NUR 265 Final Exam V3 | NUR 265 Advanced
Concepts of Medical–Surgical Nursing | Actual Q&A
with Rationale (NUR 265 Final Exam) | Galen
1. Sarah Miller, a 65-year-old patient admitted with septic shock, has a Mean Arterial
Pressure (MAP) of 58 mmHg despite receiving 3 liters of 0.9% Normal Saline. The nurse
anticipates an order for which vasoactive medication to maintain a MAP above 65 mmHg?
A. Norepinephrine
B. Nitroglycerin
C. Atenolol
D. Nitroprusside
Correct Answer: A
Explanation: Norepinephrine is the first-line vasopressor used in septic shock to increase
systemic vascular resistance and improve blood pressure when fluid resuscitation is
insufficient. In this clinical scenario, the patient remains hypotensive despite adequate fluid
volume, indicating a need for vasoconstriction. The nurse must monitor the infusion site for
extravasation and assess for improved peripheral perfusion and vital sign stability.
,2. David Wilson is a 54-year-old patient diagnosed with Acute Respiratory Distress Syndrome
(ARDS) secondary to aspiration pneumonia. The nurse notes that the patient’s PaO2 is 55
mmHg while receiving 100% oxygen via mechanical ventilation with a PEEP of 5 cm H2O.
What is the nurse’s priority action?
A. Obtain an order to decrease the FiO2 to prevent oxygen toxicity
B. Prepare to increase the PEEP as ordered to improve oxygenation
C. Administer a bolus of intravenous fluids to improve cardiac output
D. Place the patient in a supine position to maximize lung expansion
Correct Answer: B
Explanation: PEEP (Positive End-Expiratory Pressure) is used in ARDS to keep alveoli
open at the end of expiration, which improves gas exchange and reduces shunting. This
patient is experiencing refractory hypoxemia, a hallmark of ARDS where PaO2 remains low
despite high FiO2 levels. Increasing PEEP is the appropriate intervention to recruit
collapsed alveoli and improve the PaO2/FiO2 ratio.
3. Maria Hernandez, a 42-year-old female, is admitted to the burn unit with partial-thickness
burns to her entire right arm, her anterior chest, and her entire left leg. Using the Rule of
Nines, the nurse calculates the Total Body Surface Area (TBSA) burned as:
A. 27%
B. 36%
C. 45%
,D. 54%
Correct Answer: C
Explanation: According to the Rule of Nines, the entire right arm is 9%, the anterior chest
is 18%, and the entire left leg is 18%. Adding these values together (9 + 18 + 18) results in
a total body surface area calculation of 45%. This assessment is critical for determining the
fluid resuscitation requirements using the Parkland formula for the first 24 hours post-
burn.
4. A 72-year-old patient, Robert Thompson, is in the ICU with Acute Kidney Injury (AKI) and is
undergoing Continuous Renal Replacement Therapy (CRRT). The nurse notices the pressure
alarms on the CRRT machine are triggering, and the filter appears dark and clotted. Which
action should the nurse take first?
A. Flush the system with 500 mL of normal saline
B. Increase the heparin infusion rate to dissolve the clot
C. Discontinue the treatment and return the blood to the patient if possible
D. Call the healthcare provider to request a change in the dialysate rate
Correct Answer: C
Explanation: If the filter in a CRRT circuit has clotted, the priority is to stop the treatment
to prevent further blood loss or machine malfunction. The nurse should attempt to return
the patient’s blood remaining in the lines if the system allows and then prepare to set up a
, new circuit. Prevention of clotting involves adequate anticoagulation and maintaining
vascular access patency throughout the therapy.
5. Emily Chen is admitted with a traumatic brain injury (TBI) after a motor vehicle accident.
Her intracranial pressure (ICP) monitor shows a reading of 24 mmHg. Which nursing
intervention is most appropriate to help reduce the ICP?
A. Cluster nursing activities to ensure the patient has long rest periods
B. Keep the room brightly lit and provide constant verbal stimulation
C. Encourage the patient to perform frequent coughing and deep breathing exercises
D. Maintain the head of the bed at 30 to 45 degrees in a neutral position
Correct Answer: D
Explanation: Elevating the head of the bed to 30-45 degrees promotes venous drainage
from the brain via the jugular veins, which helps lower intracranial pressure. Maintaining a
neutral neck alignment is essential because neck flexion or rotation can obstruct venous
outflow and increase ICP further. Activities that increase intrathoracic or intra-abdominal
pressure, such as coughing, should be minimized in this patient population.
6. James Peterson, a 58-year-old with a history of heart failure, is admitted with an acute
exacerbation. He is currently on a Dobutamine infusion. Which assessment finding indicates
the medication is having the desired therapeutic effect?
A. Decreased heart rate from 110 to 85 bpm
B. A decrease in the patient’s systolic blood pressure
Concepts of Medical–Surgical Nursing | Actual Q&A
with Rationale (NUR 265 Final Exam) | Galen
1. Sarah Miller, a 65-year-old patient admitted with septic shock, has a Mean Arterial
Pressure (MAP) of 58 mmHg despite receiving 3 liters of 0.9% Normal Saline. The nurse
anticipates an order for which vasoactive medication to maintain a MAP above 65 mmHg?
A. Norepinephrine
B. Nitroglycerin
C. Atenolol
D. Nitroprusside
Correct Answer: A
Explanation: Norepinephrine is the first-line vasopressor used in septic shock to increase
systemic vascular resistance and improve blood pressure when fluid resuscitation is
insufficient. In this clinical scenario, the patient remains hypotensive despite adequate fluid
volume, indicating a need for vasoconstriction. The nurse must monitor the infusion site for
extravasation and assess for improved peripheral perfusion and vital sign stability.
,2. David Wilson is a 54-year-old patient diagnosed with Acute Respiratory Distress Syndrome
(ARDS) secondary to aspiration pneumonia. The nurse notes that the patient’s PaO2 is 55
mmHg while receiving 100% oxygen via mechanical ventilation with a PEEP of 5 cm H2O.
What is the nurse’s priority action?
A. Obtain an order to decrease the FiO2 to prevent oxygen toxicity
B. Prepare to increase the PEEP as ordered to improve oxygenation
C. Administer a bolus of intravenous fluids to improve cardiac output
D. Place the patient in a supine position to maximize lung expansion
Correct Answer: B
Explanation: PEEP (Positive End-Expiratory Pressure) is used in ARDS to keep alveoli
open at the end of expiration, which improves gas exchange and reduces shunting. This
patient is experiencing refractory hypoxemia, a hallmark of ARDS where PaO2 remains low
despite high FiO2 levels. Increasing PEEP is the appropriate intervention to recruit
collapsed alveoli and improve the PaO2/FiO2 ratio.
3. Maria Hernandez, a 42-year-old female, is admitted to the burn unit with partial-thickness
burns to her entire right arm, her anterior chest, and her entire left leg. Using the Rule of
Nines, the nurse calculates the Total Body Surface Area (TBSA) burned as:
A. 27%
B. 36%
C. 45%
,D. 54%
Correct Answer: C
Explanation: According to the Rule of Nines, the entire right arm is 9%, the anterior chest
is 18%, and the entire left leg is 18%. Adding these values together (9 + 18 + 18) results in
a total body surface area calculation of 45%. This assessment is critical for determining the
fluid resuscitation requirements using the Parkland formula for the first 24 hours post-
burn.
4. A 72-year-old patient, Robert Thompson, is in the ICU with Acute Kidney Injury (AKI) and is
undergoing Continuous Renal Replacement Therapy (CRRT). The nurse notices the pressure
alarms on the CRRT machine are triggering, and the filter appears dark and clotted. Which
action should the nurse take first?
A. Flush the system with 500 mL of normal saline
B. Increase the heparin infusion rate to dissolve the clot
C. Discontinue the treatment and return the blood to the patient if possible
D. Call the healthcare provider to request a change in the dialysate rate
Correct Answer: C
Explanation: If the filter in a CRRT circuit has clotted, the priority is to stop the treatment
to prevent further blood loss or machine malfunction. The nurse should attempt to return
the patient’s blood remaining in the lines if the system allows and then prepare to set up a
, new circuit. Prevention of clotting involves adequate anticoagulation and maintaining
vascular access patency throughout the therapy.
5. Emily Chen is admitted with a traumatic brain injury (TBI) after a motor vehicle accident.
Her intracranial pressure (ICP) monitor shows a reading of 24 mmHg. Which nursing
intervention is most appropriate to help reduce the ICP?
A. Cluster nursing activities to ensure the patient has long rest periods
B. Keep the room brightly lit and provide constant verbal stimulation
C. Encourage the patient to perform frequent coughing and deep breathing exercises
D. Maintain the head of the bed at 30 to 45 degrees in a neutral position
Correct Answer: D
Explanation: Elevating the head of the bed to 30-45 degrees promotes venous drainage
from the brain via the jugular veins, which helps lower intracranial pressure. Maintaining a
neutral neck alignment is essential because neck flexion or rotation can obstruct venous
outflow and increase ICP further. Activities that increase intrathoracic or intra-abdominal
pressure, such as coughing, should be minimized in this patient population.
6. James Peterson, a 58-year-old with a history of heart failure, is admitted with an acute
exacerbation. He is currently on a Dobutamine infusion. Which assessment finding indicates
the medication is having the desired therapeutic effect?
A. Decreased heart rate from 110 to 85 bpm
B. A decrease in the patient’s systolic blood pressure
