1
NUR265 Exam 2 Advanced Concepts of Medical-
Surgical Nursing Galen College of Nursing Actual
Exam 2026/2027 Complete Exam-Style Questions
with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
Part I: Complex Cardiovascular & Respiratory Disorders (Questions 1–15)
Q1: A 68-year-old male is admitted with acute decompensated heart failure. His vital signs are BP 92/58
mmHg, HR 118 bpm, RR 28/min, SpO₂ 88% on room air. He has bilateral crackles and reports severe
dyspnea. Which intervention should the nurse prioritize first?
A. Administer IV furosemide 40 mg as ordered
B. Apply high-flow nasal cannula oxygen at 15 L/min NUR265 EXAM 2 | ADVANCED CONCEPTS OF
MEDICAL-SURGICAL NURSING | Galen College of Nursing | 2023/2024
Part I: Complex Cardiovascular & Respiratory Disorders (Questions 1–15)
Q1: A 68-year-old male is admitted with acute decompensated heart failure. His vital signs are BP 92/58
mmHg, HR 118 bpm, RR 28/min, SpO₂ 88% on room air. He has bilateral crackles and reports severe
dyspnea. Which intervention should the nurse prioritize first?
A. Administer IV furosemide 40 mg as ordered
B. Apply high-flow nasal cannula oxygen at 15 L/min
C. Place the patient in high-Fowler's position and prepare for BiPAP
D. Insert a Foley catheter to monitor strict intake and output
C. Place the patient in high-Fowler's position and prepare for BiPAP [CORRECT]
Correct Answer: C
Rationale: The best answer is C because this patient is in respiratory distress with hypoxemia and signs
of impending respiratory failure—positioning him upright maximizes diaphragmatic excursion and lung
expansion, while BiPAP reduces work of breathing and improves oxygenation. This aligns with the
advanced nursing principle that airway and breathing take priority before diuresis or fluid monitoring in
an unstable patient.
Q2: A patient with a history of atrial fibrillation is on warfarin therapy. Today's INR is 4.8, and the patient
has epistaxis that has persisted for 20 minutes. Which action should the nurse take first?
A. Hold the next dose of warfarin and notify the provider
B. Administer vitamin K 10 mg IV push immediately
, 2
C. Apply firm pressure to the nares and tilt the head back
D. Draw a STAT PT/INR and type and screen for blood products
A. Hold the next dose of warfarin and notify the provider [CORRECT]
Correct Answer: A
Rationale: The best answer is A because an INR of 4.8 with active bleeding indicates supratherapeutic
anticoagulation, and the first step is to stop further anticoagulant effect by holding the warfarin and
getting provider orders for reversal. This matches the advanced nursing principle that you stop the
offending agent first while managing the complication.
Q3: A patient post-CABG on day 2 suddenly develops muffled heart sounds, hypotension, and jugular
venous distension. The nurse recognizes these as signs of which life-threatening condition?
A. Cardiac tamponade
B. Acute pulmonary embolism
C. Acute myocardial infarction
D. Tension pneumothorax
A. Cardiac tamponade [CORRECT]
Correct Answer: A
Rationale: The best answer is A because Beck's triad—muffled heart sounds, hypotension, and JVD—is
the classic presentation of cardiac tamponade, which is a known complication after cardiac surgery. This
aligns with NUR265 curriculum content on postoperative cardiac complications and the importance of
rapid recognition.
Q4: The nurse is reviewing an ABG result for a patient with COPD exacerbation: pH 7.32, PaCO₂ 58
mmHg, PaO₂ 62 mmHg, HCO₃⁻ 30 mEq/L. Which interpretation is most accurate?
A. Respiratory acidosis with partial metabolic compensation
B. Metabolic alkalosis with respiratory compensation
C. Respiratory acidosis with full metabolic compensation
D. Mixed respiratory and metabolic acidosis
A. Respiratory acidosis with partial metabolic compensation [CORRECT]
Correct Answer: A
Rationale: The best answer is A because the low pH indicates acidosis, the elevated PaCO₂ confirms a
respiratory cause, and the elevated bicarbonate shows the kidneys are trying to compensate—but since
the pH is still abnormal, compensation is only partial. This matches the advanced nursing principle that
full compensation returns pH to the normal range.
, 3
Q5: A patient with a pulmonary embolism is receiving a heparin infusion at 1,000 units/hour. The most
recent aPTT is 92 seconds (control 30–40 seconds). Which action should the nurse take?
A. Increase the infusion rate by 2 units/kg/hour
B. Continue the current rate and recheck in 4 hours
C. Stop the infusion for 1 hour, then resume at a decreased rate per protocol
D. Administer protamine sulfate 10 mg IV immediately
C. Stop the infusion for 1 hour, then resume at a decreased rate per protocol [CORRECT]
Correct Answer: C
Rationale: The best answer is C because an aPTT of 92 seconds indicates supratherapeutic heparin
levels, and the standard protocol is to hold the infusion briefly and reduce the rate to bring the aPTT
back into the therapeutic range. This aligns with NUR265 curriculum on anticoagulation monitoring and
the need to prevent bleeding complications.
Q6: A patient with ARDS is on mechanical ventilation with the following settings: FiO₂ 60%, PEEP 12 cm
H₂O, tidal volume 6 mL/kg ideal body weight. The nurse notes the plateau pressure is 35 cm H₂O. Which
concern is most appropriate?
A. The patient is at risk for ventilator-induced lung injury
B. The tidal volume is too low and causing atelectasis
C. The PEEP is insufficient for ARDS management
D. The FiO₂ should be increased to 80% to improve oxygenation
A. The patient is at risk for ventilator-induced lung injury [CORRECT]
Correct Answer: A
Rationale: The best answer is A because plateau pressures above 30 cm H₂O increase the risk of
barotrauma and ventilator-induced lung injury in ARDS patients, which is why lung-protective ventilation
strategies aim to keep plateau pressure below that threshold. This matches the advanced nursing
principle that in ARDS, preventing further lung damage is as important as improving oxygenation.
Q7: A 54-year-old patient with acute coronary syndrome is receiving nitroglycerin IV at 10 mcg/min. The
patient's BP drops from 142/88 to 88/52 mmHg. Which action should the nurse take first?
A. Administer a 500 mL normal saline bolus
B. Reduce the nitroglycerin infusion rate and reassess
C. Place the patient in Trendelenburg position
D. Give sublingual nitroglycerin 0.4 mg for chest pain
B. Reduce the nitroglycerin infusion rate and reassess [CORRECT]
, 4
Correct Answer: B
Rationale: The best answer is B because nitroglycerin causes venodilation and can precipitate
hypotension, so the first step is to reduce the dose causing the problem and monitor for improvement.
This aligns with the advanced nursing principle that you address the iatrogenic cause before
implementing other interventions.
Q8: A patient with a chest tube to water seal after a pneumothorax has continuous bubbling in the
water seal chamber. The nurse should recognize this as indicating:
A. An air leak in the system
B. Normal function of the chest tube
C. A blocked chest tube
D. The lung has fully re-expanded
A. An air leak in the system [CORRECT]
Correct Answer: A
Rationale: The best answer is A because continuous bubbling in the water seal chamber indicates an
active air leak, which could be from the patient or from a break in the system that needs assessment.
This matches the NUR265 curriculum on chest tube management and the need to distinguish normal
intermittent bubbling from pathological continuous bubbling.
Q9: A patient with aortic dissection presents with tearing chest pain radiating to the back. Vital signs
show BP 198/110 mmHg in the right arm and 156/94 mmHg in the left arm. Which medication should
the nurse anticipate administering first?
A. Nitroprusside IV infusion
B. Metoprolol IV push
C. Labetalol IV bolus
D. Hydralazine IV push
C. Labetalol IV bolus [CORRECT]
Correct Answer: C
Rationale: The best answer is C because labetalol provides both alpha and beta blockade, reducing both
blood pressure and shear force on the aortic wall without causing reflex tachycardia. This aligns with the
advanced nursing principle that in aortic dissection, you must lower both pressure and dP/dT to prevent
extension of the tear.
Q10: A patient post-cardiac catheterization via the femoral artery develops a hematoma at the insertion
site. The foot on the affected side is cool, pale, and the dorsalis pedis pulse is absent. Which
complication should the nurse suspect?
A. Retroperitoneal bleed
NUR265 Exam 2 Advanced Concepts of Medical-
Surgical Nursing Galen College of Nursing Actual
Exam 2026/2027 Complete Exam-Style Questions
with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
Part I: Complex Cardiovascular & Respiratory Disorders (Questions 1–15)
Q1: A 68-year-old male is admitted with acute decompensated heart failure. His vital signs are BP 92/58
mmHg, HR 118 bpm, RR 28/min, SpO₂ 88% on room air. He has bilateral crackles and reports severe
dyspnea. Which intervention should the nurse prioritize first?
A. Administer IV furosemide 40 mg as ordered
B. Apply high-flow nasal cannula oxygen at 15 L/min NUR265 EXAM 2 | ADVANCED CONCEPTS OF
MEDICAL-SURGICAL NURSING | Galen College of Nursing | 2023/2024
Part I: Complex Cardiovascular & Respiratory Disorders (Questions 1–15)
Q1: A 68-year-old male is admitted with acute decompensated heart failure. His vital signs are BP 92/58
mmHg, HR 118 bpm, RR 28/min, SpO₂ 88% on room air. He has bilateral crackles and reports severe
dyspnea. Which intervention should the nurse prioritize first?
A. Administer IV furosemide 40 mg as ordered
B. Apply high-flow nasal cannula oxygen at 15 L/min
C. Place the patient in high-Fowler's position and prepare for BiPAP
D. Insert a Foley catheter to monitor strict intake and output
C. Place the patient in high-Fowler's position and prepare for BiPAP [CORRECT]
Correct Answer: C
Rationale: The best answer is C because this patient is in respiratory distress with hypoxemia and signs
of impending respiratory failure—positioning him upright maximizes diaphragmatic excursion and lung
expansion, while BiPAP reduces work of breathing and improves oxygenation. This aligns with the
advanced nursing principle that airway and breathing take priority before diuresis or fluid monitoring in
an unstable patient.
Q2: A patient with a history of atrial fibrillation is on warfarin therapy. Today's INR is 4.8, and the patient
has epistaxis that has persisted for 20 minutes. Which action should the nurse take first?
A. Hold the next dose of warfarin and notify the provider
B. Administer vitamin K 10 mg IV push immediately
, 2
C. Apply firm pressure to the nares and tilt the head back
D. Draw a STAT PT/INR and type and screen for blood products
A. Hold the next dose of warfarin and notify the provider [CORRECT]
Correct Answer: A
Rationale: The best answer is A because an INR of 4.8 with active bleeding indicates supratherapeutic
anticoagulation, and the first step is to stop further anticoagulant effect by holding the warfarin and
getting provider orders for reversal. This matches the advanced nursing principle that you stop the
offending agent first while managing the complication.
Q3: A patient post-CABG on day 2 suddenly develops muffled heart sounds, hypotension, and jugular
venous distension. The nurse recognizes these as signs of which life-threatening condition?
A. Cardiac tamponade
B. Acute pulmonary embolism
C. Acute myocardial infarction
D. Tension pneumothorax
A. Cardiac tamponade [CORRECT]
Correct Answer: A
Rationale: The best answer is A because Beck's triad—muffled heart sounds, hypotension, and JVD—is
the classic presentation of cardiac tamponade, which is a known complication after cardiac surgery. This
aligns with NUR265 curriculum content on postoperative cardiac complications and the importance of
rapid recognition.
Q4: The nurse is reviewing an ABG result for a patient with COPD exacerbation: pH 7.32, PaCO₂ 58
mmHg, PaO₂ 62 mmHg, HCO₃⁻ 30 mEq/L. Which interpretation is most accurate?
A. Respiratory acidosis with partial metabolic compensation
B. Metabolic alkalosis with respiratory compensation
C. Respiratory acidosis with full metabolic compensation
D. Mixed respiratory and metabolic acidosis
A. Respiratory acidosis with partial metabolic compensation [CORRECT]
Correct Answer: A
Rationale: The best answer is A because the low pH indicates acidosis, the elevated PaCO₂ confirms a
respiratory cause, and the elevated bicarbonate shows the kidneys are trying to compensate—but since
the pH is still abnormal, compensation is only partial. This matches the advanced nursing principle that
full compensation returns pH to the normal range.
, 3
Q5: A patient with a pulmonary embolism is receiving a heparin infusion at 1,000 units/hour. The most
recent aPTT is 92 seconds (control 30–40 seconds). Which action should the nurse take?
A. Increase the infusion rate by 2 units/kg/hour
B. Continue the current rate and recheck in 4 hours
C. Stop the infusion for 1 hour, then resume at a decreased rate per protocol
D. Administer protamine sulfate 10 mg IV immediately
C. Stop the infusion for 1 hour, then resume at a decreased rate per protocol [CORRECT]
Correct Answer: C
Rationale: The best answer is C because an aPTT of 92 seconds indicates supratherapeutic heparin
levels, and the standard protocol is to hold the infusion briefly and reduce the rate to bring the aPTT
back into the therapeutic range. This aligns with NUR265 curriculum on anticoagulation monitoring and
the need to prevent bleeding complications.
Q6: A patient with ARDS is on mechanical ventilation with the following settings: FiO₂ 60%, PEEP 12 cm
H₂O, tidal volume 6 mL/kg ideal body weight. The nurse notes the plateau pressure is 35 cm H₂O. Which
concern is most appropriate?
A. The patient is at risk for ventilator-induced lung injury
B. The tidal volume is too low and causing atelectasis
C. The PEEP is insufficient for ARDS management
D. The FiO₂ should be increased to 80% to improve oxygenation
A. The patient is at risk for ventilator-induced lung injury [CORRECT]
Correct Answer: A
Rationale: The best answer is A because plateau pressures above 30 cm H₂O increase the risk of
barotrauma and ventilator-induced lung injury in ARDS patients, which is why lung-protective ventilation
strategies aim to keep plateau pressure below that threshold. This matches the advanced nursing
principle that in ARDS, preventing further lung damage is as important as improving oxygenation.
Q7: A 54-year-old patient with acute coronary syndrome is receiving nitroglycerin IV at 10 mcg/min. The
patient's BP drops from 142/88 to 88/52 mmHg. Which action should the nurse take first?
A. Administer a 500 mL normal saline bolus
B. Reduce the nitroglycerin infusion rate and reassess
C. Place the patient in Trendelenburg position
D. Give sublingual nitroglycerin 0.4 mg for chest pain
B. Reduce the nitroglycerin infusion rate and reassess [CORRECT]
, 4
Correct Answer: B
Rationale: The best answer is B because nitroglycerin causes venodilation and can precipitate
hypotension, so the first step is to reduce the dose causing the problem and monitor for improvement.
This aligns with the advanced nursing principle that you address the iatrogenic cause before
implementing other interventions.
Q8: A patient with a chest tube to water seal after a pneumothorax has continuous bubbling in the
water seal chamber. The nurse should recognize this as indicating:
A. An air leak in the system
B. Normal function of the chest tube
C. A blocked chest tube
D. The lung has fully re-expanded
A. An air leak in the system [CORRECT]
Correct Answer: A
Rationale: The best answer is A because continuous bubbling in the water seal chamber indicates an
active air leak, which could be from the patient or from a break in the system that needs assessment.
This matches the NUR265 curriculum on chest tube management and the need to distinguish normal
intermittent bubbling from pathological continuous bubbling.
Q9: A patient with aortic dissection presents with tearing chest pain radiating to the back. Vital signs
show BP 198/110 mmHg in the right arm and 156/94 mmHg in the left arm. Which medication should
the nurse anticipate administering first?
A. Nitroprusside IV infusion
B. Metoprolol IV push
C. Labetalol IV bolus
D. Hydralazine IV push
C. Labetalol IV bolus [CORRECT]
Correct Answer: C
Rationale: The best answer is C because labetalol provides both alpha and beta blockade, reducing both
blood pressure and shear force on the aortic wall without causing reflex tachycardia. This aligns with the
advanced nursing principle that in aortic dissection, you must lower both pressure and dP/dT to prevent
extension of the tear.
Q10: A patient post-cardiac catheterization via the femoral artery develops a hematoma at the insertion
site. The foot on the affected side is cool, pale, and the dorsalis pedis pulse is absent. Which
complication should the nurse suspect?
A. Retroperitoneal bleed
