NUR 265 Advanced Medical-Surgical Nursing Final Exam Prep 2026
|Galen College
1. A patient in the early stages of septic shock is likely to exhibit which of the
following hemodynamic trends?
A. Decreased heart rate and increased blood pressure
B. Decreased cardiac output and increased central venous pressure
C. Increased heart rate and decreased systemic vascular resistance
D. Normal heart rate and increased mean arterial pressure
Answer: C
Rationale: In early (hyperdynamic) septic shock, the body compensates with a high
cardiac output and tachycardia, but vasodilation leads to decreased systemic vascular
resistance (SVR).
2. A nurse is caring for a patient with a T4 spinal cord injury who reports a
pounding headache and has a BP of 190/100 mmHg. What is the priority nursing
action?
A. Administer prescribed pain medication
B. Check the patient for bladder distension
C. Lower the head of the bed immediately
D. Notify the healthcare provider for an antihypertensive order
Answer: B
Rationale: These are classic signs of Autonomic Dysreflexia. The priority is to identify and
remove the stimulus, most commonly a distended bladder or impacted bowel, while sitting
the patient upright.
,3. Which assessment finding is most characteristic of the ‘Progressive Stage’ of
shock?
A. Cold, clammy skin and metabolic acidosis
B. Mean arterial pressure (MAP) within normal limits
C. Mild tachycardia and narrowing pulse pressure
D. Increased urine output due to compensatory mechanisms
Answer: A
Rationale: In the progressive stage, compensatory mechanisms fail, leading to organ
dysfunction, metabolic acidosis, and poor peripheral perfusion (cold, clammy skin).
4. Using the Rule of Nines, what is the estimated Burn Surface Area (BSA) for an
adult with burns to the entire right arm and the anterior trunk?
A. 27%
B. 18%
C. 36%
D. 45%
Answer: A
Rationale: The entire arm is 9% and the anterior trunk is 18%. Total = 27%.
5. A patient with Acute Respiratory Distress Syndrome (ARDS) is on mechanical
ventilation with High PEEP. What is the primary purpose of PEEP in this patient?
A. To keep the alveoli open at the end of expiration
B. To prevent barotrauma by lowering peak pressures
C. To increase the respiratory rate
D. To decrease the fraction of inspired oxygen (FiO2)
Answer: A
Rationale: Positive End-Expiratory Pressure (PEEP) improves oxygenation by preventing
alveolar collapse and increasing the surface area for gas exchange.
, 6. Which laboratory value is the most specific indicator of acute myocardial
infarction?
A. Creatine Kinase (CK-MB)
B. Troponin I
C. C-reactive protein (CRP)
D. Myoglobin
Answer: B
Rationale: Troponin I is highly specific to cardiac muscle and remains elevated longer than
other enzymes, making it the gold standard for MI diagnosis.
7. A patient is admitted with a suspected Tension Pneumothorax. Which clinical
finding should the nurse expect to see?
A. Tracheal deviation toward the affected side
B. Increased breath sounds on the affected side
C. Hyperresonance on percussion of the affected side
D. Bradycardia and hypertension
Answer: C
Rationale: Tension pneumothorax causes hyperresonance due to trapped air, absent
breath sounds on the affected side, and tracheal deviation away from the affected side.
8. What is the first-line medication for a patient in Ventricular Fibrillation (V-Fib)
after the first unsuccessful defibrillation?
A. Amiodarone
B. Epinephrine
C. Atropine
D. Magnesium Sulfate
Answer: B
Rationale: According to ACLS guidelines, Epinephrine is the first medication administered
during cardiac arrest (V-Fib, Pulseless V-Tach) after the initial shock and resume of CPR.
|Galen College
1. A patient in the early stages of septic shock is likely to exhibit which of the
following hemodynamic trends?
A. Decreased heart rate and increased blood pressure
B. Decreased cardiac output and increased central venous pressure
C. Increased heart rate and decreased systemic vascular resistance
D. Normal heart rate and increased mean arterial pressure
Answer: C
Rationale: In early (hyperdynamic) septic shock, the body compensates with a high
cardiac output and tachycardia, but vasodilation leads to decreased systemic vascular
resistance (SVR).
2. A nurse is caring for a patient with a T4 spinal cord injury who reports a
pounding headache and has a BP of 190/100 mmHg. What is the priority nursing
action?
A. Administer prescribed pain medication
B. Check the patient for bladder distension
C. Lower the head of the bed immediately
D. Notify the healthcare provider for an antihypertensive order
Answer: B
Rationale: These are classic signs of Autonomic Dysreflexia. The priority is to identify and
remove the stimulus, most commonly a distended bladder or impacted bowel, while sitting
the patient upright.
,3. Which assessment finding is most characteristic of the ‘Progressive Stage’ of
shock?
A. Cold, clammy skin and metabolic acidosis
B. Mean arterial pressure (MAP) within normal limits
C. Mild tachycardia and narrowing pulse pressure
D. Increased urine output due to compensatory mechanisms
Answer: A
Rationale: In the progressive stage, compensatory mechanisms fail, leading to organ
dysfunction, metabolic acidosis, and poor peripheral perfusion (cold, clammy skin).
4. Using the Rule of Nines, what is the estimated Burn Surface Area (BSA) for an
adult with burns to the entire right arm and the anterior trunk?
A. 27%
B. 18%
C. 36%
D. 45%
Answer: A
Rationale: The entire arm is 9% and the anterior trunk is 18%. Total = 27%.
5. A patient with Acute Respiratory Distress Syndrome (ARDS) is on mechanical
ventilation with High PEEP. What is the primary purpose of PEEP in this patient?
A. To keep the alveoli open at the end of expiration
B. To prevent barotrauma by lowering peak pressures
C. To increase the respiratory rate
D. To decrease the fraction of inspired oxygen (FiO2)
Answer: A
Rationale: Positive End-Expiratory Pressure (PEEP) improves oxygenation by preventing
alveolar collapse and increasing the surface area for gas exchange.
, 6. Which laboratory value is the most specific indicator of acute myocardial
infarction?
A. Creatine Kinase (CK-MB)
B. Troponin I
C. C-reactive protein (CRP)
D. Myoglobin
Answer: B
Rationale: Troponin I is highly specific to cardiac muscle and remains elevated longer than
other enzymes, making it the gold standard for MI diagnosis.
7. A patient is admitted with a suspected Tension Pneumothorax. Which clinical
finding should the nurse expect to see?
A. Tracheal deviation toward the affected side
B. Increased breath sounds on the affected side
C. Hyperresonance on percussion of the affected side
D. Bradycardia and hypertension
Answer: C
Rationale: Tension pneumothorax causes hyperresonance due to trapped air, absent
breath sounds on the affected side, and tracheal deviation away from the affected side.
8. What is the first-line medication for a patient in Ventricular Fibrillation (V-Fib)
after the first unsuccessful defibrillation?
A. Amiodarone
B. Epinephrine
C. Atropine
D. Magnesium Sulfate
Answer: B
Rationale: According to ACLS guidelines, Epinephrine is the first medication administered
during cardiac arrest (V-Fib, Pulseless V-Tach) after the initial shock and resume of CPR.
