NUR 265
Exam 3 Advanced Medical-Surgical Nursing
Exam 3 • Practice Questions & Rationales
UPDATE
Actual Questions & Verified Answers
with Detailed Clinical Rationales
Practice Questions with Rationales
Galen College of Nursing
NUR 265
✓ 100% Verified Answers
✓ Complete Rationales Included
Exam (elaborations)
Instant PDF Download • Ready for Study
,NUR 265 Exam 3: Advanced Medical-Surgical Nursing 2026/2027 UPDATE – Galen
1. A patient in the ICU is diagnosed with Acute Respiratory Distress Syndrome (ARDS). Which
clinical manifestation is the hallmark sign that differentiates ARDS from other forms of
respiratory failure?
A. Refractory hypoxemia where PaO2 does not improve with increased FiO2
B. Hypercapnia despite high-flow oxygen administration
C. Increased lung compliance and decreased airway resistance
D. Presence of bilateral crackles and high pulmonary capillary wedge pressure
Answer: A
Rationale: Refractory hypoxemia is the hallmark of ARDS. Unlike cardiogenic pulmonary
edema, the PaO2 remains low even when the patient is given 100% oxygen.
2. When managing a patient on mechanical ventilation with High-Frequency Oscillatory
Ventilation (HFOV), what is the primary goal for this intervention?
A. To provide high tidal volumes at a low respiratory rate
B. To allow the patient to trigger their own breaths comfortably
C. To increase dead space ventilation in patients with COPD
D. To prevent lung injury by providing very low tidal volumes at high frequencies
, Answer: D
Rationale: HFOV provides very small tidal volumes at very high rates (3-15 hertz) to
maintain lung recruitment and prevent barotrauma in severe ARDS.
3. A patient with a history of liver cirrhosis presents with encephalopathy and a serum
ammonia level of 120 mcg/dL. The nurse administers lactulose. Which finding indicates the
medication is effective?
A. The patient has one soft, formed bowel movement per day
B. The patient’s skin appears less jaundiced
C. The patient is more alert and oriented to person, place, and time
D. The patient’s serum potassium level increases to 4.5 mEq/L
Answer: C
Rationale: Lactulose works by trapping ammonia in the gut and expelling it through
diarrhea. The goal is improved neurologic status, not just bowel movements.
4. During the emergent phase of a 45% Total Body Surface Area (TBSA) burn injury, which
electrolyte abnormality should the nurse most closely monitor for?
A. Hypokalemia due to fluid resuscitation dilution
B. Hyperkalemia due to massive cellular destruction
C. Hypernatremia due to evaporative water loss
D. Hypocalcemia due to protein loss in the interstitial space
Exam 3 Advanced Medical-Surgical Nursing
Exam 3 • Practice Questions & Rationales
UPDATE
Actual Questions & Verified Answers
with Detailed Clinical Rationales
Practice Questions with Rationales
Galen College of Nursing
NUR 265
✓ 100% Verified Answers
✓ Complete Rationales Included
Exam (elaborations)
Instant PDF Download • Ready for Study
,NUR 265 Exam 3: Advanced Medical-Surgical Nursing 2026/2027 UPDATE – Galen
1. A patient in the ICU is diagnosed with Acute Respiratory Distress Syndrome (ARDS). Which
clinical manifestation is the hallmark sign that differentiates ARDS from other forms of
respiratory failure?
A. Refractory hypoxemia where PaO2 does not improve with increased FiO2
B. Hypercapnia despite high-flow oxygen administration
C. Increased lung compliance and decreased airway resistance
D. Presence of bilateral crackles and high pulmonary capillary wedge pressure
Answer: A
Rationale: Refractory hypoxemia is the hallmark of ARDS. Unlike cardiogenic pulmonary
edema, the PaO2 remains low even when the patient is given 100% oxygen.
2. When managing a patient on mechanical ventilation with High-Frequency Oscillatory
Ventilation (HFOV), what is the primary goal for this intervention?
A. To provide high tidal volumes at a low respiratory rate
B. To allow the patient to trigger their own breaths comfortably
C. To increase dead space ventilation in patients with COPD
D. To prevent lung injury by providing very low tidal volumes at high frequencies
, Answer: D
Rationale: HFOV provides very small tidal volumes at very high rates (3-15 hertz) to
maintain lung recruitment and prevent barotrauma in severe ARDS.
3. A patient with a history of liver cirrhosis presents with encephalopathy and a serum
ammonia level of 120 mcg/dL. The nurse administers lactulose. Which finding indicates the
medication is effective?
A. The patient has one soft, formed bowel movement per day
B. The patient’s skin appears less jaundiced
C. The patient is more alert and oriented to person, place, and time
D. The patient’s serum potassium level increases to 4.5 mEq/L
Answer: C
Rationale: Lactulose works by trapping ammonia in the gut and expelling it through
diarrhea. The goal is improved neurologic status, not just bowel movements.
4. During the emergent phase of a 45% Total Body Surface Area (TBSA) burn injury, which
electrolyte abnormality should the nurse most closely monitor for?
A. Hypokalemia due to fluid resuscitation dilution
B. Hyperkalemia due to massive cellular destruction
C. Hypernatremia due to evaporative water loss
D. Hypocalcemia due to protein loss in the interstitial space
