NUR 265 Exams 1–3 & Final Medical-Surgical Nursing
(2026/2027) PDF | Nursing | Galen College
INTRODUCTION
Welcome to the ultimate preparation resource for NUR 265: Advanced
Medical-Surgical Nursing. This premium study bank is systematically
curated to align with the core curriculum standards of major institutions
like Galen College of Nursing, focusing on the complex physiological
concepts tested in Exams 1, 2, 3, and the comprehensive Final
Assessment. Each question is structured to challenge your clinical
judgment, offering verified answers and in-depth rationales to bridge the
gap between theoretical knowledge and critical bedside decision-making.
Whether you are prepping for your next unit exam or building foundational
mastery for the NCLEX-RN, this document delivers the high-yield insights
required to succeed.
Question 1
A patient is admitted to the emergency department displaying signs of a
severe ischemic stroke. The medical team is preparing to administer
tissue plasminogen activator (tPA). Which of the following findings in the
patient's medical history constitutes an absolute contraindication to tPA
therapy?
,A) Blood pressure reading of 175/95 mmHg
B) Minor surgical procedure performed 4 weeks ago
C) Ischemic stroke occurring 6 months prior
D) Serious head trauma or intracranial surgery within the past 3 months
ANSWER: D) Serious head trauma or intracranial surgery within the
past 3 months
EXPLANATION: Intracranial surgery or serious head trauma within
the last 3 months significantly elevates the risk of severe, life-
threatening intracranial hemorrhage, making it an absolute
contraindication for thrombolytic therapy like tPA. A blood pressure
above 185/110 mmHg is a contraindication, but 175/95 mmHg can be
managed antihypertensively to meet safety criteria.
Question 2
A nurse is managing a patient in the intensive care unit who is receiving
mechanical ventilation. The ventilator’s high-pressure alarm suddenly
sounds. Which of the following conditions is a potential cause of this
alarm?
A) A leak or disconnection in the ventilator circuit
B) Increased accumulation of secretions or patient biting the
endotracheal tube
C) Total self-extubation by the patient
D) Cuff leak within the endotracheal tube
,ANSWER: B) Increased accumulation of secretions or patient biting
the endotracheal tube
EXPLANATION: High-pressure alarms are triggered by conditions
that increase airway resistance or decrease lung compliance, such
as excess secretions, coughing, bronchospasm, or mechanical
obstruction like biting the tube. Disconnections, leaks, and
extubation lead to low-pressure alarms due to a drop in resistance.
Question 3
A patient with a history of severe chronic obstructive pulmonary disease
(COPD) is admitted to the medical-surgical floor with acute respiratory
distress. The arterial blood gas (ABG) results show: pH 7.31, PaCO2 58
mmHg, and HCO3 28 mEq/L. How should the nurse interpret these
laboratory findings?
A) Uncompensated metabolic acidosis
B) Partially compensated respiratory acidosis
C) Fully compensated respiratory acidosis
D) Uncompensated respiratory alkalosis
ANSWER: B) Partially compensated respiratory acidosis
EXPLANATION: The pH is below normal (7.35–7.45), indicating
acidosis. The PaCO2 is elevated above normal (35–45 mmHg),
matching the acidotic state and pointing to a respiratory cause. The
HCO3 is elevated (normal is 22–26 mEq/L), demonstrating that the
kidneys have begun to retain bicarbonate to compensate, but
, because the pH is not yet within normal limits, it is only partially
compensated.
Question 4
A nurse is assessing a patient who is 12 hours postoperative following a
total thyroidectomy. The patient reports a tingling sensation around the
mouth and fingertips. Which action should the nurse prioritize?
A) Evaluate the patient for Trousseau’s or Chvostek’s sign
B) Reassure the patient that this is a typical postoperative effect of
anesthesia
C) Administer a prescribed dose of an oral potassium supplement
D) Place the patient in a prone position to optimize airway safety
ANSWER: A) Evaluate the patient for Trousseau’s or Chvostek’s sign
EXPLANATION: Accidental damage or removal of the parathyroid
glands during a thyroidectomy can lead to acute hypocalcemia. Early
manifestations include circumoral and digital paresthesia. The nurse
must assess for neuromuscular irritability using Chvostek's or
Trousseau's signs and prepare to administer emergency calcium
gluconate.
Question 5
A patient presents to the emergency room with a sudden onset of severe,
tearing chest pain that radiates directly to the back between the
(2026/2027) PDF | Nursing | Galen College
INTRODUCTION
Welcome to the ultimate preparation resource for NUR 265: Advanced
Medical-Surgical Nursing. This premium study bank is systematically
curated to align with the core curriculum standards of major institutions
like Galen College of Nursing, focusing on the complex physiological
concepts tested in Exams 1, 2, 3, and the comprehensive Final
Assessment. Each question is structured to challenge your clinical
judgment, offering verified answers and in-depth rationales to bridge the
gap between theoretical knowledge and critical bedside decision-making.
Whether you are prepping for your next unit exam or building foundational
mastery for the NCLEX-RN, this document delivers the high-yield insights
required to succeed.
Question 1
A patient is admitted to the emergency department displaying signs of a
severe ischemic stroke. The medical team is preparing to administer
tissue plasminogen activator (tPA). Which of the following findings in the
patient's medical history constitutes an absolute contraindication to tPA
therapy?
,A) Blood pressure reading of 175/95 mmHg
B) Minor surgical procedure performed 4 weeks ago
C) Ischemic stroke occurring 6 months prior
D) Serious head trauma or intracranial surgery within the past 3 months
ANSWER: D) Serious head trauma or intracranial surgery within the
past 3 months
EXPLANATION: Intracranial surgery or serious head trauma within
the last 3 months significantly elevates the risk of severe, life-
threatening intracranial hemorrhage, making it an absolute
contraindication for thrombolytic therapy like tPA. A blood pressure
above 185/110 mmHg is a contraindication, but 175/95 mmHg can be
managed antihypertensively to meet safety criteria.
Question 2
A nurse is managing a patient in the intensive care unit who is receiving
mechanical ventilation. The ventilator’s high-pressure alarm suddenly
sounds. Which of the following conditions is a potential cause of this
alarm?
A) A leak or disconnection in the ventilator circuit
B) Increased accumulation of secretions or patient biting the
endotracheal tube
C) Total self-extubation by the patient
D) Cuff leak within the endotracheal tube
,ANSWER: B) Increased accumulation of secretions or patient biting
the endotracheal tube
EXPLANATION: High-pressure alarms are triggered by conditions
that increase airway resistance or decrease lung compliance, such
as excess secretions, coughing, bronchospasm, or mechanical
obstruction like biting the tube. Disconnections, leaks, and
extubation lead to low-pressure alarms due to a drop in resistance.
Question 3
A patient with a history of severe chronic obstructive pulmonary disease
(COPD) is admitted to the medical-surgical floor with acute respiratory
distress. The arterial blood gas (ABG) results show: pH 7.31, PaCO2 58
mmHg, and HCO3 28 mEq/L. How should the nurse interpret these
laboratory findings?
A) Uncompensated metabolic acidosis
B) Partially compensated respiratory acidosis
C) Fully compensated respiratory acidosis
D) Uncompensated respiratory alkalosis
ANSWER: B) Partially compensated respiratory acidosis
EXPLANATION: The pH is below normal (7.35–7.45), indicating
acidosis. The PaCO2 is elevated above normal (35–45 mmHg),
matching the acidotic state and pointing to a respiratory cause. The
HCO3 is elevated (normal is 22–26 mEq/L), demonstrating that the
kidneys have begun to retain bicarbonate to compensate, but
, because the pH is not yet within normal limits, it is only partially
compensated.
Question 4
A nurse is assessing a patient who is 12 hours postoperative following a
total thyroidectomy. The patient reports a tingling sensation around the
mouth and fingertips. Which action should the nurse prioritize?
A) Evaluate the patient for Trousseau’s or Chvostek’s sign
B) Reassure the patient that this is a typical postoperative effect of
anesthesia
C) Administer a prescribed dose of an oral potassium supplement
D) Place the patient in a prone position to optimize airway safety
ANSWER: A) Evaluate the patient for Trousseau’s or Chvostek’s sign
EXPLANATION: Accidental damage or removal of the parathyroid
glands during a thyroidectomy can lead to acute hypocalcemia. Early
manifestations include circumoral and digital paresthesia. The nurse
must assess for neuromuscular irritability using Chvostek's or
Trousseau's signs and prepare to administer emergency calcium
gluconate.
Question 5
A patient presents to the emergency room with a sudden onset of severe,
tearing chest pain that radiates directly to the back between the
