic shock, the body compensates with a
hyperdynamic state characterized by high cardiac output and vasodilation (low SVR).
2. Using the Parkland Formula, calculate the total fluid resuscitation needed in
the first 24 hours for a 70 kg patient with 40% Total Body Surface Area (TBSA)
burns.
A. 5,600 mL
B. 11,200 mL
C. 2,800 mL
D. 8,400 mL
Answer: B
Rationale: The Parkland Formula is 4 mL x kg x %TBSA. So, 4 x 70 x 40 = 11,200 mL.
,3. A nurse is caring for a patient on a mechanical ventilator. The high-pressure
alarm sounds. Which action should the nurse take first?
A. Assess the patient’s breath sounds and respiratory status
B. Manually bag the patient with 100% oxygen
C. Suction the patient’s airway
D. Check for a kink in the ventilator tubing
Answer: A
Rationale: Assessment is always the priority. The nurse must check the patient first to
determine if the cause is physiological (e.g., bronchospasm, coughing) or mechanical.
4. Which clinical manifestation is a hallmark sign of Acute Respiratory Distress
Syndrome (ARDS)?
A. Hypoxemia that does not respond to supplemental oxygen (refractory hypoxemia)
B. Hypercapnia with a low respiratory rate
C. Clearing of lung fields on X-ray within 24 hours
D. Increased lung compliance
Answer: A
Rationale: Refractory hypoxemia, where the PaO2 remains low despite high levels of FiO2,
is a classic sign of ARDS due to significant shunting.
5. A patient with Acute Kidney Injury (AKI) enters the oliguric phase. Which
electrolyte imbalance is the nurse most concerned about?
A. Hypokalemia
B. Hyperkalemia
C. Hypernatremia
D. Hypocalcemia
Answer: B
Rationale: In the oliguric phase, the kidneys fail to excrete potassium, leading to
hyperkalemia, which can cause life-threatening cardiac arrhythmias.
, 6. What is the primary goal of administering a vasopressor like Norepinephrine
in a patient with distributive shock?
A. To decrease the heart rate
B. To increase systemic vascular resistance and blood pressure
C. To increase the stroke volume by decreasing afterload
D. To promote diuresis
Answer: B
Rationale: Vasopressors cause vasoconstriction, which increases SVR and MAP in patients
whose shock is caused by massive vasodilation.
7. A patient is admitted with a suspected Cervical Spinal Cord Injury (C3-C4).
What is the priority nursing assessment?
A. Monitoring for autonomic dysreflexia
B. Monitoring respiratory effort and rate
C. Assessing lower extremity motor strength
D. Checking for bladder distension
Answer: B
Rationale: Injuries at C3-C5 affect the phrenic nerve, which controls the diaphragm.
Respiratory failure is a major risk and the highest priority.
8. Which of the following is an early sign of increased intracranial pressure
(ICP)?
A. Altered level of consciousness (LOC)
B. Fixed and dilated pupils
C. Cushing’s Triad
D. Decerebrate posturing
Answer: A
Rationale: A change in LOC is the most sensitive and earliest indicator of neurological
deterioration and increased ICP.
