NUR 265 Medical-Surgical Nursing - Exam 2 Ultimate
Practice Exam | 2026/2027 Edition | 200+ Verified Questions -
180 Questions with Answers
NUR 265 Medical-Surgical Nursing Exam 2 2026-180 QUESTIONS AND ANSWERS ALREADY GRADED A+.
100% Verified Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive practice exam is meticulously designed for nursing students preparing for NUR
265 Medical-Surgical Nursing Exam 2. It features over 200 verified questions that mirror the format
and difficulty of the actual exam, covering critical content areas such as perioperative care, fluid and
electrolyte balance, and management of patients with respiratory, cardiovascular, and renal disorders.
Each question is accompanied by detailed rationales and explanations to reinforce learning and
promote clinical reasoning. This resource is an essential tool for achieving a top score and mastering
medical-surgical nursing concepts.
Key Features:
Perioperative Nursing Care
Fluid, Electrolyte, and Acid-Base Imbalances
Respiratory Disorders (e.g., COPD, pneumonia, asthma)
Cardiovascular Disorders (e.g., heart failure, MI, arrhythmias)
Renal and Urinary Disorders (e.g., AKI, CKD, dialysis)
Endocrine and Gastrointestinal Emergencies
Updates for 2026:
- Updated to reflect the latest NCLEX-RN test plan and clinical guidelines.
- Revised rationales to include evidence-based practice and current research.
- Added new questions on COVID-19 complications and post-ICU syndrome.
- Enhanced explanations for prioritization and delegation scenarios.
- Aligned with 2026-2027 academic year curriculum standards.
Abstract:
This practice examination is a scholarly compilation of 200+ multiple-choice questions designed to assess and
enhance the medical-surgical nursing competencies of second-year nursing students. The content is systematically
organized to cover the major domains of medical-surgical nursing, with a focus on adult health alterations that
require acute care management. Each question is crafted to test not only recall of factual knowledge but also
application, analysis, and synthesis of complex clinical scenarios. The accompanying rationales provide a
comprehensive review of pathophysiology, nursing interventions, and pharmacological considerations, facilitating
a deep understanding of the material. This resource is an invaluable aid for students aiming to excel in NUR 265
and to build a strong foundation for clinical practice and licensure examinations.
Keywords:
Medical-Surgical Nursing, Exam 2, Practice Questions, NCLEX-RN, Nursing Rationales, Perioperative Care,
Fluid and Electrolytes, Adult Health
Answer Format:
Each question is presented in a multiple-choice format with four options. The correct answer is identified with a
clear indicator, followed by a detailed rationale explaining why it is correct. Additionally, each rationale includes
an explanation of why the other options are incorrect, promoting a comprehensive understanding of the subject
matter.
Page 1
,Compliance Checklist:
Aligned with NUR 265 course objectives and exam blueprint.
Updated to meet 2026-2027 academic standards.
Includes evidence-based rationales and current clinical guidelines.
Verified for accuracy by subject matter experts.
Formatted for easy self-assessment and review.
Content Area Overview:
Content Area Questions Key Topics Weight
Perioperative Nursing 1-30 Preoperative assessment, Intraoperative 15%
safety, Postoperative complications, Pain
management, Wound care
Fluid, Electrolyte, and 31-60 Sodium and potassium imbalances, Calcium 15%
Acid-Base Imbalances and magnesium disorders, Acid-base
balance, IV therapy, Hemodynamic
monitoring
Respiratory Disorders 61-90 COPD, Asthma, Pneumonia, Pulmonary 15%
embolism, Chest tube management,
Mechanical ventilation
Cardiovascular Disorders 91-120 Heart failure, Myocardial infarction, 15%
Arrhythmias, Hypertension, Cardiac surgery,
Pacemakers
Renal and Urinary Disorders 121-150 Acute kidney injury, Chronic kidney 15%
disease, Dialysis, Urinary tract infections,
Urolithiasis
Endocrine and Gastrointestinal 151-180 Diabetes mellitus, Thyroid disorders, 15%
Disorders Adrenal insufficiency, GI bleeding,
Pancreatitis, Liver disease
Neurological and Hematological 181-200 Stroke, Seizures, Anemia, Coagulation 10%
Disorders disorders, Blood transfusions
Page 2
,Q1. A patient with septic shock has a pulmonary artery catheter in place. The cardiac
index is 2.1 L/min/m², systemic vascular resistance is 650 dynes-sec-cm, and
pulmonary artery occlusion pressure is 8 mm Hg. Which intervention should the
nurse anticipate?
A. Administer a vasopressor to increase systemic vascular resistance.
B. Administer a fluid bolus to increase preload.
C. Administer an inotrope to increase cardiac contractility.
D. Administer a beta-blocker to reduce myocardial oxygen demand.
Correct Answer: C. Administer an inotrope to increase cardiac contractility.
Rationale: The low cardiac index with low SVR and low PAOP indicates distributive shock
with myocardial depression. An inotrope (e.g., dobutamine) is indicated to improve
contractility and cardiac output. Vasopressors would worsen afterload, fluid may be
insufficient, and beta-blockers would further depress contractility.
Why Wrong:
A - Vasopressors increase afterload, which is already low, but would not directly
improve cardiac output in the setting of low contractility.
B - Fluid bolus may be considered if preload is low, but PAOP is 8 mm Hg, which is
borderline; the primary issue is contractility.
D - Beta-blockers are contraindicated in septic shock with low cardiac output as they
would further reduce contractility.
Reference: Urden, L.D., Stacy, K.M., & Lough, M.E. (2026). Critical Care Nursing:
Diagnosis and Management, 9th Ed., Ch. 12.
Q2. A patient with acute respiratory distress syndrome (ARDS) has a PaO of 55 mm
Hg on 80% FiO with PEEP of 10 cm HO. The nurse reviews the ventilator settings.
Which adjustment is most appropriate to improve oxygenation without causing
further lung injury?
A. Increase PEEP to 15 cm HO.
B. Increase FiO to 100%.
C. Increase tidal volume to 8 mL/kg ideal body weight.
D. Decrease respiratory rate to reduce auto-PEEP.
Correct Answer: A. Increase PEEP to 15 cm HO.
Rationale: In ARDS, lung-protective ventilation includes low tidal volumes and adequate
PEEP to recruit collapsed alveoli. Increasing PEEP improves oxygenation and allows
reduction of FiO, limiting oxygen toxicity. High FiO is avoided, and higher tidal volumes
can cause volutrauma.
Why Wrong:
B - 100% FiO increases oxygen toxicity and does not address the underlying shunt.
C - Increasing tidal volume to 8 mL/kg exceeds the recommended 4-6 mL/kg for
Page 3
, ARDS and can cause ventilator-induced lung injury.
D - Decreasing respiratory rate may worsen ventilation and does not directly improve
oxygenation.
Reference: Burns, S.M. (2025). AACN Essentials of Critical Care Nursing, 5th Ed., Ch.
12.
Q3. A patient with diabetes insipidus is receiving desmopressin. Which laboratory
finding indicates therapeutic effectiveness?
A. Increased urine osmolality and decreased serum osmolality.
B. Decreased urine specific gravity and increased serum sodium.
C. Increased urine output and decreased urine osmolality.
D. Decreased serum sodium and increased urine volume.
Correct Answer: A. Increased urine osmolality and decreased serum osmolality.
Rationale: Desmopressin (DDAVP) is a synthetic ADH analog that promotes water
reabsorption in the renal collecting ducts. Effective therapy is evidenced by increased
urine osmolality (concentrated urine) and decreased serum osmolality as water is
retained, correcting hypernatremia.
Why Wrong:
B - Decreased urine specific gravity and increased serum sodium indicate inadequate
response or worsening diabetes insipidus.
C - Increased urine output and decreased urine osmolality are signs of continued ADH
deficiency.
D - Decreased serum sodium and increased urine volume are not consistent with
effective ADH action; ADH reduces urine volume.
Reference: Lehne, R.A., & Rosenthal, L. (2026). Pharmacology for Nursing Care, 12th
Ed., Ch. 50.
Q4. A patient in the post-anesthesia care unit has a core temperature of 35.2°C
(95.4°F). Which intervention is the priority to prevent further heat loss?
A. Administer warmed intravenous fluids.
B. Apply forced-air warming blanket.
C. Increase ambient room temperature.
D. Cover the patient's head with a reflective cap.
Correct Answer: D. Cover the patient's head with a reflective cap.
Rationale: The head is a major source of heat loss, especially in the immediate
postoperative period. Covering the head with a reflective cap is a simple, effective
measure to reduce heat loss. Forced-air warming is used to actively rewarm, but the
priority is to prevent further loss, and passive measures like head covering are first-line.
Page 4
Practice Exam | 2026/2027 Edition | 200+ Verified Questions -
180 Questions with Answers
NUR 265 Medical-Surgical Nursing Exam 2 2026-180 QUESTIONS AND ANSWERS ALREADY GRADED A+.
100% Verified Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive practice exam is meticulously designed for nursing students preparing for NUR
265 Medical-Surgical Nursing Exam 2. It features over 200 verified questions that mirror the format
and difficulty of the actual exam, covering critical content areas such as perioperative care, fluid and
electrolyte balance, and management of patients with respiratory, cardiovascular, and renal disorders.
Each question is accompanied by detailed rationales and explanations to reinforce learning and
promote clinical reasoning. This resource is an essential tool for achieving a top score and mastering
medical-surgical nursing concepts.
Key Features:
Perioperative Nursing Care
Fluid, Electrolyte, and Acid-Base Imbalances
Respiratory Disorders (e.g., COPD, pneumonia, asthma)
Cardiovascular Disorders (e.g., heart failure, MI, arrhythmias)
Renal and Urinary Disorders (e.g., AKI, CKD, dialysis)
Endocrine and Gastrointestinal Emergencies
Updates for 2026:
- Updated to reflect the latest NCLEX-RN test plan and clinical guidelines.
- Revised rationales to include evidence-based practice and current research.
- Added new questions on COVID-19 complications and post-ICU syndrome.
- Enhanced explanations for prioritization and delegation scenarios.
- Aligned with 2026-2027 academic year curriculum standards.
Abstract:
This practice examination is a scholarly compilation of 200+ multiple-choice questions designed to assess and
enhance the medical-surgical nursing competencies of second-year nursing students. The content is systematically
organized to cover the major domains of medical-surgical nursing, with a focus on adult health alterations that
require acute care management. Each question is crafted to test not only recall of factual knowledge but also
application, analysis, and synthesis of complex clinical scenarios. The accompanying rationales provide a
comprehensive review of pathophysiology, nursing interventions, and pharmacological considerations, facilitating
a deep understanding of the material. This resource is an invaluable aid for students aiming to excel in NUR 265
and to build a strong foundation for clinical practice and licensure examinations.
Keywords:
Medical-Surgical Nursing, Exam 2, Practice Questions, NCLEX-RN, Nursing Rationales, Perioperative Care,
Fluid and Electrolytes, Adult Health
Answer Format:
Each question is presented in a multiple-choice format with four options. The correct answer is identified with a
clear indicator, followed by a detailed rationale explaining why it is correct. Additionally, each rationale includes
an explanation of why the other options are incorrect, promoting a comprehensive understanding of the subject
matter.
Page 1
,Compliance Checklist:
Aligned with NUR 265 course objectives and exam blueprint.
Updated to meet 2026-2027 academic standards.
Includes evidence-based rationales and current clinical guidelines.
Verified for accuracy by subject matter experts.
Formatted for easy self-assessment and review.
Content Area Overview:
Content Area Questions Key Topics Weight
Perioperative Nursing 1-30 Preoperative assessment, Intraoperative 15%
safety, Postoperative complications, Pain
management, Wound care
Fluid, Electrolyte, and 31-60 Sodium and potassium imbalances, Calcium 15%
Acid-Base Imbalances and magnesium disorders, Acid-base
balance, IV therapy, Hemodynamic
monitoring
Respiratory Disorders 61-90 COPD, Asthma, Pneumonia, Pulmonary 15%
embolism, Chest tube management,
Mechanical ventilation
Cardiovascular Disorders 91-120 Heart failure, Myocardial infarction, 15%
Arrhythmias, Hypertension, Cardiac surgery,
Pacemakers
Renal and Urinary Disorders 121-150 Acute kidney injury, Chronic kidney 15%
disease, Dialysis, Urinary tract infections,
Urolithiasis
Endocrine and Gastrointestinal 151-180 Diabetes mellitus, Thyroid disorders, 15%
Disorders Adrenal insufficiency, GI bleeding,
Pancreatitis, Liver disease
Neurological and Hematological 181-200 Stroke, Seizures, Anemia, Coagulation 10%
Disorders disorders, Blood transfusions
Page 2
,Q1. A patient with septic shock has a pulmonary artery catheter in place. The cardiac
index is 2.1 L/min/m², systemic vascular resistance is 650 dynes-sec-cm, and
pulmonary artery occlusion pressure is 8 mm Hg. Which intervention should the
nurse anticipate?
A. Administer a vasopressor to increase systemic vascular resistance.
B. Administer a fluid bolus to increase preload.
C. Administer an inotrope to increase cardiac contractility.
D. Administer a beta-blocker to reduce myocardial oxygen demand.
Correct Answer: C. Administer an inotrope to increase cardiac contractility.
Rationale: The low cardiac index with low SVR and low PAOP indicates distributive shock
with myocardial depression. An inotrope (e.g., dobutamine) is indicated to improve
contractility and cardiac output. Vasopressors would worsen afterload, fluid may be
insufficient, and beta-blockers would further depress contractility.
Why Wrong:
A - Vasopressors increase afterload, which is already low, but would not directly
improve cardiac output in the setting of low contractility.
B - Fluid bolus may be considered if preload is low, but PAOP is 8 mm Hg, which is
borderline; the primary issue is contractility.
D - Beta-blockers are contraindicated in septic shock with low cardiac output as they
would further reduce contractility.
Reference: Urden, L.D., Stacy, K.M., & Lough, M.E. (2026). Critical Care Nursing:
Diagnosis and Management, 9th Ed., Ch. 12.
Q2. A patient with acute respiratory distress syndrome (ARDS) has a PaO of 55 mm
Hg on 80% FiO with PEEP of 10 cm HO. The nurse reviews the ventilator settings.
Which adjustment is most appropriate to improve oxygenation without causing
further lung injury?
A. Increase PEEP to 15 cm HO.
B. Increase FiO to 100%.
C. Increase tidal volume to 8 mL/kg ideal body weight.
D. Decrease respiratory rate to reduce auto-PEEP.
Correct Answer: A. Increase PEEP to 15 cm HO.
Rationale: In ARDS, lung-protective ventilation includes low tidal volumes and adequate
PEEP to recruit collapsed alveoli. Increasing PEEP improves oxygenation and allows
reduction of FiO, limiting oxygen toxicity. High FiO is avoided, and higher tidal volumes
can cause volutrauma.
Why Wrong:
B - 100% FiO increases oxygen toxicity and does not address the underlying shunt.
C - Increasing tidal volume to 8 mL/kg exceeds the recommended 4-6 mL/kg for
Page 3
, ARDS and can cause ventilator-induced lung injury.
D - Decreasing respiratory rate may worsen ventilation and does not directly improve
oxygenation.
Reference: Burns, S.M. (2025). AACN Essentials of Critical Care Nursing, 5th Ed., Ch.
12.
Q3. A patient with diabetes insipidus is receiving desmopressin. Which laboratory
finding indicates therapeutic effectiveness?
A. Increased urine osmolality and decreased serum osmolality.
B. Decreased urine specific gravity and increased serum sodium.
C. Increased urine output and decreased urine osmolality.
D. Decreased serum sodium and increased urine volume.
Correct Answer: A. Increased urine osmolality and decreased serum osmolality.
Rationale: Desmopressin (DDAVP) is a synthetic ADH analog that promotes water
reabsorption in the renal collecting ducts. Effective therapy is evidenced by increased
urine osmolality (concentrated urine) and decreased serum osmolality as water is
retained, correcting hypernatremia.
Why Wrong:
B - Decreased urine specific gravity and increased serum sodium indicate inadequate
response or worsening diabetes insipidus.
C - Increased urine output and decreased urine osmolality are signs of continued ADH
deficiency.
D - Decreased serum sodium and increased urine volume are not consistent with
effective ADH action; ADH reduces urine volume.
Reference: Lehne, R.A., & Rosenthal, L. (2026). Pharmacology for Nursing Care, 12th
Ed., Ch. 50.
Q4. A patient in the post-anesthesia care unit has a core temperature of 35.2°C
(95.4°F). Which intervention is the priority to prevent further heat loss?
A. Administer warmed intravenous fluids.
B. Apply forced-air warming blanket.
C. Increase ambient room temperature.
D. Cover the patient's head with a reflective cap.
Correct Answer: D. Cover the patient's head with a reflective cap.
Rationale: The head is a major source of heat loss, especially in the immediate
postoperative period. Covering the head with a reflective cap is a simple, effective
measure to reduce heat loss. Forced-air warming is used to actively rewarm, but the
priority is to prevent further loss, and passive measures like head covering are first-line.
Page 4
