NUR 265 Exam 1 | NUR 265 Advanced Medical-Surgical
Nursing | Questions and Answers with Rationales
2026/2027 Update
Question 1
A client with acute respiratory distress syndrome (ARDS) is mechanically
ventilated with positive end-expiratory pressure (PEEP) set at 12 cm H2O. Which
assessment finding indicates a potential life-threatening complication of high
PEEP levels?
A) Blood pressure drop from 125/82 mmHg to 84/50 mmHg and diminished
breath sounds on the left side
B) Increase in arterial oxygen saturation from 88% to 97%
C) PaCO2 of 38 mmHg and arterial pH of 7.42
D) Soft, non-distended abdomen with active bowel sounds
Correct Answer: A
Rationale: High levels of positive end-expiratory pressure (PEEP) increase
intrathoracic pressure, which can impede venous return and lead to a significant
drop in cardiac output and systemic blood pressure. Furthermore, excessive
alveolar pressure can cause barotrauma, resulting in a tension pneumothorax
manifested by absent or diminished breath sounds on the affected side.
Question 2
A client is admitted to the intensive care unit with severe sepsis. Hemodynamic
monitoring shows a central venous pressure (CVP) of 2 mmHg, a mean arterial
pressure (MAP) of 54 mmHg, and a urine output of 15 mL/hr over the past 2
hours. Which collaborative order should the nurse implement first?
A) Administer furosemide 40 mg IV push
B) Initiate an IV fluid bolus of 0.9 percent sodium chloride at 30 mL/kg
C) Start a continuous infusion of dopamine at 10 mcg/kg/min
,D) Prepare for immediate endotracheal intubation
Correct Answer: B
Rationale:* The client is exhibiting signs of septic shock characterized by
hypovolemia (low CVP), hypotension (low MAP), and inadequate organ perfusion
(oliguria). Surviving Sepsis Campaign guidelines recommend initial fluid
resuscitation with at least 30 mL/kg of crystalloid fluids as the primary priority
before initiating vasopressor therapy.
Question 3
An adult client is admitted to the burn unit with full-thickness burns over 40
percent of total body surface area sustained 2 hours ago. Using the Parkland
formula, calculate the total volume of lactated Ringer solution that should be
infused in the first 8 hours post-injury for an 80 kg client.
A) 3200 mL
B) 6400 mL
C) 12800 mL
D) 2560 mL
Correct Answer: B
Rationale:* The Parkland formula is 4 mL of lactated Ringer solution per kilogram
of body weight per percent total body surface area burned. Exactly half of this
total volume is to be administered in the first 8 hours following the time of injury.
Question 4
A client with a traumatic brain injury has an intracranial pressure of 22 mmHg and
a mean arterial pressure of 80 mmHg. What is the client cerebral perfusion
pressure, and is it within the normal therapeutic range?
A) Cerebral perfusion pressure is 58 mmHg, which is below the normal
therapeutic range.
B) Cerebral perfusion pressure is 102 mmHg, which is above the normal
therapeutic range.
,C) Cerebral perfusion pressure is 58 mmHg, which is within the normal
therapeutic range.
D) Cerebral perfusion pressure is 102 mmHg, which is within the normal
therapeutic range.
Correct Answer: A
Rationale:* Cerebral perfusion pressure is calculated as mean arterial pressure
minus intracranial pressure. The normal therapeutic range for cerebral perfusion
pressure in adults with a traumatic brain injury is 60 to 100 mmHg. A value of 58
mmHg indicates inadequate cerebral blood flow and ischemia risk.
Question 5
A client in the neurological intensive care unit with increased intracranial pressure
is prescribed mannitol 20 percent IV. Which laboratory value should the nurse
monitor most closely during therapy?
A) Serum sodium and serum osmolality
B) Prothrombin time and international normalized ratio
C) Serum potassium and serum magnesium
D) Blood urea nitrogen and white blood cell count
Correct Answer: A
Rationale:* Mannitol is an osmotic diuretic that draws water from brain tissue
into the vascular space. Excessive diuresis can lead to severe hyperosmolar states,
electrolyte imbalances, and dramatic shifts in serum sodium and serum
osmolality. Serum osmolality should typically be maintained below 320 mOsm/kg.
Question 6
A client is brought to the emergency department following a motor vehicle
collision with signs of cardiac tamponade. Which classic clinical manifestations
should the nurse expect to find during the assessment?
A) Hypotension, muffled heart sounds, and distended neck veins
B) Hypertension, bounding peripheral pulses, and clear breath sounds
, C) Tracheal deviation, absent breath sounds, and hyperresonance
D) Bradycardia, widening pulse pressure, and irregular respirations
Correct Answer: A
Rationale:* Beck triad is the classic presentation of cardiac tamponade, consisting
of hypotension, muffled heart sounds, and jugular venous distension (distended
neck veins) caused by restricted ventricular filling from fluid accumulation in the
pericardial sac.
Question 7
A nurse is managing a client receiving mechanical ventilation who suddenly
develops a high-pressure ventilator alarm. What is the most common cause of a
high-pressure alarm?
A) Disconnection of the ventilator tubing circuit
B) Excess airway secretions, coughing, or biting on the endotracheal tube
C) Leak in the endotracheal tube cuff
D) Accidental extubation of the client
Correct Answer: B
Rationale:* High-pressure alarms are triggered when the ventilator encounters
increased resistance, which can be caused by the client coughing, biting the
endotracheal tube, excess secretions, bronchospasm, or kinking of the circuit.
Disconnections and leaks trigger low-pressure alarms.
Question 8
A client with chronic kidney disease on hemodialysis presents with a serum
potassium level of 6.8 mEq/L and peaked T waves on the electrocardiogram.
Which medication should the nurse administer first to protect the myocardium
from lethal arrhythmias?
A) Regular insulin 10 units IV with 50 mL of 50 percent dextrose
B) Sodium polystyrene sulfonate oral suspension
C) Intravenous calcium gluconate
Nursing | Questions and Answers with Rationales
2026/2027 Update
Question 1
A client with acute respiratory distress syndrome (ARDS) is mechanically
ventilated with positive end-expiratory pressure (PEEP) set at 12 cm H2O. Which
assessment finding indicates a potential life-threatening complication of high
PEEP levels?
A) Blood pressure drop from 125/82 mmHg to 84/50 mmHg and diminished
breath sounds on the left side
B) Increase in arterial oxygen saturation from 88% to 97%
C) PaCO2 of 38 mmHg and arterial pH of 7.42
D) Soft, non-distended abdomen with active bowel sounds
Correct Answer: A
Rationale: High levels of positive end-expiratory pressure (PEEP) increase
intrathoracic pressure, which can impede venous return and lead to a significant
drop in cardiac output and systemic blood pressure. Furthermore, excessive
alveolar pressure can cause barotrauma, resulting in a tension pneumothorax
manifested by absent or diminished breath sounds on the affected side.
Question 2
A client is admitted to the intensive care unit with severe sepsis. Hemodynamic
monitoring shows a central venous pressure (CVP) of 2 mmHg, a mean arterial
pressure (MAP) of 54 mmHg, and a urine output of 15 mL/hr over the past 2
hours. Which collaborative order should the nurse implement first?
A) Administer furosemide 40 mg IV push
B) Initiate an IV fluid bolus of 0.9 percent sodium chloride at 30 mL/kg
C) Start a continuous infusion of dopamine at 10 mcg/kg/min
,D) Prepare for immediate endotracheal intubation
Correct Answer: B
Rationale:* The client is exhibiting signs of septic shock characterized by
hypovolemia (low CVP), hypotension (low MAP), and inadequate organ perfusion
(oliguria). Surviving Sepsis Campaign guidelines recommend initial fluid
resuscitation with at least 30 mL/kg of crystalloid fluids as the primary priority
before initiating vasopressor therapy.
Question 3
An adult client is admitted to the burn unit with full-thickness burns over 40
percent of total body surface area sustained 2 hours ago. Using the Parkland
formula, calculate the total volume of lactated Ringer solution that should be
infused in the first 8 hours post-injury for an 80 kg client.
A) 3200 mL
B) 6400 mL
C) 12800 mL
D) 2560 mL
Correct Answer: B
Rationale:* The Parkland formula is 4 mL of lactated Ringer solution per kilogram
of body weight per percent total body surface area burned. Exactly half of this
total volume is to be administered in the first 8 hours following the time of injury.
Question 4
A client with a traumatic brain injury has an intracranial pressure of 22 mmHg and
a mean arterial pressure of 80 mmHg. What is the client cerebral perfusion
pressure, and is it within the normal therapeutic range?
A) Cerebral perfusion pressure is 58 mmHg, which is below the normal
therapeutic range.
B) Cerebral perfusion pressure is 102 mmHg, which is above the normal
therapeutic range.
,C) Cerebral perfusion pressure is 58 mmHg, which is within the normal
therapeutic range.
D) Cerebral perfusion pressure is 102 mmHg, which is within the normal
therapeutic range.
Correct Answer: A
Rationale:* Cerebral perfusion pressure is calculated as mean arterial pressure
minus intracranial pressure. The normal therapeutic range for cerebral perfusion
pressure in adults with a traumatic brain injury is 60 to 100 mmHg. A value of 58
mmHg indicates inadequate cerebral blood flow and ischemia risk.
Question 5
A client in the neurological intensive care unit with increased intracranial pressure
is prescribed mannitol 20 percent IV. Which laboratory value should the nurse
monitor most closely during therapy?
A) Serum sodium and serum osmolality
B) Prothrombin time and international normalized ratio
C) Serum potassium and serum magnesium
D) Blood urea nitrogen and white blood cell count
Correct Answer: A
Rationale:* Mannitol is an osmotic diuretic that draws water from brain tissue
into the vascular space. Excessive diuresis can lead to severe hyperosmolar states,
electrolyte imbalances, and dramatic shifts in serum sodium and serum
osmolality. Serum osmolality should typically be maintained below 320 mOsm/kg.
Question 6
A client is brought to the emergency department following a motor vehicle
collision with signs of cardiac tamponade. Which classic clinical manifestations
should the nurse expect to find during the assessment?
A) Hypotension, muffled heart sounds, and distended neck veins
B) Hypertension, bounding peripheral pulses, and clear breath sounds
, C) Tracheal deviation, absent breath sounds, and hyperresonance
D) Bradycardia, widening pulse pressure, and irregular respirations
Correct Answer: A
Rationale:* Beck triad is the classic presentation of cardiac tamponade, consisting
of hypotension, muffled heart sounds, and jugular venous distension (distended
neck veins) caused by restricted ventricular filling from fluid accumulation in the
pericardial sac.
Question 7
A nurse is managing a client receiving mechanical ventilation who suddenly
develops a high-pressure ventilator alarm. What is the most common cause of a
high-pressure alarm?
A) Disconnection of the ventilator tubing circuit
B) Excess airway secretions, coughing, or biting on the endotracheal tube
C) Leak in the endotracheal tube cuff
D) Accidental extubation of the client
Correct Answer: B
Rationale:* High-pressure alarms are triggered when the ventilator encounters
increased resistance, which can be caused by the client coughing, biting the
endotracheal tube, excess secretions, bronchospasm, or kinking of the circuit.
Disconnections and leaks trigger low-pressure alarms.
Question 8
A client with chronic kidney disease on hemodialysis presents with a serum
potassium level of 6.8 mEq/L and peaked T waves on the electrocardiogram.
Which medication should the nurse administer first to protect the myocardium
from lethal arrhythmias?
A) Regular insulin 10 units IV with 50 mL of 50 percent dextrose
B) Sodium polystyrene sulfonate oral suspension
C) Intravenous calcium gluconate
