NUR 265/NUR265: Exam 1
Advanced Concepts in Medical-Surgical Nursing
2026-2028 Testing Cycle | Newly Released
50 Questions With Answers & Expert Rationales Guaranteed
Pass | Graded A+ | Galen
Q1: A 68-year-old male admitted with septic shock has a blood pressure of 82/48 mmHg. The
nurse calculates the mean arterial pressure (MAP). Which result requires immediate notification
of the healthcare provider?
A. 54 mmHg
B. 61 mmHg
C. 59 mmHg
D. 68 mmHg
Correct Answer: C
Rationale: Correct because the mean arterial pressure is calculated using the formula (SBP +
2DBP) ÷ 3, yielding approximately 59 mmHg for this patient. A MAP below 65 mmHg indicates
inadequate organ perfusion and requires immediate intervention to prevent ischemic injury. The
priority intervention is to notify the provider and initiate therapies to restore adequate perfusion.
Q2: A nurse is assessing a patient in the oliguric phase of acute kidney injury. Which findings are
consistent with this phase? Select all that apply.
A. Urine output of 4 L/day
B. Peaked T waves on ECG
C. Flat T waves and U waves
D. Kussmaul respirations
E. Hypotension and tachycardia
F. Weight loss of 2 kg in 24 hours
Correct Answer(s): B, D
Rationale: Correct because the oliguric phase is characterized by urine output less than 400
mL/24h, fluid volume excess leading to hypertension and edema, hyperkalemia manifesting as
,peaked T waves, and metabolic acidosis causing Kussmaul respirations. Flat T waves and U
waves indicate hypokalemia, which occurs in the diuretic phase, not the oliguric phase.
Hypotension and weight loss are associated with fluid depletion seen in the diuretic phase.
Q3: A 54-year-old male presents with coffee-ground emesis and melena. His vital signs reveal
tachycardia and orthostatic hypotension. Which condition is the most likely cause of his
presentation?
A. Bleeding duodenal ulcer
B. Diverticulosis
C. Angiodysplasia
D. Hemorrhoids
Correct Answer: A
Rationale: Correct because coffee-ground emesis and melena are classic manifestations of upper
GI bleeding, and peptic ulcer disease is a leading cause of upper GI hemorrhage. Diverticulosis,
angiodysplasia, and hemorrhoids typically present with lower GI bleeding characterized by
hematochezia. The priority intervention is to establish large-bore IV access and prepare for fluid
resuscitation.
Q4: A patient with chest pain is found to have ST-segment elevation in leads V1-V4 and elevated
troponin levels. Which type of acute coronary syndrome is most likely present?
A. Unstable angina
B. STEMI
C. NSTEMI
D. Non-cardiac chest pain
Correct Answer: B
Rationale: Correct because ST-segment elevation in contiguous leads accompanied by elevated
troponin indicates a STEMI, representing full-thickness myocardial necrosis. Unstable angina
presents without troponin elevation, while NSTEMI shows ST depression or T-wave inversion
rather than ST elevation. The priority intervention is immediate reperfusion therapy per facility
protocol and continuous monitoring.
, Q5: A patient with ESRD presents with K+ 6.8 mEq/L, widened QRS complex, and peaked T
waves. Which interventions are appropriate? Select all that apply.
A. Administer IV calcium gluconate
B. Administer sodium polystyrene sulfonate only
C. Administer regular insulin with dextrose IV
D. Administer loop diuretics
E. Prepare for emergent hemodialysis
F. Administer sodium bicarbonate for alkalosis
Correct Answer(s): A, C, D, E
Rationale: Correct because hyperkalemia management follows a systematic three-step approach
including cardiac stabilization with calcium gluconate, intracellular shifting with insulin and
dextrose, and elimination via loop diuretics or emergent hemodialysis. Sodium polystyrene
sulfonate alone is insufficient for critical hyperkalemia with ECG changes and acts too slowly
for emergent situations. Sodium bicarbonate is indicated for metabolic acidosis, not alkalosis, to
drive potassium into cells.
Q6: A patient with cirrhosis develops confusion, asterixis, and elevated ammonia levels. Which
dietary modification is most appropriate during the acute episode?
A. High protein, high carbohydrate
B. High protein, low sodium
C. Unrestricted protein, fluid restriction
D. Low protein, high carbohydrate
Correct Answer: D
Rationale: Correct because acute hepatic encephalopathy requires temporary protein restriction
to reduce ammonia production while maintaining adequate caloric intake with carbohydrates.
Protein is eventually reintroduced to prevent malnutrition once ammonia levels stabilize and
mental status improves. High protein intake during acute episodes exacerbates encephalopathy
by increasing ammonia production from amino acid metabolism.
Advanced Concepts in Medical-Surgical Nursing
2026-2028 Testing Cycle | Newly Released
50 Questions With Answers & Expert Rationales Guaranteed
Pass | Graded A+ | Galen
Q1: A 68-year-old male admitted with septic shock has a blood pressure of 82/48 mmHg. The
nurse calculates the mean arterial pressure (MAP). Which result requires immediate notification
of the healthcare provider?
A. 54 mmHg
B. 61 mmHg
C. 59 mmHg
D. 68 mmHg
Correct Answer: C
Rationale: Correct because the mean arterial pressure is calculated using the formula (SBP +
2DBP) ÷ 3, yielding approximately 59 mmHg for this patient. A MAP below 65 mmHg indicates
inadequate organ perfusion and requires immediate intervention to prevent ischemic injury. The
priority intervention is to notify the provider and initiate therapies to restore adequate perfusion.
Q2: A nurse is assessing a patient in the oliguric phase of acute kidney injury. Which findings are
consistent with this phase? Select all that apply.
A. Urine output of 4 L/day
B. Peaked T waves on ECG
C. Flat T waves and U waves
D. Kussmaul respirations
E. Hypotension and tachycardia
F. Weight loss of 2 kg in 24 hours
Correct Answer(s): B, D
Rationale: Correct because the oliguric phase is characterized by urine output less than 400
mL/24h, fluid volume excess leading to hypertension and edema, hyperkalemia manifesting as
,peaked T waves, and metabolic acidosis causing Kussmaul respirations. Flat T waves and U
waves indicate hypokalemia, which occurs in the diuretic phase, not the oliguric phase.
Hypotension and weight loss are associated with fluid depletion seen in the diuretic phase.
Q3: A 54-year-old male presents with coffee-ground emesis and melena. His vital signs reveal
tachycardia and orthostatic hypotension. Which condition is the most likely cause of his
presentation?
A. Bleeding duodenal ulcer
B. Diverticulosis
C. Angiodysplasia
D. Hemorrhoids
Correct Answer: A
Rationale: Correct because coffee-ground emesis and melena are classic manifestations of upper
GI bleeding, and peptic ulcer disease is a leading cause of upper GI hemorrhage. Diverticulosis,
angiodysplasia, and hemorrhoids typically present with lower GI bleeding characterized by
hematochezia. The priority intervention is to establish large-bore IV access and prepare for fluid
resuscitation.
Q4: A patient with chest pain is found to have ST-segment elevation in leads V1-V4 and elevated
troponin levels. Which type of acute coronary syndrome is most likely present?
A. Unstable angina
B. STEMI
C. NSTEMI
D. Non-cardiac chest pain
Correct Answer: B
Rationale: Correct because ST-segment elevation in contiguous leads accompanied by elevated
troponin indicates a STEMI, representing full-thickness myocardial necrosis. Unstable angina
presents without troponin elevation, while NSTEMI shows ST depression or T-wave inversion
rather than ST elevation. The priority intervention is immediate reperfusion therapy per facility
protocol and continuous monitoring.
, Q5: A patient with ESRD presents with K+ 6.8 mEq/L, widened QRS complex, and peaked T
waves. Which interventions are appropriate? Select all that apply.
A. Administer IV calcium gluconate
B. Administer sodium polystyrene sulfonate only
C. Administer regular insulin with dextrose IV
D. Administer loop diuretics
E. Prepare for emergent hemodialysis
F. Administer sodium bicarbonate for alkalosis
Correct Answer(s): A, C, D, E
Rationale: Correct because hyperkalemia management follows a systematic three-step approach
including cardiac stabilization with calcium gluconate, intracellular shifting with insulin and
dextrose, and elimination via loop diuretics or emergent hemodialysis. Sodium polystyrene
sulfonate alone is insufficient for critical hyperkalemia with ECG changes and acts too slowly
for emergent situations. Sodium bicarbonate is indicated for metabolic acidosis, not alkalosis, to
drive potassium into cells.
Q6: A patient with cirrhosis develops confusion, asterixis, and elevated ammonia levels. Which
dietary modification is most appropriate during the acute episode?
A. High protein, high carbohydrate
B. High protein, low sodium
C. Unrestricted protein, fluid restriction
D. Low protein, high carbohydrate
Correct Answer: D
Rationale: Correct because acute hepatic encephalopathy requires temporary protein restriction
to reduce ammonia production while maintaining adequate caloric intake with carbohydrates.
Protein is eventually reintroduced to prevent malnutrition once ammonia levels stabilize and
mental status improves. High protein intake during acute episodes exacerbates encephalopathy
by increasing ammonia production from amino acid metabolism.
