NU 265 – Advanced Medical-Surgical Nursing / Exam V2
Questions, Verified Answers, and Clinical Rationales
2026/2027 Edition
Question 1
A client is admitted to the intensive care unit with severe acute respiratory distress
syndrome and is placed on mechanical ventilation. Which setting or parameter
represents the standard initial strategy to prevent ventilator-induced lung injury?
A. Low tidal volume ventilation at six milliliters per kilogram of predicted body
weight
B. High tidal volume ventilation exceeding twelve milliliters per kilogram
C. Permissive hypercapnia avoidance at all costs
D. Elimination of all positive end-expiratory pressure
Correct Answer: A. Low tidal volume ventilation at six milliliters per
kilogram of predicted body weight
Clinical Rationale: Low tidal volume ventilation prevents overdistension of
fragile alveoli and reduces the risk of barotrauma and volutrauma in clients with
acute respiratory distress syndrome.
Question 2
The nurse is caring for a client with a closed-chest drainage system who requires
transport to radiology. Which action is essential regarding the chest drainage unit
during transport?
A. Keep the drainage system upright and positioned below the level of the
client's chest at all times.
B. Clamp the chest tube securely to prevent air entry during transport.
C. Hang the drainage canister above the level of the client's bed for optimal
gravity flow.
, D. Disconnect the chest tube from the suction source and seal the lumen with
tape.
Correct Answer: A. Keep the drainage system upright and positioned below
the level of the client's chest at all times.
Clinical Rationale: Keeping the drainage unit below chest level prevents fluid
from draining backward into the pleural cavity, which could cause tension
pneumothorax or infection. Clamping chest tubes during transport is
contraindicated unless specifically ordered.
Question 3
A client with a massive pulmonary embolism experiences sudden cardiovascular
collapse. Which pharmacological agent is indicated for immediate thrombolytic
therapy if no absolute contraindications exist?
A. Alteplase
B. Warfarin sodium
C. Enoxaparin sodium
D. Protamine sulfate
Correct Answer: A. Alteplase
Clinical Rationale: Alteplase is a tissue plasminogen activator used to rapidly lyse
massive pulmonary emboli, restore pulmonary blood flow, and relieve right
ventricular strain during hemodynamic collapse.
Question 4
The nurse is assessing a client experiencing an acute asthma exacerbation. Which
arterial blood gas finding is an ominous sign indicating impending respiratory
arrest?
A. Elevated carbon dioxide partial pressure with a normal or acidotic pH
B. Low carbon dioxide partial pressure with an elevated pH
C. Normal carbon dioxide partial pressure with a high pH
, D. Severely elevated oxygen saturation levels on room air
Correct Answer: A. Elevated carbon dioxide partial pressure with a normal
or acidotic pH
Clinical Rationale: Initially, clients with asthma hyperventilate, leading to
respiratory alkalosis and low carbon dioxide. When fatigue sets in and airways
become severely obstructed, carbon dioxide begins to retain, signaling muscle
exhaustion and impending respiratory arrest.
Question 5
A client in hypovolemic shock is receiving aggressive crystalloid resuscitation.
Which parameter is the most reliable non-invasive indicator of adequate end-organ
perfusion and tissue oxygenation?
A. Hourly urine output maintained above thirty milliliters per hour
B. Peripheral skin temperature and color
C. Subjective report of thirst absence
D. Normal resting heart rate alone
Correct Answer: A. Hourly urine output maintained above thirty milliliters
per hour
Clinical Rationale: Urine output reflects renal blood flow, which serves as a
sensitive indicator of systemic perfusion pressure and effective circulating volume
restoration in shock states.
Question 6
The nurse is caring for a client in septic shock who has been unresponsive to fluid
resuscitation and multiple vasopressors. Which intervention is a priority to support
vascular tone?
A. Administer stress-dose intravenous hydrocortisone.
B. Initiate rapid blood transfusion of whole blood.
C. Administer high-dose oral beta-blockers.
, D. Perform emergency peritoneal dialysis.
Correct Answer: A. Administer stress-dose intravenous hydrocortisone.
Clinical Rationale: Clients with refractory septic shock often suffer from relative
adrenal insufficiency. Corticosteroid replacement restores vascular responsiveness
to catecholamines and helps reverse refractory hypotension.
Question 7
A client with cardiogenic shock secondary to acute myocardial infarction has a low
cardiac output and elevated systemic vascular resistance. Which medication
provides both inotropic support and vasodilation?
A. Dobutamine
B. Norepinephrine
C. Phenylephrine
D. Vasopressin
Correct Answer: A. Dobutamine
Clinical Rationale: Dobutamine is a synthetic inotrope with primary beta-1 and
minor beta-2 agonist properties, increasing myocardial contractility while
producing mild peripheral vasodilation to reduce afterload.
Question 8
The nurse is assessing a client with suspected cardiac tamponade. Which cluster of
clinical manifestations comprises Beck's triad?
A. Hypotension, muffled heart sounds, and jugular venous distension
B. Hypertension, bounding pulse, and clear breath sounds
C. Bradycardia, wide pulse pressure, and peripheral edema
D. Tachycardia, wheezing, and tracheal deviation
Questions, Verified Answers, and Clinical Rationales
2026/2027 Edition
Question 1
A client is admitted to the intensive care unit with severe acute respiratory distress
syndrome and is placed on mechanical ventilation. Which setting or parameter
represents the standard initial strategy to prevent ventilator-induced lung injury?
A. Low tidal volume ventilation at six milliliters per kilogram of predicted body
weight
B. High tidal volume ventilation exceeding twelve milliliters per kilogram
C. Permissive hypercapnia avoidance at all costs
D. Elimination of all positive end-expiratory pressure
Correct Answer: A. Low tidal volume ventilation at six milliliters per
kilogram of predicted body weight
Clinical Rationale: Low tidal volume ventilation prevents overdistension of
fragile alveoli and reduces the risk of barotrauma and volutrauma in clients with
acute respiratory distress syndrome.
Question 2
The nurse is caring for a client with a closed-chest drainage system who requires
transport to radiology. Which action is essential regarding the chest drainage unit
during transport?
A. Keep the drainage system upright and positioned below the level of the
client's chest at all times.
B. Clamp the chest tube securely to prevent air entry during transport.
C. Hang the drainage canister above the level of the client's bed for optimal
gravity flow.
, D. Disconnect the chest tube from the suction source and seal the lumen with
tape.
Correct Answer: A. Keep the drainage system upright and positioned below
the level of the client's chest at all times.
Clinical Rationale: Keeping the drainage unit below chest level prevents fluid
from draining backward into the pleural cavity, which could cause tension
pneumothorax or infection. Clamping chest tubes during transport is
contraindicated unless specifically ordered.
Question 3
A client with a massive pulmonary embolism experiences sudden cardiovascular
collapse. Which pharmacological agent is indicated for immediate thrombolytic
therapy if no absolute contraindications exist?
A. Alteplase
B. Warfarin sodium
C. Enoxaparin sodium
D. Protamine sulfate
Correct Answer: A. Alteplase
Clinical Rationale: Alteplase is a tissue plasminogen activator used to rapidly lyse
massive pulmonary emboli, restore pulmonary blood flow, and relieve right
ventricular strain during hemodynamic collapse.
Question 4
The nurse is assessing a client experiencing an acute asthma exacerbation. Which
arterial blood gas finding is an ominous sign indicating impending respiratory
arrest?
A. Elevated carbon dioxide partial pressure with a normal or acidotic pH
B. Low carbon dioxide partial pressure with an elevated pH
C. Normal carbon dioxide partial pressure with a high pH
, D. Severely elevated oxygen saturation levels on room air
Correct Answer: A. Elevated carbon dioxide partial pressure with a normal
or acidotic pH
Clinical Rationale: Initially, clients with asthma hyperventilate, leading to
respiratory alkalosis and low carbon dioxide. When fatigue sets in and airways
become severely obstructed, carbon dioxide begins to retain, signaling muscle
exhaustion and impending respiratory arrest.
Question 5
A client in hypovolemic shock is receiving aggressive crystalloid resuscitation.
Which parameter is the most reliable non-invasive indicator of adequate end-organ
perfusion and tissue oxygenation?
A. Hourly urine output maintained above thirty milliliters per hour
B. Peripheral skin temperature and color
C. Subjective report of thirst absence
D. Normal resting heart rate alone
Correct Answer: A. Hourly urine output maintained above thirty milliliters
per hour
Clinical Rationale: Urine output reflects renal blood flow, which serves as a
sensitive indicator of systemic perfusion pressure and effective circulating volume
restoration in shock states.
Question 6
The nurse is caring for a client in septic shock who has been unresponsive to fluid
resuscitation and multiple vasopressors. Which intervention is a priority to support
vascular tone?
A. Administer stress-dose intravenous hydrocortisone.
B. Initiate rapid blood transfusion of whole blood.
C. Administer high-dose oral beta-blockers.
, D. Perform emergency peritoneal dialysis.
Correct Answer: A. Administer stress-dose intravenous hydrocortisone.
Clinical Rationale: Clients with refractory septic shock often suffer from relative
adrenal insufficiency. Corticosteroid replacement restores vascular responsiveness
to catecholamines and helps reverse refractory hypotension.
Question 7
A client with cardiogenic shock secondary to acute myocardial infarction has a low
cardiac output and elevated systemic vascular resistance. Which medication
provides both inotropic support and vasodilation?
A. Dobutamine
B. Norepinephrine
C. Phenylephrine
D. Vasopressin
Correct Answer: A. Dobutamine
Clinical Rationale: Dobutamine is a synthetic inotrope with primary beta-1 and
minor beta-2 agonist properties, increasing myocardial contractility while
producing mild peripheral vasodilation to reduce afterload.
Question 8
The nurse is assessing a client with suspected cardiac tamponade. Which cluster of
clinical manifestations comprises Beck's triad?
A. Hypotension, muffled heart sounds, and jugular venous distension
B. Hypertension, bounding pulse, and clear breath sounds
C. Bradycardia, wide pulse pressure, and peripheral edema
D. Tachycardia, wheezing, and tracheal deviation
