NUR 265 Medical-Surgical Nursing Final Exam Prep 2026 Galen
1. A patient’s ABG results are pH 7.25, PaCO2 55, and HCO3 24. How should the
nurse interpret these findings?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: The pH is low (acidosis) and the PaCO2 is high, indicating the respiratory
system is the cause of the acid-base imbalance.
2. Which ventilator alarm should the nurse prioritize first?
A. Low pressure alarm
B. High pressure alarm
C. Low tidal volume alarm
D. Apnea alarm
Answer: D
Rationale: Apnea means the patient is not breathing; this is the most immediate life-
threatening situation among the options.
,3. A patient on a ventilator has a high-pressure alarm sounding. What is the
most likely cause?
A. Disconnected tubing
B. Patient biting the tube
C. Cuff leak
D. Self-extubation
Answer: B
Rationale: High-pressure alarms are triggered by obstructions, such as secretions, kinking
of the tube, or the patient biting the ET tube.
4. To improve oxygenation in a patient with ARDS, the nurse should anticipate
placing the patient in which position?
A. High-Fowler’s
B. Prone
C. Supine
D. Trendelenburg
Answer: B
Rationale: Prone positioning helps recruit collapsed alveoli and improves oxygenation in
severe ARDS cases.
5. What is the primary purpose of Positive End-Expiratory Pressure (PEEP)?
A. To keep the alveoli open at the end of expiration
B. To decrease the work of breathing
C. To provide 100% oxygen to the patient
D. To increase the respiratory rate
Answer: A
Rationale: PEEP provides pressure at the end of expiration to prevent alveolar collapse
and improve gas exchange.
, 6. A nurse is caring for a patient with a chest tube. Bubbling in the water seal
chamber during expiration is considered:
A. A sign of a massive air leak
B. An emergency indicating tension pneumothorax
C. Normal for a patient with a pneumothorax
D. A sign that the suction is too high
Answer: C
Rationale: Intermittent bubbling in the water seal chamber is normal as air is being
removed from the pleural space in a patient with a pneumothorax.
7. The nurse observes a sudden drop in a patient’s SpO2 and notes absent
breath sounds on the right side. Which condition is suspected?
A. Pneumonia
B. Pneumothorax
C. Pulmonary Edema
D. Pleural Effusion
Answer: B
Rationale: Absent breath sounds and rapid desaturation are classic signs of a
pneumothorax or lung collapse.
8. In the early stage of Septic Shock, the nurse would expect to find:
A. Bradycardia and hypertension
B. Tachycardia and warm, flushed skin
C. Hypotension and cold, clammy skin
D. Narrow pulse pressure and bradypnea
Answer: B
Rationale: Early (hyperdynamic) septic shock is characterized by high cardiac output,
tachycardia, and vasodilation (warm/flushed skin).
1. A patient’s ABG results are pH 7.25, PaCO2 55, and HCO3 24. How should the
nurse interpret these findings?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: The pH is low (acidosis) and the PaCO2 is high, indicating the respiratory
system is the cause of the acid-base imbalance.
2. Which ventilator alarm should the nurse prioritize first?
A. Low pressure alarm
B. High pressure alarm
C. Low tidal volume alarm
D. Apnea alarm
Answer: D
Rationale: Apnea means the patient is not breathing; this is the most immediate life-
threatening situation among the options.
,3. A patient on a ventilator has a high-pressure alarm sounding. What is the
most likely cause?
A. Disconnected tubing
B. Patient biting the tube
C. Cuff leak
D. Self-extubation
Answer: B
Rationale: High-pressure alarms are triggered by obstructions, such as secretions, kinking
of the tube, or the patient biting the ET tube.
4. To improve oxygenation in a patient with ARDS, the nurse should anticipate
placing the patient in which position?
A. High-Fowler’s
B. Prone
C. Supine
D. Trendelenburg
Answer: B
Rationale: Prone positioning helps recruit collapsed alveoli and improves oxygenation in
severe ARDS cases.
5. What is the primary purpose of Positive End-Expiratory Pressure (PEEP)?
A. To keep the alveoli open at the end of expiration
B. To decrease the work of breathing
C. To provide 100% oxygen to the patient
D. To increase the respiratory rate
Answer: A
Rationale: PEEP provides pressure at the end of expiration to prevent alveolar collapse
and improve gas exchange.
, 6. A nurse is caring for a patient with a chest tube. Bubbling in the water seal
chamber during expiration is considered:
A. A sign of a massive air leak
B. An emergency indicating tension pneumothorax
C. Normal for a patient with a pneumothorax
D. A sign that the suction is too high
Answer: C
Rationale: Intermittent bubbling in the water seal chamber is normal as air is being
removed from the pleural space in a patient with a pneumothorax.
7. The nurse observes a sudden drop in a patient’s SpO2 and notes absent
breath sounds on the right side. Which condition is suspected?
A. Pneumonia
B. Pneumothorax
C. Pulmonary Edema
D. Pleural Effusion
Answer: B
Rationale: Absent breath sounds and rapid desaturation are classic signs of a
pneumothorax or lung collapse.
8. In the early stage of Septic Shock, the nurse would expect to find:
A. Bradycardia and hypertension
B. Tachycardia and warm, flushed skin
C. Hypotension and cold, clammy skin
D. Narrow pulse pressure and bradypnea
Answer: B
Rationale: Early (hyperdynamic) septic shock is characterized by high cardiac output,
tachycardia, and vasodilation (warm/flushed skin).
