NU 265 – Advanced Medical-Surgical Nursing / Mock Exam
Questions, Verified Answers, and Clinical Rationales
2026/2027 Edition
Question 1
A client with acute respiratory distress syndrome is placed in the prone position.
Which physiological mechanism explains how prone positioning improves
oxygenation?
A. It increases total lung volume by forcing the diaphragm downward into the
abdominal cavity.
B. It relieves pressure of the heart on the posterior lung fields and improves
ventilation-perfusion matching by recruiting collapsed dorsal alveoli.
C. It decreases the overall metabolic oxygen demand of the skeletal muscles
and myocardium.
D. It completely eliminates the need for positive end-expiratory pressure on the
ventilator.
Correct Answer: B. It relieves pressure of the heart on the posterior lung
fields and improves ventilation-perfusion matching by recruiting collapsed
dorsal alveoli.
Clinical Rationale: In acute respiratory distress syndrome, dependent alveolar
collapse is prominent in posterior lung regions. Prone positioning uses gravity to
shift the heart away from the lungs, promotes drainage of secretions, and allows
recruitment of dorsal alveoli, optimizing matching and oxygenation.
Question 2
The nurse is caring for a client receiving mechanical ventilation who triggers a
high-pressure alarm. Which nursing action is appropriate first?
A. Disconnect the client from the ventilator and manually ventilate with a bag-
valve-mask device.
B. Check the ventilator tubing for kinks, assess the client for coughing or
excessive secretions, and check for tube displacement.
, C. Immediately silence the alarm and decrease the ventilator respiratory rate
setting.
D. Check the low exhaled volume alarm settings on the control panel.
Correct Answer: B. Check the ventilator tubing for kinks, assess the client for
coughing or excessive secretions, and check for tube displacement.
Clinical Rationale: High-pressure alarms indicate increased resistance to airflow
or decreased lung compliance. The nurse must first quickly assess for common,
reversible mechanical causes before disconnecting or escalating interventions.
Question 3
A client with a chest tube connected to a water-seal suction system experiences
accidental disconnection of the chest tube from the drainage unit. What is the
immediate priority action by the nurse?
A. Clamp the chest tube close to the insertion site using rubber-tipped
hemostats.
B. Submerge the distal end of the chest tube in a sterile container of sterile
water to maintain a water seal.
C. Leave the tube open to room air while preparing a new suction system.
D. Remove the chest tube immediately and apply an occlusive dressing.
Correct Answer: B. Submerge the distal end of the chest tube in a sterile
container of sterile water to maintain a water seal.
Clinical Rationale: Submerging the disconnected end in sterile water instantly
creates a temporary water seal, allowing air to escape from the pleural space while
preventing environmental air from entering the chest cavity and causing a tension
pneumothorax.
Question 4
The nurse is monitoring a client who has a chest tube following a lobectomy.
Which finding requires immediate reporting to the healthcare provider?
, A. Continuous gentle bubbling in the suction control chamber connected to wall
suction.
B. A large volume of bright red blood drained from the mediastinal tube in the
first hour post-procedure.
C. Fluctuations in the water-seal chamber with inspiration and expiration.
D. A small amount of subcutaneous emphysema palpated around the insertion
site that is non-progressive.
Correct Answer: B. A large volume of bright red blood drained from the
mediastinal tube in the first hour post-procedure.
Clinical Rationale: Drainage exceeding expected hourly parameters or an acute
massive output indicates severe postoperative hemorrhage requiring immediate
surgical intervention.
Question 5
A client with a pulmonary embolism is receiving a continuous intravenous infusion
of heparin. The baseline laboratory clotting times are checked alongside current
therapeutic targets. What is the appropriate nursing action if clotting times are
mildly above the therapeutic range?
A. Stop the heparin infusion immediately and administer protamine sulfate.
B. Continue the heparin infusion at the current rate and monitor per protocol.
C. Decrease the heparin infusion rate according to the hospital protocol.
D. Increase the heparin infusion rate to reach the upper limit.
Correct Answer: C. Decrease the heparin infusion rate according to the
hospital protocol.
Clinical Rationale: Clotting times above the therapeutic range place the client at
risk for bleeding. The nurse should follow the protocol to decrease the infusion rate
and re-check laboratory values at the specified interval.
Question 6
, A client is admitted to the emergency department with acute hypoxemic respiratory
failure due to severe pneumonia. Arterial blood gas results reveal elevated pH,
decreased carbon dioxide, decreased oxygen levels, and normal bicarbonate. How
should the nurse interpret these results?
A. Respiratory acidosis with metabolic compensation
B. Respiratory alkalosis with severe hypoxemia
C. Metabolic alkalosis with hyperoxemia
D. Combined respiratory and metabolic acidosis
Correct Answer: B. Respiratory alkalosis with severe hypoxemia
Clinical Rationale: An elevated pH combined with a low carbon dioxide level
indicates primary acute respiratory alkalosis driven by hyperventilation. The low
oxygen level indicates severe hypoxemia.
Question 7
The nurse is caring for a client in hypovolemic shock. Which of the following
physical assessment findings would the nurse expect to find?
A. Warm, flushed skin with bounding peripheral pulses and bradycardia
B. Cool, pale, clammy skin with weak, thready pulses and delayed capillary
refill
C. Jaundiced sclera with peripheral edema and warm extremities
D. Slow, bounding pulse with wide pulse pressure
Correct Answer: B. Cool, pale, clammy skin with weak, thready pulses and
delayed capillary refill
Clinical Rationale: In hypovolemic shock, sympathetic nervous system
compensation causes intense peripheral vasoconstriction to shunt blood flow away
from the skin and non-essential organs toward vital organs, resulting in cool, pale,
clammy skin and weak pulses.
Question 8
Questions, Verified Answers, and Clinical Rationales
2026/2027 Edition
Question 1
A client with acute respiratory distress syndrome is placed in the prone position.
Which physiological mechanism explains how prone positioning improves
oxygenation?
A. It increases total lung volume by forcing the diaphragm downward into the
abdominal cavity.
B. It relieves pressure of the heart on the posterior lung fields and improves
ventilation-perfusion matching by recruiting collapsed dorsal alveoli.
C. It decreases the overall metabolic oxygen demand of the skeletal muscles
and myocardium.
D. It completely eliminates the need for positive end-expiratory pressure on the
ventilator.
Correct Answer: B. It relieves pressure of the heart on the posterior lung
fields and improves ventilation-perfusion matching by recruiting collapsed
dorsal alveoli.
Clinical Rationale: In acute respiratory distress syndrome, dependent alveolar
collapse is prominent in posterior lung regions. Prone positioning uses gravity to
shift the heart away from the lungs, promotes drainage of secretions, and allows
recruitment of dorsal alveoli, optimizing matching and oxygenation.
Question 2
The nurse is caring for a client receiving mechanical ventilation who triggers a
high-pressure alarm. Which nursing action is appropriate first?
A. Disconnect the client from the ventilator and manually ventilate with a bag-
valve-mask device.
B. Check the ventilator tubing for kinks, assess the client for coughing or
excessive secretions, and check for tube displacement.
, C. Immediately silence the alarm and decrease the ventilator respiratory rate
setting.
D. Check the low exhaled volume alarm settings on the control panel.
Correct Answer: B. Check the ventilator tubing for kinks, assess the client for
coughing or excessive secretions, and check for tube displacement.
Clinical Rationale: High-pressure alarms indicate increased resistance to airflow
or decreased lung compliance. The nurse must first quickly assess for common,
reversible mechanical causes before disconnecting or escalating interventions.
Question 3
A client with a chest tube connected to a water-seal suction system experiences
accidental disconnection of the chest tube from the drainage unit. What is the
immediate priority action by the nurse?
A. Clamp the chest tube close to the insertion site using rubber-tipped
hemostats.
B. Submerge the distal end of the chest tube in a sterile container of sterile
water to maintain a water seal.
C. Leave the tube open to room air while preparing a new suction system.
D. Remove the chest tube immediately and apply an occlusive dressing.
Correct Answer: B. Submerge the distal end of the chest tube in a sterile
container of sterile water to maintain a water seal.
Clinical Rationale: Submerging the disconnected end in sterile water instantly
creates a temporary water seal, allowing air to escape from the pleural space while
preventing environmental air from entering the chest cavity and causing a tension
pneumothorax.
Question 4
The nurse is monitoring a client who has a chest tube following a lobectomy.
Which finding requires immediate reporting to the healthcare provider?
, A. Continuous gentle bubbling in the suction control chamber connected to wall
suction.
B. A large volume of bright red blood drained from the mediastinal tube in the
first hour post-procedure.
C. Fluctuations in the water-seal chamber with inspiration and expiration.
D. A small amount of subcutaneous emphysema palpated around the insertion
site that is non-progressive.
Correct Answer: B. A large volume of bright red blood drained from the
mediastinal tube in the first hour post-procedure.
Clinical Rationale: Drainage exceeding expected hourly parameters or an acute
massive output indicates severe postoperative hemorrhage requiring immediate
surgical intervention.
Question 5
A client with a pulmonary embolism is receiving a continuous intravenous infusion
of heparin. The baseline laboratory clotting times are checked alongside current
therapeutic targets. What is the appropriate nursing action if clotting times are
mildly above the therapeutic range?
A. Stop the heparin infusion immediately and administer protamine sulfate.
B. Continue the heparin infusion at the current rate and monitor per protocol.
C. Decrease the heparin infusion rate according to the hospital protocol.
D. Increase the heparin infusion rate to reach the upper limit.
Correct Answer: C. Decrease the heparin infusion rate according to the
hospital protocol.
Clinical Rationale: Clotting times above the therapeutic range place the client at
risk for bleeding. The nurse should follow the protocol to decrease the infusion rate
and re-check laboratory values at the specified interval.
Question 6
, A client is admitted to the emergency department with acute hypoxemic respiratory
failure due to severe pneumonia. Arterial blood gas results reveal elevated pH,
decreased carbon dioxide, decreased oxygen levels, and normal bicarbonate. How
should the nurse interpret these results?
A. Respiratory acidosis with metabolic compensation
B. Respiratory alkalosis with severe hypoxemia
C. Metabolic alkalosis with hyperoxemia
D. Combined respiratory and metabolic acidosis
Correct Answer: B. Respiratory alkalosis with severe hypoxemia
Clinical Rationale: An elevated pH combined with a low carbon dioxide level
indicates primary acute respiratory alkalosis driven by hyperventilation. The low
oxygen level indicates severe hypoxemia.
Question 7
The nurse is caring for a client in hypovolemic shock. Which of the following
physical assessment findings would the nurse expect to find?
A. Warm, flushed skin with bounding peripheral pulses and bradycardia
B. Cool, pale, clammy skin with weak, thready pulses and delayed capillary
refill
C. Jaundiced sclera with peripheral edema and warm extremities
D. Slow, bounding pulse with wide pulse pressure
Correct Answer: B. Cool, pale, clammy skin with weak, thready pulses and
delayed capillary refill
Clinical Rationale: In hypovolemic shock, sympathetic nervous system
compensation causes intense peripheral vasoconstriction to shunt blood flow away
from the skin and non-essential organs toward vital organs, resulting in cool, pale,
clammy skin and weak pulses.
Question 8
