NUR 265 Medical-Surgical Nursing Final Exam 2026 Galen College
1. A patient with septic shock has a BP of 70/40 mmHg and a heart rate of 130
bpm. Which IV fluid is typically the first choice for volume resuscitation?
A. 0.45% Normal Saline
B. Dextrose 5% in Water
C. 0.9% Normal Saline (Isotonic Crystalloid)
D. 3% Hypertonic Saline
Answer: C
Rationale: Isotonic crystalloids like 0.9% NS or Lactated Ringer’s are the first-line
treatment for fluid resuscitation in shock to increase intravascular volume.
2. Which clinical finding is the hallmark sign of Acute Respiratory Distress
Syndrome (ARDS)?
A. Productive cough with pink frothy sputum
B. Refractory hypoxemia
C. Respiratory alkalosis due to hypoventilation
D. Increased lung compliance
Answer: B
Rationale: Refractory hypoxemia is hypoxemia that does not respond to increasing levels
of supplemental oxygen, which is a key characteristic of ARDS.
,3. A nurse is caring for a patient with a spinal cord injury at T6. The patient
reports a severe headache and has a BP of 190/100 mmHg. What is the priority
nursing action?
A. Administer PRN pain medication
B. Lower the head of the bed
C. Check the patient’s bladder for distension
D. Notify the provider before any assessment
Answer: C
Rationale: The symptoms suggest Autonomic Dysreflexia. The priority is to sit the patient
up and then identify/remove the stimulus, most commonly a full bladder.
4. In the ‘Emergent’ phase of burn care, which electrolyte imbalance is most
common?
A. Hypokalemia
B. Hyperkalemia
C. Hypernatremia
D. Hypocalcemia
Answer: B
Rationale: During the emergent phase of burns, cell destruction releases potassium into
the extracellular fluid, leading to hyperkalemia.
5. A patient’s ECG shows a rapid, chaotic rhythm with no identifiable P waves or
QRS complexes. The patient is pulseless. What is the immediate treatment?
A. Synchronized Cardioversion
B. Vagal maneuvers
C. Administration of Atropine
D. Defibrillation
Answer: D
, Rationale: Ventricular Fibrillation (V-fib) is a shockable rhythm that requires immediate
defibrillation to restore a perfusing rhythm.
6. Which assessment finding is part of Cushing’s Triad, indicating increased
intracranial pressure?
A. Tachycardia, hypotension, and tachypnea
B. Bradycardia, widened pulse pressure, and irregular respirations
C. Narrowed pulse pressure and thready pulse
D. Hypotension and fixed pupils
Answer: B
Rationale: Cushing’s Triad consists of bradycardia, hypertension (widened pulse
pressure), and irregular respirations.
7. A patient with cirrhosis has a high ammonia level and is confused. Which
medication should the nurse anticipate administering?
A. Spironolactone
B. Lactulose
C. Furosemide
D. Neomycin
Answer: B
Rationale: Lactulose is used to reduce ammonia levels by trapping it in the gut and
promoting its excretion through bowel movements.
8. While monitoring a patient on a ventilator, the high-pressure alarm sounds.
What is a possible cause?
A. A leak in the ventilator circuit
B. The patient has disconnected from the ventilator
C. Excessive secretions in the airway
D. The ET tube cuff has deflated
Answer: C
1. A patient with septic shock has a BP of 70/40 mmHg and a heart rate of 130
bpm. Which IV fluid is typically the first choice for volume resuscitation?
A. 0.45% Normal Saline
B. Dextrose 5% in Water
C. 0.9% Normal Saline (Isotonic Crystalloid)
D. 3% Hypertonic Saline
Answer: C
Rationale: Isotonic crystalloids like 0.9% NS or Lactated Ringer’s are the first-line
treatment for fluid resuscitation in shock to increase intravascular volume.
2. Which clinical finding is the hallmark sign of Acute Respiratory Distress
Syndrome (ARDS)?
A. Productive cough with pink frothy sputum
B. Refractory hypoxemia
C. Respiratory alkalosis due to hypoventilation
D. Increased lung compliance
Answer: B
Rationale: Refractory hypoxemia is hypoxemia that does not respond to increasing levels
of supplemental oxygen, which is a key characteristic of ARDS.
,3. A nurse is caring for a patient with a spinal cord injury at T6. The patient
reports a severe headache and has a BP of 190/100 mmHg. What is the priority
nursing action?
A. Administer PRN pain medication
B. Lower the head of the bed
C. Check the patient’s bladder for distension
D. Notify the provider before any assessment
Answer: C
Rationale: The symptoms suggest Autonomic Dysreflexia. The priority is to sit the patient
up and then identify/remove the stimulus, most commonly a full bladder.
4. In the ‘Emergent’ phase of burn care, which electrolyte imbalance is most
common?
A. Hypokalemia
B. Hyperkalemia
C. Hypernatremia
D. Hypocalcemia
Answer: B
Rationale: During the emergent phase of burns, cell destruction releases potassium into
the extracellular fluid, leading to hyperkalemia.
5. A patient’s ECG shows a rapid, chaotic rhythm with no identifiable P waves or
QRS complexes. The patient is pulseless. What is the immediate treatment?
A. Synchronized Cardioversion
B. Vagal maneuvers
C. Administration of Atropine
D. Defibrillation
Answer: D
, Rationale: Ventricular Fibrillation (V-fib) is a shockable rhythm that requires immediate
defibrillation to restore a perfusing rhythm.
6. Which assessment finding is part of Cushing’s Triad, indicating increased
intracranial pressure?
A. Tachycardia, hypotension, and tachypnea
B. Bradycardia, widened pulse pressure, and irregular respirations
C. Narrowed pulse pressure and thready pulse
D. Hypotension and fixed pupils
Answer: B
Rationale: Cushing’s Triad consists of bradycardia, hypertension (widened pulse
pressure), and irregular respirations.
7. A patient with cirrhosis has a high ammonia level and is confused. Which
medication should the nurse anticipate administering?
A. Spironolactone
B. Lactulose
C. Furosemide
D. Neomycin
Answer: B
Rationale: Lactulose is used to reduce ammonia levels by trapping it in the gut and
promoting its excretion through bowel movements.
8. While monitoring a patient on a ventilator, the high-pressure alarm sounds.
What is a possible cause?
A. A leak in the ventilator circuit
B. The patient has disconnected from the ventilator
C. Excessive secretions in the airway
D. The ET tube cuff has deflated
Answer: C
