NUR 265 Actual Exam 2: Pulmonary & Endocrine
Med- Surg 2026/2027 Questions and Correct
Answers– Galen
Overview:
NUR 265 Actual Exam 3: Pulmonary & Endocrine Med- Surg topics covered
includes pulmonary embolism, heparin aPTT, warfarin teaching, ABGs respiratory
alkalosis, chest tubes, pneumothorax, hemothorax, ARDS, mechanical ventilation,
PEEP, thyroidectomy, thyroid storm, hypothyroidism, myxedema, levothyroxine,
Cushing's, Addison's, pheochromocytoma, SIADH, DI, hyperparathyroidism,
hypoparathyroidism, Trousseau's, DKA, HHS, insulin, sick-day rules, fluid
balance, electrolytes, and critical care priorities for Med-Surg nursing success .
Correct answer highlighted in bold Green + rationales
1.) The nurse is caring for a pt who is receiving a heparin infusion for treatment of a
pulmonary embolism. Which of the following indicates a therapeutic effect of treatment?
A) activated partial thromboplastin time appt is 72 seconds
B) platelet count is 160,000
C) PT is 10.2 seconds
D) d-dimer level is increased at 600
Rationale: Heparin prolongs aPTT. Therapeutic aPTT is 60-80 seconds (1.5-2.5x control). 72
seconds indicates therapeutic anticoagulation. Platelets monitor for HIT, PT/INR for warfarin,
D-dimer elevated indicates clot, not therapeutic.
2.) The nurse is caring for a pt who is 4 days postoperative and suddenly develops difficulty
breathing and sharp chest pain. The nurse has called a rapid response team, raised the head of
the bed, and applied oxygen to the nose. Which action from the box below should the nurse
take next? 1. Auscultate the pt lungs sounds 2. Initiate continuous cardiac monitoring 3.
Prepare the admin IV alteplase 4. Connect the pt to continuous pulse oximeter 5. Apply
bilateral anti embolism stocking to the legs 6. Assess the pt skin color
,A) 1,2,4,6
B) 1,4,5
C) 3,4,6
D) 2,3,5,6
Rationale: Sudden dyspnea and sharp chest pain 4 days post-op is classic PE. After raising HOB
and oxygen, priority is assessment and monitoring: lung sounds, cardiac monitoring for
dysrhythmia/R strain, pulse oximetry, skin color for perfusion.
3.) The nurse has provided discharge instructions to a pt who developed a pulmonary
embolism following a surgical procedure. The pt will be taking newly prescribed warfarin at
home. Which of the following pt statements indicates a correct understanding of the
teaching?
A) I will take this med for about 1-2 months
B) hard candy can be used if develop a dry mouth while taking warfarin
C) the warfarin will continue to break up clots over the next several months
D) I should avoid anything rectally such as enemas or suppositories
Rationale: Warfarin increases bleeding risk, so avoid rectal trauma including enemas,
suppositories, rectal temps. Warfarin does not break up clots, it prevents new clots. Duration
is typically 3-6 months minimum for PE.
4.) The nurse is caring for a pt who appears to have developed a pulmonary embolism. Which
of the following ABG results would the nurse expect the pt to initially have?
A) pH 7.45, PaO2 70, PaCO2 38, HCO3 28, SaO2 86%
B) pH 7.35, PaO2 63, PaCO2 42, HCO3 26, SaO2 84%
C) pH 7.31, PaO2 73, PaCO2 50, HCO3 22, SaO2 85%
D) pH 7.50, PaO2 79, PaCO2 32, HCO3 23, SaO2 88%
Rationale: PE causes V/Q mismatch and hyperventilation due to hypoxia, leading to
respiratory alkalosis: increased pH 7.50, decreased PaCO2 32, low PaO2 79 and low SaO2 88%.
, 5.) The nurse is working in the ER is caring for a pt who was in a boating crash 3 hours ago and
has the following data: Reports of headache, Restless and irritable, ABG pH 7.28, PaO2 60,
PaCO2 52, HCO3 24, SaO2 84%, Pulse 110, RR 10 and dysrhythmic, BP 145/86
A) PE
B) pleural effusion
C) a tension pneumothorax
D) acute respiratory failure
Rationale: ABG shows respiratory acidosis with hypoxemia (pH 7.28, PaO2 60, PaCO2 52, SaO2
84%), bradypnea 10 dysrhythmic, restlessness, tachycardia 110. This is acute respiratory
failure with hypoventilation after trauma.
6.) The nurse is caring for a pt who has a chest tube. Which assessment findings from the box
below requires the nurse to immediately notify the primary health care provider? 1.
Continuous bubbling in the suction control chamber 2. Tracheal deviation 3. Tidaling in the
water seal chamber with breathing 4. 100 ml of drainage within an hr 5. Visibility of the
eyelets of the chest tube 6. Low water level in the water seal chamber
A) 1,3,6
B) 1,2,4,3
C) 2,3,6
D) 2,4,5
Rationale: Tracheal deviation indicates tension pneumothorax/mediastinal shift, 100 mL/hr
drainage indicates hemorrhage, visible eyelets indicates chest tube dislodgement. All require
immediate provider notification.
7.) The nurse is assessing a pt who had a chest tube placed 36 hours ago for the treatment of a
pneumothorax. The nurse observes continuous bubbling in the water seal chamber. Which of
the following action should the nurse take?
A) document that the chest tube drainage system is operating properly
B) inform the PHCP that there is a leak in the system
C) turn off the suction assess the lung sounds and turn the suction back on
Med- Surg 2026/2027 Questions and Correct
Answers– Galen
Overview:
NUR 265 Actual Exam 3: Pulmonary & Endocrine Med- Surg topics covered
includes pulmonary embolism, heparin aPTT, warfarin teaching, ABGs respiratory
alkalosis, chest tubes, pneumothorax, hemothorax, ARDS, mechanical ventilation,
PEEP, thyroidectomy, thyroid storm, hypothyroidism, myxedema, levothyroxine,
Cushing's, Addison's, pheochromocytoma, SIADH, DI, hyperparathyroidism,
hypoparathyroidism, Trousseau's, DKA, HHS, insulin, sick-day rules, fluid
balance, electrolytes, and critical care priorities for Med-Surg nursing success .
Correct answer highlighted in bold Green + rationales
1.) The nurse is caring for a pt who is receiving a heparin infusion for treatment of a
pulmonary embolism. Which of the following indicates a therapeutic effect of treatment?
A) activated partial thromboplastin time appt is 72 seconds
B) platelet count is 160,000
C) PT is 10.2 seconds
D) d-dimer level is increased at 600
Rationale: Heparin prolongs aPTT. Therapeutic aPTT is 60-80 seconds (1.5-2.5x control). 72
seconds indicates therapeutic anticoagulation. Platelets monitor for HIT, PT/INR for warfarin,
D-dimer elevated indicates clot, not therapeutic.
2.) The nurse is caring for a pt who is 4 days postoperative and suddenly develops difficulty
breathing and sharp chest pain. The nurse has called a rapid response team, raised the head of
the bed, and applied oxygen to the nose. Which action from the box below should the nurse
take next? 1. Auscultate the pt lungs sounds 2. Initiate continuous cardiac monitoring 3.
Prepare the admin IV alteplase 4. Connect the pt to continuous pulse oximeter 5. Apply
bilateral anti embolism stocking to the legs 6. Assess the pt skin color
,A) 1,2,4,6
B) 1,4,5
C) 3,4,6
D) 2,3,5,6
Rationale: Sudden dyspnea and sharp chest pain 4 days post-op is classic PE. After raising HOB
and oxygen, priority is assessment and monitoring: lung sounds, cardiac monitoring for
dysrhythmia/R strain, pulse oximetry, skin color for perfusion.
3.) The nurse has provided discharge instructions to a pt who developed a pulmonary
embolism following a surgical procedure. The pt will be taking newly prescribed warfarin at
home. Which of the following pt statements indicates a correct understanding of the
teaching?
A) I will take this med for about 1-2 months
B) hard candy can be used if develop a dry mouth while taking warfarin
C) the warfarin will continue to break up clots over the next several months
D) I should avoid anything rectally such as enemas or suppositories
Rationale: Warfarin increases bleeding risk, so avoid rectal trauma including enemas,
suppositories, rectal temps. Warfarin does not break up clots, it prevents new clots. Duration
is typically 3-6 months minimum for PE.
4.) The nurse is caring for a pt who appears to have developed a pulmonary embolism. Which
of the following ABG results would the nurse expect the pt to initially have?
A) pH 7.45, PaO2 70, PaCO2 38, HCO3 28, SaO2 86%
B) pH 7.35, PaO2 63, PaCO2 42, HCO3 26, SaO2 84%
C) pH 7.31, PaO2 73, PaCO2 50, HCO3 22, SaO2 85%
D) pH 7.50, PaO2 79, PaCO2 32, HCO3 23, SaO2 88%
Rationale: PE causes V/Q mismatch and hyperventilation due to hypoxia, leading to
respiratory alkalosis: increased pH 7.50, decreased PaCO2 32, low PaO2 79 and low SaO2 88%.
, 5.) The nurse is working in the ER is caring for a pt who was in a boating crash 3 hours ago and
has the following data: Reports of headache, Restless and irritable, ABG pH 7.28, PaO2 60,
PaCO2 52, HCO3 24, SaO2 84%, Pulse 110, RR 10 and dysrhythmic, BP 145/86
A) PE
B) pleural effusion
C) a tension pneumothorax
D) acute respiratory failure
Rationale: ABG shows respiratory acidosis with hypoxemia (pH 7.28, PaO2 60, PaCO2 52, SaO2
84%), bradypnea 10 dysrhythmic, restlessness, tachycardia 110. This is acute respiratory
failure with hypoventilation after trauma.
6.) The nurse is caring for a pt who has a chest tube. Which assessment findings from the box
below requires the nurse to immediately notify the primary health care provider? 1.
Continuous bubbling in the suction control chamber 2. Tracheal deviation 3. Tidaling in the
water seal chamber with breathing 4. 100 ml of drainage within an hr 5. Visibility of the
eyelets of the chest tube 6. Low water level in the water seal chamber
A) 1,3,6
B) 1,2,4,3
C) 2,3,6
D) 2,4,5
Rationale: Tracheal deviation indicates tension pneumothorax/mediastinal shift, 100 mL/hr
drainage indicates hemorrhage, visible eyelets indicates chest tube dislodgement. All require
immediate provider notification.
7.) The nurse is assessing a pt who had a chest tube placed 36 hours ago for the treatment of a
pneumothorax. The nurse observes continuous bubbling in the water seal chamber. Which of
the following action should the nurse take?
A) document that the chest tube drainage system is operating properly
B) inform the PHCP that there is a leak in the system
C) turn off the suction assess the lung sounds and turn the suction back on
