NUR 265 Advanced Medical-Surgical Nursing Comprehensive Exam
Bundle 2026 |Galen College
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is receiving
mechanical ventilation. Which setting change is most likely intended to prevent
barotrauma?
A. Increasing the FiO2 to 100%
B. Increasing the respiratory rate to 30 breaths/min
C. Decreasing the PEEP level
D. Implementing low tidal volume ventilation
Answer: D
Rationale: Low tidal volume ventilation (4-6 mL/kg) is a key strategy in ARDS
management to prevent overdistension of alveoli and subsequent barotrauma (ventilator-
induced lung injury).
2. A patient arrives at the ED with 40% total body surface area (TBSA) burns.
Using the Parkland formula (4mL x kg x %TBSA), how much fluid should a 70kg
patient receive in the first 8 hours?
A. 11,200 mL
B. 5,600 mL
C. 2,800 mL
D. 8,400 mL
Answer: B
Rationale: Total fluid = 4mL x 70kg x 40 = 11,200 mL for 24 hours. Half of this (5,600 mL)
is administered in the first 8 hours.
,3. Which arterial blood gas (ABG) result is most indicative of early stage
compensated septic shock?
A. pH 7.32, PaCO2 48, HCO3 24
B. pH 7.48, PaCO2 30, HCO3 22
C. pH 7.25, PaCO2 35, HCO3 18
D. pH 7.35, PaCO2 40, HCO3 24
Answer: B
Rationale: In early septic shock, hyperventilation often occurs as a compensatory
mechanism or due to anxiety/pain, leading to respiratory alkalosis (high pH, low PaCO2).
4. A patient in the ICU has a Sudden decrease in Mean Arterial Pressure (MAP)
to 50 mmHg. What is the priority nursing action?
A. Re-check the blood pressure in 15 minutes
B. Administer a PRN sedative
C. Document the finding as an expected outcome of bedrest
D. Assess the patient’s level of consciousness and notify the provider
Answer: D
Rationale: A MAP below 60-65 mmHg indicates inadequate organ perfusion. Immediate
assessment and notification of the healthcare provider are required for intervention (e.g.,
fluids or vasopressors).
5. Which cardiac rhythm requires immediate unsynchronized defibrillation?
A. Atrial Fibrillation with a rate of 120
B. Ventricular Fibrillation
C. Sinus Tachycardia with PVCs
D. Stable Ventricular Tachycardia
Answer: B
,Rationale: Ventricular fibrillation is a pulseless, life-threatening rhythm that requires
immediate unsynchronized defibrillation. Synchronized cardioversion is used for stable
tachyarrhythmias with a pulse.
6. In a patient with Acute Kidney Injury (AKI), which electrolyte abnormality is
the most life-threatening?
A. Hyperkalemia
B. Hypocalcemia
C. Hyponatremia
D. Hypermagnesemia
Answer: A
Rationale: Hyperkalemia can lead to lethal cardiac dysrhythmias and is a primary concern
in patients with AKI or CKD due to impaired potassium excretion.
7. A nurse is caring for a patient with a traumatic brain injury. Which sign
indicates increasing intracranial pressure (ICP)?
A. Tachycardia and hypotension
B. Increased Glasgow Coma Scale score
C. Cushing’s Triad (Bradycardia, widened pulse pressure, irregular respirations)
D. Hypothermia
Answer: C
Rationale: Cushing’s Triad is a late sign of increased ICP and impending brain herniation,
consisting of bradycardia, hypertension with a widened pulse pressure, and respiratory
irregularities.
, 8. A patient is admitted with Diabetic Ketoacidosis (DKA). Which IV fluid is
typically used first in the rehydration process?
A. 0.9% Sodium Chloride (Normal Saline)
B. 0.45% Sodium Chloride
C. Dextrose 5% in Water (D5W)
D. Dextrose 5% in 0.9% Sodium Chloride
Answer: A
Rationale: Initial rehydration in DKA focuses on expanding the extracellular volume using
isotonic saline (0.9% NaCl). Hypotonic solutions or dextrose are added later based on
sodium and glucose levels.
9. A high-pressure alarm sounds on a patient’s ventilator. Which action should
the nurse take first?
A. Silence the alarm and check the settings
B. Manually ventilate the patient with an Ambu bag
C. Auscultate lung sounds and check for tube kinks or biting
D. Call the respiratory therapist to fix the machine
Answer: C
Rationale: The nurse should first assess the patient and the circuit for obstructions (e.g.,
biting the tube, secretions needing suction, or kinking). If the cause isn’t found or the
patient is distressed, then manual ventilation is initiated.
10. Which of the following is the most definitive clinical indicator of
disseminated intravascular coagulation (DIC)?
A. Decreased Fibrin Degradation Products (FDPs)
B. Increased platelet count
C. Shortened Prothrombin Time (PT)
D. Elevated D-dimer levels
Answer: D
Bundle 2026 |Galen College
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is receiving
mechanical ventilation. Which setting change is most likely intended to prevent
barotrauma?
A. Increasing the FiO2 to 100%
B. Increasing the respiratory rate to 30 breaths/min
C. Decreasing the PEEP level
D. Implementing low tidal volume ventilation
Answer: D
Rationale: Low tidal volume ventilation (4-6 mL/kg) is a key strategy in ARDS
management to prevent overdistension of alveoli and subsequent barotrauma (ventilator-
induced lung injury).
2. A patient arrives at the ED with 40% total body surface area (TBSA) burns.
Using the Parkland formula (4mL x kg x %TBSA), how much fluid should a 70kg
patient receive in the first 8 hours?
A. 11,200 mL
B. 5,600 mL
C. 2,800 mL
D. 8,400 mL
Answer: B
Rationale: Total fluid = 4mL x 70kg x 40 = 11,200 mL for 24 hours. Half of this (5,600 mL)
is administered in the first 8 hours.
,3. Which arterial blood gas (ABG) result is most indicative of early stage
compensated septic shock?
A. pH 7.32, PaCO2 48, HCO3 24
B. pH 7.48, PaCO2 30, HCO3 22
C. pH 7.25, PaCO2 35, HCO3 18
D. pH 7.35, PaCO2 40, HCO3 24
Answer: B
Rationale: In early septic shock, hyperventilation often occurs as a compensatory
mechanism or due to anxiety/pain, leading to respiratory alkalosis (high pH, low PaCO2).
4. A patient in the ICU has a Sudden decrease in Mean Arterial Pressure (MAP)
to 50 mmHg. What is the priority nursing action?
A. Re-check the blood pressure in 15 minutes
B. Administer a PRN sedative
C. Document the finding as an expected outcome of bedrest
D. Assess the patient’s level of consciousness and notify the provider
Answer: D
Rationale: A MAP below 60-65 mmHg indicates inadequate organ perfusion. Immediate
assessment and notification of the healthcare provider are required for intervention (e.g.,
fluids or vasopressors).
5. Which cardiac rhythm requires immediate unsynchronized defibrillation?
A. Atrial Fibrillation with a rate of 120
B. Ventricular Fibrillation
C. Sinus Tachycardia with PVCs
D. Stable Ventricular Tachycardia
Answer: B
,Rationale: Ventricular fibrillation is a pulseless, life-threatening rhythm that requires
immediate unsynchronized defibrillation. Synchronized cardioversion is used for stable
tachyarrhythmias with a pulse.
6. In a patient with Acute Kidney Injury (AKI), which electrolyte abnormality is
the most life-threatening?
A. Hyperkalemia
B. Hypocalcemia
C. Hyponatremia
D. Hypermagnesemia
Answer: A
Rationale: Hyperkalemia can lead to lethal cardiac dysrhythmias and is a primary concern
in patients with AKI or CKD due to impaired potassium excretion.
7. A nurse is caring for a patient with a traumatic brain injury. Which sign
indicates increasing intracranial pressure (ICP)?
A. Tachycardia and hypotension
B. Increased Glasgow Coma Scale score
C. Cushing’s Triad (Bradycardia, widened pulse pressure, irregular respirations)
D. Hypothermia
Answer: C
Rationale: Cushing’s Triad is a late sign of increased ICP and impending brain herniation,
consisting of bradycardia, hypertension with a widened pulse pressure, and respiratory
irregularities.
, 8. A patient is admitted with Diabetic Ketoacidosis (DKA). Which IV fluid is
typically used first in the rehydration process?
A. 0.9% Sodium Chloride (Normal Saline)
B. 0.45% Sodium Chloride
C. Dextrose 5% in Water (D5W)
D. Dextrose 5% in 0.9% Sodium Chloride
Answer: A
Rationale: Initial rehydration in DKA focuses on expanding the extracellular volume using
isotonic saline (0.9% NaCl). Hypotonic solutions or dextrose are added later based on
sodium and glucose levels.
9. A high-pressure alarm sounds on a patient’s ventilator. Which action should
the nurse take first?
A. Silence the alarm and check the settings
B. Manually ventilate the patient with an Ambu bag
C. Auscultate lung sounds and check for tube kinks or biting
D. Call the respiratory therapist to fix the machine
Answer: C
Rationale: The nurse should first assess the patient and the circuit for obstructions (e.g.,
biting the tube, secretions needing suction, or kinking). If the cause isn’t found or the
patient is distressed, then manual ventilation is initiated.
10. Which of the following is the most definitive clinical indicator of
disseminated intravascular coagulation (DIC)?
A. Decreased Fibrin Degradation Products (FDPs)
B. Increased platelet count
C. Shortened Prothrombin Time (PT)
D. Elevated D-dimer levels
Answer: D
