NUR 265 Advanced Medical-Surgical Nursing Exam Bundle 2026
|Galen College
1. A patient in the emergent phase of a burn injury has a blood pressure of
88/50 mmHg and a heart rate of 120 bpm. Which is the priority intervention?
A. Administering prophylactic antibiotics
B. Initiating enteral feedings
C. Applying topical silver sulfadiazine
D. Providing aggressive fluid resuscitation
Answer: D
Rationale: In the emergent phase of a burn, the priority is addressing hypovolemic shock
through fluid resuscitation. Antibiotics and nutrition are secondary to hemodynamic
stability.
2. Which assessment finding in a patient with a head injury suggests increasing
intracranial pressure (ICP)?
A. Hyperactivity and increased appetite
B. Constricted, equal pupils
C. Increased urine output
D. Decreased level of consciousness
Answer: D
Rationale: A change in the level of consciousness (LOC) is the earliest and most sensitive
indicator of increasing intracranial pressure.
,3. A patient is diagnosed with Septic Shock. Which of the following findings is
most characteristic of the ‘warm’ or early stage of septic shock?
A. Flushed skin and high cardiac output
B. Hypothermia and bradycardia
C. Cool, clammy skin and oliguria
D. Severe metabolic alkalosis
Answer: A
Rationale: In the early (hyperdynamic) phase of septic shock, vasodilation leads to warm,
flushed skin and a compensatory increase in cardiac output.
4. The nurse is monitoring a patient on a mechanical ventilator. The ‘High
Pressure’ alarm sounds. What is a likely cause?
A. The patient has disconnected the tubing
B. The patient is biting the endotracheal tube
C. There is a leak in the ventilator cuff
D. The patient has stopped breathing spontaneously
Answer: B
Rationale: High-pressure alarms are triggered by increased resistance, such as biting the
tube, secretions, or kinking. Disconnections and leaks trigger low-pressure alarms.
5. What is the hallmark clinical manifestation of Acute Respiratory Distress
Syndrome (ARDS)?
A. Respiratory acidosis responsive to oxygen
B. Hypercapnia that improves with PEEP
C. Refractory hypoxemia
D. Increased lung compliance
Answer: C
Rationale: Refractory hypoxemia, which is low arterial oxygen levels that do not improve
with high concentrations of inspired oxygen, is the hallmark of ARDS.
,6. A patient with a T6 spinal cord injury reports a severe headache and has a BP
of 190/100 mmHg. What is the nurse’s immediate action?
A. Lower the head of the bed to a flat position
B. Request an order for a STAT CT scan
C. Administer PRN intravenous morphine
D. Check the patient’s bladder for distention
Answer: D
Rationale: The patient is exhibiting signs of Autonomic Dysreflexia. The priority is to sit
the patient up and identify/remove the stimulus, often a distended bladder or impacted
bowel.
7. Using the Parkland Formula (4mL/kg/%TBSA), calculate the total fluid
required in the first 24 hours for a 70kg patient with 40% burns.
A. 11,200 mL
B. 5,600 mL
C. 2,800 mL
D. 14,000 mL
Answer: A
Rationale: 4mL x 70kg x 40 = 11,200 mL.
8. In a patient with Acute Kidney Injury (AKI), which electrolyte imbalance is the
most life-threatening?
A. Hyponatremia
B. Hypocalcemia
C. Hypermagnesemia
D. Hyperkalemia
Answer: D
Rationale: Hyperkalemia is the most dangerous electrolyte imbalance in AKI because it
can lead to fatal cardiac dysrhythmias.
, 9. Which rhythm is characterized by a ‘sawtooth’ pattern on the ECG?
A. Atrial Flutter
B. Atrial Fibrillation
C. Ventricular Tachycardia
D. Sinus Bradycardia
Answer: A
Rationale: Atrial flutter is classically described as having sawtooth-shaped P waves (F-
waves).
10. A patient has a Pulmonary Artery Wedge Pressure (PAWP) of 22 mmHg.
Which condition does the nurse suspect?
A. Left-sided heart failure
B. Dehydration
C. Hypovolemic shock
D. Septic shock
Answer: A
Rationale: Normal PAWP is 6-12 mmHg. An elevated PAWP indicates fluid overload or left
ventricular failure.
11. Which medication is typically the first-choice treatment for a patient in
Ventricular Fibrillation after the first defibrillation attempt?
A. Atropine
B. Epinephrine
C. Adenosine
D. Digoxin
Answer: B
Rationale: Epinephrine is the primary vasopressor used in cardiac arrest to increase
coronary and cerebral perfusion pressure.
|Galen College
1. A patient in the emergent phase of a burn injury has a blood pressure of
88/50 mmHg and a heart rate of 120 bpm. Which is the priority intervention?
A. Administering prophylactic antibiotics
B. Initiating enteral feedings
C. Applying topical silver sulfadiazine
D. Providing aggressive fluid resuscitation
Answer: D
Rationale: In the emergent phase of a burn, the priority is addressing hypovolemic shock
through fluid resuscitation. Antibiotics and nutrition are secondary to hemodynamic
stability.
2. Which assessment finding in a patient with a head injury suggests increasing
intracranial pressure (ICP)?
A. Hyperactivity and increased appetite
B. Constricted, equal pupils
C. Increased urine output
D. Decreased level of consciousness
Answer: D
Rationale: A change in the level of consciousness (LOC) is the earliest and most sensitive
indicator of increasing intracranial pressure.
,3. A patient is diagnosed with Septic Shock. Which of the following findings is
most characteristic of the ‘warm’ or early stage of septic shock?
A. Flushed skin and high cardiac output
B. Hypothermia and bradycardia
C. Cool, clammy skin and oliguria
D. Severe metabolic alkalosis
Answer: A
Rationale: In the early (hyperdynamic) phase of septic shock, vasodilation leads to warm,
flushed skin and a compensatory increase in cardiac output.
4. The nurse is monitoring a patient on a mechanical ventilator. The ‘High
Pressure’ alarm sounds. What is a likely cause?
A. The patient has disconnected the tubing
B. The patient is biting the endotracheal tube
C. There is a leak in the ventilator cuff
D. The patient has stopped breathing spontaneously
Answer: B
Rationale: High-pressure alarms are triggered by increased resistance, such as biting the
tube, secretions, or kinking. Disconnections and leaks trigger low-pressure alarms.
5. What is the hallmark clinical manifestation of Acute Respiratory Distress
Syndrome (ARDS)?
A. Respiratory acidosis responsive to oxygen
B. Hypercapnia that improves with PEEP
C. Refractory hypoxemia
D. Increased lung compliance
Answer: C
Rationale: Refractory hypoxemia, which is low arterial oxygen levels that do not improve
with high concentrations of inspired oxygen, is the hallmark of ARDS.
,6. A patient with a T6 spinal cord injury reports a severe headache and has a BP
of 190/100 mmHg. What is the nurse’s immediate action?
A. Lower the head of the bed to a flat position
B. Request an order for a STAT CT scan
C. Administer PRN intravenous morphine
D. Check the patient’s bladder for distention
Answer: D
Rationale: The patient is exhibiting signs of Autonomic Dysreflexia. The priority is to sit
the patient up and identify/remove the stimulus, often a distended bladder or impacted
bowel.
7. Using the Parkland Formula (4mL/kg/%TBSA), calculate the total fluid
required in the first 24 hours for a 70kg patient with 40% burns.
A. 11,200 mL
B. 5,600 mL
C. 2,800 mL
D. 14,000 mL
Answer: A
Rationale: 4mL x 70kg x 40 = 11,200 mL.
8. In a patient with Acute Kidney Injury (AKI), which electrolyte imbalance is the
most life-threatening?
A. Hyponatremia
B. Hypocalcemia
C. Hypermagnesemia
D. Hyperkalemia
Answer: D
Rationale: Hyperkalemia is the most dangerous electrolyte imbalance in AKI because it
can lead to fatal cardiac dysrhythmias.
, 9. Which rhythm is characterized by a ‘sawtooth’ pattern on the ECG?
A. Atrial Flutter
B. Atrial Fibrillation
C. Ventricular Tachycardia
D. Sinus Bradycardia
Answer: A
Rationale: Atrial flutter is classically described as having sawtooth-shaped P waves (F-
waves).
10. A patient has a Pulmonary Artery Wedge Pressure (PAWP) of 22 mmHg.
Which condition does the nurse suspect?
A. Left-sided heart failure
B. Dehydration
C. Hypovolemic shock
D. Septic shock
Answer: A
Rationale: Normal PAWP is 6-12 mmHg. An elevated PAWP indicates fluid overload or left
ventricular failure.
11. Which medication is typically the first-choice treatment for a patient in
Ventricular Fibrillation after the first defibrillation attempt?
A. Atropine
B. Epinephrine
C. Adenosine
D. Digoxin
Answer: B
Rationale: Epinephrine is the primary vasopressor used in cardiac arrest to increase
coronary and cerebral perfusion pressure.
