NUR 265/NUR265: Exam 2
Advanced Concepts in Medical-Surgical Nursing
2026-2028 Testing Cycle | Complete Guide
50 Questions With Answers & Expert Rationales.
Guaranteed Pass | Graded A+ | Galen
Q1: A 58-year-old patient with ARDS has a PaO₂/FiO₂ ratio of 85 despite receiving 100%
oxygen via mechanical ventilation. Which intervention is the priority?
A. Administer loop diuretics
B. Increase tidal volume to 12 mL/kg ideal body weight
C. Initiate prone positioning
D. Administer intravenous beta-blockers
Correct Answer: C
Rationale: Correct because in severe ARDS with a PaO₂/FiO₂ ratio less than 100, prone
positioning is a priority intervention to improve ventilation-perfusion matching by recruiting
dorsal alveoli and reducing ventral-dorsal transpulmonary pressure gradients. In ARDS, the
priority intervention focuses on improving oxygenation through lung-protective strategies that
prevent further alveolar collapse. Prone positioning has been shown to reduce mortality in severe
ARDS when implemented early and combined with low tidal volume ventilation.
Q2: A patient with massive pulmonary embolism presents with systolic blood pressure of 72/48
mmHg and syncope. Which medication should the nurse prepare to administer?
A. Subcutaneous enoxaparin
B. Alteplase (tPA)
C. Oral apixaban
D. Intravenous heparin bolus
Correct Answer: B
Rationale: Correct because alteplase is a thrombolytic agent indicated for massive pulmonary
embolism with hemodynamic instability to rapidly dissolve the obstructing clot and restore
pulmonary perfusion. In massive PE, the priority is immediate reperfusion through systemic
thrombolysis when hemodynamic compromise is present. Alteplase works by converting
plasminogen to plasmin, which degrades fibrin within the pulmonary artery embolus.
,Q3: The high-pressure alarm sounds on a patient’s mechanical ventilator. Which action should
the nurse take first?
A. Increase the tidal volume setting
B. Administer sedation immediately
C. Disconnect the ventilator and manually ventilate
D. Assess for tube obstruction and suction the airway
Correct Answer: D
Rationale: Correct because the first action when a high-pressure alarm sounds is to assess for
airway obstruction caused by secretions, kinking, or biting on the endotracheal tube, followed by
suctioning to clear any mucus plugs. The high-pressure alarm indicates increased resistance to
airflow, and a systematic assessment of the most common causes must precede other
interventions. Suctioning addresses the most frequent cause of high-pressure alarms and ensures
airway patency before considering sedation or equipment changes.
Q4: A nurse is assessing a patient admitted with ARDS. Which findings are consistent with this
diagnosis? Select all that apply.
A. Bilateral infiltrates on chest X-ray
B. Elevated pulmonary artery wedge pressure
C. Refractory hypoxemia
D. Unilateral pleural effusion
E. Decreased lung compliance
F. Bounding peripheral pulses
Correct Answer(s): A, C, E
Rationale: Correct because bilateral infiltrates visible on chest X-ray reflect the protein-rich
fluid filling the alveoli due to increased alveolar-capillary permeability characteristic of ARDS.
Refractory hypoxemia occurs because the shunt physiology prevents adequate oxygenation
despite high concentrations of supplemental oxygen. Decreased lung compliance results from
alveolar collapse, surfactant inactivation, and interstitial edema, making the lungs stiff and
difficult to ventilate.
Q5: A patient with syndrome of inappropriate antidiuretic hormone has a serum sodium of 128
mEq/L and mild confusion. Which intervention should the nurse implement first?
A. Initiate strict fluid restriction
B. Administer 3% saline immediately
C. Increase oral fluid intake to 2 liters daily
D. Administer intravenous furosemide
Correct Answer: A
Rationale: Correct because strict fluid restriction is the primary intervention for syndrome of
, inappropriate antidiuretic hormone to correct dilutional hyponatremia by limiting free water
intake and allowing the kidneys to excrete excess fluid. Fluid restriction typically limits intake to
500 to 1000 mL per day and addresses the fundamental pathophysiology of water retention
caused by excessive ADH secretion. This intervention takes precedence over hypertonic saline,
which is reserved for severe symptomatic hyponatremia with neurological compromise.
Q6: A patient has a 3-chamber chest tube drainage system set to negative 20 cm H₂O suction.
The nurse notes continuous gentle bubbling in the suction control chamber. Which action is
appropriate?
A. Increase the suction pressure to negative 40 cm H₂O
B. Clamp the chest tube and notify the provider
C. Document the finding as expected
D. Replace the drainage system immediately
Correct Answer: C
Rationale: Correct because continuous gentle bubbling in the suction control chamber indicates
that the prescribed suction is active and functioning appropriately to maintain negative pressure
in the pleural space. This bubbling is an expected finding that confirms the suction control
chamber is regulating the negative pressure correctly. Documentation of this expected
assessment finding is the appropriate nursing action, as increasing suction or clamping the tube
could disrupt the negative pressure balance.
Q7: A nurse is caring for a patient with diabetic ketoacidosis. Which interventions are
appropriate? Select all that apply.
A. Administer an insulin bolus of 10 units intravenous push
B. Monitor serum potassium levels every hour
C. Administer 0.45% normal saline as initial fluid resuscitation
D. Transition to D5W when glucose reaches 250 mg/dL
E. Discontinue insulin when blood glucose normalizes
F. Assess for signs of cerebral edema
Correct Answer(s): B, D, F
Rationale: Correct because hourly potassium monitoring is essential during DKA treatment
since insulin drives potassium intracellularly and places the patient at high risk for life-
threatening hypokalemia. Transitioning to D5W when blood glucose drops to 250 mg per dL
prevents hypoglycemia while allowing the continuous insulin infusion to clear ketones and
correct the underlying acidosis. Assessment for cerebral edema is critical, particularly in younger
patients, because rapid fluid shifts and osmotic changes can cause brain swelling manifesting as
headache, altered level of consciousness, or vomiting.
Q8: Which patient is at highest risk for developing a pulmonary embolism?
Advanced Concepts in Medical-Surgical Nursing
2026-2028 Testing Cycle | Complete Guide
50 Questions With Answers & Expert Rationales.
Guaranteed Pass | Graded A+ | Galen
Q1: A 58-year-old patient with ARDS has a PaO₂/FiO₂ ratio of 85 despite receiving 100%
oxygen via mechanical ventilation. Which intervention is the priority?
A. Administer loop diuretics
B. Increase tidal volume to 12 mL/kg ideal body weight
C. Initiate prone positioning
D. Administer intravenous beta-blockers
Correct Answer: C
Rationale: Correct because in severe ARDS with a PaO₂/FiO₂ ratio less than 100, prone
positioning is a priority intervention to improve ventilation-perfusion matching by recruiting
dorsal alveoli and reducing ventral-dorsal transpulmonary pressure gradients. In ARDS, the
priority intervention focuses on improving oxygenation through lung-protective strategies that
prevent further alveolar collapse. Prone positioning has been shown to reduce mortality in severe
ARDS when implemented early and combined with low tidal volume ventilation.
Q2: A patient with massive pulmonary embolism presents with systolic blood pressure of 72/48
mmHg and syncope. Which medication should the nurse prepare to administer?
A. Subcutaneous enoxaparin
B. Alteplase (tPA)
C. Oral apixaban
D. Intravenous heparin bolus
Correct Answer: B
Rationale: Correct because alteplase is a thrombolytic agent indicated for massive pulmonary
embolism with hemodynamic instability to rapidly dissolve the obstructing clot and restore
pulmonary perfusion. In massive PE, the priority is immediate reperfusion through systemic
thrombolysis when hemodynamic compromise is present. Alteplase works by converting
plasminogen to plasmin, which degrades fibrin within the pulmonary artery embolus.
,Q3: The high-pressure alarm sounds on a patient’s mechanical ventilator. Which action should
the nurse take first?
A. Increase the tidal volume setting
B. Administer sedation immediately
C. Disconnect the ventilator and manually ventilate
D. Assess for tube obstruction and suction the airway
Correct Answer: D
Rationale: Correct because the first action when a high-pressure alarm sounds is to assess for
airway obstruction caused by secretions, kinking, or biting on the endotracheal tube, followed by
suctioning to clear any mucus plugs. The high-pressure alarm indicates increased resistance to
airflow, and a systematic assessment of the most common causes must precede other
interventions. Suctioning addresses the most frequent cause of high-pressure alarms and ensures
airway patency before considering sedation or equipment changes.
Q4: A nurse is assessing a patient admitted with ARDS. Which findings are consistent with this
diagnosis? Select all that apply.
A. Bilateral infiltrates on chest X-ray
B. Elevated pulmonary artery wedge pressure
C. Refractory hypoxemia
D. Unilateral pleural effusion
E. Decreased lung compliance
F. Bounding peripheral pulses
Correct Answer(s): A, C, E
Rationale: Correct because bilateral infiltrates visible on chest X-ray reflect the protein-rich
fluid filling the alveoli due to increased alveolar-capillary permeability characteristic of ARDS.
Refractory hypoxemia occurs because the shunt physiology prevents adequate oxygenation
despite high concentrations of supplemental oxygen. Decreased lung compliance results from
alveolar collapse, surfactant inactivation, and interstitial edema, making the lungs stiff and
difficult to ventilate.
Q5: A patient with syndrome of inappropriate antidiuretic hormone has a serum sodium of 128
mEq/L and mild confusion. Which intervention should the nurse implement first?
A. Initiate strict fluid restriction
B. Administer 3% saline immediately
C. Increase oral fluid intake to 2 liters daily
D. Administer intravenous furosemide
Correct Answer: A
Rationale: Correct because strict fluid restriction is the primary intervention for syndrome of
, inappropriate antidiuretic hormone to correct dilutional hyponatremia by limiting free water
intake and allowing the kidneys to excrete excess fluid. Fluid restriction typically limits intake to
500 to 1000 mL per day and addresses the fundamental pathophysiology of water retention
caused by excessive ADH secretion. This intervention takes precedence over hypertonic saline,
which is reserved for severe symptomatic hyponatremia with neurological compromise.
Q6: A patient has a 3-chamber chest tube drainage system set to negative 20 cm H₂O suction.
The nurse notes continuous gentle bubbling in the suction control chamber. Which action is
appropriate?
A. Increase the suction pressure to negative 40 cm H₂O
B. Clamp the chest tube and notify the provider
C. Document the finding as expected
D. Replace the drainage system immediately
Correct Answer: C
Rationale: Correct because continuous gentle bubbling in the suction control chamber indicates
that the prescribed suction is active and functioning appropriately to maintain negative pressure
in the pleural space. This bubbling is an expected finding that confirms the suction control
chamber is regulating the negative pressure correctly. Documentation of this expected
assessment finding is the appropriate nursing action, as increasing suction or clamping the tube
could disrupt the negative pressure balance.
Q7: A nurse is caring for a patient with diabetic ketoacidosis. Which interventions are
appropriate? Select all that apply.
A. Administer an insulin bolus of 10 units intravenous push
B. Monitor serum potassium levels every hour
C. Administer 0.45% normal saline as initial fluid resuscitation
D. Transition to D5W when glucose reaches 250 mg/dL
E. Discontinue insulin when blood glucose normalizes
F. Assess for signs of cerebral edema
Correct Answer(s): B, D, F
Rationale: Correct because hourly potassium monitoring is essential during DKA treatment
since insulin drives potassium intracellularly and places the patient at high risk for life-
threatening hypokalemia. Transitioning to D5W when blood glucose drops to 250 mg per dL
prevents hypoglycemia while allowing the continuous insulin infusion to clear ketones and
correct the underlying acidosis. Assessment for cerebral edema is critical, particularly in younger
patients, because rapid fluid shifts and osmotic changes can cause brain swelling manifesting as
headache, altered level of consciousness, or vomiting.
Q8: Which patient is at highest risk for developing a pulmonary embolism?
