NUR 265 Medical-Surgical Nursing Final Exam 2026 Galen College
1. A patient is admitted with suspected hypovolemic shock. Which clinical
manifestation should the nurse expect to find first?
A. Narrowing pulse pressure
B. Increased heart rate
C. Decrease in urinary output
D. Loss of consciousness
Answer: B
Rationale: Tachycardia is often the earliest clinical sign of hypovolemic shock as the body
attempts to compensate for decreased stroke volume.
2. Which electrolyte imbalance is a patient at greatest risk for during the
emergent phase of a major burn injury?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypocalcemia
Answer: A
Rationale: During the emergent phase, massive cell destruction releases potassium into
the extracellular fluid, leading to hyperkalemia.
,3. A nurse is caring for a patient with a T4 spinal cord injury. The patient reports
a sudden, severe headache and has a BP of 190/100. What is the priority nursing
action?
A. Notify the healthcare provider immediately
B. Administer PRN antihypertensive medication
C. Check for bladder distention
D. Sit the patient upright
Answer: D
Rationale: The first action in autonomic dysreflexia is to sit the patient upright to help
lower blood pressure through orthostatic effects.
4. A patient with ARDS is on a mechanical ventilator with high PEEP. The nurse
monitors for which complication related to high PEEP?
A. Pneumothorax
B. Hypotension
C. Increased cardiac output
D. Metabolic alkalosis
Answer: B
Rationale: High PEEP increases intrathoracic pressure, which can decrease venous return
and lead to decreased cardiac output and hypotension.
5. During a disaster triage, a victim with a sucking chest wound and stable vitals
would be assigned which color tag?
A. Green
B. Yellow
C. Red
D. Black
Answer: C
, Rationale: A sucking chest wound is a life-threatening injury that requires immediate
intervention, placing the patient in the Red (Emergent) category.
6. Which laboratory finding is most indicative of the transition from SIRS to
Sepsis?
A. Leukocytosis with a left shift
B. Lactate level of 1.2 mmol/L
C. Positive blood cultures
D. BUN of 25 mg/dL
Answer: C
Rationale: Sepsis is defined as SIRS (Systemic Inflammatory Response Syndrome) plus a
confirmed or suspected source of infection, such as positive blood cultures.
7. A patient is in the oliguric phase of acute kidney injury (AKI). What is the
primary goal of nursing management during this phase?
A. Prevent electrolyte imbalances
B. Increase fluid intake to 3L/day
C. Encourage a high-protein diet
D. Monitor for signs of dehydration
Answer: A
Rationale: In the oliguric phase, the kidneys cannot excrete waste or electrolytes properly,
making the prevention/management of hyperkalemia and fluid overload the priority.
8. What is the primary medication used to treat life-threatening ventricular
fibrillation?
A. Atropine
B. Amiodarone
C. Adenosine
D. Epinephrine
Answer: D
1. A patient is admitted with suspected hypovolemic shock. Which clinical
manifestation should the nurse expect to find first?
A. Narrowing pulse pressure
B. Increased heart rate
C. Decrease in urinary output
D. Loss of consciousness
Answer: B
Rationale: Tachycardia is often the earliest clinical sign of hypovolemic shock as the body
attempts to compensate for decreased stroke volume.
2. Which electrolyte imbalance is a patient at greatest risk for during the
emergent phase of a major burn injury?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypocalcemia
Answer: A
Rationale: During the emergent phase, massive cell destruction releases potassium into
the extracellular fluid, leading to hyperkalemia.
,3. A nurse is caring for a patient with a T4 spinal cord injury. The patient reports
a sudden, severe headache and has a BP of 190/100. What is the priority nursing
action?
A. Notify the healthcare provider immediately
B. Administer PRN antihypertensive medication
C. Check for bladder distention
D. Sit the patient upright
Answer: D
Rationale: The first action in autonomic dysreflexia is to sit the patient upright to help
lower blood pressure through orthostatic effects.
4. A patient with ARDS is on a mechanical ventilator with high PEEP. The nurse
monitors for which complication related to high PEEP?
A. Pneumothorax
B. Hypotension
C. Increased cardiac output
D. Metabolic alkalosis
Answer: B
Rationale: High PEEP increases intrathoracic pressure, which can decrease venous return
and lead to decreased cardiac output and hypotension.
5. During a disaster triage, a victim with a sucking chest wound and stable vitals
would be assigned which color tag?
A. Green
B. Yellow
C. Red
D. Black
Answer: C
, Rationale: A sucking chest wound is a life-threatening injury that requires immediate
intervention, placing the patient in the Red (Emergent) category.
6. Which laboratory finding is most indicative of the transition from SIRS to
Sepsis?
A. Leukocytosis with a left shift
B. Lactate level of 1.2 mmol/L
C. Positive blood cultures
D. BUN of 25 mg/dL
Answer: C
Rationale: Sepsis is defined as SIRS (Systemic Inflammatory Response Syndrome) plus a
confirmed or suspected source of infection, such as positive blood cultures.
7. A patient is in the oliguric phase of acute kidney injury (AKI). What is the
primary goal of nursing management during this phase?
A. Prevent electrolyte imbalances
B. Increase fluid intake to 3L/day
C. Encourage a high-protein diet
D. Monitor for signs of dehydration
Answer: A
Rationale: In the oliguric phase, the kidneys cannot excrete waste or electrolytes properly,
making the prevention/management of hyperkalemia and fluid overload the priority.
8. What is the primary medication used to treat life-threatening ventricular
fibrillation?
A. Atropine
B. Amiodarone
C. Adenosine
D. Epinephrine
Answer: D
