Galen NUR 265 Medical-Surgical Nursing (TESTED
QUESTIONS, CLINICALLY RELEVANT
SCENARIOS & APPLICATION-LEVEL ITEMS)
Final Exam
1. Which self-management instruction is appropriate for many patients with photosensitive SLE?
A. Increase sodium intake to prevent autoantibody production.
B. Use sun-protective clothing and broad-spectrum sunscreen and avoid excessive ultraviolet exposure.
C. Stop all exercise permanently.
D. Use tanning beds to prevent rashes.
Correct Answer: B. Use sun-protective clothing and broad-spectrum sunscreen and avoid excessive ultraviolet exposure.
Rationale: Ultraviolet exposure can trigger cutaneous and systemic lupus activity in susceptible patients. Sun protection is an important
preventive strategy.
2. During a vesicant chemotherapy infusion through a peripheral IV, the patient reports burning and swelling develops
at the site. What should the nurse do first?
A. Stop the infusion immediately while leaving the catheter in place for aspiration and agent-specific management.
B. Apply vigorous massage to spread the drug through the tissue.
C. Flush the medication rapidly into the tissue with normal saline.
D. Remove the catheter first and discard it before attempting aspiration.
Correct Answer: A. Stop the infusion immediately while leaving the catheter in place for aspiration and agent-specific
management.
Rationale: Vesicant extravasation can cause severe tissue necrosis. The infusion is stopped, the catheter is usually left in place initially for
aspiration/antidote administration, and agent-specific measures are followed.
3. A breast cancer survivor with axillary node surgery reports new persistent swelling and heaviness of the affected arm.
Which problem should the nurse consider?
A. Acute DKA.
B. Thyroid storm.
C. Lymphedema requiring assessment and early management.
D. Normal postoperative change that can never be treated.
Correct Answer: C. Lymphedema requiring assessment and early management.
Rationale: Lymphatic disruption can cause chronic arm swelling, heaviness, and skin changes. Early assessment, skin care,
compression/therapy when indicated, and infection prevention can reduce complications.
, 4. Which laboratory value is most useful for evaluating the virologic response to antiretroviral therapy?
A. Serum lipase.
B. INR.
C. Erythrocyte sedimentation rate alone.
D. Plasma HIV RNA viral load.
Correct Answer: D. Plasma HIV RNA viral load.
Rationale: Viral load is the primary marker of ART response and should fall after effective treatment. CD4 count remains important for
immune status and selected prophylaxis decisions.
5. In START-style mass-casualty triage, ambulatory patients who can follow directions are initially directed to a
separate area. Which category do they generally receive initially?
A. Immediate/red automatically.
B. Minor/green, with later reassessment.
C. No triage category because they can walk.
D. Deceased/black automatically.
Correct Answer: B. Minor/green, with later reassessment.
Rationale: Walking wounded are initially categorized as minor in START triage, but they still require reassessment because occult injuries
can be missed during the first sweep.
6. A heart transplant recipient taking immunosuppressive therapy reports temperature 100.8 F and new cough. What is
the best response?
A. Contact the transplant team promptly because infection can progress rapidly and may present subtly.
B. Wait several days because fever is expected after transplantation indefinitely.
C. Stop all immunosuppressive medication immediately without guidance.
D. Take a live vaccine before seeking care.
Correct Answer: A. Contact the transplant team promptly because infection can progress rapidly and may present subtly.
Rationale: Immunosuppression raises infection risk and can blunt classic signs. Fever or new focal symptoms warrant early evaluation,
while abrupt cessation of immunosuppression can precipitate rejection.
7. After a suspected bioterrorism exposure, several people develop a flu-like prodrome followed by severe dyspnea and
mediastinal widening on chest imaging. Which agent should be considered?
A. Botulism.
B. Tetanus from a single wound.
C. Inhalational anthrax.
D. Smallpox.
Correct Answer: C. Inhalational anthrax.
Rationale: Inhalational anthrax can progress from nonspecific systemic symptoms to severe respiratory distress and mediastinal
lymphadenopathy/widening. Suspected cases require urgent treatment and public-health notification.
QUESTIONS, CLINICALLY RELEVANT
SCENARIOS & APPLICATION-LEVEL ITEMS)
Final Exam
1. Which self-management instruction is appropriate for many patients with photosensitive SLE?
A. Increase sodium intake to prevent autoantibody production.
B. Use sun-protective clothing and broad-spectrum sunscreen and avoid excessive ultraviolet exposure.
C. Stop all exercise permanently.
D. Use tanning beds to prevent rashes.
Correct Answer: B. Use sun-protective clothing and broad-spectrum sunscreen and avoid excessive ultraviolet exposure.
Rationale: Ultraviolet exposure can trigger cutaneous and systemic lupus activity in susceptible patients. Sun protection is an important
preventive strategy.
2. During a vesicant chemotherapy infusion through a peripheral IV, the patient reports burning and swelling develops
at the site. What should the nurse do first?
A. Stop the infusion immediately while leaving the catheter in place for aspiration and agent-specific management.
B. Apply vigorous massage to spread the drug through the tissue.
C. Flush the medication rapidly into the tissue with normal saline.
D. Remove the catheter first and discard it before attempting aspiration.
Correct Answer: A. Stop the infusion immediately while leaving the catheter in place for aspiration and agent-specific
management.
Rationale: Vesicant extravasation can cause severe tissue necrosis. The infusion is stopped, the catheter is usually left in place initially for
aspiration/antidote administration, and agent-specific measures are followed.
3. A breast cancer survivor with axillary node surgery reports new persistent swelling and heaviness of the affected arm.
Which problem should the nurse consider?
A. Acute DKA.
B. Thyroid storm.
C. Lymphedema requiring assessment and early management.
D. Normal postoperative change that can never be treated.
Correct Answer: C. Lymphedema requiring assessment and early management.
Rationale: Lymphatic disruption can cause chronic arm swelling, heaviness, and skin changes. Early assessment, skin care,
compression/therapy when indicated, and infection prevention can reduce complications.
, 4. Which laboratory value is most useful for evaluating the virologic response to antiretroviral therapy?
A. Serum lipase.
B. INR.
C. Erythrocyte sedimentation rate alone.
D. Plasma HIV RNA viral load.
Correct Answer: D. Plasma HIV RNA viral load.
Rationale: Viral load is the primary marker of ART response and should fall after effective treatment. CD4 count remains important for
immune status and selected prophylaxis decisions.
5. In START-style mass-casualty triage, ambulatory patients who can follow directions are initially directed to a
separate area. Which category do they generally receive initially?
A. Immediate/red automatically.
B. Minor/green, with later reassessment.
C. No triage category because they can walk.
D. Deceased/black automatically.
Correct Answer: B. Minor/green, with later reassessment.
Rationale: Walking wounded are initially categorized as minor in START triage, but they still require reassessment because occult injuries
can be missed during the first sweep.
6. A heart transplant recipient taking immunosuppressive therapy reports temperature 100.8 F and new cough. What is
the best response?
A. Contact the transplant team promptly because infection can progress rapidly and may present subtly.
B. Wait several days because fever is expected after transplantation indefinitely.
C. Stop all immunosuppressive medication immediately without guidance.
D. Take a live vaccine before seeking care.
Correct Answer: A. Contact the transplant team promptly because infection can progress rapidly and may present subtly.
Rationale: Immunosuppression raises infection risk and can blunt classic signs. Fever or new focal symptoms warrant early evaluation,
while abrupt cessation of immunosuppression can precipitate rejection.
7. After a suspected bioterrorism exposure, several people develop a flu-like prodrome followed by severe dyspnea and
mediastinal widening on chest imaging. Which agent should be considered?
A. Botulism.
B. Tetanus from a single wound.
C. Inhalational anthrax.
D. Smallpox.
Correct Answer: C. Inhalational anthrax.
Rationale: Inhalational anthrax can progress from nonspecific systemic symptoms to severe respiratory distress and mediastinal
lymphadenopathy/widening. Suspected cases require urgent treatment and public-health notification.
