Galen NUR 265 – Med-Surg Exam 3 (Practice Exam) 150 Questions with Answers & Rationales

Galen NUR 265 – Med-Surg Exam 3
(Practice Exam) 150 Questions with Answers
& Rationales

Section 1: Respiratory Disorders (Q1–20)

1. A patient with ARDS has a PaO₂ of 55 mm Hg on FiO₂ 0.8.
k k k k k k k k k k k k k



Which intervention should the nurse anticipate next?
k k k k k k k




A. Increase FiO₂ to 1.0 k k k



B. Prone positioning k



C. Administer IV fluids rapidly k k k



D. Decrease PEEP k



Answer: B – Prone positioning
k k k k



Rationale: Prone positioning improves V/Q matching and
k k k k k k



oxygenation in moderate to severe ARDS.
k k k k k k




2. A COPD patient has an SpO₂ of 86% on 2 L nasal cannula. What
k k k k k k k k k k k k k k



is the priority action?
k k k k



A. Increase oxygen to 4 L k k k k



B. Obtain a stat ABG k k k



C. Auscultate lung sounds k k



D. Encourage coughing and deep breathing k k k k



Answer: B – Obtain a stat ABG
k k k k k k k



Rationale: ABG determines PaCO₂ level before adjusting O₂ to
k k k k k k k k



avoid worsening CO₂ retention.
k k k k

,3. A patient with a chest tube has continuous bubbling in the
k k k k k k k k k k k



water seal chamber. What does this indicate?
k k k k k k



A. Normal functioning k



B. Air leak k



C. Tension pneumothorax k



D. Fluid overload k



Answer: B – Air leak
k k k k k




Rationale: Continuous bubbling in water seal chamber (not
k k k k k k k



suction chamber) indicates an air leak.
k k k k k k




4. Which finding is most concerning in a patient with a tension
k k k k k k k k k k



pneumothorax?
k



A. Respiratory rate 28 k k



B. Tracheal deviation to the left k k k k



C. Heart rate 100 bpm k k k



D. Subcutaneous emphysema k



Answer: B – Tracheal deviation to the left
k k k k k k k




Rationale: Tracheal deviation away from the affected side is a late
k k k k k k k k k k



sign of life-threatening tension pneumothorax.
k k k k k




5. A patient with pneumonia has a fever of 103°F, productive
k k k k k k k k k



cough, and confusion. Which action first?
k k k k k k



A. Blood cultures k



B. Chest X-ray k



C. Start antibioticsk



D. Assess oxygen saturation k k



Answer: D – Assess oxygen saturation
k k k k k

,Rationale: Confusion may indicate hypoxia; airway and
k k k k k k



oxygenation are always first. k k k




6. A post-operative patient suddenly develops dyspnea, pleuritic
k k k k k k



chest pain, and hemoptysis. Most likely diagnosis?
k k k k k k k



A. Atelectasis
B. Pulmonary embolism k



C. Pneumothorax
D. Pulmonary edema k



Answer: B – Pulmonary embolism k k k k



Rationale: Sudden onset dyspnea, pleuritic pain, hemoptysis post-
k k k k k k k



op suggests PE.
k k k




7. In ARDS, which ventilator strategy is standard of care?
k k k k k k k k



A. High tidal volume (10–12 mL/kg)
k k k k



B. Low tidal volume (6 mL/kg)
k k k k



C. Pressure support only k k



D. High frequency oscillation
k k



Answer: B – Low tidal volume (6 mL/kg)
k k k k k k k



Rationale: Low tidal volume prevents ventilator-induced lung
k k k k k k



injury in ARDS.
k k k




8. Which ABG finding is expected in a COPD patient with carbon
k k k k k k k k k k



dioxide retention?
k k



A. pH 7.32, PaCO₂ 58, HCO₃ 30
k k k k k



B. pH 7.48, PaCO₂ 32, HCO₃ 22
k k k k k



C. pH 7.40, PaCO₂ 40, HCO₃ 24
k k k k k



D. pH 7.50, PaCO₂ 50, HCO₃ 32
k k k k k

, Answer: A – pH 7.32, PaCO₂ 58, HCO₃ 30
k k k k k k k k



Rationale: Chronic respiratory acidosis with metabolic
k k k k k



compensation (elevated HCO₃).
k k k




9. The high-pressure alarm sounds on a ventilator. The nurse’s
k k k k k k k k



first action?
k k



A. Sedate the patient k k



B. Suction the endotracheal tube
k k k



C. Disconnect the patient k k



D. Increase the pressure limit k k k



Answer: B – Suction the endotracheal tube
k k k k k k



Rationale: High pressure often due to secretions or mucus plug;
k k k k k k k k k



suctioning is first step.
k k k k




10. Which precautions are required for a patient with active
k k k k k k k k



tuberculosis?
k



A. Contact
B. Droplet
C. Airborne
D. Reverse isolation k



Answer: C – Airborne
k k k k



Rationale: TB requires N95 mask, negative pressure room,
k k k k k k k



airborne precautions.
k k




11. A patient with asthma has a peak expiratory flow of 40% of
k k k k k k k k k k k



personal best. What should the nurse do?
k k k k k k k



A. Discharge home with follow-up k k k



B. Administer albuterol and reassess k k k