NUR 265 | Med-Surg Comprehensive Practice Exam Version 2 | 150 Questions & Rationales | Galen 2026

Master the NUR 265 Med-Surg final with this comprehensive 150-question practice exam (Version 2) for 2026. This digital download contains 150 unique questions with detailed rationales, covering all major medical-surgical nursing topics. Designed specifically for nursing students (including Galen College of Nursing), this resource reinforces clinical judgment and critical thinking. What's included in this PDF: 150 Practice Questions with correct answers and "why" rationales. Answer Key Summary organized by section. Study Tips for NUR 265 success. Exam Blueprint Topics Covered: Cardiovascular (20 questions): Heparin (bleeding risk), digoxin therapeutic effect (improved exercise tolerance, decreased dyspnea), hydrochlorothiazide (monitor potassium, calcium, glucose), post-MI new murmur (VSD or papillary muscle rupture), PAD (ABI 0.6 = moderate to severe), new-onset atrial fibrillation (assess BP and SpO2 first), endocarditis (arterial embolization → acute limb ischemia), pacemaker failure to pace (heart rate 50, no spikes), aortic stenosis syncope (fixed cardiac output), warfarin onset (3-5 days), acute decompensated HF (IV furosemide), lisinopril (dry cough may require ARB switch), AAA rupture (sudden severe back pain + hypotension), Raynaud's (remove from cold, warm hands gradually), pericardial friction rub (best heard sitting leaning forward), thrombolytics in MI (resolution of chest pain + ST segment return to baseline), varicose veins (elevate legs when resting), spironolactone with K+ 5.8 (hold and notify provider), mechanical heart valve (INR therapeutic 2.5-3.5). Respiratory (15 questions): COPD with hypercapnia (low-flow oxygen 1-2 L/min NC), peak flow meter purpose (monitor airway obstruction), pneumonia with fever 103°F and shivering (antipyretic priority), chest tube tidaling (normal function), positive PPD (next step = chest x-ray), PE with SpO2 85% (apply oxygen priority), COPD tripod position (high-Fowler's with arm support), tracheostomy suctioning (5-10 seconds per pass), pneumonia with confusion (suspect sepsis), heparin aPTT 90 seconds (supratherapeutic → decrease dose), albuterol inhaler (wait 1 minute between puffs), chest tube drainage 50 mL/hour serosanguinous (document as normal), COPD oxygen order 4 L/min (question order, suggest 2 L/min), laryngectomy discharge (humidification essential), thoracentesis lightheadedness (check BP first). Endocrine (15 questions): Unconscious hypoglycemia (IV dextrose 50% priority), DKA elevated anion gap (metabolic acidosis), PTU (report fever/sore throat for agranulocytosis), myxedema coma (hypotension + hypothermia), post-thyroidectomy stridor (prepare for emergency tracheostomy), Cushing's syndrome (hyperglycemia expected), Addisonian crisis (IV fluids + IV hydrocortisone), diabetic foot ulcer with purulent drainage (wound culture + antibiotics), severe hypercalcemia (monitor for cardiac arrhythmias), SIADH with seizure (hypertonic saline 3% NaCl), diabetes insipidus (desmopressin/DDAVP), metformin (hold for 48 hours before contrast dye), pheochromocytoma surgery (alpha-blockers first), gestational diabetes (moderate exercise helps control glucose), diabetic neuropathy neuropathic pain (gabapentin or pregabalin). Renal/Urinary (15 questions): CKD (protein restriction most important), AV fistula (palpable thrill + audible bruit = adequate blood flow), AKI oliguric phase (hyperkalemia expected), nephrotic syndrome (highest risk = thrombosis), ciprofloxacin (avoid antacids with calcium/magnesium), pyelonephritis (IV antibiotics priority), CKD hyperphosphatemia (sevelamer phosphate binder), ileal conduit infection prevention (maintain adequate fluid intake), glomerulonephritis worsening (urine output 300 mL/day), renal calculi passed (cessation of pain), CKD anemia (epoetin alfa + iron), peritoneal dialysis cloudy effluent (notify provider immediately for peritonitis), BPH tamsulosin (relaxes smooth muscle, does not reduce prostate size), urinary diversion stoma pale/bluish (notify provider immediately for ischemia), AKI diuretic phase (monitor for dehydration and hypovolemia). Gastrointestinal (15 questions): Cirrhosis asterixis (hepatic encephalopathy), lactulose (decreased ammonia levels), acute pancreatitis pain relief (fetal position), Murphy's sign (pain on inspiration with RUQ palpation), colostomy odor (avoid eggs and fish), Crohn's disease fistula (infection + electrolyte imbalance), mesalamine (take with food to reduce GI upset), small bowel obstruction high NG output (1L/8hr = complete obstruction), appendicitis rupture (fever + rigid boardlike abdomen), diverticulitis discharge (gradually increase fiber after acute episode), GERD pantoprazole (30-60 minutes before meals), hepatitis C transmission (blood-to-blood contact), paracentesis with hypotension (administer albumin IV), esophageal varices hematemesis (establish two large-bore IV lines first), dumping syndrome (lie down for 30 minutes after eating). Neurology (15 questions): Right hemisphere stroke left neglect (use seat belt in wheelchair), phenytoin toxicity (nystagmus + ataxia), GCS 6 (severe brain injury), Cushing's triad (hypertension with widened pulse pressure, bradycardia, irregular respirations), Kernig's sign (pain with knee extension while hip flexed), MS acute exacerbation (methylprednisolone IV), myasthenia gravis worsening weakness after pyridostigmine (cholinergic crisis/overmedication), Guillain-Barré (monitor vital capacity + respiratory status priority), Parkinson's gold standard (carbidopa-levodopa), tonic-clonic seizure (turn client to side priority), stroke dysphagia (no oral intake until speech therapy evaluation), subarachnoid hemorrhage ("worst headache of life" → CT scan), carbamazepine for trigeminal neuralgia (monitor for agranulocytosis), brain tumor new seizures (seizure precautions priority), autonomic dysreflexia T6 injury (sit upright + check for bladder distention). Musculoskeletal (10 questions): Buck's traction (relieve muscle spasms, immobilize hip before surgery), post-hip replacement enoxaparin (first dose 12-24 hours after surgery), osteomyelitis draining wound (contact precautions), acute gout attack (colchicine or NSAIDs), osteoporosis vertebral fracture (pain management + fall prevention priority). Hematology/Immunology (5 questions): Sickle cell crisis (administer opioids priority), iron deficiency anemia (fatigue + pallor), febrile neutropenia (blood cultures + broad-spectrum antibiotics emergency), hemophilia A (factor VIII replacement), ITP platelets 10,000 with headache/confusion (intracranial hemorrhage → immediate intervention). Infectious Diseases (5 questions): Septic shock after fluids (start norepinephrine vasopressor), HIV CD4 80 (TMP-SMX for PCP prophylaxis), cellulitis with red streak (lymphangitis → worsening infection), positive Quantiferon with normal CXR (latent TB infection), C. diff (contact precautions + soap and water, alcohol ineffective). Perioperative Care (5 questions): NPO (prevent aspiration), post-op day 1 fever 100.5°F (atelectasis most likely), post-op sudden chest pain + dyspnea (suspect PE), PCA with RR 8 (stop PCA infusion first), wound dehiscence with visible bowel (cover with sterile saline-soaked gauze first). Fluid & Electrolytes (5 questions): Severe symptomatic hyponatremia Na 115 + lethargy (hypertonic saline 3% NaCl), hyperkalemia K+ 6.8 with peaked T waves (calcium gluconate first), hypocalcemia Ca 6.5 + positive Chvostek's (tetany + muscle spasms), hypomagnesemia Mg 1.0 on digoxin (risk for digoxin toxicity), hypokalemia K+ 2.8 from vomiting/NG suction (U waves + flat T waves). Pain Management (5 questions): Chronic cancer pain (around-the-clock opioids better than PRN), morphine with RR 6 unresponsive (naloxone), gabapentin for neuropathic pain (may take weeks for full effect), ineffective PCA (assess client's pain and vital signs first), opioid addiction fear in acute pain (addiction risk very low with supervised use). End-of-Life Care (5 questions): Approaching death (cool, mottled extremities), dying client not eating (decreased appetite is normal), DNR with difficulty breathing (comfort measures: oxygen, morphine, positioning), death rattle (position on side + anticholinergic medication if ordered), client asks "How long do I have?" (assess what provider has told them). Prioritization & Delegation (10 questions): Hypoxemia with SpO2 85% on 2L (see first), UAP delegation (measure I&O for HF client), LPN assignment (stable diabetes requiring oral medications), fire in client room (Rescue client first - RACE), fall precautions (assist client to bathroom), PACU client (assess airway patency first), new tracheostomy difficulty breathing (suction first), chest tube tipped over (pick up and place upright first, do not clamp), IV infiltration (discontinue IV and restart in another site), hemolytic transfusion reaction (stop transfusion first). Pharmacology (10 questions): Digoxin toxicity (anorexia, nausea, vomiting), enoxaparin (inject into abdomen subcutaneously, do not aspirate or massage), MDI with spacer (wait 1 minute between puffs), isoniazid (supplement with vitamin B6/pyridoxine to prevent peripheral neuropathy), mixing NPH and regular insulin (draw regular first, then NPH), ondansetron (monitor for constipation), warfarin and ciprofloxacin interaction (increased warfarin effect → bleeding risk), epinephrine in anaphylaxis (bronchodilation + vasoconstriction), carbidopa-levodopa (take on empty stomach if no nausea), timolol eye drops (assess BP and heart rate before administration). Perfect for: Final exam preparation for NUR 265. Remediation and content review. Practicing clinical judgment (NGN-style scenarios). This is an original educational practice exam created to supplement course materials