NUR 265 Advanced Medical-Surgical Nursing Exam 2026 |Galen
College
1. A patient in the Emergency Department is diagnosed with a tension
pneumothorax. Which clinical finding should the nurse expect to assess first?
A. Tracheal deviation toward the unaffected side
B. Increased breath sounds on the affected side
C. Hypertension and bradycardia
D. Flattened neck veins
Answer: A
Rationale: Tension pneumothorax causes a mediastinal shift, leading to tracheal deviation
toward the unaffected side, which is a life-threatening emergency.
2. A nurse is caring for a patient in the compensatory stage of shock. Which
finding is characteristic of this stage?
A. Anuria and metabolic acidosis
B. Petechiae and mottled skin
C. Systolic blood pressure below 60 mmHg
D. Tachycardia and cool, clammy skin
Answer: D
Rationale: In the compensatory stage, the body attempts to maintain homeostasis through
the sympathetic nervous system, resulting in tachycardia and peripheral vasoconstriction
(cool, clammy skin).
,3. A patient with ARDS is being mechanically ventilated. The nurse notes the
‘High Pressure’ alarm is sounding. What is the priority action?
A. Assess for a leak in the ventilator circuit
B. Auscultate for decreased breath sounds to identify a disconnected tube
C. Increase the oxygen concentration to 100%
D. Check for kinking in the ET tube or need for suctioning
Answer: D
Rationale: High-pressure alarms are triggered by increased resistance, such as kinking,
secretions, or the patient biting the tube.
4. Which lab value is the most sensitive indicator of Acute Kidney Injury (AKI) in
a critically ill patient?
A. Serum Creatinine
B. Urine specific gravity
C. Blood Urea Nitrogen (BUN)
D. Hemoglobin level
Answer: A
Rationale: Creatinine is more specific to kidney function than BUN, which can be
influenced by diet, hydration, and protein breakdown.
5. A patient has sustained 40% total body surface area (TBSA) burns. According
to the Parkland Formula, how much fluid should be administered in the first 8
hours?
A. One-fourth of the total calculated volume
B. One-third of the total calculated volume
C. Half of the total calculated volume
D. The entire calculated volume
Answer: C
, Rationale: The Parkland Formula dictates that half of the total 24-hour fluid requirement
is administered in the first 8 hours post-injury.
6. A patient presents with Cushing’s Triad following a head injury. Which set of
vital signs does the nurse expect?
A. Bradycardia, widening pulse pressure, and irregular respirations
B. Tachycardia, hypotension, and tachypnea
C. Tachycardia, hypertension, and Cheyne-Stokes breathing
D. Bradycardia, hypotension, and shallow breathing
Answer: A
Rationale: Cushing’s Triad consists of bradycardia, widening pulse pressure (increased
systolic BP), and irregular/slowed respirations, signaling increased ICP.
7. The nurse is monitoring a patient for Autonomic Dysreflexia. Which symptom
is the most common trigger for this condition?
A. Lower extremity fracture
B. Bladder distention
C. Sunburn
D. Severe headache
Answer: B
Rationale: Bladder distention or fecal impaction are the most frequent noxious stimuli that
trigger Autonomic Dysreflexia in spinal cord injury patients.
8. Which rhythm is considered a ‘shockable’ rhythm during cardiac arrest using
an AED?
A. Asystole
B. Pulseless Electrical Activity (PEA)
C. Normal Sinus Rhythm
D. Ventricular Fibrillation (V-fib)
Answer: D
College
1. A patient in the Emergency Department is diagnosed with a tension
pneumothorax. Which clinical finding should the nurse expect to assess first?
A. Tracheal deviation toward the unaffected side
B. Increased breath sounds on the affected side
C. Hypertension and bradycardia
D. Flattened neck veins
Answer: A
Rationale: Tension pneumothorax causes a mediastinal shift, leading to tracheal deviation
toward the unaffected side, which is a life-threatening emergency.
2. A nurse is caring for a patient in the compensatory stage of shock. Which
finding is characteristic of this stage?
A. Anuria and metabolic acidosis
B. Petechiae and mottled skin
C. Systolic blood pressure below 60 mmHg
D. Tachycardia and cool, clammy skin
Answer: D
Rationale: In the compensatory stage, the body attempts to maintain homeostasis through
the sympathetic nervous system, resulting in tachycardia and peripheral vasoconstriction
(cool, clammy skin).
,3. A patient with ARDS is being mechanically ventilated. The nurse notes the
‘High Pressure’ alarm is sounding. What is the priority action?
A. Assess for a leak in the ventilator circuit
B. Auscultate for decreased breath sounds to identify a disconnected tube
C. Increase the oxygen concentration to 100%
D. Check for kinking in the ET tube or need for suctioning
Answer: D
Rationale: High-pressure alarms are triggered by increased resistance, such as kinking,
secretions, or the patient biting the tube.
4. Which lab value is the most sensitive indicator of Acute Kidney Injury (AKI) in
a critically ill patient?
A. Serum Creatinine
B. Urine specific gravity
C. Blood Urea Nitrogen (BUN)
D. Hemoglobin level
Answer: A
Rationale: Creatinine is more specific to kidney function than BUN, which can be
influenced by diet, hydration, and protein breakdown.
5. A patient has sustained 40% total body surface area (TBSA) burns. According
to the Parkland Formula, how much fluid should be administered in the first 8
hours?
A. One-fourth of the total calculated volume
B. One-third of the total calculated volume
C. Half of the total calculated volume
D. The entire calculated volume
Answer: C
, Rationale: The Parkland Formula dictates that half of the total 24-hour fluid requirement
is administered in the first 8 hours post-injury.
6. A patient presents with Cushing’s Triad following a head injury. Which set of
vital signs does the nurse expect?
A. Bradycardia, widening pulse pressure, and irregular respirations
B. Tachycardia, hypotension, and tachypnea
C. Tachycardia, hypertension, and Cheyne-Stokes breathing
D. Bradycardia, hypotension, and shallow breathing
Answer: A
Rationale: Cushing’s Triad consists of bradycardia, widening pulse pressure (increased
systolic BP), and irregular/slowed respirations, signaling increased ICP.
7. The nurse is monitoring a patient for Autonomic Dysreflexia. Which symptom
is the most common trigger for this condition?
A. Lower extremity fracture
B. Bladder distention
C. Sunburn
D. Severe headache
Answer: B
Rationale: Bladder distention or fecal impaction are the most frequent noxious stimuli that
trigger Autonomic Dysreflexia in spinal cord injury patients.
8. Which rhythm is considered a ‘shockable’ rhythm during cardiac arrest using
an AED?
A. Asystole
B. Pulseless Electrical Activity (PEA)
C. Normal Sinus Rhythm
D. Ventricular Fibrillation (V-fib)
Answer: D
