NUR 265 Comprehensive Nursing Final Exam | Medical-
Surgical Concepts, Clinical Practice & Evidence-Based
Questions and answers 2026/2027
Question 1
A nurse is caring for a client with cirrhosis who has developed severe
ascites. Which of the following pre-procedure actions should the nurse
perform prior to a paracentesis?
• A. Administer an enema to empty the bowel
• B. Have the client empty their bladder
• C. Place the client in a high-Fowler's position
• D. Apply a continuous cold compress to the abdomen
Correct Answer: B. Have the client empty their bladder.
Detailed Rationale: Having the client void immediately before a
paracentesis reduces the risk of accidental bladder perforation during
the insertion of the paracentesis needle.
Question 2
A nurse is assessing a client admitted with acute pancreatitis. Which of
the following laboratory findings should the nurse expect to be
elevated?
• A. Serum calcium
• B. Serum amylase and lipase
• C. Red blood cell count
, • D. Serum albumin
Correct Answer: B. Serum amylase and lipase.
Detailed Rationale: Serum amylase and lipase levels rise significantly
within hours of acute pancreatic inflammation as pancreatic enzymes
leak into the bloodstream.
Question 3
A client is admitted to the emergency department with acute chest pain
suggestive of a myocardial infarction (MI). Which of the following
interventions should be the nurse's immediate priority?
• A. Obtain a 12-lead electrocardiogram (ECG)
• B. Administer sublingual nitroglycerin
• C. Apply supplemental oxygen if saturation is below 90%
• D. Draw cardiac biomarker blood levels
Correct Answer: A. Obtain a 12-lead electrocardiogram (ECG).
Detailed Rationale: A 12-lead ECG must be obtained within 10 minutes
of arrival for any client presenting with chest pain to rapidly diagnose
ST-elevation myocardial infarction (STEMI) and guide urgent reperfusion
therapy.
Question 4
A client on telemetry is in ventricular tachycardia with a pulse, reports
feeling lightheaded, and has a blood pressure of 90/60 mmHg. Which of
the following is the appropriate nursing action?
• A. Prepare for immediate defibrillation
, • B. Administer IV adenosine rapidly
• C. Prepare for synchronized cardioversion
• D. Document the rhythm as a normal variant
Correct Answer: C. Prepare for synchronized cardioversion.
Detailed Rationale: For unstable ventricular tachycardia with a pulse
(manifested by hypotension and lightheadedness), synchronized
cardioversion is the recommended intervention to restore a stable
perfusion rhythm.
Question 5
A client with acute heart failure is receiving intravenous furosemide.
Which of the following laboratory values should the nurse monitor most
closely during therapy?
• A. Serum sodium
• B. Serum potassium
• C. Serum creatinine only
• D. Platelet count
Correct Answer: B. Serum potassium.
Detailed Rationale: Loop diuretics like furosemide cause renal excretion
of potassium, putting clients at high risk for hypokalemia, which can
trigger dangerous cardiac dysrhythmias.
Question 6
A client undergoing hemodialysis develops a headache, nausea,
restlessness, and confusion midway through the treatment. The nurse
, suspects disequilibrium syndrome. What is the primary cause of this
condition?
• A. Rapid removal of toxins and electrolytes from the blood,
causing cerebral edema
• B. Severe hyperkalemia due to dialysate fluid contamination
• C. Air embolism entering the central venous catheter
• D. Acute hypovolemic shock from excessive fluid removal
Correct Answer: A. Rapid removal of toxins and electrolytes from the
blood, causing cerebral edema.
Detailed Rationale: Dialysis disequilibrium syndrome occurs when
solutes are removed from the blood faster than they can be cleared
from the cerebrospinal fluid, creating an osmotic gradient that leads to
cerebral edema.
Question 7
A nurse is caring for a client receiving peritoneal dialysis. The nurse
notes that the peritoneal effluent drainage is cloudy. Which of the
following actions should the nurse take first?
• A. Warm the next dialysate bag to a higher temperature
• B. Notify the healthcare provider and save the effluent for
laboratory culture
• C. Flush the peritoneal catheter forcefully with heparinized saline
• D. Document the finding as a normal expected variation
Correct Answer: B. Notify the healthcare provider and save the effluent
for laboratory culture.
Surgical Concepts, Clinical Practice & Evidence-Based
Questions and answers 2026/2027
Question 1
A nurse is caring for a client with cirrhosis who has developed severe
ascites. Which of the following pre-procedure actions should the nurse
perform prior to a paracentesis?
• A. Administer an enema to empty the bowel
• B. Have the client empty their bladder
• C. Place the client in a high-Fowler's position
• D. Apply a continuous cold compress to the abdomen
Correct Answer: B. Have the client empty their bladder.
Detailed Rationale: Having the client void immediately before a
paracentesis reduces the risk of accidental bladder perforation during
the insertion of the paracentesis needle.
Question 2
A nurse is assessing a client admitted with acute pancreatitis. Which of
the following laboratory findings should the nurse expect to be
elevated?
• A. Serum calcium
• B. Serum amylase and lipase
• C. Red blood cell count
, • D. Serum albumin
Correct Answer: B. Serum amylase and lipase.
Detailed Rationale: Serum amylase and lipase levels rise significantly
within hours of acute pancreatic inflammation as pancreatic enzymes
leak into the bloodstream.
Question 3
A client is admitted to the emergency department with acute chest pain
suggestive of a myocardial infarction (MI). Which of the following
interventions should be the nurse's immediate priority?
• A. Obtain a 12-lead electrocardiogram (ECG)
• B. Administer sublingual nitroglycerin
• C. Apply supplemental oxygen if saturation is below 90%
• D. Draw cardiac biomarker blood levels
Correct Answer: A. Obtain a 12-lead electrocardiogram (ECG).
Detailed Rationale: A 12-lead ECG must be obtained within 10 minutes
of arrival for any client presenting with chest pain to rapidly diagnose
ST-elevation myocardial infarction (STEMI) and guide urgent reperfusion
therapy.
Question 4
A client on telemetry is in ventricular tachycardia with a pulse, reports
feeling lightheaded, and has a blood pressure of 90/60 mmHg. Which of
the following is the appropriate nursing action?
• A. Prepare for immediate defibrillation
, • B. Administer IV adenosine rapidly
• C. Prepare for synchronized cardioversion
• D. Document the rhythm as a normal variant
Correct Answer: C. Prepare for synchronized cardioversion.
Detailed Rationale: For unstable ventricular tachycardia with a pulse
(manifested by hypotension and lightheadedness), synchronized
cardioversion is the recommended intervention to restore a stable
perfusion rhythm.
Question 5
A client with acute heart failure is receiving intravenous furosemide.
Which of the following laboratory values should the nurse monitor most
closely during therapy?
• A. Serum sodium
• B. Serum potassium
• C. Serum creatinine only
• D. Platelet count
Correct Answer: B. Serum potassium.
Detailed Rationale: Loop diuretics like furosemide cause renal excretion
of potassium, putting clients at high risk for hypokalemia, which can
trigger dangerous cardiac dysrhythmias.
Question 6
A client undergoing hemodialysis develops a headache, nausea,
restlessness, and confusion midway through the treatment. The nurse
, suspects disequilibrium syndrome. What is the primary cause of this
condition?
• A. Rapid removal of toxins and electrolytes from the blood,
causing cerebral edema
• B. Severe hyperkalemia due to dialysate fluid contamination
• C. Air embolism entering the central venous catheter
• D. Acute hypovolemic shock from excessive fluid removal
Correct Answer: A. Rapid removal of toxins and electrolytes from the
blood, causing cerebral edema.
Detailed Rationale: Dialysis disequilibrium syndrome occurs when
solutes are removed from the blood faster than they can be cleared
from the cerebrospinal fluid, creating an osmotic gradient that leads to
cerebral edema.
Question 7
A nurse is caring for a client receiving peritoneal dialysis. The nurse
notes that the peritoneal effluent drainage is cloudy. Which of the
following actions should the nurse take first?
• A. Warm the next dialysate bag to a higher temperature
• B. Notify the healthcare provider and save the effluent for
laboratory culture
• C. Flush the peritoneal catheter forcefully with heparinized saline
• D. Document the finding as a normal expected variation
Correct Answer: B. Notify the healthcare provider and save the effluent
for laboratory culture.
