NUR 265 Advanced Medical-Surgical Nursing Comprehensive Exam
2026 |Galen College
1. A patient exhibits a sudden onset of shortness of breath and chest pain. The
nurse notes a heart rate of 120 bpm and a respiratory rate of 28. Which
diagnostic test is the gold standard for confirming a Pulmonary Embolism (PE)?
A. Pulmonary Angiography
B. D-dimer assay
C. Chest X-ray
D. 12-lead ECG
Answer: A
Rationale: While CT pulmonary angiography is common, Pulmonary Angiography remains
the gold standard for definitive diagnosis of PE.
2. A nurse is caring for a patient in the early stage of septic shock. Which clinical
finding is most characteristic of this stage?
A. Cool, clammy skin
B. Severe hypotension
C. Bradypnea
D. Increased cardiac output
Answer: D
Rationale: The early (hyperdynamic) phase of septic shock is characterized by high
cardiac output, vasodilation, and warm, flushed skin.
,3. In a patient with Increased Intracranial Pressure (ICP), which of the following
assessments constitutes Cushing’s Triad?
A. Bradycardia, hypertension with widened pulse pressure, and irregular respirations
B. Tachycardia, hypotension, and tachypnea
C. Bradycardia, hypotension, and Cheyne-Stokes respirations
D. Tachycardia, narrowed pulse pressure, and bradypnea
Answer: A
Rationale: Cushing’s Triad is a late sign of increased ICP indicating brainstem
compression.
4. A patient with Acute Respiratory Distress Syndrome (ARDS) is on a ventilator.
The high-pressure alarm sounds. What is the nurse’s first action?
A. Manually bag the patient
B. Increase the oxygen concentration
C. Assess the patient’s breath sounds and tubing
D. Silence the alarm and observe
Answer: C
Rationale: Assessment is the priority to identify causes like secretions, biting the tube, or
kinked tubing before moving to manual ventilation.
5. Which arterial blood gas (ABG) result is most indicative of a patient in Acute
Renal Failure?
A. pH 7.30, HCO3 18, PaCO2 35
B. pH 7.50, HCO3 28, PaCO2 40
C. pH 7.32, HCO3 24, PaCO2 50
D. pH 7.48, HCO3 22, PaCO2 30
Answer: A
Rationale: Acute Renal Failure leads to metabolic acidosis due to the kidneys’ inability to
excrete hydrogen ions and regenerate bicarbonate.
,6. A patient has suffered full-thickness burns to the entire left arm and the
anterior trunk. Using the Rule of Nines, what is the estimated Total Body
Surface Area (TBSA) affected?
A. 18%
B. 45%
C. 36%
D. 27%
Answer: D
Rationale: Left arm (9%) + Anterior trunk (18%) = 27%.
7. What is the priority nursing intervention for a patient experiencing
Autonomic Dysreflexia?
A. Raising the head of the bed to 90 degrees
B. Placing the patient in a supine position
C. Administering a beta-blocker
D. Performing a digital rectal exam immediately
Answer: A
Rationale: The first action is to sit the patient upright to lower blood pressure via
orthostatic effect, then identify the stimulus.
8. A patient’s ECG shows a saw-tooth pattern with a ventricular rate of 80 bpm.
What rhythm is the patient experiencing?
A. Atrial Fibrillation
B. Atrial Flutter
C. Ventricular Tachycardia
D. First-degree Heart Block
Answer: B
Rationale: Atrial flutter is characterized by ‘F’ waves that create a saw-tooth appearance
on the ECG.
, 9. A nurse is managing a patient with Diabetic Ketoacidosis (DKA). Which IV fluid
is typically administered once the blood glucose reaches 250 mg/dL?
A. 5% Dextrose in 0.45% Normal Saline
B. 0.45% Normal Saline
C. 0.9% Normal Saline
D. Lactated Ringer’s
Answer: A
Rationale: Dextrose is added to prevent hypoglycemia and cerebral edema as insulin
drives glucose into cells.
10. Which laboratory value is the most sensitive indicator of Acute Kidney Injury
(AKI)?
A. Blood Urea Nitrogen (BUN)
B. Serum Creatinine
C. Urinary Output
D. Glomerular Filtration Rate (GFR)
Answer: B
Rationale: Serum creatinine is more specific to kidney function than BUN, though GFR is
used for staging chronic disease.
11. During a trauma assessment, the nurse notes paradoxical chest wall
movement. This is indicative of:
A. Tension Pneumothorax
B. Flail Chest
C. Cardiac Tamponade
D. Pulmonary Contusion
Answer: B
Rationale: Flail chest occurs when multiple rib fractures cause a segment of the chest wall
to move inward during inspiration and outward during expiration.
2026 |Galen College
1. A patient exhibits a sudden onset of shortness of breath and chest pain. The
nurse notes a heart rate of 120 bpm and a respiratory rate of 28. Which
diagnostic test is the gold standard for confirming a Pulmonary Embolism (PE)?
A. Pulmonary Angiography
B. D-dimer assay
C. Chest X-ray
D. 12-lead ECG
Answer: A
Rationale: While CT pulmonary angiography is common, Pulmonary Angiography remains
the gold standard for definitive diagnosis of PE.
2. A nurse is caring for a patient in the early stage of septic shock. Which clinical
finding is most characteristic of this stage?
A. Cool, clammy skin
B. Severe hypotension
C. Bradypnea
D. Increased cardiac output
Answer: D
Rationale: The early (hyperdynamic) phase of septic shock is characterized by high
cardiac output, vasodilation, and warm, flushed skin.
,3. In a patient with Increased Intracranial Pressure (ICP), which of the following
assessments constitutes Cushing’s Triad?
A. Bradycardia, hypertension with widened pulse pressure, and irregular respirations
B. Tachycardia, hypotension, and tachypnea
C. Bradycardia, hypotension, and Cheyne-Stokes respirations
D. Tachycardia, narrowed pulse pressure, and bradypnea
Answer: A
Rationale: Cushing’s Triad is a late sign of increased ICP indicating brainstem
compression.
4. A patient with Acute Respiratory Distress Syndrome (ARDS) is on a ventilator.
The high-pressure alarm sounds. What is the nurse’s first action?
A. Manually bag the patient
B. Increase the oxygen concentration
C. Assess the patient’s breath sounds and tubing
D. Silence the alarm and observe
Answer: C
Rationale: Assessment is the priority to identify causes like secretions, biting the tube, or
kinked tubing before moving to manual ventilation.
5. Which arterial blood gas (ABG) result is most indicative of a patient in Acute
Renal Failure?
A. pH 7.30, HCO3 18, PaCO2 35
B. pH 7.50, HCO3 28, PaCO2 40
C. pH 7.32, HCO3 24, PaCO2 50
D. pH 7.48, HCO3 22, PaCO2 30
Answer: A
Rationale: Acute Renal Failure leads to metabolic acidosis due to the kidneys’ inability to
excrete hydrogen ions and regenerate bicarbonate.
,6. A patient has suffered full-thickness burns to the entire left arm and the
anterior trunk. Using the Rule of Nines, what is the estimated Total Body
Surface Area (TBSA) affected?
A. 18%
B. 45%
C. 36%
D. 27%
Answer: D
Rationale: Left arm (9%) + Anterior trunk (18%) = 27%.
7. What is the priority nursing intervention for a patient experiencing
Autonomic Dysreflexia?
A. Raising the head of the bed to 90 degrees
B. Placing the patient in a supine position
C. Administering a beta-blocker
D. Performing a digital rectal exam immediately
Answer: A
Rationale: The first action is to sit the patient upright to lower blood pressure via
orthostatic effect, then identify the stimulus.
8. A patient’s ECG shows a saw-tooth pattern with a ventricular rate of 80 bpm.
What rhythm is the patient experiencing?
A. Atrial Fibrillation
B. Atrial Flutter
C. Ventricular Tachycardia
D. First-degree Heart Block
Answer: B
Rationale: Atrial flutter is characterized by ‘F’ waves that create a saw-tooth appearance
on the ECG.
, 9. A nurse is managing a patient with Diabetic Ketoacidosis (DKA). Which IV fluid
is typically administered once the blood glucose reaches 250 mg/dL?
A. 5% Dextrose in 0.45% Normal Saline
B. 0.45% Normal Saline
C. 0.9% Normal Saline
D. Lactated Ringer’s
Answer: A
Rationale: Dextrose is added to prevent hypoglycemia and cerebral edema as insulin
drives glucose into cells.
10. Which laboratory value is the most sensitive indicator of Acute Kidney Injury
(AKI)?
A. Blood Urea Nitrogen (BUN)
B. Serum Creatinine
C. Urinary Output
D. Glomerular Filtration Rate (GFR)
Answer: B
Rationale: Serum creatinine is more specific to kidney function than BUN, though GFR is
used for staging chronic disease.
11. During a trauma assessment, the nurse notes paradoxical chest wall
movement. This is indicative of:
A. Tension Pneumothorax
B. Flail Chest
C. Cardiac Tamponade
D. Pulmonary Contusion
Answer: B
Rationale: Flail chest occurs when multiple rib fractures cause a segment of the chest wall
to move inward during inspiration and outward during expiration.
