NUR265/ NUR 265 Advanced Concepts of
Medical-Surgical Nursing Exam Review Actual Exam
2026/2027 | Complete Exam-Style Questions with
Detailed Rationales | Pass Guaranteed – A+ Graded
Q1: A patient with acute myocardial infarction is prescribed morphine sulfate. Which
assessment finding requires the nurse to hold the medication?
A. Heart rate 88 beats per minute
B. Respiratory rate 10 breaths per minute [CORRECT]
C. Blood pressure 118/72 mmHg
D. Pain rating 8/10
Correct Answer: B
Rationale: Correct because morphine causes respiratory depression; a rate below 12 breaths
per minute requires withholding the dose and notifying the provider.
---
Q2: The nurse is interpreting an ECG rhythm strip showing a sawtooth pattern with a ventricular
rate of 150 beats per minute. Which dysrhythmia is present?
A. Atrial fibrillation
B. Atrial flutter [CORRECT]
C. Ventricular tachycardia
D. Sinus tachycardia
Correct Answer: B
Rationale: Correct because the sawtooth (F-wave) pattern with a rapid atrial rate is
characteristic of atrial flutter, distinguishing it from the irregularly irregular pattern of atrial
fibrillation.
---
Q3: A patient with heart failure has a BNP of 1,200 pg/mL. Which intervention is the priority?
A. Administer furosemide as prescribed. [CORRECT]
B. Increase IV fluid rate.
C. Encourage oral fluid intake.
D. Place in Trendelenburg position.
Correct Answer: A
Rationale: Correct because elevated BNP indicates fluid overload from heart failure; diuresis is
the priority to reduce preload and pulmonary congestion.
,---
Q4: The nurse is assessing a patient with COPD who has an oxygen saturation of 85% on room
air. Which oxygen delivery method is most appropriate?
A. Non-rebreather mask at 10 L/min
B. Nasal cannula at 2 L/min [CORRECT]
C. Simple face mask at 8 L/min
D. Venturi mask at 50%
Correct Answer: B
Rationale: Correct because COPD patients rely on hypoxic drive; low-flow oxygen at 1-2 L/min
via nasal cannula prevents CO2 retention while correcting hypoxemia.
---
Q5: A patient with a traumatic brain injury has a Glasgow Coma Scale score of 6. Which nursing
intervention takes priority?
A. Maintain head of bed at 30 degrees and midline alignment. [CORRECT]
B. Perform oral care every 4 hours.
C. Encourage family visitation.
D. Administer PRN acetaminophen for fever.
Correct Answer: A
Rationale: Correct because elevating the head and maintaining neutral neck alignment
promotes venous drainage and reduces intracranial pressure in severe TBI.
---
Q6: The nurse suspects increased intracranial pressure in a patient with a TBI. Which early sign
is most indicative?
A. Decreased level of consciousness [CORRECT]
B. Fixed and dilated pupils
C. Decerebrate posturing
D. Cushing triad
Correct Answer: A
Rationale: Correct because a declining level of consciousness is the earliest and most reliable
indicator of rising ICP, preceding late signs like Cushing triad.
---
Q7: A patient with diabetes mellitus type 1 has a blood glucose of 480 mg/dL, pH 7.20, and
positive serum ketones. Which intervention is the priority?
, A. Administer regular insulin IV infusion. [CORRECT]
B. Give subcutaneous insulin glargine.
C. Administer sodium bicarbonate bolus.
D. Restrict fluid intake.
Correct Answer: A
Rationale: Correct because DKA requires rapid IV regular insulin to reverse ketosis and lower
glucose; IV route ensures immediate onset and titratability.
---
Q8: The nurse is assessing a patient with SIADH. Which finding is expected?
A. Serum sodium 122 mEq/L [CORRECT]
B. Serum sodium 148 mEq/L
C. Urine output 3 L/day
D. Serum osmolality 310 mOsm/kg
Correct Answer: A
Rationale: Correct because SIADH causes water retention, diluting serum sodium to below 135
mEq/L with concentrated urine.
---
Q9: A patient with chronic kidney disease has a potassium level of 6.8 mEq/L. Which
intervention is the priority?
A. Administer sodium polystyrene sulfonate. [CORRECT]
B. Restrict dietary potassium.
C. Administer furosemide.
D. Prepare for dialysis.
Correct Answer: A
Rationale: Correct because a potassium above 6.5 mEq/L requires immediate treatment;
sodium polystyrene sulfonate exchanges sodium for potassium in the GI tract to lower serum
levels.
---
Q10: A patient on hemodialysis develops muscle cramps and hypotension during treatment.
Which action should the nurse take first?
A. Decrease ultrafiltration rate and administer saline bolus. [CORRECT]
B. Increase ultrafiltration rate.
C. Administer antihypertensive medication.
D. Stop dialysis immediately.
Medical-Surgical Nursing Exam Review Actual Exam
2026/2027 | Complete Exam-Style Questions with
Detailed Rationales | Pass Guaranteed – A+ Graded
Q1: A patient with acute myocardial infarction is prescribed morphine sulfate. Which
assessment finding requires the nurse to hold the medication?
A. Heart rate 88 beats per minute
B. Respiratory rate 10 breaths per minute [CORRECT]
C. Blood pressure 118/72 mmHg
D. Pain rating 8/10
Correct Answer: B
Rationale: Correct because morphine causes respiratory depression; a rate below 12 breaths
per minute requires withholding the dose and notifying the provider.
---
Q2: The nurse is interpreting an ECG rhythm strip showing a sawtooth pattern with a ventricular
rate of 150 beats per minute. Which dysrhythmia is present?
A. Atrial fibrillation
B. Atrial flutter [CORRECT]
C. Ventricular tachycardia
D. Sinus tachycardia
Correct Answer: B
Rationale: Correct because the sawtooth (F-wave) pattern with a rapid atrial rate is
characteristic of atrial flutter, distinguishing it from the irregularly irregular pattern of atrial
fibrillation.
---
Q3: A patient with heart failure has a BNP of 1,200 pg/mL. Which intervention is the priority?
A. Administer furosemide as prescribed. [CORRECT]
B. Increase IV fluid rate.
C. Encourage oral fluid intake.
D. Place in Trendelenburg position.
Correct Answer: A
Rationale: Correct because elevated BNP indicates fluid overload from heart failure; diuresis is
the priority to reduce preload and pulmonary congestion.
,---
Q4: The nurse is assessing a patient with COPD who has an oxygen saturation of 85% on room
air. Which oxygen delivery method is most appropriate?
A. Non-rebreather mask at 10 L/min
B. Nasal cannula at 2 L/min [CORRECT]
C. Simple face mask at 8 L/min
D. Venturi mask at 50%
Correct Answer: B
Rationale: Correct because COPD patients rely on hypoxic drive; low-flow oxygen at 1-2 L/min
via nasal cannula prevents CO2 retention while correcting hypoxemia.
---
Q5: A patient with a traumatic brain injury has a Glasgow Coma Scale score of 6. Which nursing
intervention takes priority?
A. Maintain head of bed at 30 degrees and midline alignment. [CORRECT]
B. Perform oral care every 4 hours.
C. Encourage family visitation.
D. Administer PRN acetaminophen for fever.
Correct Answer: A
Rationale: Correct because elevating the head and maintaining neutral neck alignment
promotes venous drainage and reduces intracranial pressure in severe TBI.
---
Q6: The nurse suspects increased intracranial pressure in a patient with a TBI. Which early sign
is most indicative?
A. Decreased level of consciousness [CORRECT]
B. Fixed and dilated pupils
C. Decerebrate posturing
D. Cushing triad
Correct Answer: A
Rationale: Correct because a declining level of consciousness is the earliest and most reliable
indicator of rising ICP, preceding late signs like Cushing triad.
---
Q7: A patient with diabetes mellitus type 1 has a blood glucose of 480 mg/dL, pH 7.20, and
positive serum ketones. Which intervention is the priority?
, A. Administer regular insulin IV infusion. [CORRECT]
B. Give subcutaneous insulin glargine.
C. Administer sodium bicarbonate bolus.
D. Restrict fluid intake.
Correct Answer: A
Rationale: Correct because DKA requires rapid IV regular insulin to reverse ketosis and lower
glucose; IV route ensures immediate onset and titratability.
---
Q8: The nurse is assessing a patient with SIADH. Which finding is expected?
A. Serum sodium 122 mEq/L [CORRECT]
B. Serum sodium 148 mEq/L
C. Urine output 3 L/day
D. Serum osmolality 310 mOsm/kg
Correct Answer: A
Rationale: Correct because SIADH causes water retention, diluting serum sodium to below 135
mEq/L with concentrated urine.
---
Q9: A patient with chronic kidney disease has a potassium level of 6.8 mEq/L. Which
intervention is the priority?
A. Administer sodium polystyrene sulfonate. [CORRECT]
B. Restrict dietary potassium.
C. Administer furosemide.
D. Prepare for dialysis.
Correct Answer: A
Rationale: Correct because a potassium above 6.5 mEq/L requires immediate treatment;
sodium polystyrene sulfonate exchanges sodium for potassium in the GI tract to lower serum
levels.
---
Q10: A patient on hemodialysis develops muscle cramps and hypotension during treatment.
Which action should the nurse take first?
A. Decrease ultrafiltration rate and administer saline bolus. [CORRECT]
B. Increase ultrafiltration rate.
C. Administer antihypertensive medication.
D. Stop dialysis immediately.
