NUR 253 FINAL EXAM - ADVANCED
MEDICAL-SURGICAL NURSING
QUESTIONS & ANSWERS (VERIFIED
ANSWERS) WITH EXPERT
EXPLANATIONS | 2026 – 2027 UPDATE
(PDF) GALEN COLLEGE OF NURSING
1. A client with acute respiratory distress syndrome (ARDS) is on mechanical ventilation with
high PEEP. The nurse notes a sudden drop in oxygen saturation and absent breath sounds on
the right side. What is the priority nursing action?
A. Increase the FiO2 to 100%
B. Suction the endotracheal tube
C. Prepare for immediate needle thoracostomy
D. Obtain a portable chest X-ray
Answer: C
Conceptual Explanation: Sudden drop in O2 saturation and absent breath sounds in a
patient on high PEEP suggests a tension pneumothorax, which is a medical emergency
requiring immediate decompression.
,2. A nurse is caring for a client in the oliguric phase of acute kidney injury (AKI). Which
laboratory finding should the nurse expect to find?
A. Hyperphosphatemia
B. Hypercalcemia
C. Hypokalemia
D. Hypouricemia
Answer: A
Conceptual Explanation: In the oliguric phase of AKI, the kidneys cannot excrete
phosphorus, leading to hyperphosphatemia, which is inversely related to calcium levels.
3. A client is admitted with a suspected pheochromocytoma. Which clinical manifestation
should the nurse prioritize for monitoring?
A. Profuse diaphoresis and hypertension
B. Severe bradycardia
C. Weight gain and lethargy
D. Hypoglycemia
Answer: A
Conceptual Explanation: Pheochromocytoma is a catecholamine-secreting tumor that
causes severe hypertension, tachycardia, and diaphoresis.
, 4. The nurse is assessing a client with a history of cirrhosis who is now presenting with altered
mental status and asterixis. Which medication does the nurse anticipate administering?
A. Lactulose
B. Propranolol
C. Spironolactone
D. Vitamin K
Answer: A
Conceptual Explanation: Lactulose is used to reduce serum ammonia levels in hepatic
encephalopathy by promoting ammonia excretion through the stool.
5. A client with a C6 spinal cord injury reports a sudden, throbbing headache and has a blood
pressure of 210/110 mmHg. What is the nurse’s first action?
A. Administer prescribed antihypertensive medication
B. Notify the rapid response team
C. Check the client for bladder distention
D. Place the client in a high-Fowler’s position
Answer: D
Conceptual Explanation: The first action for autonomic dysreflexia is to sit the patient up
to lower blood pressure via orthostatic effect before addressing the cause.
MEDICAL-SURGICAL NURSING
QUESTIONS & ANSWERS (VERIFIED
ANSWERS) WITH EXPERT
EXPLANATIONS | 2026 – 2027 UPDATE
(PDF) GALEN COLLEGE OF NURSING
1. A client with acute respiratory distress syndrome (ARDS) is on mechanical ventilation with
high PEEP. The nurse notes a sudden drop in oxygen saturation and absent breath sounds on
the right side. What is the priority nursing action?
A. Increase the FiO2 to 100%
B. Suction the endotracheal tube
C. Prepare for immediate needle thoracostomy
D. Obtain a portable chest X-ray
Answer: C
Conceptual Explanation: Sudden drop in O2 saturation and absent breath sounds in a
patient on high PEEP suggests a tension pneumothorax, which is a medical emergency
requiring immediate decompression.
,2. A nurse is caring for a client in the oliguric phase of acute kidney injury (AKI). Which
laboratory finding should the nurse expect to find?
A. Hyperphosphatemia
B. Hypercalcemia
C. Hypokalemia
D. Hypouricemia
Answer: A
Conceptual Explanation: In the oliguric phase of AKI, the kidneys cannot excrete
phosphorus, leading to hyperphosphatemia, which is inversely related to calcium levels.
3. A client is admitted with a suspected pheochromocytoma. Which clinical manifestation
should the nurse prioritize for monitoring?
A. Profuse diaphoresis and hypertension
B. Severe bradycardia
C. Weight gain and lethargy
D. Hypoglycemia
Answer: A
Conceptual Explanation: Pheochromocytoma is a catecholamine-secreting tumor that
causes severe hypertension, tachycardia, and diaphoresis.
, 4. The nurse is assessing a client with a history of cirrhosis who is now presenting with altered
mental status and asterixis. Which medication does the nurse anticipate administering?
A. Lactulose
B. Propranolol
C. Spironolactone
D. Vitamin K
Answer: A
Conceptual Explanation: Lactulose is used to reduce serum ammonia levels in hepatic
encephalopathy by promoting ammonia excretion through the stool.
5. A client with a C6 spinal cord injury reports a sudden, throbbing headache and has a blood
pressure of 210/110 mmHg. What is the nurse’s first action?
A. Administer prescribed antihypertensive medication
B. Notify the rapid response team
C. Check the client for bladder distention
D. Place the client in a high-Fowler’s position
Answer: D
Conceptual Explanation: The first action for autonomic dysreflexia is to sit the patient up
to lower blood pressure via orthostatic effect before addressing the cause.
