NUR 265 – Exam 1: Critical Care & Medical-
Surgical Nursing ACTUAL Exam 2026/2027
UPDATE
Overview:
This comprehensive exam is designed to prepare nursing students for NUR 265 assessments
covering acute care, critical thinking, and clinical decision-making in medical-surgical and
critical care settings.
Key Features:
100+ NCLEX-style multiple-choice questions
Answers provided in bold with detailed rationales
Covers respiratory, cardiovascular, endocrine, renal, hepatic, neurological, and
electrolyte disorders
Emphasizes priority interventions, safety, and patient-centered care
Focused on realistic scenarios commonly encountered in clinical practice
Includes acute emergencies, post-op care, shock, sepsis, DKA, MI, and electrolyte
imbalances
1. The nurse receives shift report for four patients. Which
patient should be assessed first?
A. A postoperative cholecystectomy patient with 7/10 pain
B. A COPD patient with SpO₂ 88% on 2 L NC
C. A heart failure patient with +3 edema
D. A diabetic patient with glucose 65 mg/dL and diaphoresis
Answer: D
Rationale: Hypoglycemia with symptoms is immediately life-threatening and must be corrected
first to prevent seizures/coma.
,2. A patient with suspected sepsis is admitted. Which order
should the nurse perform first?
A. Begin IV antibiotics
B. Obtain blood cultures
C. Insert Foley catheter
D. Start maintenance IV fluids
Answer: B
Rationale: Blood cultures must be drawn before antibiotic administration to prevent false-
negative results.
3. A patient with pneumonia has crackles, fever, and RR
30/min. Priority action?
A. Encourage fluids
B. Give PRN acetaminophen
C. Apply oxygen to maintain SpO₂ > 94%
D. Elevate HOB
Answer: C
Rationale: The patient is in respiratory distress; airway/oxygenation is the priority.
4. Which hypertension statement indicates need for
additional teaching?
A. “I'll check my blood pressure at home.”
B. “I can stop taking my medication when my numbers improve.”
C. “I’ll reduce salt in my diet.”
D. “I need to exercise most days.”
Answer: B
Rationale: BP meds must be continued even when readings improve; hypertension is chronic.
5. A patient has K⁺ = 6.2 mEq/L. Which finding requires
immediate action?
, A. Muscle weakness
B. Abdominal cramping
C. Peaked T waves on ECG
D. Hyperactive bowel sounds
Answer: C
Rationale: Peaked T waves indicate dangerous hyperkalemia → risk for lethal arrhythmias.
6. Acute pancreatitis — which order is priority?
A. Provide clear liquids
B. Administer IV fluids
C. Give morphine
D. Insert NGT
Answer: B
Rationale: Severe fluid shifts occur; aggressive fluid resuscitation prevents shock.
7. A post-op patient suddenly has SOB and chest pain. First
action?
A. Give nitroglycerin
B. Apply high-flow oxygen
C. Obtain ECG
D. Call rapid response
Answer: B
Rationale: Suspected PE → oxygenation priority before diagnostics.
8. ABG: pH 7.29, CO₂ 60, HCO₃ 25. Interpretation?
A. Metabolic acidosis
B. Respiratory acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
Answer: B
Rationale: Low pH + high CO₂ = respiratory acidosis.
Surgical Nursing ACTUAL Exam 2026/2027
UPDATE
Overview:
This comprehensive exam is designed to prepare nursing students for NUR 265 assessments
covering acute care, critical thinking, and clinical decision-making in medical-surgical and
critical care settings.
Key Features:
100+ NCLEX-style multiple-choice questions
Answers provided in bold with detailed rationales
Covers respiratory, cardiovascular, endocrine, renal, hepatic, neurological, and
electrolyte disorders
Emphasizes priority interventions, safety, and patient-centered care
Focused on realistic scenarios commonly encountered in clinical practice
Includes acute emergencies, post-op care, shock, sepsis, DKA, MI, and electrolyte
imbalances
1. The nurse receives shift report for four patients. Which
patient should be assessed first?
A. A postoperative cholecystectomy patient with 7/10 pain
B. A COPD patient with SpO₂ 88% on 2 L NC
C. A heart failure patient with +3 edema
D. A diabetic patient with glucose 65 mg/dL and diaphoresis
Answer: D
Rationale: Hypoglycemia with symptoms is immediately life-threatening and must be corrected
first to prevent seizures/coma.
,2. A patient with suspected sepsis is admitted. Which order
should the nurse perform first?
A. Begin IV antibiotics
B. Obtain blood cultures
C. Insert Foley catheter
D. Start maintenance IV fluids
Answer: B
Rationale: Blood cultures must be drawn before antibiotic administration to prevent false-
negative results.
3. A patient with pneumonia has crackles, fever, and RR
30/min. Priority action?
A. Encourage fluids
B. Give PRN acetaminophen
C. Apply oxygen to maintain SpO₂ > 94%
D. Elevate HOB
Answer: C
Rationale: The patient is in respiratory distress; airway/oxygenation is the priority.
4. Which hypertension statement indicates need for
additional teaching?
A. “I'll check my blood pressure at home.”
B. “I can stop taking my medication when my numbers improve.”
C. “I’ll reduce salt in my diet.”
D. “I need to exercise most days.”
Answer: B
Rationale: BP meds must be continued even when readings improve; hypertension is chronic.
5. A patient has K⁺ = 6.2 mEq/L. Which finding requires
immediate action?
, A. Muscle weakness
B. Abdominal cramping
C. Peaked T waves on ECG
D. Hyperactive bowel sounds
Answer: C
Rationale: Peaked T waves indicate dangerous hyperkalemia → risk for lethal arrhythmias.
6. Acute pancreatitis — which order is priority?
A. Provide clear liquids
B. Administer IV fluids
C. Give morphine
D. Insert NGT
Answer: B
Rationale: Severe fluid shifts occur; aggressive fluid resuscitation prevents shock.
7. A post-op patient suddenly has SOB and chest pain. First
action?
A. Give nitroglycerin
B. Apply high-flow oxygen
C. Obtain ECG
D. Call rapid response
Answer: B
Rationale: Suspected PE → oxygenation priority before diagnostics.
8. ABG: pH 7.29, CO₂ 60, HCO₃ 25. Interpretation?
A. Metabolic acidosis
B. Respiratory acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
Answer: B
Rationale: Low pH + high CO₂ = respiratory acidosis.
