NUR 265 EXAM 1 (3 EXAM
SETS) – MEDICAL-
SURGICAL NURSING –
(2026/2027) GALEN
ACTUAL QUESTIONS &
ANSWERS, 100%
GUARANTEE PASS
NUR 265 Exam 1 – Advanced Concepts of Medical-
Surgical Nursing
Comprehensive Practice Exam Questions with Bolded
Correct Answers & Rationales
Galen College of Nursing | 2026/2027 Curriculum Aligned
,Section 1: Acid-Base Balance & ABG Interpretation
(Questions 1–25)
1. A patient's ABG results are pH 7.30, PaCO2 52 mmHg, and HCO3 25 mEq/L. How
should the nurse interpret these findings?
A. Respiratory Alkalosis
B. Respiratory Acidosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Rationale: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg indicates a
respiratory cause. Since the HCO3 is within the normal range (22-26), it is
uncompensated respiratory acidosis .
2. A patient's ABG shows pH 7.48, PaCO2 30 mmHg, and HCO3 24 mEq/L. What is
the interpretation?
A. Respiratory Acidosis
B. Metabolic Alkalosis
C. Respiratory Alkalosis
D. Metabolic Acidosis
Rationale: A pH above 7.45 indicates alkalosis. A PaCO2 below 35 mmHg indicates a
respiratory cause. Normal HCO3 indicates no compensation.
3. Which condition is most likely to cause respiratory acidosis?
A. Hyperventilation
B. Hypoventilation
C. Excessive vomiting
D. Diuretic use
Rationale: Hypoventilation causes CO2 retention, leading to respiratory acidosis.
4. A patient with COPD has ABG results: pH 7.32, PaCO2 58 mmHg, PaO2 55
mmHg, and HCO3 31 mEq/L. Which oxygen delivery system is most appropriate?
A. Non-rebreather mask at 15 L/min
B. Simple face mask at 8 L/min
C. Nasal cannula at 1 to 2 L/min or a Venturi mask
D. High-flow nasal cannula at 50 L/min with 100% FiO2
Rationale: Clients with chronic hypercapnia rely on their hypoxic drive to breathe. High-
flow oxygen can suppress this drive. Controlled, low-flow oxygen is critical .
,5. Which finding indicates metabolic acidosis?
A. pH 7.48, HCO3 28
B. pH 7.30, HCO3 18
C. pH 7.50, PaCO2 30
D. pH 7.32, PaCO2 50
Rationale: Metabolic acidosis is indicated by low pH and low HCO3.
6. A patient with severe diarrhea is at risk for which acid-base imbalance?
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
Rationale: Diarrhea causes loss of bicarbonate, leading to metabolic acidosis.
7. A patient with excessive vomiting is at risk for which acid-base imbalance?
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
Rationale: Vomiting causes loss of gastric acid (HCl), leading to metabolic alkalosis.
8. Which ABG finding indicates full compensation?
A. pH 7.30, PaCO2 50, HCO3 24
B. pH 7.36, PaCO2 55, HCO3 32
C. pH 7.50, PaCO2 30, HCO3 24
D. pH 7.28, PaCO2 30, HCO3 18
Rationale: Full compensation occurs when pH returns to normal range despite
abnormal PaCO2 and HCO3.
9. A patient with a panic attack is hyperventilating. Which acid-base imbalance is
expected?
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
Rationale: Hyperventilation causes excessive CO2 loss, leading to respiratory alkalosis.
, 10. Which condition increases the risk of metabolic alkalosis?
A. Diarrhea
B. Prolonged vomiting
C. Renal failure
D. Diabetic ketoacidosis
Rationale: Vomiting causes loss of hydrogen ions and chloride, leading to metabolic
alkalosis.
11. A patient with renal failure is at risk for which acid-base imbalance?
A. Respiratory alkalosis
B. Metabolic acidosis
C. Metabolic alkalosis
D. Respiratory acidosis
Rationale: Renal failure impairs bicarbonate reabsorption and acid excretion, causing
metabolic acidosis.
12. Which ABG value indicates compensated respiratory acidosis?
A. pH 7.30, PaCO2 50, HCO3 24
B. pH 7.36, PaCO2 55, HCO3 32
C. pH 7.48, PaCO2 30, HCO3 24
D. pH 7.32, PaCO2 50, HCO3 24
Rationale: Compensated respiratory acidosis has elevated PaCO2 with elevated HCO3
and near-normal pH.
13. A patient with diabetic ketoacidosis has ABG results: pH 7.25, PaCO2 30, HCO3
15. What is the interpretation?
A. Respiratory acidosis
B. Metabolic acidosis with respiratory compensation
C. Metabolic alkalosis
D. Respiratory alkalosis
Rationale: DKA causes metabolic acidosis. The low PaCO2 indicates respiratory
compensation (Kussmaul respirations).
14. Which condition causes respiratory alkalosis?
A. Opioid overdose
B. High altitude
C. COPD
D. Sedative use
SETS) – MEDICAL-
SURGICAL NURSING –
(2026/2027) GALEN
ACTUAL QUESTIONS &
ANSWERS, 100%
GUARANTEE PASS
NUR 265 Exam 1 – Advanced Concepts of Medical-
Surgical Nursing
Comprehensive Practice Exam Questions with Bolded
Correct Answers & Rationales
Galen College of Nursing | 2026/2027 Curriculum Aligned
,Section 1: Acid-Base Balance & ABG Interpretation
(Questions 1–25)
1. A patient's ABG results are pH 7.30, PaCO2 52 mmHg, and HCO3 25 mEq/L. How
should the nurse interpret these findings?
A. Respiratory Alkalosis
B. Respiratory Acidosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Rationale: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg indicates a
respiratory cause. Since the HCO3 is within the normal range (22-26), it is
uncompensated respiratory acidosis .
2. A patient's ABG shows pH 7.48, PaCO2 30 mmHg, and HCO3 24 mEq/L. What is
the interpretation?
A. Respiratory Acidosis
B. Metabolic Alkalosis
C. Respiratory Alkalosis
D. Metabolic Acidosis
Rationale: A pH above 7.45 indicates alkalosis. A PaCO2 below 35 mmHg indicates a
respiratory cause. Normal HCO3 indicates no compensation.
3. Which condition is most likely to cause respiratory acidosis?
A. Hyperventilation
B. Hypoventilation
C. Excessive vomiting
D. Diuretic use
Rationale: Hypoventilation causes CO2 retention, leading to respiratory acidosis.
4. A patient with COPD has ABG results: pH 7.32, PaCO2 58 mmHg, PaO2 55
mmHg, and HCO3 31 mEq/L. Which oxygen delivery system is most appropriate?
A. Non-rebreather mask at 15 L/min
B. Simple face mask at 8 L/min
C. Nasal cannula at 1 to 2 L/min or a Venturi mask
D. High-flow nasal cannula at 50 L/min with 100% FiO2
Rationale: Clients with chronic hypercapnia rely on their hypoxic drive to breathe. High-
flow oxygen can suppress this drive. Controlled, low-flow oxygen is critical .
,5. Which finding indicates metabolic acidosis?
A. pH 7.48, HCO3 28
B. pH 7.30, HCO3 18
C. pH 7.50, PaCO2 30
D. pH 7.32, PaCO2 50
Rationale: Metabolic acidosis is indicated by low pH and low HCO3.
6. A patient with severe diarrhea is at risk for which acid-base imbalance?
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
Rationale: Diarrhea causes loss of bicarbonate, leading to metabolic acidosis.
7. A patient with excessive vomiting is at risk for which acid-base imbalance?
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
Rationale: Vomiting causes loss of gastric acid (HCl), leading to metabolic alkalosis.
8. Which ABG finding indicates full compensation?
A. pH 7.30, PaCO2 50, HCO3 24
B. pH 7.36, PaCO2 55, HCO3 32
C. pH 7.50, PaCO2 30, HCO3 24
D. pH 7.28, PaCO2 30, HCO3 18
Rationale: Full compensation occurs when pH returns to normal range despite
abnormal PaCO2 and HCO3.
9. A patient with a panic attack is hyperventilating. Which acid-base imbalance is
expected?
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
Rationale: Hyperventilation causes excessive CO2 loss, leading to respiratory alkalosis.
, 10. Which condition increases the risk of metabolic alkalosis?
A. Diarrhea
B. Prolonged vomiting
C. Renal failure
D. Diabetic ketoacidosis
Rationale: Vomiting causes loss of hydrogen ions and chloride, leading to metabolic
alkalosis.
11. A patient with renal failure is at risk for which acid-base imbalance?
A. Respiratory alkalosis
B. Metabolic acidosis
C. Metabolic alkalosis
D. Respiratory acidosis
Rationale: Renal failure impairs bicarbonate reabsorption and acid excretion, causing
metabolic acidosis.
12. Which ABG value indicates compensated respiratory acidosis?
A. pH 7.30, PaCO2 50, HCO3 24
B. pH 7.36, PaCO2 55, HCO3 32
C. pH 7.48, PaCO2 30, HCO3 24
D. pH 7.32, PaCO2 50, HCO3 24
Rationale: Compensated respiratory acidosis has elevated PaCO2 with elevated HCO3
and near-normal pH.
13. A patient with diabetic ketoacidosis has ABG results: pH 7.25, PaCO2 30, HCO3
15. What is the interpretation?
A. Respiratory acidosis
B. Metabolic acidosis with respiratory compensation
C. Metabolic alkalosis
D. Respiratory alkalosis
Rationale: DKA causes metabolic acidosis. The low PaCO2 indicates respiratory
compensation (Kussmaul respirations).
14. Which condition causes respiratory alkalosis?
A. Opioid overdose
B. High altitude
C. COPD
D. Sedative use
