NUR 265 Advanced Med-Surg Exam
with 100 questions and correct
answers with rationale updated
2026
Section A: Cardiovascular Disorders (Questions 1-20)
1. A nurse is caring for a client receiving digoxin. Which finding requires the
nurse to withhold the medication?
A. Blood pressure of 140/80 mmHg
B. Apical pulse of 52/min
C. Respiratory rate of 18/min
D. Potassium level of 4.2 mEq/L
Correct Answer: B. Apical pulse of 52/min
Rationale: Digoxin can cause bradycardia. The medication should be withheld when
the apical pulse is below 60/min, and the provider should be notified. Blood pressure,
respiratory rate, and potassium level within normal limits do not require withholding
the medication -5 .
2. A patient with acute decompensated heart failure and severe renal
impairment requires cautious administration of which medication?
A. Metoprolol succinate
B. Furosemide
C. Nesiritide
D. Dobutamine
Correct Answer: C. Nesiritide
Rationale: Nesiritide (BNP) is renally cleared and may accumulate in renal
impairment, increasing hypotension risk. The FDA has issued a warning against its
use in renal impairment due to worsened outcomes. Metoprolol is contraindicated in
,acute decompensation, furosemide may be less effective but not contraindicated,
and dobutamine is used for inotropic support -11 .
3. A patient with a central venous pressure (CVP) reading of 1 mmHg likely has
which condition?
A. Hypovolemia
B. Right-sided heart failure
C. Fluid volume overload
D. Cardiac tamponade
Correct Answer: A. Hypovolemia
Rationale: Normal CVP is 2-8 mmHg. A low CVP (<2 mmHg) indicates reduced
venous return and low intravascular volume, such as in hypovolemia. Right-sided
heart failure, fluid volume overload, and cardiac tamponade would present with
elevated CVP readings -2 .
4. Which sign is an early indicator of increased intracranial pressure (ICP)?
A. Cushing's Triad
B. Altered level of consciousness
C. Fixed and dilated pupils
D. Decerebrate posturing
Correct Answer: B. Altered level of consciousness
Rationale: The earliest and most sensitive indicator of changes in neurological status
and increased ICP is a change in the level of consciousness (LOC). Cushing's Triad,
fixed pupils, and posturing are later signs -2 .
5. A nurse is caring for a client with a chest tube after a pneumothorax. Which
finding requires intervention?
A. Tidaling in the water-seal chamber
B. Mild discomfort at insertion site
,C. Continuous bubbling in the water-seal chamber
D. Drainage of 50 mL during the first hour
Correct Answer: C. Continuous bubbling in the water-seal chamber
Rationale: Continuous bubbling indicates an air leak in the system. Tidaling is
expected with respirations. Excessive drainage or sudden changes require evaluation
but are not necessarily abnormal -5 .
6. The nurse is caring for a patient with pheochromocytoma. Which vital sign is
most critical to monitor?
A. Blood pressure
B. Oxygen saturation
C. Temperature
D. Respiratory rate
Correct Answer: A. Blood pressure
Rationale: Pheochromocytoma is a tumor of the adrenal medulla that secretes
excessive catecholamines, causing severe hypertension. Blood pressure monitoring is
critical due to the risk of hypertensive crisis -2 .
7. A client is in the compensatory stage of shock. What clinical finding would
the nurse expect?
A. Tachycardia and cool, clammy skin
B. Hypotension and lethargy
C. Anuria and metabolic acidosis
D. Jaundice and weak pulses
Correct Answer: A. Tachycardia and cool, clammy skin
Rationale: During compensation, the body activates the sympathetic nervous
system, leading to tachycardia and peripheral vasoconstriction (cool, clammy skin) to
maintain blood pressure. Hypotension, anuria, and jaundice occur in later stages -2 .
, 8. A patient in septic shock develops acute respiratory distress syndrome
(ARDS). Which ventilator strategy is most appropriate?
A. Tidal volume 10 mL/kg ideal body weight, plateau pressure < 30 cm H2O
B. Tidal volume 6 mL/kg ideal body weight, plateau pressure < 30 cm H2O
C. Tidal volume 8 mL/kg actual body weight, PEEP 5
D. Tidal volume 12 mL/kg ideal body weight, permissive hypercapnia
Correct Answer: B. Tidal volume 6 mL/kg ideal body weight, plateau pressure <
30 cm H2O
Rationale: Low tidal volume ventilation (6 mL/kg ideal body weight) with plateau
pressure <30 cm H2O is the recommended strategy to minimize ventilator-induced
lung injury in ARDS -4 .
9. Which lab value is most helpful in determining the severity of tissue
hypoperfusion in septic shock?
A. White blood cell count
B. Blood Urea Nitrogen (BUN)
C. Serum Lactate
D. Hemoglobin levels
Correct Answer: C. Serum Lactate
Rationale: Elevated serum lactate levels are a marker of anaerobic metabolism due
to tissue hypoperfusion in shock states. Lactate clearance is used to monitor
resuscitation effectiveness -2 .
10. A patient in the ICU has a MAP of 58 mmHg despite fluid resuscitation.
Norepinephrine is started. Which parameter best indicates improving target
organ perfusion?
A. Heart rate decreasing from 120 to 100 bpm
B. Urine output increasing from 10 to 40 mL/hour
C. Central venous pressure increasing from 4 to 10 mmHg
D. Serum lactate decreasing from 6 to 4 mmol/L
Correct Answer: B. Urine output increasing from 10 to 40 mL/hour
with 100 questions and correct
answers with rationale updated
2026
Section A: Cardiovascular Disorders (Questions 1-20)
1. A nurse is caring for a client receiving digoxin. Which finding requires the
nurse to withhold the medication?
A. Blood pressure of 140/80 mmHg
B. Apical pulse of 52/min
C. Respiratory rate of 18/min
D. Potassium level of 4.2 mEq/L
Correct Answer: B. Apical pulse of 52/min
Rationale: Digoxin can cause bradycardia. The medication should be withheld when
the apical pulse is below 60/min, and the provider should be notified. Blood pressure,
respiratory rate, and potassium level within normal limits do not require withholding
the medication -5 .
2. A patient with acute decompensated heart failure and severe renal
impairment requires cautious administration of which medication?
A. Metoprolol succinate
B. Furosemide
C. Nesiritide
D. Dobutamine
Correct Answer: C. Nesiritide
Rationale: Nesiritide (BNP) is renally cleared and may accumulate in renal
impairment, increasing hypotension risk. The FDA has issued a warning against its
use in renal impairment due to worsened outcomes. Metoprolol is contraindicated in
,acute decompensation, furosemide may be less effective but not contraindicated,
and dobutamine is used for inotropic support -11 .
3. A patient with a central venous pressure (CVP) reading of 1 mmHg likely has
which condition?
A. Hypovolemia
B. Right-sided heart failure
C. Fluid volume overload
D. Cardiac tamponade
Correct Answer: A. Hypovolemia
Rationale: Normal CVP is 2-8 mmHg. A low CVP (<2 mmHg) indicates reduced
venous return and low intravascular volume, such as in hypovolemia. Right-sided
heart failure, fluid volume overload, and cardiac tamponade would present with
elevated CVP readings -2 .
4. Which sign is an early indicator of increased intracranial pressure (ICP)?
A. Cushing's Triad
B. Altered level of consciousness
C. Fixed and dilated pupils
D. Decerebrate posturing
Correct Answer: B. Altered level of consciousness
Rationale: The earliest and most sensitive indicator of changes in neurological status
and increased ICP is a change in the level of consciousness (LOC). Cushing's Triad,
fixed pupils, and posturing are later signs -2 .
5. A nurse is caring for a client with a chest tube after a pneumothorax. Which
finding requires intervention?
A. Tidaling in the water-seal chamber
B. Mild discomfort at insertion site
,C. Continuous bubbling in the water-seal chamber
D. Drainage of 50 mL during the first hour
Correct Answer: C. Continuous bubbling in the water-seal chamber
Rationale: Continuous bubbling indicates an air leak in the system. Tidaling is
expected with respirations. Excessive drainage or sudden changes require evaluation
but are not necessarily abnormal -5 .
6. The nurse is caring for a patient with pheochromocytoma. Which vital sign is
most critical to monitor?
A. Blood pressure
B. Oxygen saturation
C. Temperature
D. Respiratory rate
Correct Answer: A. Blood pressure
Rationale: Pheochromocytoma is a tumor of the adrenal medulla that secretes
excessive catecholamines, causing severe hypertension. Blood pressure monitoring is
critical due to the risk of hypertensive crisis -2 .
7. A client is in the compensatory stage of shock. What clinical finding would
the nurse expect?
A. Tachycardia and cool, clammy skin
B. Hypotension and lethargy
C. Anuria and metabolic acidosis
D. Jaundice and weak pulses
Correct Answer: A. Tachycardia and cool, clammy skin
Rationale: During compensation, the body activates the sympathetic nervous
system, leading to tachycardia and peripheral vasoconstriction (cool, clammy skin) to
maintain blood pressure. Hypotension, anuria, and jaundice occur in later stages -2 .
, 8. A patient in septic shock develops acute respiratory distress syndrome
(ARDS). Which ventilator strategy is most appropriate?
A. Tidal volume 10 mL/kg ideal body weight, plateau pressure < 30 cm H2O
B. Tidal volume 6 mL/kg ideal body weight, plateau pressure < 30 cm H2O
C. Tidal volume 8 mL/kg actual body weight, PEEP 5
D. Tidal volume 12 mL/kg ideal body weight, permissive hypercapnia
Correct Answer: B. Tidal volume 6 mL/kg ideal body weight, plateau pressure <
30 cm H2O
Rationale: Low tidal volume ventilation (6 mL/kg ideal body weight) with plateau
pressure <30 cm H2O is the recommended strategy to minimize ventilator-induced
lung injury in ARDS -4 .
9. Which lab value is most helpful in determining the severity of tissue
hypoperfusion in septic shock?
A. White blood cell count
B. Blood Urea Nitrogen (BUN)
C. Serum Lactate
D. Hemoglobin levels
Correct Answer: C. Serum Lactate
Rationale: Elevated serum lactate levels are a marker of anaerobic metabolism due
to tissue hypoperfusion in shock states. Lactate clearance is used to monitor
resuscitation effectiveness -2 .
10. A patient in the ICU has a MAP of 58 mmHg despite fluid resuscitation.
Norepinephrine is started. Which parameter best indicates improving target
organ perfusion?
A. Heart rate decreasing from 120 to 100 bpm
B. Urine output increasing from 10 to 40 mL/hour
C. Central venous pressure increasing from 4 to 10 mmHg
D. Serum lactate decreasing from 6 to 4 mmol/L
Correct Answer: B. Urine output increasing from 10 to 40 mL/hour
