NUR 265 Advanced Medical-Surgical Nursing Practice
Exam | Comprehensive Questions, Answers &
Rationales 2026/2027
Question 1
A client with cardiogenic shock is managed with an intra-aortic balloon
pump (IABP). The nurse understands that the primary physiological
benefit of IABP therapy is achieved through balloon deflation occurring
precisely:
• A. Immediately before aortic valve closure during systole.
• B. Just prior to systolic ejection, reducing afterload and myocardial
oxygen demand.
• C. Throughout the entire duration of ventricular diastole.
• D. Simultaneously with the QRS complex on the
electrocardiogram.
Correct Answer: B. Just prior to systolic ejection, reducing afterload and
myocardial oxygen demand.
Detailed Rationale: The IABP inflates during diastole to augment
coronary artery perfusion and deflates just prior to systolic ejection
(triggered by the R wave). Deflating right before systole creates a
vacuum effect that lowers aortic impedance (afterload), decreasing the
workload and oxygen consumption of the failing left ventricle.
Question 2
,A client with acute respiratory distress syndrome (ARDS) is receiving
mechanical ventilation with positive end-expiratory pressure (PEEP).
The nurse identifies that the primary therapeutic goal of PEEP is to:
• A. Increase peak inspiratory airway pressure to maximum limits.
• B. Prevent alveolar collapse at the end of expiration and improve
oxygenation.
• C. Eliminate the need for any supplemental inspired oxygen.
• D. Promote rapid elimination of excess carbon dioxide through the
kidneys.
Correct Answer: B. Prevent alveolar collapse at the end of expiration
and improve oxygenation.
Detailed Rationale: PEEP applies positive pressure to the airways at the
end of expiration, keeping fragile alveoli open that would otherwise
collapse. This increases functional residual capacity, improves
ventilation-perfusion matching, and enhances arterial oxygenation in
clients with ARDS.
Question 3
A client has an external ventricular drain (EVD) inserted to monitor
intracranial pressure (ICP). When repositioning the client or adjusting
the bed, what is the nurse's critical responsibility regarding the
transducer system?
• A. Zero and level the transducer to the external auditory meatus
(Foramen of Monro) with every position change.
• B. Clamp the drainage tubing continuously for 4 hours after any
movement.
, • C. Elevate the drainage bag above the level of the client's head.
• D. Flush the intraventricular catheter directly with heparinized
saline every 30 minutes.
Correct Answer: A. Zero and level the transducer to the external
auditory meatus (Foramen of Monro) with every position change.
Detailed Rationale: Accurate ICP readings depend on correct leveling of
the transducer reference point to the Foramen of Monro (approximate
level of the tragus of the ear). If the transducer is too low, readings are
falsely elevated; if too high, readings are falsely low, risking inaccurate
management.
Question 4
A client with suspected cardiac tamponade exhibits muffled heart
sounds, jugular venous distension, and hypotension. The nurse
prepares for which emergency intervention?
• A. Insertion of a chest tube in the second intercostal space.
• B. Emergency needle pericardiocentesis.
• C. Immediate total cardiopulmonary bypass cannulation.
• D. Administration of high-dose intravenous beta-blockers.
Correct Answer: B. Emergency needle pericardiocentesis.
Detailed Rationale: Cardiac tamponade involves fluid accumulation in
the pericardial sac, restricting ventricular filling and causing Beck's triad
(hypotension, muffled heart sounds, JVD). Needle pericardiocentesis
drains the pericardial fluid and relieves life-threatening cardiac
compression.
, Question 5
A client weighing 90 kg sustains deep partial and full-thickness burns
over 40% of their total body surface area. Using the Parkland formula
(4 mL × kg × %TBSA), calculate the total fluid volume required for the
first 24 hours post-injury.
• A. 7,200 mL
• B. 14,400 mL
• C. 10,800 mL
• D. 16,000 mL
Correct Answer: B. 14,400 mL
Detailed Rationale: Using the Parkland formula: 4 mL × 90 kg ×
40(TBSA) = 14,400 mL total fluid required in the first 24 hours, with
half given in the first 8 hours post-burn.
Question 6
A client is brought to the emergency department experiencing status
epilepticus. After initial intravenous lorazepam fails to terminate the
seizure, the nurse anticipates the immediate administration of:
• A. Intravenous levetiracetam or fosphenytoin.
• B. Oral diazepam tablets.
• C. Subcutaneous regular insulin.
• D. Intramuscular morphine sulfate.
Correct Answer: A. Intravenous levetiracetam or fosphenytoin.
Exam | Comprehensive Questions, Answers &
Rationales 2026/2027
Question 1
A client with cardiogenic shock is managed with an intra-aortic balloon
pump (IABP). The nurse understands that the primary physiological
benefit of IABP therapy is achieved through balloon deflation occurring
precisely:
• A. Immediately before aortic valve closure during systole.
• B. Just prior to systolic ejection, reducing afterload and myocardial
oxygen demand.
• C. Throughout the entire duration of ventricular diastole.
• D. Simultaneously with the QRS complex on the
electrocardiogram.
Correct Answer: B. Just prior to systolic ejection, reducing afterload and
myocardial oxygen demand.
Detailed Rationale: The IABP inflates during diastole to augment
coronary artery perfusion and deflates just prior to systolic ejection
(triggered by the R wave). Deflating right before systole creates a
vacuum effect that lowers aortic impedance (afterload), decreasing the
workload and oxygen consumption of the failing left ventricle.
Question 2
,A client with acute respiratory distress syndrome (ARDS) is receiving
mechanical ventilation with positive end-expiratory pressure (PEEP).
The nurse identifies that the primary therapeutic goal of PEEP is to:
• A. Increase peak inspiratory airway pressure to maximum limits.
• B. Prevent alveolar collapse at the end of expiration and improve
oxygenation.
• C. Eliminate the need for any supplemental inspired oxygen.
• D. Promote rapid elimination of excess carbon dioxide through the
kidneys.
Correct Answer: B. Prevent alveolar collapse at the end of expiration
and improve oxygenation.
Detailed Rationale: PEEP applies positive pressure to the airways at the
end of expiration, keeping fragile alveoli open that would otherwise
collapse. This increases functional residual capacity, improves
ventilation-perfusion matching, and enhances arterial oxygenation in
clients with ARDS.
Question 3
A client has an external ventricular drain (EVD) inserted to monitor
intracranial pressure (ICP). When repositioning the client or adjusting
the bed, what is the nurse's critical responsibility regarding the
transducer system?
• A. Zero and level the transducer to the external auditory meatus
(Foramen of Monro) with every position change.
• B. Clamp the drainage tubing continuously for 4 hours after any
movement.
, • C. Elevate the drainage bag above the level of the client's head.
• D. Flush the intraventricular catheter directly with heparinized
saline every 30 minutes.
Correct Answer: A. Zero and level the transducer to the external
auditory meatus (Foramen of Monro) with every position change.
Detailed Rationale: Accurate ICP readings depend on correct leveling of
the transducer reference point to the Foramen of Monro (approximate
level of the tragus of the ear). If the transducer is too low, readings are
falsely elevated; if too high, readings are falsely low, risking inaccurate
management.
Question 4
A client with suspected cardiac tamponade exhibits muffled heart
sounds, jugular venous distension, and hypotension. The nurse
prepares for which emergency intervention?
• A. Insertion of a chest tube in the second intercostal space.
• B. Emergency needle pericardiocentesis.
• C. Immediate total cardiopulmonary bypass cannulation.
• D. Administration of high-dose intravenous beta-blockers.
Correct Answer: B. Emergency needle pericardiocentesis.
Detailed Rationale: Cardiac tamponade involves fluid accumulation in
the pericardial sac, restricting ventricular filling and causing Beck's triad
(hypotension, muffled heart sounds, JVD). Needle pericardiocentesis
drains the pericardial fluid and relieves life-threatening cardiac
compression.
, Question 5
A client weighing 90 kg sustains deep partial and full-thickness burns
over 40% of their total body surface area. Using the Parkland formula
(4 mL × kg × %TBSA), calculate the total fluid volume required for the
first 24 hours post-injury.
• A. 7,200 mL
• B. 14,400 mL
• C. 10,800 mL
• D. 16,000 mL
Correct Answer: B. 14,400 mL
Detailed Rationale: Using the Parkland formula: 4 mL × 90 kg ×
40(TBSA) = 14,400 mL total fluid required in the first 24 hours, with
half given in the first 8 hours post-burn.
Question 6
A client is brought to the emergency department experiencing status
epilepticus. After initial intravenous lorazepam fails to terminate the
seizure, the nurse anticipates the immediate administration of:
• A. Intravenous levetiracetam or fosphenytoin.
• B. Oral diazepam tablets.
• C. Subcutaneous regular insulin.
• D. Intramuscular morphine sulfate.
Correct Answer: A. Intravenous levetiracetam or fosphenytoin.
