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NUR 265 ADVANCED MEDICAL-SURGICAL
NURSING FINAL ACTUAL EXAM PREP 2026 ALL
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES ALREADY A
GRADED WITH EXPERT FEEDBACK|NEW AND
REVISED
1. A 68-year-old male presents with acute onset of severe chest pain,
diaphoresis, and nausea. ECG reveals ST-segment elevation in leads V1-
V4. Which of the following is the priority nursing intervention?
A. Administer morphine sulfate IV
B. Prepare the client for immediate percutaneous coronary
intervention (PCI)
C. Administer sublingual nitroglycerin
D. Obtain a 12-lead ECG
Rationale: ST-segment elevation in leads V1-V4 indicates an anterior
STEMI. The priority is to restore coronary perfusion; PCI within 90
minutes of arrival is the gold standard. While morphine and
nitroglycerin are important, they are secondary to reperfusion therapy.
The ECG is already obtained, as indicated in the stem.
2. A client with heart failure (HFrEF) is prescribed carvedilol. Which of
the following is the most important teaching point regarding this
medication?
A. Take the medication with food to increase absorption
B. Monitor for signs of bradycardia and report a heart rate below
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60 bpm
C. The medication will cause immediate improvement in symptoms
D. The medication can be stopped abruptly if dizziness occurs
Rationale: Carvedilol is a beta-blocker that can cause bradycardia.
Clients should monitor their pulse and report rates below 60 bpm. It
should be taken with food to reduce orthostatic hypotension. Symptom
improvement is gradual, and the medication must be tapered off, not
abruptly discontinued.
3. A client is receiving IV furosemide for acute pulmonary edema.
Which of the following assessment findings indicates the medication is
having the desired effect?
A. Increased blood pressure
B. Increased heart rate
C. Decreased respiratory rate and crackles
D. Increased urine output only
Rationale: Furosemide reduces fluid volume, decreasing pulmonary
congestion. Desired effects include decreased dyspnea, decreased
crackles, and decreased respiratory rate. While increased urine output
is expected, the most clinically significant finding is improvement in
respiratory status.
4. A client with chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 2 L/min via nasal cannula. Which of the following is
the target oxygen saturation for this client?
A. 95-100%
B. 88-92%
C. 85-88%
D. 90-95%
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Rationale: For clients with COPD, the target oxygen saturation is 88-
92% to avoid suppressing the hypoxic drive. Higher saturations may
lead to CO₂ retention and respiratory acidosis. The hypoxic drive is the
primary stimulus to breathe in some clients with chronic hypercapnia.
5. A client with acute respiratory distress syndrome (ARDS) is on
mechanical ventilation with a PaO₂/FiO₂ ratio of 150. Which of the
following is an appropriate intervention?
A. Increase the FiO₂ to 100%
B. Place the client in the Trendelenburg position
C. Initiate prone positioning
D. Decrease the PEEP to improve cardiac output
Rationale: Prone positioning improves oxygenation in ARDS by
recruiting dorsal lung units and improving ventilation-perfusion
matching. A PaO₂/FiO₂ ratio <150 is an indication for prone
positioning. Increasing FiO₂ to 100% may cause oxygen toxicity, and
PEEP should be optimized, not decreased.
6. A client with a subarachnoid hemorrhage is at risk for vasospasm.
Which of the following medications is used to prevent or treat
vasospasm?
A. Mannitol
B. Nimodipine
C. Phenytoin
D. Dexamethasone
Rationale: Nimodipine is a calcium channel blocker that prevents and
treats cerebral vasospasm following subarachnoid hemorrhage,
improving neurological outcomes. Mannitol is used for increased
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intracranial pressure. Phenytoin is used for seizures. Dexamethasone
is used for cerebral edema from tumors.
7. A client with cirrhosis is prescribed lactulose. Which of the following
is the purpose of this medication?
A. To decrease portal hypertension
B. To increase serum albumin
C. To reduce serum ammonia levels
D. To promote diuresis
Rationale: Lactulose is a non-absorbable disaccharide used to treat
hepatic encephalopathy by converting ammonia (NH₃) to ammonium
(NH₄⁺) in the colon, which is then excreted in the stool. It does not
affect portal hypertension, albumin, or diuresis.
8. A client with acute pancreatitis is complaining of severe abdominal
pain. Which of the following medications is preferred for pain
management?
A. Morphine sulfate
B. Fentanyl
C. Meperidine
D. Hydromorphone
Rationale: Fentanyl is preferred for pain management in acute
pancreatitis because it has minimal effect on the sphincter of Oddi,
unlike morphine. Morphine can cause sphincter spasm, theoretically
worsening pancreatitis. Meperidine is no longer recommended due to
neurotoxicity.
NUR 265 ADVANCED MEDICAL-SURGICAL
NURSING FINAL ACTUAL EXAM PREP 2026 ALL
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES ALREADY A
GRADED WITH EXPERT FEEDBACK|NEW AND
REVISED
1. A 68-year-old male presents with acute onset of severe chest pain,
diaphoresis, and nausea. ECG reveals ST-segment elevation in leads V1-
V4. Which of the following is the priority nursing intervention?
A. Administer morphine sulfate IV
B. Prepare the client for immediate percutaneous coronary
intervention (PCI)
C. Administer sublingual nitroglycerin
D. Obtain a 12-lead ECG
Rationale: ST-segment elevation in leads V1-V4 indicates an anterior
STEMI. The priority is to restore coronary perfusion; PCI within 90
minutes of arrival is the gold standard. While morphine and
nitroglycerin are important, they are secondary to reperfusion therapy.
The ECG is already obtained, as indicated in the stem.
2. A client with heart failure (HFrEF) is prescribed carvedilol. Which of
the following is the most important teaching point regarding this
medication?
A. Take the medication with food to increase absorption
B. Monitor for signs of bradycardia and report a heart rate below
,2|Page
60 bpm
C. The medication will cause immediate improvement in symptoms
D. The medication can be stopped abruptly if dizziness occurs
Rationale: Carvedilol is a beta-blocker that can cause bradycardia.
Clients should monitor their pulse and report rates below 60 bpm. It
should be taken with food to reduce orthostatic hypotension. Symptom
improvement is gradual, and the medication must be tapered off, not
abruptly discontinued.
3. A client is receiving IV furosemide for acute pulmonary edema.
Which of the following assessment findings indicates the medication is
having the desired effect?
A. Increased blood pressure
B. Increased heart rate
C. Decreased respiratory rate and crackles
D. Increased urine output only
Rationale: Furosemide reduces fluid volume, decreasing pulmonary
congestion. Desired effects include decreased dyspnea, decreased
crackles, and decreased respiratory rate. While increased urine output
is expected, the most clinically significant finding is improvement in
respiratory status.
4. A client with chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 2 L/min via nasal cannula. Which of the following is
the target oxygen saturation for this client?
A. 95-100%
B. 88-92%
C. 85-88%
D. 90-95%
,3|Page
Rationale: For clients with COPD, the target oxygen saturation is 88-
92% to avoid suppressing the hypoxic drive. Higher saturations may
lead to CO₂ retention and respiratory acidosis. The hypoxic drive is the
primary stimulus to breathe in some clients with chronic hypercapnia.
5. A client with acute respiratory distress syndrome (ARDS) is on
mechanical ventilation with a PaO₂/FiO₂ ratio of 150. Which of the
following is an appropriate intervention?
A. Increase the FiO₂ to 100%
B. Place the client in the Trendelenburg position
C. Initiate prone positioning
D. Decrease the PEEP to improve cardiac output
Rationale: Prone positioning improves oxygenation in ARDS by
recruiting dorsal lung units and improving ventilation-perfusion
matching. A PaO₂/FiO₂ ratio <150 is an indication for prone
positioning. Increasing FiO₂ to 100% may cause oxygen toxicity, and
PEEP should be optimized, not decreased.
6. A client with a subarachnoid hemorrhage is at risk for vasospasm.
Which of the following medications is used to prevent or treat
vasospasm?
A. Mannitol
B. Nimodipine
C. Phenytoin
D. Dexamethasone
Rationale: Nimodipine is a calcium channel blocker that prevents and
treats cerebral vasospasm following subarachnoid hemorrhage,
improving neurological outcomes. Mannitol is used for increased
, 4|Page
intracranial pressure. Phenytoin is used for seizures. Dexamethasone
is used for cerebral edema from tumors.
7. A client with cirrhosis is prescribed lactulose. Which of the following
is the purpose of this medication?
A. To decrease portal hypertension
B. To increase serum albumin
C. To reduce serum ammonia levels
D. To promote diuresis
Rationale: Lactulose is a non-absorbable disaccharide used to treat
hepatic encephalopathy by converting ammonia (NH₃) to ammonium
(NH₄⁺) in the colon, which is then excreted in the stool. It does not
affect portal hypertension, albumin, or diuresis.
8. A client with acute pancreatitis is complaining of severe abdominal
pain. Which of the following medications is preferred for pain
management?
A. Morphine sulfate
B. Fentanyl
C. Meperidine
D. Hydromorphone
Rationale: Fentanyl is preferred for pain management in acute
pancreatitis because it has minimal effect on the sphincter of Oddi,
unlike morphine. Morphine can cause sphincter spasm, theoretically
worsening pancreatitis. Meperidine is no longer recommended due to
neurotoxicity.
