NUR 265 Final Exam V3 | NUR 265 Advanced
Concepts of Medical–Surgical Nursing | Actual Q&A
with Rationale (NUR 265 Final Exam) | Galen
1. A 62-year-old male patient, Mr. Henderson, is admitted to the ICU with a diagnosis of
Septic Shock. Despite receiving 3 liters of normal saline, his mean arterial pressure (MAP)
remains at 54 mmHg. Which of the following is the most appropriate next step in his
management?
A. Administer an additional 2-liter fluid bolus of Ringer’s Lactate.
B. Administer a bolus of 50% Dextrose to improve metabolic demand.
C. Prepare the patient for immediate hemodialysis.
D. Initiate an intravenous infusion of norepinephrine (Levophed).
Correct Answer: D
Explanation: In septic shock, if fluid resuscitation fails to restore hemodynamic stability
(MAP > 65 mmHg), vasopressors are indicated. Norepinephrine is considered the first-line
vasopressor to increase systemic vascular resistance. The nurse must monitor for
peripheral ischemia and ensure the medication is delivered through a central line if
possible.
,2. Ms. Clara, a 45-year-old patient with ARDS, is currently on mechanical ventilation. The
provider decides to increase the Positive End-Expiratory Pressure (PEEP) from 10 cm H2O to
15 cm H2O. Which physiological effect should the nurse monitor for most closely?
A. Increased urine output due to improved renal perfusion.
B. Decreased cardiac output and hypotension.
C. Improved cerebral perfusion pressure.
D. Respiratory alkalosis from increased carbon dioxide clearance.
Correct Answer: B
Explanation: Increasing PEEP increases intrathoracic pressure, which can compress the
vena cava and decrease venous return to the heart. This reduction in preload leads to a
decrease in cardiac output and can result in significant hypotension. The nurse must assess
blood pressure and peripheral pulses immediately following any PEEP adjustments.
3. Mr. Thompson is a 28-year-old patient who sustained a T4 spinal cord injury three weeks
ago. He suddenly reports a severe, throbbing headache and his blood pressure is 190/110
mmHg. What is the priority nursing intervention?
A. Administer the prescribed PRN dose of hydralazine.
B. Check the patient’s Foley catheter for kinks or obstruction.
C. Sit the patient upright at a 90-degree angle.
D. Place the patient in a supine position with legs elevated.
,Correct Answer: C
Explanation: Autonomic dysreflexia is a medical emergency characterized by sudden
hypertension in patients with SCI at or above T6. The first action is to sit the patient
upright to utilize orthostatic pressure to help lower the blood pressure. Subsequently, the
nurse should identify and remove the noxious stimulus, such as a full bladder or impacted
bowel.
4. A 55-year-old patient, Mrs. Garcia, is admitted with Diabetic Ketoacidosis (DKA). Her
laboratory results show a serum potassium of 3.1 mEq/L and a blood glucose of 450 mg/dL.
Which action by the nurse is most critical before starting the insulin drip?
A. Administering a dose of subcutaneous rapid-acting insulin.
B. Ensuring potassium replacement is initiated or administered.
C. Obtaining a baseline arterial blood gas (ABG).
D. Measuring the patient’s hourly urine output.
Correct Answer: B
Explanation: Insulin therapy shifts potassium from the extracellular space into the
intracellular space, which can dangerously worsen hypokalemia. If the patient’s potassium
is below 3.3 mEq/L, insulin should be held until potassium levels are being actively
addressed to prevent cardiac arrest. The nurse must monitor the ECG for signs of
dysrhythmias throughout this process.
, 5. A 34-year-old patient arrives in the Emergency Department with thermal burns to the
entire left arm and the entire anterior trunk. Using the Rule of Nines, what is the estimated
Total Body Surface Area (TBSA) affected?
A. 18%
B. 27%
C. 36%
D. 45%
Correct Answer: B
Explanation: According to the Rule of Nines, the entire arm (anterior and posterior)
accounts for 9%, and the anterior trunk accounts for 18%. Adding 9% and 18% results in a
total of 27% TBSA. Accurate estimation is crucial for calculating fluid resuscitation needs
using the Parkland formula.
6. Mr. Miller is 2 days post-op after a right lower lobectomy. He has a chest tube connected
to a suction water-seal drainage system. The nurse notes continuous bubbling in the water-
seal chamber. Which is the most likely interpretation of this finding?
A. There is an air leak in the system or the pleural space.
B. This is a normal finding while the lung is re-expanding.
C. The suction pressure is set too high.
D. The chest tube is occluded by a blood clot.
Concepts of Medical–Surgical Nursing | Actual Q&A
with Rationale (NUR 265 Final Exam) | Galen
1. A 62-year-old male patient, Mr. Henderson, is admitted to the ICU with a diagnosis of
Septic Shock. Despite receiving 3 liters of normal saline, his mean arterial pressure (MAP)
remains at 54 mmHg. Which of the following is the most appropriate next step in his
management?
A. Administer an additional 2-liter fluid bolus of Ringer’s Lactate.
B. Administer a bolus of 50% Dextrose to improve metabolic demand.
C. Prepare the patient for immediate hemodialysis.
D. Initiate an intravenous infusion of norepinephrine (Levophed).
Correct Answer: D
Explanation: In septic shock, if fluid resuscitation fails to restore hemodynamic stability
(MAP > 65 mmHg), vasopressors are indicated. Norepinephrine is considered the first-line
vasopressor to increase systemic vascular resistance. The nurse must monitor for
peripheral ischemia and ensure the medication is delivered through a central line if
possible.
,2. Ms. Clara, a 45-year-old patient with ARDS, is currently on mechanical ventilation. The
provider decides to increase the Positive End-Expiratory Pressure (PEEP) from 10 cm H2O to
15 cm H2O. Which physiological effect should the nurse monitor for most closely?
A. Increased urine output due to improved renal perfusion.
B. Decreased cardiac output and hypotension.
C. Improved cerebral perfusion pressure.
D. Respiratory alkalosis from increased carbon dioxide clearance.
Correct Answer: B
Explanation: Increasing PEEP increases intrathoracic pressure, which can compress the
vena cava and decrease venous return to the heart. This reduction in preload leads to a
decrease in cardiac output and can result in significant hypotension. The nurse must assess
blood pressure and peripheral pulses immediately following any PEEP adjustments.
3. Mr. Thompson is a 28-year-old patient who sustained a T4 spinal cord injury three weeks
ago. He suddenly reports a severe, throbbing headache and his blood pressure is 190/110
mmHg. What is the priority nursing intervention?
A. Administer the prescribed PRN dose of hydralazine.
B. Check the patient’s Foley catheter for kinks or obstruction.
C. Sit the patient upright at a 90-degree angle.
D. Place the patient in a supine position with legs elevated.
,Correct Answer: C
Explanation: Autonomic dysreflexia is a medical emergency characterized by sudden
hypertension in patients with SCI at or above T6. The first action is to sit the patient
upright to utilize orthostatic pressure to help lower the blood pressure. Subsequently, the
nurse should identify and remove the noxious stimulus, such as a full bladder or impacted
bowel.
4. A 55-year-old patient, Mrs. Garcia, is admitted with Diabetic Ketoacidosis (DKA). Her
laboratory results show a serum potassium of 3.1 mEq/L and a blood glucose of 450 mg/dL.
Which action by the nurse is most critical before starting the insulin drip?
A. Administering a dose of subcutaneous rapid-acting insulin.
B. Ensuring potassium replacement is initiated or administered.
C. Obtaining a baseline arterial blood gas (ABG).
D. Measuring the patient’s hourly urine output.
Correct Answer: B
Explanation: Insulin therapy shifts potassium from the extracellular space into the
intracellular space, which can dangerously worsen hypokalemia. If the patient’s potassium
is below 3.3 mEq/L, insulin should be held until potassium levels are being actively
addressed to prevent cardiac arrest. The nurse must monitor the ECG for signs of
dysrhythmias throughout this process.
, 5. A 34-year-old patient arrives in the Emergency Department with thermal burns to the
entire left arm and the entire anterior trunk. Using the Rule of Nines, what is the estimated
Total Body Surface Area (TBSA) affected?
A. 18%
B. 27%
C. 36%
D. 45%
Correct Answer: B
Explanation: According to the Rule of Nines, the entire arm (anterior and posterior)
accounts for 9%, and the anterior trunk accounts for 18%. Adding 9% and 18% results in a
total of 27% TBSA. Accurate estimation is crucial for calculating fluid resuscitation needs
using the Parkland formula.
6. Mr. Miller is 2 days post-op after a right lower lobectomy. He has a chest tube connected
to a suction water-seal drainage system. The nurse notes continuous bubbling in the water-
seal chamber. Which is the most likely interpretation of this finding?
A. There is an air leak in the system or the pleural space.
B. This is a normal finding while the lung is re-expanding.
C. The suction pressure is set too high.
D. The chest tube is occluded by a blood clot.
