NUR 265 Exams 1–3 & Final Medical-
Surgical Nursing Questions and Answers |
Nursing | Galen College
Question 1
Which sexually transmitted infection (STI) should the nurse include in a client's
teaching plan about the risk for cervical cancer?
A. neisseria gonorrhoea
B. human papillomavirus
C. chlamydia trachomatis
D. herpes simplex virus
Correct Answer
B. human papillomavirus
HPV is known to alter cervical epithelium cytology, which is consistent with early
changes of cervical cancer. Although the others place the client at risk for exposure
to HPV, these are likely to place the client at risk for PID
Page 1 of 122
,Question 2
A couple trying to cope with an infertility problem wants to know what can be done
to preserve emotional equilibrium. What is the best response for the nurse to
provide?
A. "talk only to other friends who are infertile since only they can help"
B. "tell your friends and family so that they can help you"
C. "get involved in a support group. I will give you some names"
D. "start adoption proceedings immediately since obtaining an infant is very difficult"
Correct Answer
C
A support group provides a safe haven for the couple to share experiences and gain
insight from others' experiences. Although talking about feelings may unburden the
couple of negative feelings, infertility is a major stressor that affects the couple's
relationships, so discussion with family and friends should be minimal. Limiting
interaction to other infertile couples may address some psychosocial needs, but
depending on where the other couples are in the recovery process, it may not be
helpful. Giving an opinion about adoption is not therapeutic nor supportive of the
psychosocial needs.
Question 1: A client in the intensive care unit is monitored with a pulmonary
artery catheter. The nurse notes a pulmonary artery wedge pressure (PAWP)
reading of 22 mmHg and a central venous pressure (CVP) of 14 mmHg,
accompanied by bilateral crackles and dyspnea. Which clinical state do these
hemodynamic values most strongly indicate?
A. Hypovolemic shock
B. Hypervolemia secondary to left-sided heart failure
C. Right-ventricular infarction
D. Systemic vasodilation from septic shock
CORRECT ANSWER: B. Hypervolemia secondary to left-sided heart failure
Rationale: Normal PAWP ranges from 6 to 12 mmHg, and normal CVP ranges from
2 to 8 mmHg. An elevated PAWP (22 mmHg) reflects increased left ventricular end-
diastolic pressure, indicating volume overload or left-sided heart failure. Elevated
CVP further reflects systemic venous congestion. These findings, combined with
pulmonary edema (crackles and dyspnea), point directly to left-sided heart failure
and fluid volume excess.
Question 2: A nurse is caring for a client with oliguric acute kidney injury
(AKI). The client’s morning laboratory results reveal a serum potassium level
of 6.8 mEq/L with peak T-waves noted on the continuous cardiac monitor.
Which medication should the nurse anticipate administering first to
immediately protect the myocardium?
Page 2 of 122
,A. Sodium polystyrene sulfonate orally
B. Regular insulin IV with 50% dextrose
C. Calcium gluconate IV
D. Furosemide IV push
CORRECT ANSWER: C. Calcium gluconate IV
Rationale: While insulin/dextrose and sodium polystyrene sulfonate work to lower
serum potassium levels, intravenous calcium gluconate is the immediate priority to
stabilize the myocardial cell membrane and prevent fatal dysrhythmias (such as
ventricular fibrillation). Calcium gluconate does not lower potassium levels but
antagonizes the toxic cardiac effects of severe hyperkalemia while other potassium-
lowering therapies take effect.
Question 3: A mechanically ventilated client on volume-control mode
suddenly triggers the high-pressure limit alarm on the ventilator. Upon
entering the room, the nurse observes acute distress, tachypnea, and
diminished breath sounds on the right side with tracheal deviation to the left.
What is the priority nursing action?
A. Suction the endotracheal tube for suspected mucous plugging
B. Increase the oxygen concentration to 100% and notify the provider for immediate
decompression
C. Administer a sedative to reduce patient-ventilator dyssynchrony
D. Sedate the patient and recalibrate the high-pressure alarm settings
CORRECT ANSWER: B. Increase the oxygen concentration to 100% and
notify the provider for immediate decompression
Rationale: Diminished breath sounds on one side, tracheal deviation to the
contralateral side, and high ventilator pressures indicate a tension pneumothorax—
a life-threatening emergency. The increased intrathoracic pressure compresses the
lung and heart, compromising cardiac output. The immediate priority is providing
100% oxygen and obtaining emergency needle decompression/chest tube
insertion. Suctioning or sedating would delay critical lifesaving intervention.
Question 4: A client presenting with severe burn injuries over 45% of total
body surface area (TBSA) is in the emergent resuscitation phase. Which fluid
administration strategy is essential to prevent hypovolemic shock during the
first 24 hours post-injury?
A. Continuous infusion of 0.45% normal saline with potassium chloride
B. Rapid infusion of 5% Dextrose in Water ($D_5W$)
C. Intravenous administration of Lactated Ringer's solution calculated by the
Parkland formula
Page 3 of 122
, D. Immediate administration of fresh frozen plasma and packed red blood cells
CORRECT ANSWER: C. Intravenous administration of Lactated Ringer's
solution calculated by the Parkland formula
Rationale: In the first 24 hours of burn shock, massive capillary permeability leads
to third-spacing and loss of intravascular plasma. Lactated Ringer's (an isotonic
crystalloid) is the fluid of choice because its composition closely mirrors
extracellular fluid and helps maintain electrolyte balance without causing
hyperchloremic acidosis. The required volume is calculated using resuscitation
formulas (e.g., Parkland formula: $4\text{ mL} \times \text{weight in kg} \times
\%\text{TBSA}$).
Question 5: A client admitted with septic shock remains hypotensive despite
receiving a $30\text{ mL/kg}$ fluid bolus of crystalloids. The healthcare
provider orders a continuous intravenous infusion of norepinephrine. What is
the primary therapeutic goal of initiating this vasopressor?
A. Decrease systemic vascular resistance to improve renal perfusion
B. Increase mean arterial pressure (MAP) by stimulating alpha-1 adrenergic
receptors
C. Produce selective venous dilation to reduce cardiac workload
D. Inhibit beta-2 receptors to reduce heart rate and myocardial oxygen demand
CORRECT ANSWER: B. Increase mean arterial pressure (MAP) by stimulating
alpha-1 adrenergic receptors
Rationale: Norepinephrine is a potent alpha-1 agonist with modest beta-1 activity. It
induces peripheral vasoconstriction, increasing systemic vascular resistance and
raising mean arterial pressure (MAP) to maintain vital organ perfusion (target
$\text{MAP} \ge 65\text{ mmHg}$) in fluid-refractory septic shock.
Question 6: A client with chronic liver cirrhosis presents with acute upper
gastrointestinal bleeding due to esophageal varices. Which continuous
intravenous vasoactive medication should the nurse prepare to administer to
reduce portal venous pressure?
A. Octreotide
B. Pantoprazole
C. Metoclopramide
D. Lactulose
CORRECT ANSWER: A. Octreotide
Rationale: Octreotide is a synthetic somatostatin analog that causes selective
splanchnic vasoconstriction. By constricting the visceral blood vessels supplying the
portal system, octreotide decreases portal venous inflow and pressure, thereby
Page 4 of 122
Surgical Nursing Questions and Answers |
Nursing | Galen College
Question 1
Which sexually transmitted infection (STI) should the nurse include in a client's
teaching plan about the risk for cervical cancer?
A. neisseria gonorrhoea
B. human papillomavirus
C. chlamydia trachomatis
D. herpes simplex virus
Correct Answer
B. human papillomavirus
HPV is known to alter cervical epithelium cytology, which is consistent with early
changes of cervical cancer. Although the others place the client at risk for exposure
to HPV, these are likely to place the client at risk for PID
Page 1 of 122
,Question 2
A couple trying to cope with an infertility problem wants to know what can be done
to preserve emotional equilibrium. What is the best response for the nurse to
provide?
A. "talk only to other friends who are infertile since only they can help"
B. "tell your friends and family so that they can help you"
C. "get involved in a support group. I will give you some names"
D. "start adoption proceedings immediately since obtaining an infant is very difficult"
Correct Answer
C
A support group provides a safe haven for the couple to share experiences and gain
insight from others' experiences. Although talking about feelings may unburden the
couple of negative feelings, infertility is a major stressor that affects the couple's
relationships, so discussion with family and friends should be minimal. Limiting
interaction to other infertile couples may address some psychosocial needs, but
depending on where the other couples are in the recovery process, it may not be
helpful. Giving an opinion about adoption is not therapeutic nor supportive of the
psychosocial needs.
Question 1: A client in the intensive care unit is monitored with a pulmonary
artery catheter. The nurse notes a pulmonary artery wedge pressure (PAWP)
reading of 22 mmHg and a central venous pressure (CVP) of 14 mmHg,
accompanied by bilateral crackles and dyspnea. Which clinical state do these
hemodynamic values most strongly indicate?
A. Hypovolemic shock
B. Hypervolemia secondary to left-sided heart failure
C. Right-ventricular infarction
D. Systemic vasodilation from septic shock
CORRECT ANSWER: B. Hypervolemia secondary to left-sided heart failure
Rationale: Normal PAWP ranges from 6 to 12 mmHg, and normal CVP ranges from
2 to 8 mmHg. An elevated PAWP (22 mmHg) reflects increased left ventricular end-
diastolic pressure, indicating volume overload or left-sided heart failure. Elevated
CVP further reflects systemic venous congestion. These findings, combined with
pulmonary edema (crackles and dyspnea), point directly to left-sided heart failure
and fluid volume excess.
Question 2: A nurse is caring for a client with oliguric acute kidney injury
(AKI). The client’s morning laboratory results reveal a serum potassium level
of 6.8 mEq/L with peak T-waves noted on the continuous cardiac monitor.
Which medication should the nurse anticipate administering first to
immediately protect the myocardium?
Page 2 of 122
,A. Sodium polystyrene sulfonate orally
B. Regular insulin IV with 50% dextrose
C. Calcium gluconate IV
D. Furosemide IV push
CORRECT ANSWER: C. Calcium gluconate IV
Rationale: While insulin/dextrose and sodium polystyrene sulfonate work to lower
serum potassium levels, intravenous calcium gluconate is the immediate priority to
stabilize the myocardial cell membrane and prevent fatal dysrhythmias (such as
ventricular fibrillation). Calcium gluconate does not lower potassium levels but
antagonizes the toxic cardiac effects of severe hyperkalemia while other potassium-
lowering therapies take effect.
Question 3: A mechanically ventilated client on volume-control mode
suddenly triggers the high-pressure limit alarm on the ventilator. Upon
entering the room, the nurse observes acute distress, tachypnea, and
diminished breath sounds on the right side with tracheal deviation to the left.
What is the priority nursing action?
A. Suction the endotracheal tube for suspected mucous plugging
B. Increase the oxygen concentration to 100% and notify the provider for immediate
decompression
C. Administer a sedative to reduce patient-ventilator dyssynchrony
D. Sedate the patient and recalibrate the high-pressure alarm settings
CORRECT ANSWER: B. Increase the oxygen concentration to 100% and
notify the provider for immediate decompression
Rationale: Diminished breath sounds on one side, tracheal deviation to the
contralateral side, and high ventilator pressures indicate a tension pneumothorax—
a life-threatening emergency. The increased intrathoracic pressure compresses the
lung and heart, compromising cardiac output. The immediate priority is providing
100% oxygen and obtaining emergency needle decompression/chest tube
insertion. Suctioning or sedating would delay critical lifesaving intervention.
Question 4: A client presenting with severe burn injuries over 45% of total
body surface area (TBSA) is in the emergent resuscitation phase. Which fluid
administration strategy is essential to prevent hypovolemic shock during the
first 24 hours post-injury?
A. Continuous infusion of 0.45% normal saline with potassium chloride
B. Rapid infusion of 5% Dextrose in Water ($D_5W$)
C. Intravenous administration of Lactated Ringer's solution calculated by the
Parkland formula
Page 3 of 122
, D. Immediate administration of fresh frozen plasma and packed red blood cells
CORRECT ANSWER: C. Intravenous administration of Lactated Ringer's
solution calculated by the Parkland formula
Rationale: In the first 24 hours of burn shock, massive capillary permeability leads
to third-spacing and loss of intravascular plasma. Lactated Ringer's (an isotonic
crystalloid) is the fluid of choice because its composition closely mirrors
extracellular fluid and helps maintain electrolyte balance without causing
hyperchloremic acidosis. The required volume is calculated using resuscitation
formulas (e.g., Parkland formula: $4\text{ mL} \times \text{weight in kg} \times
\%\text{TBSA}$).
Question 5: A client admitted with septic shock remains hypotensive despite
receiving a $30\text{ mL/kg}$ fluid bolus of crystalloids. The healthcare
provider orders a continuous intravenous infusion of norepinephrine. What is
the primary therapeutic goal of initiating this vasopressor?
A. Decrease systemic vascular resistance to improve renal perfusion
B. Increase mean arterial pressure (MAP) by stimulating alpha-1 adrenergic
receptors
C. Produce selective venous dilation to reduce cardiac workload
D. Inhibit beta-2 receptors to reduce heart rate and myocardial oxygen demand
CORRECT ANSWER: B. Increase mean arterial pressure (MAP) by stimulating
alpha-1 adrenergic receptors
Rationale: Norepinephrine is a potent alpha-1 agonist with modest beta-1 activity. It
induces peripheral vasoconstriction, increasing systemic vascular resistance and
raising mean arterial pressure (MAP) to maintain vital organ perfusion (target
$\text{MAP} \ge 65\text{ mmHg}$) in fluid-refractory septic shock.
Question 6: A client with chronic liver cirrhosis presents with acute upper
gastrointestinal bleeding due to esophageal varices. Which continuous
intravenous vasoactive medication should the nurse prepare to administer to
reduce portal venous pressure?
A. Octreotide
B. Pantoprazole
C. Metoclopramide
D. Lactulose
CORRECT ANSWER: A. Octreotide
Rationale: Octreotide is a synthetic somatostatin analog that causes selective
splanchnic vasoconstriction. By constricting the visceral blood vessels supplying the
portal system, octreotide decreases portal venous inflow and pressure, thereby
Page 4 of 122
