NUR 265 EXAM 4 - ATI-STYLE REVIEW GUIDE (V1 & V2)
COMPLETE QUESTIONS AND CORRECT ANSWERS
PLUS RATIONALE NEW UPDATE 2026-2027 GALEN
93 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Analyze hemodynamic and ventilatory data to prioritize nursing interventions for critically ill adults
2 Differentiate endocrine, renal, and hematologic emergencies using laboratory and clinical findings to
guide safe medication and transfusion decisions
3 Apply evidence-based protocols for sepsis, increased intracranial pressure, and oncologic emergencies
while recognizing contraindications and complications
4 NUR 265 Exam 4
5 Style Review Guide
6 V1 & V2
7 Complete Questions and Correct Answers plus Rationale New Update 2026
8 2027 Galen
9 Foundations of Medical-Surgical Nursing / Complex Adult Health
10 Applied Medical-Surgical Nursing / Complex Adult Health
11 Advanced Medical-Surgical Nursing / Complex Adult Health
12 Medical-Surgical Nursing / Complex Adult Health Review
ABSTRACT
Page 1
,This study document brings together 93 carefully worded exam questions drawn from NUR 265
Exam 4 - ATI-Style Review Guide (V1 & V2) Complete Questions and Correct Answers plus
Rationale New Update 2026-2027 Galen, with the strongest emphasis placed on Analyze
hemodynamic and ventilatory data to prioritize nursing interventions for critically ill adults,
Differentiate endocrine, renal, and hematologic emergencies using laboratory and clinical findings
to guide safe medication and transfusion decisions, Apply evidence-based protocols for sepsis,
increased intracranial pressure and and oncologic emergencies while recognizing contraindications
and complications. Every item follows the wording style and level of reasoning you meet in the real
paper, and each one is paired with a clear rationale so the correct choice is never a guess. Work
through the set at your own pace, mark the questions that slow you down, then come back to them
until the reasoning feels automatic. Learners who revise this way walk into the exam room
recognising the pattern behind the questions instead of meeting them for the first time. Keep going
- steady, honest practice is what turns a difficult paper into a comfortable pass.
Q1 ANALYZE HEMODYNAMIC AND VENTILATORY DATA TO PRIORITIZE NURSING
INTERVENTIONS FOR CRITICALLY ILL ADULTS
A patient with septic shock has been fluid-resuscitated and started on
norepinephrine. Which parameter best indicates that the norepinephrine is
achieving its intended therapeutic effect at the tissue level?
A. Mean arterial pressure sustained at 65 mm Hg or greater
B. Central venous oxygen saturation (ScvO2) of 70% or greater CORRECT
C. Urine output of 0.5 mL/kg/hr or greater
D. Central venous pressure of 8 to 12 mm Hg
RATIONALE: ScvO2 reflects the balance between oxygen delivery and consumption, so a value
70% indicates improved tissue perfusion, the ultimate goal of vasopressor therapy. MAP and
urine output are targets but do not directly confirm adequate tissue oxygenation, and CVP
reflects preload rather than the effect of norepinephrine.
Page 2
,Q2 ANALYZE HEMODYNAMIC AND VENTILATORY DATA TO PRIORITIZE NURSING
INTERVENTIONS FOR CRITICALLY ILL ADULTS
A patient on volume-control mechanical ventilation has the following data: PIP 42
cm H2O, plateau pressure 34 cm H2O, tidal volume 500 mL, PEEP 8 cm H2O.
Which action should the nurse anticipate?
A. Increase the respiratory rate to improve minute ventilation
B. Reduce tidal volume to 4-6 mL/kg predicted body weight CORRECT
C. Increase PEEP to 12 cm H2O to recruit collapsed alveoli
D. Suction the airway to relieve a mucus plug
RATIONALE: A plateau pressure >30 cm H2O indicates alveolar overdistention and risk for
ventilator-induced lung injury, so lung-protective ventilation with 4-6 mL/kg predicted body weight
is indicated. Increasing PEEP or tidal volume would worsen overdistention, and suctioning
addresses airway resistance, not elevated plateau pressure.
Q3 ANALYZE HEMODYNAMIC AND VENTILATORY DATA TO PRIORITIZE NURSING
INTERVENTIONS FOR CRITICALLY ILL ADULTS
A patient in diabetic ketoacidosis has a serum potassium of 3.1 mEq/L. Which
prescription should the nurse question?
A. Administer 0.9% sodium chloride IV bolus
B. Start an insulin infusion at 0.1 units/kg/hr CORRECT
C. Add 20 mEq KCl to the IV fluids
D. Monitor blood glucose every hour
RATIONALE: Insulin drives potassium intracellularly and can precipitate life-threatening
hypokalemia when serum potassium is already <3.3 mEq/L, so insulin should be withheld until
potassium is corrected. Fluid resuscitation, potassium replacement, and glucose monitoring are
appropriate in DKA management.
Page 3
, Q4 ANALYZE HEMODYNAMIC AND VENTILATORY DATA TO PRIORITIZE NURSING
INTERVENTIONS FOR CRITICALLY ILL ADULTS
A patient with acute kidney injury receiving continuous renal replacement therapy
(CRRT) develops a sudden drop in circuit pressure with dark, cloudy effluent.
Which complication should the nurse suspect?
A. Air embolism
B. Filter clotting CORRECT
C. Hypophosphatemia
D. Dialysis disequilibrium syndrome
RATIONALE: A sudden pressure change with dark, cloudy effluent indicates clotting within the
hemofilter, which reduces clearance and requires circuit change. Air embolism presents with
cardiovascular collapse, hypophosphatemia is a metabolic complication, and disequilibrium
syndrome occurs with rapid solute removal, not circuit pressure changes.
Q5 ANALYZE HEMODYNAMIC AND VENTILATORY DATA TO PRIORITIZE NURSING
INTERVENTIONS FOR CRITICALLY ILL ADULTS
A patient receiving a blood transfusion develops fever, chills, and flank pain 15
minutes into the infusion. Which action should the nurse take first?
A. Administer acetaminophen and continue the transfusion
B. Stop the transfusion and maintain IV access with normal saline CORRECT
C. Slow the transfusion rate and reassess in 15 minutes
D. Obtain a urine specimen for hemoglobinuria
RATIONALE: Fever, chills, and flank pain suggest an acute hemolytic transfusion reaction, so the
transfusion must be stopped immediately and IV access maintained with normal saline to support
renal perfusion. Continuing or slowing the transfusion delays treatment, and obtaining a urine
specimen is secondary to stopping the reaction.
Page 4
COMPLETE QUESTIONS AND CORRECT ANSWERS
PLUS RATIONALE NEW UPDATE 2026-2027 GALEN
93 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Analyze hemodynamic and ventilatory data to prioritize nursing interventions for critically ill adults
2 Differentiate endocrine, renal, and hematologic emergencies using laboratory and clinical findings to
guide safe medication and transfusion decisions
3 Apply evidence-based protocols for sepsis, increased intracranial pressure, and oncologic emergencies
while recognizing contraindications and complications
4 NUR 265 Exam 4
5 Style Review Guide
6 V1 & V2
7 Complete Questions and Correct Answers plus Rationale New Update 2026
8 2027 Galen
9 Foundations of Medical-Surgical Nursing / Complex Adult Health
10 Applied Medical-Surgical Nursing / Complex Adult Health
11 Advanced Medical-Surgical Nursing / Complex Adult Health
12 Medical-Surgical Nursing / Complex Adult Health Review
ABSTRACT
Page 1
,This study document brings together 93 carefully worded exam questions drawn from NUR 265
Exam 4 - ATI-Style Review Guide (V1 & V2) Complete Questions and Correct Answers plus
Rationale New Update 2026-2027 Galen, with the strongest emphasis placed on Analyze
hemodynamic and ventilatory data to prioritize nursing interventions for critically ill adults,
Differentiate endocrine, renal, and hematologic emergencies using laboratory and clinical findings
to guide safe medication and transfusion decisions, Apply evidence-based protocols for sepsis,
increased intracranial pressure and and oncologic emergencies while recognizing contraindications
and complications. Every item follows the wording style and level of reasoning you meet in the real
paper, and each one is paired with a clear rationale so the correct choice is never a guess. Work
through the set at your own pace, mark the questions that slow you down, then come back to them
until the reasoning feels automatic. Learners who revise this way walk into the exam room
recognising the pattern behind the questions instead of meeting them for the first time. Keep going
- steady, honest practice is what turns a difficult paper into a comfortable pass.
Q1 ANALYZE HEMODYNAMIC AND VENTILATORY DATA TO PRIORITIZE NURSING
INTERVENTIONS FOR CRITICALLY ILL ADULTS
A patient with septic shock has been fluid-resuscitated and started on
norepinephrine. Which parameter best indicates that the norepinephrine is
achieving its intended therapeutic effect at the tissue level?
A. Mean arterial pressure sustained at 65 mm Hg or greater
B. Central venous oxygen saturation (ScvO2) of 70% or greater CORRECT
C. Urine output of 0.5 mL/kg/hr or greater
D. Central venous pressure of 8 to 12 mm Hg
RATIONALE: ScvO2 reflects the balance between oxygen delivery and consumption, so a value
70% indicates improved tissue perfusion, the ultimate goal of vasopressor therapy. MAP and
urine output are targets but do not directly confirm adequate tissue oxygenation, and CVP
reflects preload rather than the effect of norepinephrine.
Page 2
,Q2 ANALYZE HEMODYNAMIC AND VENTILATORY DATA TO PRIORITIZE NURSING
INTERVENTIONS FOR CRITICALLY ILL ADULTS
A patient on volume-control mechanical ventilation has the following data: PIP 42
cm H2O, plateau pressure 34 cm H2O, tidal volume 500 mL, PEEP 8 cm H2O.
Which action should the nurse anticipate?
A. Increase the respiratory rate to improve minute ventilation
B. Reduce tidal volume to 4-6 mL/kg predicted body weight CORRECT
C. Increase PEEP to 12 cm H2O to recruit collapsed alveoli
D. Suction the airway to relieve a mucus plug
RATIONALE: A plateau pressure >30 cm H2O indicates alveolar overdistention and risk for
ventilator-induced lung injury, so lung-protective ventilation with 4-6 mL/kg predicted body weight
is indicated. Increasing PEEP or tidal volume would worsen overdistention, and suctioning
addresses airway resistance, not elevated plateau pressure.
Q3 ANALYZE HEMODYNAMIC AND VENTILATORY DATA TO PRIORITIZE NURSING
INTERVENTIONS FOR CRITICALLY ILL ADULTS
A patient in diabetic ketoacidosis has a serum potassium of 3.1 mEq/L. Which
prescription should the nurse question?
A. Administer 0.9% sodium chloride IV bolus
B. Start an insulin infusion at 0.1 units/kg/hr CORRECT
C. Add 20 mEq KCl to the IV fluids
D. Monitor blood glucose every hour
RATIONALE: Insulin drives potassium intracellularly and can precipitate life-threatening
hypokalemia when serum potassium is already <3.3 mEq/L, so insulin should be withheld until
potassium is corrected. Fluid resuscitation, potassium replacement, and glucose monitoring are
appropriate in DKA management.
Page 3
, Q4 ANALYZE HEMODYNAMIC AND VENTILATORY DATA TO PRIORITIZE NURSING
INTERVENTIONS FOR CRITICALLY ILL ADULTS
A patient with acute kidney injury receiving continuous renal replacement therapy
(CRRT) develops a sudden drop in circuit pressure with dark, cloudy effluent.
Which complication should the nurse suspect?
A. Air embolism
B. Filter clotting CORRECT
C. Hypophosphatemia
D. Dialysis disequilibrium syndrome
RATIONALE: A sudden pressure change with dark, cloudy effluent indicates clotting within the
hemofilter, which reduces clearance and requires circuit change. Air embolism presents with
cardiovascular collapse, hypophosphatemia is a metabolic complication, and disequilibrium
syndrome occurs with rapid solute removal, not circuit pressure changes.
Q5 ANALYZE HEMODYNAMIC AND VENTILATORY DATA TO PRIORITIZE NURSING
INTERVENTIONS FOR CRITICALLY ILL ADULTS
A patient receiving a blood transfusion develops fever, chills, and flank pain 15
minutes into the infusion. Which action should the nurse take first?
A. Administer acetaminophen and continue the transfusion
B. Stop the transfusion and maintain IV access with normal saline CORRECT
C. Slow the transfusion rate and reassess in 15 minutes
D. Obtain a urine specimen for hemoglobinuria
RATIONALE: Fever, chills, and flank pain suggest an acute hemolytic transfusion reaction, so the
transfusion must be stopped immediately and IV access maintained with normal saline to support
renal perfusion. Continuing or slowing the transfusion delays treatment, and obtaining a urine
specimen is secondary to stopping the reaction.
Page 4
