NUR 265 Exam 2 - Version 1
Comprehensive Examination - Medical-
Surgical Nursing 2026
1. The nurse is assessing a client who is suspected of having a pulmonary embolism (PE). Which of the
following findings is consistent with this diagnosis?
a) Bradycardia
b) Productive cough with yellow sputum
c) Cough
d) Lower extremity edema
Correct ANSWER: c) Cough
Rationale:
Option A: Bradycardia is incorrect because tachycardia is a more common finding in PE due to
sympathetic nervous system activation and decreased cardiac output. Bradycardia would be an atypical
presentation.
Option B: Productive cough with yellow sputum is incorrect as this suggests a respiratory infection such
as pneumonia, not a pulmonary embolism. PE typically presents with a dry cough or minimal sputum
production.
Option C: Cough is correct because irritation or infarction of pulmonary tissues triggers the cough reflex.
The cough is often nonproductive or produces minimal bloody sputum (hemoptysis).
,Option D: Lower extremity edema is incorrect because while it may indicate deep vein thrombosis (a risk
factor for PE), it is not a direct symptom of PE itself. The classic PE symptoms include sudden dyspnea,
chest pain, and tachypnea.
2. The nurse is caring for a client who is 4 days postoperative and suddenly develops difficulty breathing
and sharp chest pain. The nurse has called the rapid response team (RRT) and raised the head of the
bed. Which of the following actions should the nurse take next?
a) Administer morphine sulfate as prescribed
b) Apply oxygen via nasal cannula at 2 L/min
c) Prepare for endotracheal intubation
d) Obtain a stat electrocardiogram
Correct ANSWER: b) Apply oxygen via nasal cannula at 2 L/min
Rationale:
Option A: Administering morphine sulfate is incorrect as the priority is oxygenation. Morphine may be
given later for pain and anxiety but is not the immediate next step.
Option B: Applying oxygen is correct because the priority intervention for a client with suspected PE is to
improve oxygenation. Oxygen should be administered to maintain SpO2 above 90%.
Option C: Preparing for intubation is incorrect unless the client's respiratory status deteriorates
significantly. This would not be the next step after calling RRT and positioning the client.
Option D: Obtaining a stat ECG is incorrect because while cardiac monitoring is important, oxygenation
is the priority. ECG may show changes but does not address the immediate physiologic need.
3. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen therapy at 2 L/min via
nasal cannula. Which assessment finding indicates the client is experiencing oxygen toxicity?
a) Respiratory rate of 18 breaths per minute
b) Increased confusion and disorientation
c) Heart rate of 72 beats per minute
d) Pulse oximetry reading of 94%
,Correct ANSWER: b) Increased confusion and disorientation
Rationale:
Option A: A respiratory rate of 18 is incorrect because this is within normal range and does not indicate
oxygen toxicity.
Option B: Increased confusion and disorientation is correct because oxygen toxicity can cause neurologic
symptoms including confusion, headache, and restlessness due to excessive oxygen administration.
Option C: A heart rate of 72 is incorrect because this is a normal heart rate and not indicative of oxygen
toxicity.
Option D: A pulse oximetry reading of 94% is incorrect because this is an acceptable oxygen saturation
level for a COPD client and does not indicate toxicity.
4. The nurse is preparing to administer a bronchodilator via metered-dose inhaler (MDI) to a client with
asthma. Which of the following actions demonstrates proper administration technique?
a) Administer the medication while the client is exhaling
b) Instruct the client to hold the breath for 10 seconds after inhalation
c) Shake the inhaler vigorously for 2 seconds before use
d) Place the inhaler 4 inches away from the open mouth
Correct ANSWER: b) Instruct the client to hold the breath for 10 seconds after inhalation
Rationale:
Option A: Administering while exhaling is incorrect because the medication should be administered at
the beginning of inspiration, not during exhalation.
Option B: Holding the breath for 10 seconds is correct because this allows the medication to deposit in
the airways and maximizes absorption.
Option C: Shaking for only 2 seconds is incorrect because the inhaler should be shaken vigorously for at
least 5 seconds to ensure proper mixing of medication.
Option D: Placing the inhaler 4 inches away is incorrect because the inhaler should be placed 1-2 inches
from the mouth or used with a spacer for optimal delivery.
, 5. A client with pneumonia has a temperature of 39.2°C (102.6°F), productive cough with green sputum,
and crackles in the right lower lobe. Which of the following interventions should the nurse implement
first?
a) Administer prescribed antibiotics
b) Obtain a sputum culture
c) Administer antipyretic medication
d) Encourage increased fluid intake
Correct ANSWER: b) Obtain a sputum culture
Rationale:
Option A: Administering antibiotics is incorrect because the sputum culture should be obtained before
antibiotics are started to identify the causative organism and ensure appropriate treatment.
Option B: Obtaining a sputum culture is correct because this should be done prior to initiating antibiotic
therapy to guide treatment decisions.
Option C: Administering antipyretic medication is incorrect because while this will reduce fever, it is not
the priority before obtaining diagnostic specimens.
Option D: Encouraging fluid intake is incorrect because while hydration is important, obtaining a sputum
culture takes priority before antibiotics are administered.
6. The nurse is caring for a client with tuberculosis (TB) who is on airborne precautions. Which personal
protective equipment (PPE) is essential when entering the client's room?
a) Surgical mask
b) N95 respirator mask
c) Gown and gloves only
d) Eye protection and gown
Correct ANSWER: b) N95 respirator mask
Comprehensive Examination - Medical-
Surgical Nursing 2026
1. The nurse is assessing a client who is suspected of having a pulmonary embolism (PE). Which of the
following findings is consistent with this diagnosis?
a) Bradycardia
b) Productive cough with yellow sputum
c) Cough
d) Lower extremity edema
Correct ANSWER: c) Cough
Rationale:
Option A: Bradycardia is incorrect because tachycardia is a more common finding in PE due to
sympathetic nervous system activation and decreased cardiac output. Bradycardia would be an atypical
presentation.
Option B: Productive cough with yellow sputum is incorrect as this suggests a respiratory infection such
as pneumonia, not a pulmonary embolism. PE typically presents with a dry cough or minimal sputum
production.
Option C: Cough is correct because irritation or infarction of pulmonary tissues triggers the cough reflex.
The cough is often nonproductive or produces minimal bloody sputum (hemoptysis).
,Option D: Lower extremity edema is incorrect because while it may indicate deep vein thrombosis (a risk
factor for PE), it is not a direct symptom of PE itself. The classic PE symptoms include sudden dyspnea,
chest pain, and tachypnea.
2. The nurse is caring for a client who is 4 days postoperative and suddenly develops difficulty breathing
and sharp chest pain. The nurse has called the rapid response team (RRT) and raised the head of the
bed. Which of the following actions should the nurse take next?
a) Administer morphine sulfate as prescribed
b) Apply oxygen via nasal cannula at 2 L/min
c) Prepare for endotracheal intubation
d) Obtain a stat electrocardiogram
Correct ANSWER: b) Apply oxygen via nasal cannula at 2 L/min
Rationale:
Option A: Administering morphine sulfate is incorrect as the priority is oxygenation. Morphine may be
given later for pain and anxiety but is not the immediate next step.
Option B: Applying oxygen is correct because the priority intervention for a client with suspected PE is to
improve oxygenation. Oxygen should be administered to maintain SpO2 above 90%.
Option C: Preparing for intubation is incorrect unless the client's respiratory status deteriorates
significantly. This would not be the next step after calling RRT and positioning the client.
Option D: Obtaining a stat ECG is incorrect because while cardiac monitoring is important, oxygenation
is the priority. ECG may show changes but does not address the immediate physiologic need.
3. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen therapy at 2 L/min via
nasal cannula. Which assessment finding indicates the client is experiencing oxygen toxicity?
a) Respiratory rate of 18 breaths per minute
b) Increased confusion and disorientation
c) Heart rate of 72 beats per minute
d) Pulse oximetry reading of 94%
,Correct ANSWER: b) Increased confusion and disorientation
Rationale:
Option A: A respiratory rate of 18 is incorrect because this is within normal range and does not indicate
oxygen toxicity.
Option B: Increased confusion and disorientation is correct because oxygen toxicity can cause neurologic
symptoms including confusion, headache, and restlessness due to excessive oxygen administration.
Option C: A heart rate of 72 is incorrect because this is a normal heart rate and not indicative of oxygen
toxicity.
Option D: A pulse oximetry reading of 94% is incorrect because this is an acceptable oxygen saturation
level for a COPD client and does not indicate toxicity.
4. The nurse is preparing to administer a bronchodilator via metered-dose inhaler (MDI) to a client with
asthma. Which of the following actions demonstrates proper administration technique?
a) Administer the medication while the client is exhaling
b) Instruct the client to hold the breath for 10 seconds after inhalation
c) Shake the inhaler vigorously for 2 seconds before use
d) Place the inhaler 4 inches away from the open mouth
Correct ANSWER: b) Instruct the client to hold the breath for 10 seconds after inhalation
Rationale:
Option A: Administering while exhaling is incorrect because the medication should be administered at
the beginning of inspiration, not during exhalation.
Option B: Holding the breath for 10 seconds is correct because this allows the medication to deposit in
the airways and maximizes absorption.
Option C: Shaking for only 2 seconds is incorrect because the inhaler should be shaken vigorously for at
least 5 seconds to ensure proper mixing of medication.
Option D: Placing the inhaler 4 inches away is incorrect because the inhaler should be placed 1-2 inches
from the mouth or used with a spacer for optimal delivery.
, 5. A client with pneumonia has a temperature of 39.2°C (102.6°F), productive cough with green sputum,
and crackles in the right lower lobe. Which of the following interventions should the nurse implement
first?
a) Administer prescribed antibiotics
b) Obtain a sputum culture
c) Administer antipyretic medication
d) Encourage increased fluid intake
Correct ANSWER: b) Obtain a sputum culture
Rationale:
Option A: Administering antibiotics is incorrect because the sputum culture should be obtained before
antibiotics are started to identify the causative organism and ensure appropriate treatment.
Option B: Obtaining a sputum culture is correct because this should be done prior to initiating antibiotic
therapy to guide treatment decisions.
Option C: Administering antipyretic medication is incorrect because while this will reduce fever, it is not
the priority before obtaining diagnostic specimens.
Option D: Encouraging fluid intake is incorrect because while hydration is important, obtaining a sputum
culture takes priority before antibiotics are administered.
6. The nurse is caring for a client with tuberculosis (TB) who is on airborne precautions. Which personal
protective equipment (PPE) is essential when entering the client's room?
a) Surgical mask
b) N95 respirator mask
c) Gown and gloves only
d) Eye protection and gown
Correct ANSWER: b) N95 respirator mask
