NUR 265 Final Exam
Medical-Surgical Nursing
Galen College of Nursing
150 Questions | Verified Answers with Rationales
THIS DOCUMENT CONTAINS:
➢ GUARANTEE PASSING SCORE
➢ QUESTIONS AND ANSWERS
➢ EXPERT VERIFIED EXPLANATIONS
➢ FORMAT SET OF MULTIPLE-CHOICE
, This exam is designed to mirror the format, style, and complexity of the actual NUR
265 Final Exam. It covers high-priority content including shock, respiratory failure,
renal disorders, and complex medical-surgical management.
Topic 1: Shock & Hemodynamics (Questions 1-25)
1. The nurse is assessing a patient with a suspected pulmonary embolism (PE).
Which of the following findings is consistent with this diagnosis?
• A) Bradycardia and hypertension
• B) Productive cough with yellow sputum
• C) Sudden onset of dyspnea and pleuritic chest pain
• D) Bilateral crackles in the lung bases
Correct Answer: C
Rationale: The classic presentation of a PE includes the sudden onset of dyspnea
and sharp, pleuritic chest pain. Tachycardia (not bradycardia) is common due to
decreased cardiac output. A productive cough suggests infection, and crackles are
more typical of pneumonia or heart failure .
2. A patient is being treated for septic shock. Which order should the nurse
implement first?
• A) Send blood cultures to the lab
• B) Administer broad-spectrum antibiotics
• C) Infuse 500 mL bolus of Lactated Ringers
• D) Obtain a serum lactate level
Correct Answer: C
Rationale: While all actions are important in sepsis, the "Surviving Sepsis Campaign"
guidelines emphasize early fluid resuscitation as the top priority to restore
intravascular volume and improve tissue perfusion. Antibiotics should be given within
1 hour, but fluid comes first .
3. The nurse is caring for a patient in the compensatory stage of shock. Which
assessment finding would the nurse expect?
• A) Cold, clammy skin and absent peripheral pulses
• B) Blood pressure 100/60 with a heart rate of 110
• C) Urinary output of 90 mL over the last 4 hours
• D) pH of 7.30 and PaCO2 of 55 mmHg
, Correct Answer: B
Rationale: In compensatory shock, the body uses neural and hormonal mechanisms
(increased HR, vasoconstriction) to maintain near-normal blood pressure.
Tachycardia is often the first sign. Urine output should be at least 30 mL/hr, so 90
mL/4 hrs (22.5 mL/hr) indicates impaired perfusion . Cold/clammy skin occurs in
progressive shock.
4. A patient with a history of heparin-induced thrombocytopenia (HIT) is being
admitted. What action should the nurse take?
• A) Administer enoxaparin as ordered for DVT prophylaxis
• B) Place a "Heparin Allergy" bracelet on the patient
• C) Prepare to administer warfarin (Coumadin) immediately
• D) Flush all peripheral IV lines with heparin solution
Correct Answer: B
Rationale: HIT is a life-threatening prothrombotic reaction to heparin. The priority is
to prevent any further heparin exposure (including flushes and coated catheters). The
patient should be identified clearly to prevent accidental administration .
5. The nurse notes a narrowing pulse pressure from 40 to 20 mmHg in a patient
with a traumatic injury. What does this indicate?
• A) The patient is responding well to fluid resuscitation
• B) The patient is at risk for a spontaneous pneumothorax
• C) The patient is experiencing increased intracranial pressure
• D) The patient is in the early stages of hypovolemic shock
Correct Answer: D
Rationale: Narrowing pulse pressure (the difference between systolic and diastolic
pressure) is an early indicator of decreasing stroke volume and cardiac output, often
seen before a significant drop in systolic blood pressure in hypovolemic or
cardiogenic shock .
6. A patient with severe pancreatitis develops hypotension, tachycardia, and
fever. Which type of shock is the patient most likely experiencing?
• A) Cardiogenic shock
• B) Neurogenic shock
• C) Hypovolemic shock
• D) Distributive shock (Septic)
Correct Answer: D
Rationale: While pancreatitis can cause hypovolemia (third-spacing), the presence of
fever indicates a systemic inflammatory response. Severe pancreatitis often leads to a
, "cytokine storm" causing vasodilation and increased capillary permeability,
characteristic of distributive (septic/distributive) shock.
7. The nurse is administering dopamine (Intropin) to a patient in cardiogenic
shock. Which assessment finding indicates the medication is having the desired
therapeutic effect?
• A) Heart rate decreases from 110 to 60
• B) Systolic blood pressure increases to 100 mmHg
• C) Patient reports a headache
• D) Urine output decreases to 20 mL/hr
Correct Answer: B
Rationale: Dopamine is used to increase blood pressure and cardiac output in shock.
An increase in systolic BP to an acceptable level (e.g., 100 mmHg) indicates improved
perfusion. Decreasing urine output is a negative sign .
8. A patient is admitted with a diagnosis of a pulmonary embolism. The nurse
anticipates which medication to be ordered first?
• A) Warfarin (Coumadin)
• B) Enoxaparin (Lovenox)
• C) Unfractionated Heparin IV bolus
• D) Alteplase (tPA)
Correct Answer: C
Rationale: In a massive PE, immediate anticoagulation is critical. Unfractionated
Heparin IV is preferred initially because it has a short half-life and can be titrated or
reversed quickly if needed. Warfarin takes days to work. tPA is used for massive, life-
threatening PEs with hemodynamic instability.
9. The nurse is caring for a patient with a pulmonary artery catheter. The
cardiac output (CO) is low, and the systemic vascular resistance (SVR) is high.
This indicates:
• A) Distributive shock
• B) Obstructive shock
• C) Hypovolemic shock
• D) Cardiogenic shock
Correct Answer: D
Rationale: Low CO with high SVR (afterload) indicates the heart is failing to pump
effectively (cardiogenic shock). The body is vasoconstricting (high SVR) to try to
maintain pressure. Distributive shock typically has low SVR.
Medical-Surgical Nursing
Galen College of Nursing
150 Questions | Verified Answers with Rationales
THIS DOCUMENT CONTAINS:
➢ GUARANTEE PASSING SCORE
➢ QUESTIONS AND ANSWERS
➢ EXPERT VERIFIED EXPLANATIONS
➢ FORMAT SET OF MULTIPLE-CHOICE
, This exam is designed to mirror the format, style, and complexity of the actual NUR
265 Final Exam. It covers high-priority content including shock, respiratory failure,
renal disorders, and complex medical-surgical management.
Topic 1: Shock & Hemodynamics (Questions 1-25)
1. The nurse is assessing a patient with a suspected pulmonary embolism (PE).
Which of the following findings is consistent with this diagnosis?
• A) Bradycardia and hypertension
• B) Productive cough with yellow sputum
• C) Sudden onset of dyspnea and pleuritic chest pain
• D) Bilateral crackles in the lung bases
Correct Answer: C
Rationale: The classic presentation of a PE includes the sudden onset of dyspnea
and sharp, pleuritic chest pain. Tachycardia (not bradycardia) is common due to
decreased cardiac output. A productive cough suggests infection, and crackles are
more typical of pneumonia or heart failure .
2. A patient is being treated for septic shock. Which order should the nurse
implement first?
• A) Send blood cultures to the lab
• B) Administer broad-spectrum antibiotics
• C) Infuse 500 mL bolus of Lactated Ringers
• D) Obtain a serum lactate level
Correct Answer: C
Rationale: While all actions are important in sepsis, the "Surviving Sepsis Campaign"
guidelines emphasize early fluid resuscitation as the top priority to restore
intravascular volume and improve tissue perfusion. Antibiotics should be given within
1 hour, but fluid comes first .
3. The nurse is caring for a patient in the compensatory stage of shock. Which
assessment finding would the nurse expect?
• A) Cold, clammy skin and absent peripheral pulses
• B) Blood pressure 100/60 with a heart rate of 110
• C) Urinary output of 90 mL over the last 4 hours
• D) pH of 7.30 and PaCO2 of 55 mmHg
, Correct Answer: B
Rationale: In compensatory shock, the body uses neural and hormonal mechanisms
(increased HR, vasoconstriction) to maintain near-normal blood pressure.
Tachycardia is often the first sign. Urine output should be at least 30 mL/hr, so 90
mL/4 hrs (22.5 mL/hr) indicates impaired perfusion . Cold/clammy skin occurs in
progressive shock.
4. A patient with a history of heparin-induced thrombocytopenia (HIT) is being
admitted. What action should the nurse take?
• A) Administer enoxaparin as ordered for DVT prophylaxis
• B) Place a "Heparin Allergy" bracelet on the patient
• C) Prepare to administer warfarin (Coumadin) immediately
• D) Flush all peripheral IV lines with heparin solution
Correct Answer: B
Rationale: HIT is a life-threatening prothrombotic reaction to heparin. The priority is
to prevent any further heparin exposure (including flushes and coated catheters). The
patient should be identified clearly to prevent accidental administration .
5. The nurse notes a narrowing pulse pressure from 40 to 20 mmHg in a patient
with a traumatic injury. What does this indicate?
• A) The patient is responding well to fluid resuscitation
• B) The patient is at risk for a spontaneous pneumothorax
• C) The patient is experiencing increased intracranial pressure
• D) The patient is in the early stages of hypovolemic shock
Correct Answer: D
Rationale: Narrowing pulse pressure (the difference between systolic and diastolic
pressure) is an early indicator of decreasing stroke volume and cardiac output, often
seen before a significant drop in systolic blood pressure in hypovolemic or
cardiogenic shock .
6. A patient with severe pancreatitis develops hypotension, tachycardia, and
fever. Which type of shock is the patient most likely experiencing?
• A) Cardiogenic shock
• B) Neurogenic shock
• C) Hypovolemic shock
• D) Distributive shock (Septic)
Correct Answer: D
Rationale: While pancreatitis can cause hypovolemia (third-spacing), the presence of
fever indicates a systemic inflammatory response. Severe pancreatitis often leads to a
, "cytokine storm" causing vasodilation and increased capillary permeability,
characteristic of distributive (septic/distributive) shock.
7. The nurse is administering dopamine (Intropin) to a patient in cardiogenic
shock. Which assessment finding indicates the medication is having the desired
therapeutic effect?
• A) Heart rate decreases from 110 to 60
• B) Systolic blood pressure increases to 100 mmHg
• C) Patient reports a headache
• D) Urine output decreases to 20 mL/hr
Correct Answer: B
Rationale: Dopamine is used to increase blood pressure and cardiac output in shock.
An increase in systolic BP to an acceptable level (e.g., 100 mmHg) indicates improved
perfusion. Decreasing urine output is a negative sign .
8. A patient is admitted with a diagnosis of a pulmonary embolism. The nurse
anticipates which medication to be ordered first?
• A) Warfarin (Coumadin)
• B) Enoxaparin (Lovenox)
• C) Unfractionated Heparin IV bolus
• D) Alteplase (tPA)
Correct Answer: C
Rationale: In a massive PE, immediate anticoagulation is critical. Unfractionated
Heparin IV is preferred initially because it has a short half-life and can be titrated or
reversed quickly if needed. Warfarin takes days to work. tPA is used for massive, life-
threatening PEs with hemodynamic instability.
9. The nurse is caring for a patient with a pulmonary artery catheter. The
cardiac output (CO) is low, and the systemic vascular resistance (SVR) is high.
This indicates:
• A) Distributive shock
• B) Obstructive shock
• C) Hypovolemic shock
• D) Cardiogenic shock
Correct Answer: D
Rationale: Low CO with high SVR (afterload) indicates the heart is failing to pump
effectively (cardiogenic shock). The body is vasoconstricting (high SVR) to try to
maintain pressure. Distributive shock typically has low SVR.
