,NUR 265 Exam 4 | Advanced Concepts of Medical-
Surgical Nursing (2026) Q&A | Galen College
1. A patient with HIV has a CD4+ count of 180 cells/µL and reports fever,
headache, and stiff neck. The nurse suspects which opportunistic infection?
A) Pneumocystis jirovecii pneumonia
B) Cryptococcal meningitis
C) Cytomegalovirus retinitis
D) Toxoplasmosis encephalitis
Correct Answer: Cryptococcal meningitis
Rationale: Cryptococcal meningitis is a fungal CNS infection common when CD4+
drops below 200. Symptoms include fever, headache, and nuchal rigidity. PJP
presents with respiratory symptoms, CMV with visual changes, and
toxoplasmosis with focal neurological deficits.
2. The nurse is teaching a patient with AIDS about preventing infection. Which
statement by the patient indicates a need for further teaching?
A) "I will clean my toothbrush in the dishwasher."
B) "I will avoid drinking water that has been standing for longer than an hour."
C) "I will wear a surgical mask when changing my cat's litter box."
D) "I will notify my provider if my temperature is above 100°F."
Correct Answer: "I will wear a surgical mask when changing my cat's litter box."
,Rationale: A mask alone is insufficient; patients with AIDS should avoid
changing cat litter due to toxoplasmosis risk. If unavoidable, they should wear
gloves and a mask, and wash hands thoroughly. The other statements reflect
correct prevention measures.
3. A patient who had a heart transplant 24 hours ago develops hypotension and
tachycardia. The nurse suspects which complication?
A) Infection
B) Acute graft rejection
C) Fluid overload
D) Medication side effect
Correct Answer: Acute graft rejection
Rationale: Hypotension and tachycardia may indicate acute rejection, where the
immune system attacks the donor heart. This requires immediate evaluation
and intervention. Infection may cause fever, and fluid overload would cause
hypertension.
4. The nurse is assessing a patient 10 days after a lung transplant. Which finding
is most concerning?
A) Clear sputum
B) Yellow-tinged sputum
C) Mild shortness of breath on exertion
D) Temperature 99.0°F
Correct Answer: Yellow-tinged sputum
, Rationale: Yellow or purulent sputum suggests infection or possible rejection
and requires prompt investigation. Clear sputum is normal; mild dyspnea and
low-grade temperature are less immediately alarming.
5. A patient 48 hours post-liver transplant has decreased urine output from 50
to 30 mL/hr and increased serum bilirubin. What is the priority nursing action?
A) Document the findings
B) Increase IV fluid rate independently
C) Notify the transplant team immediately
D) Administer a diuretic as prescribed
Correct Answer: Notify the transplant team immediately
Rationale: Oliguria and rising bilirubin are signs of possible graft dysfunction or
rejection. The transplant team must be notified for urgent assessment and
intervention. The nurse should not adjust fluids or give medications without
orders.
6. The nurse is caring for a patient with an ischemic stroke whose symptoms
began 2 hours ago. What is the priority intervention?
A) Administer IV alteplase immediately
B) Obtain a non-contrast CT scan of the head
C) Give aspirin 325 mg orally
D) Start a heparin infusion
Correct Answer: Obtain a non-contrast CT scan of the head
Surgical Nursing (2026) Q&A | Galen College
1. A patient with HIV has a CD4+ count of 180 cells/µL and reports fever,
headache, and stiff neck. The nurse suspects which opportunistic infection?
A) Pneumocystis jirovecii pneumonia
B) Cryptococcal meningitis
C) Cytomegalovirus retinitis
D) Toxoplasmosis encephalitis
Correct Answer: Cryptococcal meningitis
Rationale: Cryptococcal meningitis is a fungal CNS infection common when CD4+
drops below 200. Symptoms include fever, headache, and nuchal rigidity. PJP
presents with respiratory symptoms, CMV with visual changes, and
toxoplasmosis with focal neurological deficits.
2. The nurse is teaching a patient with AIDS about preventing infection. Which
statement by the patient indicates a need for further teaching?
A) "I will clean my toothbrush in the dishwasher."
B) "I will avoid drinking water that has been standing for longer than an hour."
C) "I will wear a surgical mask when changing my cat's litter box."
D) "I will notify my provider if my temperature is above 100°F."
Correct Answer: "I will wear a surgical mask when changing my cat's litter box."
,Rationale: A mask alone is insufficient; patients with AIDS should avoid
changing cat litter due to toxoplasmosis risk. If unavoidable, they should wear
gloves and a mask, and wash hands thoroughly. The other statements reflect
correct prevention measures.
3. A patient who had a heart transplant 24 hours ago develops hypotension and
tachycardia. The nurse suspects which complication?
A) Infection
B) Acute graft rejection
C) Fluid overload
D) Medication side effect
Correct Answer: Acute graft rejection
Rationale: Hypotension and tachycardia may indicate acute rejection, where the
immune system attacks the donor heart. This requires immediate evaluation
and intervention. Infection may cause fever, and fluid overload would cause
hypertension.
4. The nurse is assessing a patient 10 days after a lung transplant. Which finding
is most concerning?
A) Clear sputum
B) Yellow-tinged sputum
C) Mild shortness of breath on exertion
D) Temperature 99.0°F
Correct Answer: Yellow-tinged sputum
, Rationale: Yellow or purulent sputum suggests infection or possible rejection
and requires prompt investigation. Clear sputum is normal; mild dyspnea and
low-grade temperature are less immediately alarming.
5. A patient 48 hours post-liver transplant has decreased urine output from 50
to 30 mL/hr and increased serum bilirubin. What is the priority nursing action?
A) Document the findings
B) Increase IV fluid rate independently
C) Notify the transplant team immediately
D) Administer a diuretic as prescribed
Correct Answer: Notify the transplant team immediately
Rationale: Oliguria and rising bilirubin are signs of possible graft dysfunction or
rejection. The transplant team must be notified for urgent assessment and
intervention. The nurse should not adjust fluids or give medications without
orders.
6. The nurse is caring for a patient with an ischemic stroke whose symptoms
began 2 hours ago. What is the priority intervention?
A) Administer IV alteplase immediately
B) Obtain a non-contrast CT scan of the head
C) Give aspirin 325 mg orally
D) Start a heparin infusion
Correct Answer: Obtain a non-contrast CT scan of the head
