NUR 265 Final Exam | 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 10 cm H2O. Which
assessment finding indicates a potential complication of high PEEP levels?
A) Blood pressure drop from 120/80 mmHg to 88/50 mmHg and diminished
breath sounds on the left side
B) Increase in arterial oxygen saturation from 88% to 96%
C) PaCO2 of 40 mmHg and pH of 7.40
D) Soft, flat 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 cause a significant
drop in cardiac output and blood pressure. Furthermore, high pressure can lead
to alveolar overdistension and barotrauma, manifesting as a tension
pneumothorax with diminished breath sounds on the affected side.
Question 2
A nurse is caring for a client admitted with severe sepsis who has a central venous
pressure (CVP) of 2 mmHg, a mean arterial pressure (MAP) of 55 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% 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 with hypovolemia (low
CVP), hypotension (low MAP), and inadequate organ perfusion (oliguria).
Surviving Sepsis Campaign guidelines recommend initial resuscitation with at least
30 mL/kg of crystalloid fluids as the primary priority before starting vasopressors.
Question 3
An adult client is admitted to the burn unit with full-thickness burns over 40% of
total body surface area (TBSA) sustained 2 hours ago. Using the Parkland formula,
calculate the total volume of lactated Ringer's 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's per kilogram of body
weight per percent TBSA burned. 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 (TBI) has an intracranial pressure (ICP) of 22
mmHg and a mean arterial pressure (MAP) of 80 mmHg. What is the client's
cerebral perfusion pressure (CPP), and is it within the normal therapeutic range?
A) CPP is 58 mmHg, which is below the normal therapeutic range.
B) CPP is 102 mmHg, which is above the normal therapeutic range.
C) CPP is 58 mmHg, which is within the normal therapeutic range.
D) CPP is 102 mmHg, which is within the normal therapeutic range.
,Correct Answer: A
Rationale:* The normal therapeutic range for CPP in adults with a TBI is 60 to 100
mmHg. A CPP of 58 mmHg indicates inadequate cerebral perfusion.
Question 5
A client in the neurological intensive care unit with increased intracranial pressure
is prescribed mannitol 20% 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 magnesium
D) Blood urea nitrogen and white blood cell count
Correct Answer: A
Rationale:* Mannitol is an osmotic diuretic that pulls fluid from the 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 admitted 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 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's triad is the classic presentation of cardiac tamponade,
consisting of hypotension, muffled heart sounds, and jugular venous distension
, (distended neck veins) due to restricted ventricular filling from fluid accumulation
in the pericardial sac.
Question 7
A nurse is managing a client receiving mechanical ventilation who develops a
high-pressure alarm. What is the most common cause of a high-pressure
ventilator alarm?
A) Disconnection of the ventilator tubing circuit
B) Secretions, coughing, or biting on the endotracheal tube
C) Leak in the endotracheal tube cuff
D) Extubation of the client
Correct Answer: B
Rationale:* High-pressure alarms are triggered when the ventilator encounters
increased resistance, which can be caused by client coughing, biting the tube,
excess airway secretions, bronchospasm, or kinking of the ventilator tubing.
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% dextrose
B) Sodium polystyrene sulfonate oral suspension
C) Intravenous calcium gluconate
D) Intravenous sodium bicarbonate infusion
Correct Answer: C
Rationale:* While insulin/glucose, bicarbonate, and binders help shift or eliminate
potassium, intravenous calcium gluconate does not lower serum potassium;
rather, it stabilizes the cardiac cell membrane threshold against the depolarizing
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 10 cm H2O. Which
assessment finding indicates a potential complication of high PEEP levels?
A) Blood pressure drop from 120/80 mmHg to 88/50 mmHg and diminished
breath sounds on the left side
B) Increase in arterial oxygen saturation from 88% to 96%
C) PaCO2 of 40 mmHg and pH of 7.40
D) Soft, flat 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 cause a significant
drop in cardiac output and blood pressure. Furthermore, high pressure can lead
to alveolar overdistension and barotrauma, manifesting as a tension
pneumothorax with diminished breath sounds on the affected side.
Question 2
A nurse is caring for a client admitted with severe sepsis who has a central venous
pressure (CVP) of 2 mmHg, a mean arterial pressure (MAP) of 55 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% 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 with hypovolemia (low
CVP), hypotension (low MAP), and inadequate organ perfusion (oliguria).
Surviving Sepsis Campaign guidelines recommend initial resuscitation with at least
30 mL/kg of crystalloid fluids as the primary priority before starting vasopressors.
Question 3
An adult client is admitted to the burn unit with full-thickness burns over 40% of
total body surface area (TBSA) sustained 2 hours ago. Using the Parkland formula,
calculate the total volume of lactated Ringer's 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's per kilogram of body
weight per percent TBSA burned. 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 (TBI) has an intracranial pressure (ICP) of 22
mmHg and a mean arterial pressure (MAP) of 80 mmHg. What is the client's
cerebral perfusion pressure (CPP), and is it within the normal therapeutic range?
A) CPP is 58 mmHg, which is below the normal therapeutic range.
B) CPP is 102 mmHg, which is above the normal therapeutic range.
C) CPP is 58 mmHg, which is within the normal therapeutic range.
D) CPP is 102 mmHg, which is within the normal therapeutic range.
,Correct Answer: A
Rationale:* The normal therapeutic range for CPP in adults with a TBI is 60 to 100
mmHg. A CPP of 58 mmHg indicates inadequate cerebral perfusion.
Question 5
A client in the neurological intensive care unit with increased intracranial pressure
is prescribed mannitol 20% 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 magnesium
D) Blood urea nitrogen and white blood cell count
Correct Answer: A
Rationale:* Mannitol is an osmotic diuretic that pulls fluid from the 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 admitted 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 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's triad is the classic presentation of cardiac tamponade,
consisting of hypotension, muffled heart sounds, and jugular venous distension
, (distended neck veins) due to restricted ventricular filling from fluid accumulation
in the pericardial sac.
Question 7
A nurse is managing a client receiving mechanical ventilation who develops a
high-pressure alarm. What is the most common cause of a high-pressure
ventilator alarm?
A) Disconnection of the ventilator tubing circuit
B) Secretions, coughing, or biting on the endotracheal tube
C) Leak in the endotracheal tube cuff
D) Extubation of the client
Correct Answer: B
Rationale:* High-pressure alarms are triggered when the ventilator encounters
increased resistance, which can be caused by client coughing, biting the tube,
excess airway secretions, bronchospasm, or kinking of the ventilator tubing.
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% dextrose
B) Sodium polystyrene sulfonate oral suspension
C) Intravenous calcium gluconate
D) Intravenous sodium bicarbonate infusion
Correct Answer: C
Rationale:* While insulin/glucose, bicarbonate, and binders help shift or eliminate
potassium, intravenous calcium gluconate does not lower serum potassium;
rather, it stabilizes the cardiac cell membrane threshold against the depolarizing
