NUR 265 Medical-Surgical Nursing Midterm Exam Prep
Document | 2026/2027 Edition | 200+ Verified Questions - 189
Questions with Answers
NUR 265 Medical-Surgical Nursing Midterm Exam 2026-189 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 the
NUR 265 Medical-Surgical Nursing midterm. It features over 200 verified questions that mirror the
format and complexity of actual exam items, covering essential concepts in adult health nursing. Each
question is accompanied by detailed rationales and evidence-based explanations to reinforce learning
and critical thinking. Updated for the 2026-2027 academic year, this resource aligns with current
clinical guidelines and best practices. Ideal for self-assessment and mastery of medical-surgical nursing
principles.
Key Features:
Comprehensive coverage of cardiovascular, respiratory, and renal disorders
In-depth focus on perioperative nursing and patient safety
Evidence-based practice questions with rationales
Critical thinking scenarios for prioritization and delegation
Pharmacological and fluid/electrolyte management
Updated to reflect latest NCLEX-RN test plan and guidelines
Updates for 2026:
- Incorporated 2026-2027 evidence-based clinical guidelines
- Revised rationales to align with latest NCLEX-RN test plan
- Added new questions on emerging healthcare topics
- Enhanced explanations for pharmacology and lab value interpretation
- Updated references to reflect current medical-surgical nursing standards
Abstract:
This practice examination serves as an essential tool for nursing students enrolled in NUR 265 Medical-Surgical
Nursing, offering a rigorous assessment of knowledge and clinical reasoning skills. The 200+ questions are
strategically distributed across major content areas, including cardiovascular, respiratory, renal, gastrointestinal,
and neurological systems, as well as perioperative care and fluid/electrolyte balance. Each question is crafted to
challenge students' ability to apply theoretical knowledge to clinical scenarios, with rationales that explain both
correct and incorrect options. The exam emphasizes critical thinking, prioritization, and patient safety, reflecting
the competencies required for successful nursing practice. Updated for the 2026-2027 academic year, this resource
integrates the latest evidence-based guidelines and NCLEX-RN test plan changes. By engaging with this
comprehensive practice exam, students can identify knowledge gaps, reinforce learning, and build confidence for
the midterm examination.
Keywords:
Medical-Surgical Nursing, NUR 265, Midterm Exam, Practice Questions, NCLEX-RN, Evidence-Based Practice,
Nursing Rationales, Adult Health
Answer Format:
Each question is presented in multiple-choice format with four options. The correct answer is followed by a
detailed rationale explaining the underlying pathophysiology and clinical reasoning. Incorrect options are also
analyzed to clarify common misconceptions and enhance understanding.
Page 1
,Compliance Checklist:
Aligned with 2026-2027 NCLEX-RN test plan
Updated per latest evidence-based clinical guidelines
Includes rationales for all answers and distractors
Covers all major medical-surgical nursing content areas
Designed to promote critical thinking and clinical judgment
Verified for accuracy by subject matter experts
Content Area Overview:
Content Area Questions Key Topics Weight
Cardiovascular Disorders 1-40 Heart failure, MI, arrhythmias, hypertension, 20%
cardiac medications
Respiratory Disorders 41-70 COPD, asthma, pneumonia, pulmonary 15%
embolism, oxygen therapy
Renal and Urinary Disorders 71-95 Acute kidney injury, chronic kidney disease, 12%
dialysis, urinary tract infections
Gastrointestinal Disorders 96-120 GI bleeding, pancreatitis, liver disease, 12%
bowel obstruction, nutrition
Neurological Disorders 121-145 Stroke, seizures, increased ICP, meningitis, 12%
neuro assessments
Perioperative Nursing 146-165 Preoperative assessment, intraoperative care, 10%
postoperative complications
Fluid, Electrolyte, and 166-185 Fluid imbalances, electrolyte disturbances, 10%
Acid-Base Balance ABG interpretation
Endocrine Disorders 186-200 Diabetes mellitus, thyroid disorders, adrenal 9%
insufficiency
Page 2
,Q1. A patient with septic shock is on a norepinephrine infusion. Which finding
warrants immediate action by the nurse?
A. Mean arterial pressure (MAP) of 65 mm Hg
B. Central venous oxygen saturation (ScvO2) of 70%
C. Cardiac index of 2.5 L/min/m²
D. Lactate level of 4.5 mmol/L
Correct Answer: D. Lactate level of 4.5 mmol/L
Rationale: In septic shock, lactate "e4 mmol/L indicates persistent tissue hypoxia and poor
perfusion despite hemodynamic support, requiring immediate escalation of therapy. A
MAP of 65 mm Hg is the target, ScvO2 70% is adequate, and a cardiac index of 2.5
L/min/m² is within normal range.
Why Wrong:
A - MAP of 65 mm Hg is the target goal, indicating adequate perfusion pressure.
B - ScvO2 of 70% indicates adequate oxygen delivery relative to consumption.
C - Cardiac index of 2.5 L/min/m² is within the normal range (2.5-4.0).
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 18; SCCM
Surviving Sepsis Campaign 2021
Q2. A patient with type 2 diabetes is started on metformin. Which instruction is
essential to reduce the risk of lactic acidosis?
A. Take the medication with food to prevent gastrointestinal upset
B. Hold the medication for 48 hours after receiving intravenous contrast
C. Monitor blood glucose levels at least four times daily
D. Increase fluid intake to prevent dehydration
Correct Answer: B. Hold the medication for 48 hours after receiving intravenous
contrast
Rationale: Metformin is contraindicated in situations that increase the risk of lactic
acidosis, including acute kidney injury, severe infection, or use of iodinated contrast
media. Current guidelines recommend withholding metformin at the time of contrast
administration and for 48 hours afterward, resuming only after renal function is
re-evaluated.
Why Wrong:
A - Taking with food reduces GI upset but does not address the risk of lactic acidosis.
C - Frequent glucose monitoring is important for diabetes management but not
specific to lactic acidosis prevention.
D - Adequate hydration is important but not the primary preventive measure for
contrast-induced lactic acidosis.
Reference: American Diabetes Association. (2026). Standards of Medical Care in
Diabetes, Sec. 9.
Page 3
, Q3. A patient with heart failure is receiving furosemide 40 mg IV twice daily. Which
assessment finding indicates a need for the healthcare provider to adjust the
potassium supplement?
A. Serum potassium 3.8 mEq/L
B. Urine output 80 mL/hr
C. Serum potassium 3.2 mEq/L
D. Serum creatinine 1.0 mg/dL
Correct Answer: C. Serum potassium 3.2 mEq/L
Rationale: Furosemide causes hypokalemia; a potassium of 3.2 mEq/L is below normal
(3.5-5.0) and indicates the need for increased potassium supplementation or a change in
diuretic therapy. Other values are within normal limits.
Why Wrong:
A - Potassium 3.8 mEq/L is within normal range and does not require adjustment.
B - Urine output 80 mL/hr is adequate renal function.
D - Creatinine 1.0 mg/dL is normal, indicating no renal impairment.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 35.
Q4. A patient with chronic obstructive pulmonary disease (COPD) is prescribed
long-acting beta2-agonist (LABA) and inhaled corticosteroid (ICS) combination
therapy. Which statement by the patient indicates correct understanding of the
medication regimen?
A. I should use this inhaler as needed for sudden shortness of breath
B. I will rinse my mouth after using the inhaler to prevent oral thrush
C. This medication will cure my COPD over time
D. I can stop using it once I feel better
Correct Answer: B. I will rinse my mouth after using the inhaler to prevent oral
thrush
Rationale: Rinsing the mouth after ICS use reduces the risk of oral candidiasis. LABA/ICS
combinations are maintenance therapies, not rescue medications, and they do not cure
COPD. They must be used regularly even when symptoms are controlled.
Why Wrong:
A - LABA/ICS are not for acute symptom relief; short-acting bronchodilators are used
for rescue.
C - COPD is not curable; therapy aims to manage symptoms and prevent
exacerbations.
D - Discontinuing maintenance therapy can lead to exacerbations; it should be used
continuously.
Reference: Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2026).
Global Strategy for Prevention, Diagnosis and Management of COPD.
Page 4
Document | 2026/2027 Edition | 200+ Verified Questions - 189
Questions with Answers
NUR 265 Medical-Surgical Nursing Midterm Exam 2026-189 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 the
NUR 265 Medical-Surgical Nursing midterm. It features over 200 verified questions that mirror the
format and complexity of actual exam items, covering essential concepts in adult health nursing. Each
question is accompanied by detailed rationales and evidence-based explanations to reinforce learning
and critical thinking. Updated for the 2026-2027 academic year, this resource aligns with current
clinical guidelines and best practices. Ideal for self-assessment and mastery of medical-surgical nursing
principles.
Key Features:
Comprehensive coverage of cardiovascular, respiratory, and renal disorders
In-depth focus on perioperative nursing and patient safety
Evidence-based practice questions with rationales
Critical thinking scenarios for prioritization and delegation
Pharmacological and fluid/electrolyte management
Updated to reflect latest NCLEX-RN test plan and guidelines
Updates for 2026:
- Incorporated 2026-2027 evidence-based clinical guidelines
- Revised rationales to align with latest NCLEX-RN test plan
- Added new questions on emerging healthcare topics
- Enhanced explanations for pharmacology and lab value interpretation
- Updated references to reflect current medical-surgical nursing standards
Abstract:
This practice examination serves as an essential tool for nursing students enrolled in NUR 265 Medical-Surgical
Nursing, offering a rigorous assessment of knowledge and clinical reasoning skills. The 200+ questions are
strategically distributed across major content areas, including cardiovascular, respiratory, renal, gastrointestinal,
and neurological systems, as well as perioperative care and fluid/electrolyte balance. Each question is crafted to
challenge students' ability to apply theoretical knowledge to clinical scenarios, with rationales that explain both
correct and incorrect options. The exam emphasizes critical thinking, prioritization, and patient safety, reflecting
the competencies required for successful nursing practice. Updated for the 2026-2027 academic year, this resource
integrates the latest evidence-based guidelines and NCLEX-RN test plan changes. By engaging with this
comprehensive practice exam, students can identify knowledge gaps, reinforce learning, and build confidence for
the midterm examination.
Keywords:
Medical-Surgical Nursing, NUR 265, Midterm Exam, Practice Questions, NCLEX-RN, Evidence-Based Practice,
Nursing Rationales, Adult Health
Answer Format:
Each question is presented in multiple-choice format with four options. The correct answer is followed by a
detailed rationale explaining the underlying pathophysiology and clinical reasoning. Incorrect options are also
analyzed to clarify common misconceptions and enhance understanding.
Page 1
,Compliance Checklist:
Aligned with 2026-2027 NCLEX-RN test plan
Updated per latest evidence-based clinical guidelines
Includes rationales for all answers and distractors
Covers all major medical-surgical nursing content areas
Designed to promote critical thinking and clinical judgment
Verified for accuracy by subject matter experts
Content Area Overview:
Content Area Questions Key Topics Weight
Cardiovascular Disorders 1-40 Heart failure, MI, arrhythmias, hypertension, 20%
cardiac medications
Respiratory Disorders 41-70 COPD, asthma, pneumonia, pulmonary 15%
embolism, oxygen therapy
Renal and Urinary Disorders 71-95 Acute kidney injury, chronic kidney disease, 12%
dialysis, urinary tract infections
Gastrointestinal Disorders 96-120 GI bleeding, pancreatitis, liver disease, 12%
bowel obstruction, nutrition
Neurological Disorders 121-145 Stroke, seizures, increased ICP, meningitis, 12%
neuro assessments
Perioperative Nursing 146-165 Preoperative assessment, intraoperative care, 10%
postoperative complications
Fluid, Electrolyte, and 166-185 Fluid imbalances, electrolyte disturbances, 10%
Acid-Base Balance ABG interpretation
Endocrine Disorders 186-200 Diabetes mellitus, thyroid disorders, adrenal 9%
insufficiency
Page 2
,Q1. A patient with septic shock is on a norepinephrine infusion. Which finding
warrants immediate action by the nurse?
A. Mean arterial pressure (MAP) of 65 mm Hg
B. Central venous oxygen saturation (ScvO2) of 70%
C. Cardiac index of 2.5 L/min/m²
D. Lactate level of 4.5 mmol/L
Correct Answer: D. Lactate level of 4.5 mmol/L
Rationale: In septic shock, lactate "e4 mmol/L indicates persistent tissue hypoxia and poor
perfusion despite hemodynamic support, requiring immediate escalation of therapy. A
MAP of 65 mm Hg is the target, ScvO2 70% is adequate, and a cardiac index of 2.5
L/min/m² is within normal range.
Why Wrong:
A - MAP of 65 mm Hg is the target goal, indicating adequate perfusion pressure.
B - ScvO2 of 70% indicates adequate oxygen delivery relative to consumption.
C - Cardiac index of 2.5 L/min/m² is within the normal range (2.5-4.0).
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 18; SCCM
Surviving Sepsis Campaign 2021
Q2. A patient with type 2 diabetes is started on metformin. Which instruction is
essential to reduce the risk of lactic acidosis?
A. Take the medication with food to prevent gastrointestinal upset
B. Hold the medication for 48 hours after receiving intravenous contrast
C. Monitor blood glucose levels at least four times daily
D. Increase fluid intake to prevent dehydration
Correct Answer: B. Hold the medication for 48 hours after receiving intravenous
contrast
Rationale: Metformin is contraindicated in situations that increase the risk of lactic
acidosis, including acute kidney injury, severe infection, or use of iodinated contrast
media. Current guidelines recommend withholding metformin at the time of contrast
administration and for 48 hours afterward, resuming only after renal function is
re-evaluated.
Why Wrong:
A - Taking with food reduces GI upset but does not address the risk of lactic acidosis.
C - Frequent glucose monitoring is important for diabetes management but not
specific to lactic acidosis prevention.
D - Adequate hydration is important but not the primary preventive measure for
contrast-induced lactic acidosis.
Reference: American Diabetes Association. (2026). Standards of Medical Care in
Diabetes, Sec. 9.
Page 3
, Q3. A patient with heart failure is receiving furosemide 40 mg IV twice daily. Which
assessment finding indicates a need for the healthcare provider to adjust the
potassium supplement?
A. Serum potassium 3.8 mEq/L
B. Urine output 80 mL/hr
C. Serum potassium 3.2 mEq/L
D. Serum creatinine 1.0 mg/dL
Correct Answer: C. Serum potassium 3.2 mEq/L
Rationale: Furosemide causes hypokalemia; a potassium of 3.2 mEq/L is below normal
(3.5-5.0) and indicates the need for increased potassium supplementation or a change in
diuretic therapy. Other values are within normal limits.
Why Wrong:
A - Potassium 3.8 mEq/L is within normal range and does not require adjustment.
B - Urine output 80 mL/hr is adequate renal function.
D - Creatinine 1.0 mg/dL is normal, indicating no renal impairment.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 35.
Q4. A patient with chronic obstructive pulmonary disease (COPD) is prescribed
long-acting beta2-agonist (LABA) and inhaled corticosteroid (ICS) combination
therapy. Which statement by the patient indicates correct understanding of the
medication regimen?
A. I should use this inhaler as needed for sudden shortness of breath
B. I will rinse my mouth after using the inhaler to prevent oral thrush
C. This medication will cure my COPD over time
D. I can stop using it once I feel better
Correct Answer: B. I will rinse my mouth after using the inhaler to prevent oral
thrush
Rationale: Rinsing the mouth after ICS use reduces the risk of oral candidiasis. LABA/ICS
combinations are maintenance therapies, not rescue medications, and they do not cure
COPD. They must be used regularly even when symptoms are controlled.
Why Wrong:
A - LABA/ICS are not for acute symptom relief; short-acting bronchodilators are used
for rescue.
C - COPD is not curable; therapy aims to manage symptoms and prevent
exacerbations.
D - Discontinuing maintenance therapy can lead to exacerbations; it should be used
continuously.
Reference: Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2026).
Global Strategy for Prevention, Diagnosis and Management of COPD.
Page 4
