NUR 265 ADVANCED CONCEPTS IN MED-SURG NURSING
EXAM– QUESTIONS AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS PLUS RATIONALES | GUARANTEED PASS |
LATEST EXAM UPDATE | EXAM PREP | STUDY GUIDE |
PRACTICE TEST| DOWNLOAD INSTANT PDF
1. A patient admitted with acute decompensated heart failure is receiving an infusion of
nitroprusside. Which of the following hemodynamic parameters requires the nurse to
immediately titrate down the infusion?
A. Mean arterial pressure (MAP) drops from 95 mmHg to 68 mmHg
B. Pulmonary capillary wedge pressure (PCWP) decreases from 22 mmHg to 14 mmHg
C. Heart rate decreases from 92 beats per minute to 78 beats per minute
D. Cardiac index increases from 1.8 L/min/m2 to 2.4 L/min/m2
ANSWER: A. Mean arterial pressure (MAP) drops from 95 mmHg to 68 mmHg
Nitroprusside is a potent direct-acting vasodilator that decreases both preload and afterload. A
drop in MAP to 68 mmHg indicates systemic hypotension, which compromises coronary and
cerebral perfusion, requiring immediate titration or cessation. Options B, C, and D reflect
therapeutic improvements in hemodynamics and do not indicate dangerous hypotension.
2. A post-operative cardiothoracic surgery patient suddenly exhibits diminished breath
sounds on the right side, tracheal deviation to the left, and severe agitation. What is the
priority nursing action?
A. Prepare the patient for an emergent stat chest X-ray
B. Administer prescribed rescue intravenous analgesia for agitation
C. Assist the healthcare provider with immediate needle decompression or chest tube insertion
D. Increase the supplemental oxygen flow rate via nasal cannula
ANSWER: C. Assist the healthcare provider with immediate needle decompression or chest
tube insertion
These clinical manifestations are classic indicators of a tension pneumothorax, a life-
threatening complication that causes mediastinal shift and hemodynamic collapse. Immediate
,decompression is required to relieve intrapleural pressure, making a chest X-ray dangerously
time-consuming. Oxygen and pain control do not address the mechanical obstruction.
3. The nurse is managing a client diagnosed with acute respiratory distress syndrome
(ARDS) who is mechanically ventilated. Which ventilator setting strategy is most critical to
incorporate to prevent ventilator-induced lung injury (VILI)?
A. Delivering high tidal volumes (12 mL/kg) to maximize minute ventilation
B. Utilizing low positive end-expiratory pressure (PEEP) levels below 5 cmH2O
C. Applying low tidal volumes (4 to 6 mL/kg of ideal body weight) and maintaining plateau
pressures below 30 cmH2O
D. Maintaining high fraction of inspired oxygen (FiO2) at 1.0 continuously to prevent
desaturation
ANSWER: C. Applying low tidal volumes (4 to 6 mL/kg of ideal body weight) and
maintaining plateau pressures below 30 cmH2O
Lung-protective ventilation strategies in ARDS rely on low tidal volumes to prevent
volutrauma and barotrauma, alongside maintaining low plateau pressures. High tidal volumes
exacerbate alveolar overdistension and injury. High FiO2 levels maintained for long periods
risk oxygen toxicity, and low PEEP fails to prevent alveolar collapse.
4. A patient in the neuro-intensive care unit following a traumatic brain injury has an
intracranial pressure (ICP) reading of 24 mmHg and a mean arterial pressure (MAP) of 85
mmHg. Calculate the cerebral perfusion pressure (CPP) and evaluate the finding.
A. 51 mmHg, which indicates impaired cerebral perfusion
B. 61 mmHg, which is within the normal therapeutic range
C. 109 mmHg, which places the patient at risk for hyperperfusion
D. 65 mmHg, which reflects borderline normal cerebral dynamics
ANSWER: A. 51 mmHg, which indicates impaired cerebral perfusion
Cerebral perfusion pressure is calculated using the formula CPP equals MAP minus ICP (85
minus 24 equals 61? Wait, let's recalculate: 85 minus 24 equals 61 mmHg. Let us check
standard normal CPP ranges, which are 60 to 100 mmHg. Wait, 85 minus 24 is 61 mmHg,
which falls into the lower limit of normal or borderline, but let us re-verify standard clinical
thresholds where target CPP is 60 to 80 mmHg. Let us re-evaluate option values: if MAP is 85
and ICP is 24, 85 - 24 = 61 mmHg. Let us adjust the numbers in the question stem or options
to make 51 correct: if MAP is 75 and ICP is 24, 75 - 24 = 51 mmHg. Let us rewrite the prompt
,stem values so the math aligns with option A: MAP of 75 mmHg and ICP of 24 mmHg yields
51 mmHg, which indicates impaired perfusion since normal is 60 to 100 mmHg.)
Correction for Question 4 text: A patient in the neuro-intensive care unit following a
traumatic brain injury has an intracranial pressure (ICP) reading of 24 mmHg and a mean
arterial pressure (MAP) of 75 mmHg. Calculate the cerebral perfusion pressure (CPP) and
evaluate the finding.
A. 51 mmHg, which indicates impaired cerebral perfusion
B. 61 mmHg, which is within the normal therapeutic range
C. 99 mmHg, which places the patient at risk for cerebral edema
D. 40 mmHg, which represents brain death criteria
ANSWER: A. 51 mmHg, which indicates impaired cerebral perfusion
Cerebral perfusion pressure is calculated by subtracting ICP from MAP (75 minus 24 equals
51 mmHg). The normal therapeutic range for CPP in brain-injured patients is 60 to 100
mmHg. A value of 51 mmHg indicates inadequate cerebral blood flow and ischemia risk.
5. A patient with severe sepsis is receiving norepinephrine via a peripheral IV line in the
forearm. The nurse observes blanching and cool, pale skin surrounding the insertion site
with sluggish capillary refill. What is the immediate priority intervention?
A. Apply warm compresses to the affected site to promote local vasodilation
B. Stop the infusion immediately and notify the provider to obtain an order for subcutaneous
phentolamine
C. Elevate the affected extremity and administer a rapid intravenous bolus of normal saline
D. Aspirate as much fluid as possible from the catheter and flush with heparinized saline
ANSWER: B. Stop the infusion immediately and notify the provider to obtain an order for
subcutaneous phentolamine
Norepinephrine is a potent vasoconstrictor that causes severe tissue necrosis and sloughing if
extravasated. The infusion must be stopped immediately, and phentolamine (an alpha-
adrenergic blocker) should be infiltrated into the affected tissue to counteract localized
vasoconstriction. Warm compresses are generally avoided or used according to specific facility
protocol, but the immediate cessation and reversal agent administration are paramount.
6. An adult client is admitted with diabetic ketoacidosis (DKA). Initial laboratory results
reveal a blood glucose of 520 mg/dL, arterial pH of 7.18, serum bicarbonate of 10 mEq/L,
, and a serum potassium level of 3.2 mEq/L. What is the nurse's priority action before
starting the regular insulin infusion?
A. Administer an immediate IV push bolus of regular insulin
B. Initiate aggressive potassium replacement therapy until levels exceed 3.3 mEq/L
C. Administer sodium bicarbonate to correct the severe metabolic acidosis
D. Begin a 0.9 percent normal saline fluid bolus without potassium additives
ANSWER: B. Initiate aggressive potassium replacement therapy until levels exceed 3.3
mEq/L
Insulin drives potassium back into intracellular spaces, which will dangerously worsen
hypokalemia if correction is not initiated first. Protocol dictates that insulin should not be
started until serum potassium is greater than 3.3 mEq/L to prevent fatal cardiac arrhythmias.
Sodium bicarbonate is generally avoided unless pH is below 6.9 because it can cause
paradoxical central nervous system acidosis.
7. A patient with end-stage liver disease develops acute confusion, inverted sleep-wake
cycles, and asterixis. Which dietary modification should the nurse anticipate implementing
to manage hepatic encephalopathy?
A. Strict high-protein diet to rebuild lean muscle mass
B. Complete elimination of all dietary fats
C. Moderate protein restriction balanced with branched-chain amino acids
D. High-sodium diet to combat ascites fluid retention
ANSWER: C. Moderate protein restriction balanced with branched-chain amino acids
Hepatic encephalopathy is caused by the accumulation of neurotoxins such as ammonia due
to impaired hepatic metabolism. While historical management relied on severe protein
restriction, current guidelines recommend moderate protein intake (1.2 to 1.5 g/kg/day)
balanced with vegetable or branched-chain amino acids to prevent muscle wasting without
precipitating encephalopathy. High protein worsens ammonia levels, while fat restriction is
unnecessary.
8. A client is admitted to the emergency department following a motor vehicle collision with
signs of Beck's triad. Which clinical findings should the nurse expect to assess?
A. Hypertension, widened pulse pressure, and bradypnea
EXAM– QUESTIONS AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS PLUS RATIONALES | GUARANTEED PASS |
LATEST EXAM UPDATE | EXAM PREP | STUDY GUIDE |
PRACTICE TEST| DOWNLOAD INSTANT PDF
1. A patient admitted with acute decompensated heart failure is receiving an infusion of
nitroprusside. Which of the following hemodynamic parameters requires the nurse to
immediately titrate down the infusion?
A. Mean arterial pressure (MAP) drops from 95 mmHg to 68 mmHg
B. Pulmonary capillary wedge pressure (PCWP) decreases from 22 mmHg to 14 mmHg
C. Heart rate decreases from 92 beats per minute to 78 beats per minute
D. Cardiac index increases from 1.8 L/min/m2 to 2.4 L/min/m2
ANSWER: A. Mean arterial pressure (MAP) drops from 95 mmHg to 68 mmHg
Nitroprusside is a potent direct-acting vasodilator that decreases both preload and afterload. A
drop in MAP to 68 mmHg indicates systemic hypotension, which compromises coronary and
cerebral perfusion, requiring immediate titration or cessation. Options B, C, and D reflect
therapeutic improvements in hemodynamics and do not indicate dangerous hypotension.
2. A post-operative cardiothoracic surgery patient suddenly exhibits diminished breath
sounds on the right side, tracheal deviation to the left, and severe agitation. What is the
priority nursing action?
A. Prepare the patient for an emergent stat chest X-ray
B. Administer prescribed rescue intravenous analgesia for agitation
C. Assist the healthcare provider with immediate needle decompression or chest tube insertion
D. Increase the supplemental oxygen flow rate via nasal cannula
ANSWER: C. Assist the healthcare provider with immediate needle decompression or chest
tube insertion
These clinical manifestations are classic indicators of a tension pneumothorax, a life-
threatening complication that causes mediastinal shift and hemodynamic collapse. Immediate
,decompression is required to relieve intrapleural pressure, making a chest X-ray dangerously
time-consuming. Oxygen and pain control do not address the mechanical obstruction.
3. The nurse is managing a client diagnosed with acute respiratory distress syndrome
(ARDS) who is mechanically ventilated. Which ventilator setting strategy is most critical to
incorporate to prevent ventilator-induced lung injury (VILI)?
A. Delivering high tidal volumes (12 mL/kg) to maximize minute ventilation
B. Utilizing low positive end-expiratory pressure (PEEP) levels below 5 cmH2O
C. Applying low tidal volumes (4 to 6 mL/kg of ideal body weight) and maintaining plateau
pressures below 30 cmH2O
D. Maintaining high fraction of inspired oxygen (FiO2) at 1.0 continuously to prevent
desaturation
ANSWER: C. Applying low tidal volumes (4 to 6 mL/kg of ideal body weight) and
maintaining plateau pressures below 30 cmH2O
Lung-protective ventilation strategies in ARDS rely on low tidal volumes to prevent
volutrauma and barotrauma, alongside maintaining low plateau pressures. High tidal volumes
exacerbate alveolar overdistension and injury. High FiO2 levels maintained for long periods
risk oxygen toxicity, and low PEEP fails to prevent alveolar collapse.
4. A patient in the neuro-intensive care unit following a traumatic brain injury has an
intracranial pressure (ICP) reading of 24 mmHg and a mean arterial pressure (MAP) of 85
mmHg. Calculate the cerebral perfusion pressure (CPP) and evaluate the finding.
A. 51 mmHg, which indicates impaired cerebral perfusion
B. 61 mmHg, which is within the normal therapeutic range
C. 109 mmHg, which places the patient at risk for hyperperfusion
D. 65 mmHg, which reflects borderline normal cerebral dynamics
ANSWER: A. 51 mmHg, which indicates impaired cerebral perfusion
Cerebral perfusion pressure is calculated using the formula CPP equals MAP minus ICP (85
minus 24 equals 61? Wait, let's recalculate: 85 minus 24 equals 61 mmHg. Let us check
standard normal CPP ranges, which are 60 to 100 mmHg. Wait, 85 minus 24 is 61 mmHg,
which falls into the lower limit of normal or borderline, but let us re-verify standard clinical
thresholds where target CPP is 60 to 80 mmHg. Let us re-evaluate option values: if MAP is 85
and ICP is 24, 85 - 24 = 61 mmHg. Let us adjust the numbers in the question stem or options
to make 51 correct: if MAP is 75 and ICP is 24, 75 - 24 = 51 mmHg. Let us rewrite the prompt
,stem values so the math aligns with option A: MAP of 75 mmHg and ICP of 24 mmHg yields
51 mmHg, which indicates impaired perfusion since normal is 60 to 100 mmHg.)
Correction for Question 4 text: A patient in the neuro-intensive care unit following a
traumatic brain injury has an intracranial pressure (ICP) reading of 24 mmHg and a mean
arterial pressure (MAP) of 75 mmHg. Calculate the cerebral perfusion pressure (CPP) and
evaluate the finding.
A. 51 mmHg, which indicates impaired cerebral perfusion
B. 61 mmHg, which is within the normal therapeutic range
C. 99 mmHg, which places the patient at risk for cerebral edema
D. 40 mmHg, which represents brain death criteria
ANSWER: A. 51 mmHg, which indicates impaired cerebral perfusion
Cerebral perfusion pressure is calculated by subtracting ICP from MAP (75 minus 24 equals
51 mmHg). The normal therapeutic range for CPP in brain-injured patients is 60 to 100
mmHg. A value of 51 mmHg indicates inadequate cerebral blood flow and ischemia risk.
5. A patient with severe sepsis is receiving norepinephrine via a peripheral IV line in the
forearm. The nurse observes blanching and cool, pale skin surrounding the insertion site
with sluggish capillary refill. What is the immediate priority intervention?
A. Apply warm compresses to the affected site to promote local vasodilation
B. Stop the infusion immediately and notify the provider to obtain an order for subcutaneous
phentolamine
C. Elevate the affected extremity and administer a rapid intravenous bolus of normal saline
D. Aspirate as much fluid as possible from the catheter and flush with heparinized saline
ANSWER: B. Stop the infusion immediately and notify the provider to obtain an order for
subcutaneous phentolamine
Norepinephrine is a potent vasoconstrictor that causes severe tissue necrosis and sloughing if
extravasated. The infusion must be stopped immediately, and phentolamine (an alpha-
adrenergic blocker) should be infiltrated into the affected tissue to counteract localized
vasoconstriction. Warm compresses are generally avoided or used according to specific facility
protocol, but the immediate cessation and reversal agent administration are paramount.
6. An adult client is admitted with diabetic ketoacidosis (DKA). Initial laboratory results
reveal a blood glucose of 520 mg/dL, arterial pH of 7.18, serum bicarbonate of 10 mEq/L,
, and a serum potassium level of 3.2 mEq/L. What is the nurse's priority action before
starting the regular insulin infusion?
A. Administer an immediate IV push bolus of regular insulin
B. Initiate aggressive potassium replacement therapy until levels exceed 3.3 mEq/L
C. Administer sodium bicarbonate to correct the severe metabolic acidosis
D. Begin a 0.9 percent normal saline fluid bolus without potassium additives
ANSWER: B. Initiate aggressive potassium replacement therapy until levels exceed 3.3
mEq/L
Insulin drives potassium back into intracellular spaces, which will dangerously worsen
hypokalemia if correction is not initiated first. Protocol dictates that insulin should not be
started until serum potassium is greater than 3.3 mEq/L to prevent fatal cardiac arrhythmias.
Sodium bicarbonate is generally avoided unless pH is below 6.9 because it can cause
paradoxical central nervous system acidosis.
7. A patient with end-stage liver disease develops acute confusion, inverted sleep-wake
cycles, and asterixis. Which dietary modification should the nurse anticipate implementing
to manage hepatic encephalopathy?
A. Strict high-protein diet to rebuild lean muscle mass
B. Complete elimination of all dietary fats
C. Moderate protein restriction balanced with branched-chain amino acids
D. High-sodium diet to combat ascites fluid retention
ANSWER: C. Moderate protein restriction balanced with branched-chain amino acids
Hepatic encephalopathy is caused by the accumulation of neurotoxins such as ammonia due
to impaired hepatic metabolism. While historical management relied on severe protein
restriction, current guidelines recommend moderate protein intake (1.2 to 1.5 g/kg/day)
balanced with vegetable or branched-chain amino acids to prevent muscle wasting without
precipitating encephalopathy. High protein worsens ammonia levels, while fat restriction is
unnecessary.
8. A client is admitted to the emergency department following a motor vehicle collision with
signs of Beck's triad. Which clinical findings should the nurse expect to assess?
A. Hypertension, widened pulse pressure, and bradypnea
