Advanced Concepts Of Medical-Surgical Nursing NUR 265 (NUR265): Exam 3 Complete Review Questions and Answers | A+ Latest Updated 100% Fall 2026/2027-Galen.

Galen NUR 265 (NUR265) Advanced Concepts of Medical-Surgical Nursing – Exam 3 Review | Questions & Answers | Latest 2026–2027. 1. A nurse is caring for a patient at risk for increased intracranial pressure (ICP). Which ICP reading is considered within the normal range? A. 20–25 mmHg B. 5–8 mmHg C. 10–15 mmHg D. 25–30 mmHg 2. Which assessment finding is considered the earliest indication of increasing ICP? A. Papilledema B. Bradycardia C. Declining level of consciousness D. Decerebrate posturing 3. Which group of findings represents Cushing's triad? A. Hypotension, tachycardia, and tachypnea B. Severe hypertension, widened pulse pressure, and bradycardia C. Bradycardia, hypotension, and fever D. Hypertension, tachycardia, and narrowed pulse pressure 4. Which position is most appropriate for a patient with increased ICP? A. Flat with the neck flexed B. Trendelenburg with the head rotated C. HOB elevated 30–45 degrees with the head midline and neutral D. High Fowler's with the hips sharply flexed 5. Which nursing action should be avoided in a patient with increased ICP? A. Clustering multiple care activities together B. Maintaining a quiet environment C. Using a stool softener D. Keeping the head in neutral alignment 6. Why is mannitol administered to a patient with cerebral edema? A. To increase CSF production B. To stimulate acetylcholine receptors C. To increase cerebral vasodilation D. To draw fluid from cerebral tissue into the vascular space 7. Which finding best indicates that mannitol is producing the expected effect? A. Decreased respiratory rate B. Decreased temperature C. Increased urinary output D. Increased pulse pressure 8. A patient has a Glasgow Coma Scale score of 7. How should the nurse classify this injury? A. Mild B. Moderate C. Severe D. Normal 9. Which change in Glasgow Coma Scale requires immediate notification of the healthcare provider? A. Increase from 13 to 14 B. Increase from 8 to 9 C. No change during two assessments D. A change of 2 points 10. Which finding is most characteristic of an epidural hematoma? A. Slow venous bleeding over several months B. No alteration in consciousness C. Bleeding within the brain tissue D. An arterial bleed with a lucid interval 11. Which statement correctly describes a subdural hematoma? A. It is always caused by arterial bleeding. B. It occurs only inside brain tissue. C. It involves venous bleeding beneath the dura. D. It cannot become chronic. 12. Which assessment findings are associated with central brain herniation? A. Cheyne-Stokes respirations and pinpoint nonreactive pupils B. Hypertension with bounding peripheral pulses only C. Increased appetite and alertness D. Polyuria and extreme thirst 13. What is the priority assessment for a newly admitted patient with traumatic brain injury? A. Nutritional status B. Bowel function C. Family coping D. Airway, breathing, and circulation 14. For a mechanically ventilated patient with brain injury, which PaCO₂ range is identified as desirable to prevent cerebral vasodilation? A. 45–50 mmHg B. 20–25 mmHg C. 55–60 mmHg D. 35–38 mmHg 15. Which intervention is appropriate after a decompressive craniotomy? A. Position the patient directly on the operative side. B. Avoid positioning the patient on the side where the skull fragment was removed. C. Keep the patient permanently flat. D. Encourage the patient to ambulate without head protection. 16. Which symptom following a mild head injury should prompt the family to take the patient back to the emergency department? A. Mild temporary fatigue B. Worsening headache C. Mild headache relieved by acetaminophen D. Brief initial dizziness 17. Which statement describes endovascular coiling of a cerebral aneurysm? A. The entire cerebral artery is removed. B. Detachable coils are placed to occlude the aneurysm while preserving the main vessel. C. The patient requires no neurologic monitoring afterward. D. Coiling eliminates the need for later follow-up. 18. Which symptom is particularly associated with a brain tumor? A. Headache that improves immediately after awakening B. Absence of neurologic changes C. Headache that is more severe on awakening D. Increased peripheral sensation 19. Which diagnostic procedure should be avoided when a patient has signs of increased ICP? A. Lumbar puncture B. CT scan C. MRI D. Neurologic assessment 20. How should the nurse position a patient following supratentorial brain surgery? A. Flat with hips flexed B. Trendelenburg C. HOB approximately 30 degrees with the head midline D. Prone with the neck rotated 21. Which position is appropriate following an infratentorial craniotomy? A. High Fowler's continuously B. Flat and side-lying, alternating sides C. Trendelenburg D. Prone with the head flexed 22. Which postoperative craniotomy finding requires immediate notification of the surgeon? A. Mild periorbital edema B. Small amount of expected drainage C. Mild incisional discomfort D. Head dressing drainage greater than 50 mL in 8 hours 23. Which manifestations are consistent with a brain abscess? A. Fever, headache, seizures, aphasia, and focal deficits B. Polyuria with extreme thirst only C. Ascending flaccid paralysis D. Isolated chest pain 24. Which CSF pattern is associated with bacterial meningitis? A. Clear CSF, decreased protein, high glucose B. Clear CSF with normal WBC count C. Cloudy CSF with normal protein and high glucose D. Cloudy CSF, increased WBCs and protein, decreased glucose 25. Which patient requires droplet precautions? A. Patient with trigeminal neuralgia B. Patient with ALS C. Patient with meningococcal meningitis D. Patient with Bell's palsy 26. Which medication is identified for herpes encephalitis? A. Pyridostigmine B. Acyclovir C. Mannitol only D. Riluzole 27. Which statement best describes myasthenia gravis? A. Weakness improves with repetitive activity. B. Sensation is permanently lost. C. Muscle function is unrelated to activity. D. Weakness worsens with activity and improves with rest. 28. What underlying problem is associated with myasthenia gravis? A. Destruction of sensory neurons B. Loss or blockage of acetylcholine receptors at the neuromuscular junction C. Excessive dopamine production D. Increased CSF formation 29. When should pyridostigmine generally be administered in relation to meals? A. Immediately after eating B. Approximately 45 minutes to 1 hour before meals C. Only at bedtime D. Two hours after meals 30. Which intervention is the priority during a myasthenic crisis? A. Increase physical activity B. Begin oral feeding C. Maintain the airway and prepare for possible ventilation D. Restrict oxygen 31. Which finding most strongly supports cholinergic crisis? A. Dry mouth and constipation B. Isolated headache C. Excessive salivation, sweating, diarrhea, and increasing weakness D. Increased appetite 32. What response to the Tensilon test helps distinguish myasthenic crisis from cholinergic crisis? A. Both improve equally. B. Neither changes. C. Cholinergic crisis improves and myasthenic crisis worsens. D. Myasthenic crisis temporarily improves while cholinergic crisis worsens. 33. Which manifestation is most characteristic of Guillain-Barré syndrome? A. Descending rigid paralysis B. Progressive ascending symmetric weakness C. Permanent cognitive decline D. Increased deep tendon reflexes initially 34. Which neurologic function typically remains unaffected in Guillain-Barré syndrome? A. Respiratory muscle strength B. Level of consciousness and cognition C. Deep tendon reflexes D. Swallowing ability 35. What is the nursing priority for a patient with Guillain-Barré syndrome? A. Establishing a bowel program B. Maintaining respiratory function and airway patency C. Encouraging strenuous ambulation D. Restricting fluids 36. Which finding indicates that a patient with Guillain-Barré syndrome may require intubation? A. Mild paresthesia B. Normal oxygen saturation C. Vital capacity below approximately 15–20 mL/kg D. Increased appetite 37. Which treatment is appropriate for Guillain-Barré syndrome? A. Long-term corticosteroids as the primary therapy B. IVIG or plasmapheresis C. Mannitol alone D. Pyridostigmine 38. A patient has a spinal cord injury above C4. Which complication is the nurse most concerned about? A. Hyperactive bowel sounds B. Inability to breathe independently C. Isolated hand weakness D. Increased sympathetic tone 39. Which finding is expected during spinal shock? A. Severe hyperreflexia immediately after injury B. Persistent hypertension C. Loss of movement, sensation, and reflexes below the injury D. Purposeful muscle spasms 40. Which finding suggests that spinal shock is resolving? A. Continued absence of all reflexes B. Increasing hypotension C. Persistent flaccidity D. Development of muscle spasticity below the injury 41. Which patient is at greatest risk for autonomic dysreflexia? A. Patient with an ankle fracture B. Patient with an S1 injury C. Patient with an isolated lumbar strain D. Patient with a spinal cord injury above T6 42. What is the first nursing intervention for autonomic dysreflexia? A. Place the patient flat. B. Increase IV fluids rapidly. C. Perform strenuous ROM. D. Sit the patient upright. 43. A patient with SCI develops severe hypertension, bradycardia, flushing, and a pounding headache. Which potential trigger should the nurse assess first? A. Hyperglycemia B. Increased appetite C. Bladder distention or a kinked urinary catheter D. Mild fatigue 44. Which function is generally preserved in amyotrophic lateral sclerosis (ALS)? A. Respiratory muscle function B. Sensory function and cognition C. Skeletal muscle strength D. Swallowing 45. Which statement about riluzole is correct? A. It cures ALS. B. It reverses muscle atrophy. C. It eliminates the need for respiratory support. D. It may extend survival but does not cure ALS. 46. Which medication is the first-choice drug listed for trigeminal neuralgia? A. Morphine B. Pyridostigmine C. Carbamazepine D. Mannitol 47. What is an important nursing intervention for a patient with Bell's palsy? A. Encourage rubbing of the affected eye. B. Restrict artificial tears. C. Leave the eye uncovered at night. D. Protect the cornea with artificial tears and eye closure measures. 48. What is the hallmark physiologic problem in shock? A. Excessive tissue oxygenation B. Increased renal perfusion C. Increased blood flow to nonessential organs D. Inadequate tissue perfusion 49. Which condition is a cause of cardiogenic shock? A. Myocardial infarction causing pump failure B. Severe diarrhea C. Anaphylaxis D. Spinal cord injury 50. Which pathophysiologic change characterizes distributive shock? A. Increased circulating blood volume B. Vasodilation and pooling of blood C. Increased vascular tone D. Increased preload from fluid overload 51. Which finding is identified as the first manifestation of shock? A. Anuria B. Increased heart rate C. Severe cyanosis D. Loss of consciousness 52. In the nonprogressive/compensatory stage of shock, MAP typically decreases by: A. 10–15 mmHg from baseline B. More than 30 mmHg C. Less than 2 mmHg D. 40–50 mmHg 53. Which MAP change is associated with progressive/decompensated shock? A. Less than 5 mmHg B. More than 20 mmHg below baseline C. Exactly 10 mmHg D. No change 54. Which condition is characteristic of refractory shock? A. Complete recovery without treatment B. Mild vasoconstriction only C. Increased urine output D. Irreversible organ damage and MODS 55. Which laboratory pattern is expected with worsening hypovolemic shock? A. Low pH with elevated lactate B. High pH with low lactate C. High PaO₂ and low PaCO₂ only D. Low potassium with alkalosis 56. Which intervention is the primary method of restoring circulating volume in hypovolemic shock? A. Rapid IV crystalloid replacement B. Fluid restriction C. Diuretics D. Oral fluids only 57. Which findings are most consistent with cardiogenic shock? A. JVD, hypotension, decreased urine output, and cool extremities B. Severe hypertension and polyuria C. Warm dry skin with increased urine output D. Bradycardia with increased cardiac output 58. Which combination is especially characteristic of neurogenic shock? A. Hypertension and tachycardia B. Hypertension and bradycardia C. Hypotension and bradycardia D. Hypotension and severe tachycardia 59. Why is anaphylactic shock classified as distributive shock? A. Histamine causes massive vasodilation. B. The heart stops producing blood. C. Blood volume increases sharply. D. The kidneys retain too much fluid. 60. Which finding is most consistent with tension pneumothorax as a cause of obstructive shock? A. Bilateral equal chest expansion B. Tracheal deviation with asymmetrical chest findings C. Increased bowel sounds D. Polyuria 61. Treatment of shock focuses on restoring a MAP above approximately: A. 40 mmHg B. 50 mmHg C. 55 mmHg D. 65 mmHg 62. A decrease in CVP from baseline most strongly supports which condition? A. Fluid overload B. Hypovolemic shock C. Severe hypertension D. Hypervolemia 63. Which patient findings satisfy several criteria for sepsis with SIRS? A. HR 58, RR 12, temperature 98°F B. BP 130/80 with normal WBC count C. UOP 80 mL/hr and HR 70 D. Temperature above 101°F, HR above 90, and RR above 20 64. Which intervention should occur before administering broad-spectrum antibiotics for suspected severe sepsis? A. Obtain blood cultures B. Delay treatment for 24 hours C. Give a diuretic D. Restrict IV fluids 65. A patient with suspected severe sepsis has hypotension and a lactate greater than 4 mmol/L. Which treatment is identified for the first 3 hours? A. 30 mL/kg IV crystalloid B. Complete fluid restriction C. Oral water only D. Diuretics immediately 66. After adequate fluid resuscitation, a septic patient's hypotension persists. Which therapy should the nurse anticipate? A. Fluid restriction B. No further intervention C. Vasopressor therapy to maintain MAP above 65 mmHg D. Routine diuretics 67. Which statement defines septic shock? A. Infection with normal blood pressure B. Any isolated fever C. Temporary tachycardia after exercise D. Sepsis-induced hypotension that persists despite adequate fluid resuscitation 68. Which finding may be an early clue that DIC is developing? A. Oozing or bleeding from IV and puncture sites B. Increased platelet count C. Increased fibrinogen D. Absence of bleeding 69. Why do platelets decrease during severe sepsis and DIC? A. The kidneys produce excess platelets. B. Platelets move into the stomach. C. Widespread microthrombi consume platelets and clotting factors. D. Platelets are diluted by oxygen therapy. 70. Which finding should make the nurse suspect worsening severe sepsis or septic shock? A. Increased urine output B. Stable creatinine C. Improved cognition D. Sudden decrease in urine output with increasing creatinine 71. Burns involving more than approximately 25% TBSA are most likely to cause: A. Only local effects B. No fluid shifts C. No inflammatory response D. Local and systemic effects 72. Using the Rule of Nines, burns involving both entire lower extremities equal approximately what percentage of TBSA? A. 18% B. 27% C. 36% D. 45% 73. Which finding best describes a superficial-thickness burn? A. Injury limited to the epidermis B. Destruction of muscle and bone C. Hard leathery eschar D. Complete absence of sensation 74. Which wound description is characteristic of a superficial partial-thickness burn? A. Black and completely insensate B. Pink, moist, blanching, and blistered C. Hard leathery eschar D. Red-dry wound with no blanching 75. Which finding is characteristic of a deep partial-thickness burn? A. Red-to-white, dry wound that blanches slowly or not at all B. Injury limited only to epidermis C. Completely black wound involving bone D. Pink moist wound with rapid blanching 76. Which description best matches a full-thickness burn? A. Destruction of the entire epidermis and dermis with hard eschar B. Epidermal erythema only C. Pink moist wound without tissue destruction D. Mild edema that heals in 3 days 77. Why might an escharotomy be required for a circumferential full-thickness burn? A. To increase scar formation B. To cause vasoconstriction C. To relieve pressure and restore circulation or chest expansion D. To reduce caloric needs 78. Why are electrical burns called the “grand masquerader”? A. Small external injuries may conceal extensive internal damage. B. They always produce superficial wounds only. C. They do not affect internal organs. D. They never cause dysrhythmias. 79. Which assessment is especially important after an electrical burn? A. ECG/cardiac rhythm monitoring B. Visual acuity only C. Bowel sounds only D. Hearing test first 80. Which electrolyte and acid-base pattern is expected during the early fluid-shift phase of a major burn? A. Hypokalemia and alkalosis B. Hyperkalemia, hyponatremia, and metabolic acidosis C. Hypernatremia and respiratory alkalosis only D. Normal electrolytes 81. Approximately when does fluid remobilization begin after a major burn? A. Around 24 hours after injury B. Immediately after the burn only C. After 2 weeks D. After complete wound closure 82. What metabolic state occurs after a major burn? A. Profound hypometabolism B. No change in metabolism C. Hypermetabolism with greatly increased calorie needs D. Permanent fasting metabolism 83. Which assessment finding after a house fire suggests impending airway obstruction? A. Progressive hoarseness, stridor, or drooling B. Increased appetite C. Clear speech with no facial burns D. Normal airway sounds 84. Why can conventional pulse oximetry be misleading in carbon monoxide poisoning? A. It always reads zero. B. It measures blood pressure instead of oxygen. C. CO immediately destroys the pulse oximeter. D. The reading may appear normal or high despite significant hypoxia. 85. Which test is specifically identified for accurately assessing suspected carbon monoxide poisoning? A. Serum sodium B. Carboxyhemoglobin level C. Hematocrit only D. Serum creatinine only 86. Which treatment is identified for carbon monoxide poisoning? A. Room air only B. Fluid restriction C. Diuretics D. 100% oxygen 87. Which formula is used to calculate initial burn fluid requirements? A. 1 mL × kg × %TBSA B. 10 mL × kg × age C. 4 mL × body weight in kg × %TBSA D. 20 mL × %TBSA only 88. A 75-kg patient has burns over 20% TBSA. Using the formula above, how much fluid is calculated for the first 24 hours? A. 6,000 mL B. 3,000 mL C. 1,500 mL D. 12,000 mL 89. The same patient requires 6,000 mL during the first 24 hours. How much should be given during the first 8 hours from the time of injury? A. 1,500 mL B. 6,000 mL C. 3,000 mL D. 4,500 mL 90. Which urine output indicates adequate adult burn fluid resuscitation? A. At least approximately 0.5 mL/kg/hr B. Less than 5 mL/hr C. No urine for the first 24 hours D. Exactly 5 L/hr 91. A burn patient's urine output falls during the resuscitation phase. What should the nurse anticipate? A. Immediately stop all IV fluids. B. Give routine diuretics. C. Adjust/titrate fluid replacement rather than routinely giving a diuretic. D. Restrict the patient to oral intake only. 92. What route is preferred for opioid analgesics during the initial burn resuscitation phase? A. IV B. IM C. Subcutaneous D. Oral only 93. Approximately when does the acute phase of a burn injury begin? A. Immediately at the scene B. Only after hospital discharge C. Six months after healing D. About 36–48 hours after injury as fluid shifting resolves 94. Which wound change may indicate infection in a burn patient? A. Increasing burn depth, odor, edema, or excessive drainage B. Healthy granulation only C. Progressive improvement in wound appearance D. Decreasing drainage with stable tissue 95. How should blisters generally be managed according to the burn material? A. Small blisters are left intact and larger blisters may be opened/debrided. B. Every blister must remain intact. C. Every blister must be surgically grafted. D. All wounds should be left completely untreated. 96. Which intervention is appropriate immediately after placement of a skin graft? A. Perform vigorous ROM of the graft every hour. B. Avoid disturbing the dressing and immobilize/elevate the grafted area. C. Remove the bulky dressing several times daily. D. Massage the graft vigorously. 97. When are systemic antibiotics indicated for a burn patient? A. For every burn immediately B. When the patient has signs of an actual systemic or wound infection C. Never D. Only after complete wound healing 98. Which positioning principle helps prevent burn contractures? A. Keep joints flexed continuously. B. Place pillows under every joint. C. Maintain the patient in a fetal position. D. Maintain neutral positioning with minimal joint flexion. 99. After burn grafts heal, how are compression garments generally used? A. Only one hour per week B. Only while sleeping C. Only during physical therapy D. Approximately 23 hours per day until scar tissue matures 100. What is a major goal of the rehabilitative phase of burn care? A. Prevent all patient independence B. Maximize independence and functional recovery C. Continue fluid resuscitation indefinitely D. Maintain permanent bed rest