NUR 265 Advanced Medical-Surgical Nursing - Week 1 Study Guide
2026 |Galen College
1. A patient is admitted with Acute Respiratory Failure (ARF). Which ABG result
best represents Type II (Hypercapnic) failure?
A. pH 7.28, PaO2 60, PaCO2 52
B. pH 7.35, PaO2 55, PaCO2 38
C. pH 7.48, PaO2 80, PaCO2 30
D. pH 7.32, PaO2 90, PaCO2 40
Answer: A
Rationale: Type II ARF is characterized by hypercapnia (PaCO2 > 45 mmHg) and often
respiratory acidosis (low pH).
2. Which clinical hallmark is most characteristic of Acute Respiratory Distress
Syndrome (ARDS)?
A. Improvement of oxygenation with low-flow oxygen
B. Increased pulmonary artery wedge pressure (PAWP) > 18
C. Decreased lung compliance and hypocapnia
D. Refractory hypoxemia
Answer: D
Rationale: Refractory hypoxemia is the inability to improve oxygen saturation despite
increasing FiO2, a classic sign of ARDS.
,3. A nurse is caring for a patient on a mechanical ventilator. The ‘High Pressure’
alarm sounds. What is the priority action?
A. Check for a disconnection in the circuit
B. Assess the patient for a cuff leak
C. Auscultate breath sounds and check for secretions
D. Silence the alarm and document the event
Answer: C
Rationale: High pressure alarms are triggered by increased resistance, such as secretions,
biting the tube, or kinks. Lower pressure alarms indicate leaks or disconnections.
4. To prevent Ventilator-Associated Pneumonia (VAP), at what angle should the
head of the bed be maintained?
A. 30 to 45 degrees
B. Flat or trendelenburg
C. 10 to 15 degrees
D. 90 degrees
Answer: A
Rationale: Maintaining the HOB at 30-45 degrees is a core component of the VAP bundle to
prevent aspiration.
5. What is the primary purpose of Positive End-Expiratory Pressure (PEEP) in a
patient with ARDS?
A. To increase the work of breathing
B. To increase the respiratory rate
C. To decrease the risk of barotrauma
D. To prevent alveolar collapse at the end of expiration
Answer: D
Rationale: PEEP keeps alveoli open (recruitment) to improve gas exchange and
oxygenation.
, 6. A patient with a pulmonary embolism (PE) is started on a Heparin drip. What
lab value must the nurse monitor to adjust the dose?
A. Activated Partial Thromboplastin Time (aPTT)
B. International Normalized Ratio (INR)
C. Prothrombin Time (PT)
D. Platelet count
Answer: A
Rationale: aPTT is the standard laboratory test used to monitor the effectiveness of
unfractionated Heparin.
7. A patient has a chest tube connected to a water-seal drainage system. The
nurse notes continuous bubbling in the water-seal chamber. This indicates:
A. An air leak in the system or patient
B. Normal functioning of the system
C. The lung has fully re-expanded
D. The suction is turned up too high
Answer: A
Rationale: Continuous bubbling in the water-seal chamber usually signifies an air leak;
intermittent bubbling occurs with respiration if a pneumothorax is present.
8. Which of the following is the gold standard diagnostic test for confirming a
Pulmonary Embolism?
A. Chest X-ray
B. D-dimer assay
C. CT Angiography (CTA)
D. Arterial Blood Gas
Answer: C
Rationale: CT Angiography is the preferred imaging modality for diagnosing PE due to its
high sensitivity and specificity.
2026 |Galen College
1. A patient is admitted with Acute Respiratory Failure (ARF). Which ABG result
best represents Type II (Hypercapnic) failure?
A. pH 7.28, PaO2 60, PaCO2 52
B. pH 7.35, PaO2 55, PaCO2 38
C. pH 7.48, PaO2 80, PaCO2 30
D. pH 7.32, PaO2 90, PaCO2 40
Answer: A
Rationale: Type II ARF is characterized by hypercapnia (PaCO2 > 45 mmHg) and often
respiratory acidosis (low pH).
2. Which clinical hallmark is most characteristic of Acute Respiratory Distress
Syndrome (ARDS)?
A. Improvement of oxygenation with low-flow oxygen
B. Increased pulmonary artery wedge pressure (PAWP) > 18
C. Decreased lung compliance and hypocapnia
D. Refractory hypoxemia
Answer: D
Rationale: Refractory hypoxemia is the inability to improve oxygen saturation despite
increasing FiO2, a classic sign of ARDS.
,3. A nurse is caring for a patient on a mechanical ventilator. The ‘High Pressure’
alarm sounds. What is the priority action?
A. Check for a disconnection in the circuit
B. Assess the patient for a cuff leak
C. Auscultate breath sounds and check for secretions
D. Silence the alarm and document the event
Answer: C
Rationale: High pressure alarms are triggered by increased resistance, such as secretions,
biting the tube, or kinks. Lower pressure alarms indicate leaks or disconnections.
4. To prevent Ventilator-Associated Pneumonia (VAP), at what angle should the
head of the bed be maintained?
A. 30 to 45 degrees
B. Flat or trendelenburg
C. 10 to 15 degrees
D. 90 degrees
Answer: A
Rationale: Maintaining the HOB at 30-45 degrees is a core component of the VAP bundle to
prevent aspiration.
5. What is the primary purpose of Positive End-Expiratory Pressure (PEEP) in a
patient with ARDS?
A. To increase the work of breathing
B. To increase the respiratory rate
C. To decrease the risk of barotrauma
D. To prevent alveolar collapse at the end of expiration
Answer: D
Rationale: PEEP keeps alveoli open (recruitment) to improve gas exchange and
oxygenation.
, 6. A patient with a pulmonary embolism (PE) is started on a Heparin drip. What
lab value must the nurse monitor to adjust the dose?
A. Activated Partial Thromboplastin Time (aPTT)
B. International Normalized Ratio (INR)
C. Prothrombin Time (PT)
D. Platelet count
Answer: A
Rationale: aPTT is the standard laboratory test used to monitor the effectiveness of
unfractionated Heparin.
7. A patient has a chest tube connected to a water-seal drainage system. The
nurse notes continuous bubbling in the water-seal chamber. This indicates:
A. An air leak in the system or patient
B. Normal functioning of the system
C. The lung has fully re-expanded
D. The suction is turned up too high
Answer: A
Rationale: Continuous bubbling in the water-seal chamber usually signifies an air leak;
intermittent bubbling occurs with respiration if a pneumothorax is present.
8. Which of the following is the gold standard diagnostic test for confirming a
Pulmonary Embolism?
A. Chest X-ray
B. D-dimer assay
C. CT Angiography (CTA)
D. Arterial Blood Gas
Answer: C
Rationale: CT Angiography is the preferred imaging modality for diagnosing PE due to its
high sensitivity and specificity.
