NUR 265 Advanced Medical-Surgical Nursing Mega Exam 2026 |Galen
College
1. A patient with acute respiratory distress syndrome (ARDS) is on mechanical
ventilation. The nurse notes the high-pressure alarm is sounding. Which action
should the nurse take first?
A. Check the patient’s oxygen saturation
B. Increase the oxygen concentration
C. Call the respiratory therapist
D. Assess the patient’s need for suctioning
Answer: D
Rationale: High-pressure alarms are often caused by secretions in the airway, biting the
tube, or kinks. Assessing the need for suctioning is the priority intervention to clear the
airway.
2. Which arterial blood gas (ABG) result is most indicative of a patient in early
stage hypovolemic shock?
A. pH 7.35, PaCO2 40, HCO3 24
B. pH 7.30, PaCO2 50, HCO3 28
C. pH 7.48, PaCO2 30, HCO3 22
D. pH 7.25, PaCO2 35, HCO3 15
Answer: C
Rationale: Early shock often causes tachypnea due to anxiety and hypoxia, leading to
respiratory alkalosis (high pH, low PaCO2).
,3. A nurse is caring for a patient with a traumatic brain injury. Which finding is
the earliest sign of increased intracranial pressure (ICP)?
A. Cushing’s triad
B. Change in level of consciousness (LOC)
C. Decerebrate posturing
D. Dilated and fixed pupils
Answer: B
Rationale: Change in LOC is the most sensitive and earliest indicator of increased ICP.
4. The nurse identifies which rhythm as needing immediate synchronized
cardioversion?
A. Ventricular Fibrillation
B. Asystole
C. Unstable Supraventricular Tachycardia (SVT)
D. Sinus Bradycardia
Answer: C
Rationale: Synchronized cardioversion is used for unstable tachyarrhythmias with a pulse,
such as SVT. V-fib requires defibrillation (unsynchronized).
5. A patient with chronic kidney disease (CKD) has a serum potassium level of
6.8 mEq/L. Which medication should the nurse anticipate administering first to
protect the heart?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Calcium Gluconate
C. Insulin and Dextrose
D. Furosemide (Lasix)
Answer: B
Rationale: Calcium gluconate does not lower potassium but stabilizes the myocardial cell
membrane to prevent lethal dysrhythmias.
,6. Which clinical manifestation is expected in a patient experiencing neurogenic
shock?
A. Tachycardia and hypertension
B. Cool, clammy skin
C. Bradycardia and hypotension
D. Increased systemic vascular resistance (SVR)
Answer: C
Rationale: Neurogenic shock results from loss of sympathetic tone, leading to vasodilation
(hypotension) and a lack of compensatory tachycardia (bradycardia).
7. A patient has a CVP (Central Venous Pressure) reading of 1 mm Hg. What is
the nurse’s priority action?
A. Administer a diuretic
B. Decrease the IV infusion rate
C. Document as a normal finding
D. Administer a fluid bolus as ordered
Answer: D
Rationale: Normal CVP is 2-6 mm Hg. A reading of 1 indicates fluid volume deficit,
requiring fluid resuscitation.
8. In the emergent phase of burn care, which electrolyte abnormality is most
common?
A. Hypokalemia
B. Hypernatremia
C. Hyperkalemia
D. Hypocalcemia
Answer: C
Rationale: Potassium is released from damaged cells into the extracellular fluid, leading to
hyperkalemia during the first 24-48 hours.
, 9. A patient is admitted with Diabetic Ketoacidosis (DKA). Which IV fluid should
the nurse expect to hang once the blood glucose reaches 250 mg/dL?
A. 0.45% Normal Saline
B. 3% Hypertonic Saline
C. Lactated Ringer’s
D. 5% Dextrose in 0.45% Normal Saline
Answer: D
Rationale: Dextrose is added to the IV fluids once glucose drops to 250 mg/dL to prevent
hypoglycemia and cerebral edema during the transition.
10. Which assessment finding is a hallmark of a Tension Pneumothorax?
A. Hypertension
B. Increased breath sounds on the affected side
C. Bradycardia
D. Tracheal deviation toward the unaffected side
Answer: D
Rationale: Tension pneumothorax causes pressure to build in the pleural space, pushing
the mediastinum and trachea toward the opposite (unaffected) side.
11. A patient is suspected of having Disseminated Intravascular Coagulation
(DIC). Which lab result supports this?
A. Elevated Fibrinogen
B. Decreased Platelets
C. Decreased D-dimer
D. Shortened Prothrombin Time (PT)
Answer: B
Rationale: DIC is characterized by the consumption of clotting factors and platelets,
leading to low platelet counts and elevated D-dimer.
College
1. A patient with acute respiratory distress syndrome (ARDS) is on mechanical
ventilation. The nurse notes the high-pressure alarm is sounding. Which action
should the nurse take first?
A. Check the patient’s oxygen saturation
B. Increase the oxygen concentration
C. Call the respiratory therapist
D. Assess the patient’s need for suctioning
Answer: D
Rationale: High-pressure alarms are often caused by secretions in the airway, biting the
tube, or kinks. Assessing the need for suctioning is the priority intervention to clear the
airway.
2. Which arterial blood gas (ABG) result is most indicative of a patient in early
stage hypovolemic shock?
A. pH 7.35, PaCO2 40, HCO3 24
B. pH 7.30, PaCO2 50, HCO3 28
C. pH 7.48, PaCO2 30, HCO3 22
D. pH 7.25, PaCO2 35, HCO3 15
Answer: C
Rationale: Early shock often causes tachypnea due to anxiety and hypoxia, leading to
respiratory alkalosis (high pH, low PaCO2).
,3. A nurse is caring for a patient with a traumatic brain injury. Which finding is
the earliest sign of increased intracranial pressure (ICP)?
A. Cushing’s triad
B. Change in level of consciousness (LOC)
C. Decerebrate posturing
D. Dilated and fixed pupils
Answer: B
Rationale: Change in LOC is the most sensitive and earliest indicator of increased ICP.
4. The nurse identifies which rhythm as needing immediate synchronized
cardioversion?
A. Ventricular Fibrillation
B. Asystole
C. Unstable Supraventricular Tachycardia (SVT)
D. Sinus Bradycardia
Answer: C
Rationale: Synchronized cardioversion is used for unstable tachyarrhythmias with a pulse,
such as SVT. V-fib requires defibrillation (unsynchronized).
5. A patient with chronic kidney disease (CKD) has a serum potassium level of
6.8 mEq/L. Which medication should the nurse anticipate administering first to
protect the heart?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Calcium Gluconate
C. Insulin and Dextrose
D. Furosemide (Lasix)
Answer: B
Rationale: Calcium gluconate does not lower potassium but stabilizes the myocardial cell
membrane to prevent lethal dysrhythmias.
,6. Which clinical manifestation is expected in a patient experiencing neurogenic
shock?
A. Tachycardia and hypertension
B. Cool, clammy skin
C. Bradycardia and hypotension
D. Increased systemic vascular resistance (SVR)
Answer: C
Rationale: Neurogenic shock results from loss of sympathetic tone, leading to vasodilation
(hypotension) and a lack of compensatory tachycardia (bradycardia).
7. A patient has a CVP (Central Venous Pressure) reading of 1 mm Hg. What is
the nurse’s priority action?
A. Administer a diuretic
B. Decrease the IV infusion rate
C. Document as a normal finding
D. Administer a fluid bolus as ordered
Answer: D
Rationale: Normal CVP is 2-6 mm Hg. A reading of 1 indicates fluid volume deficit,
requiring fluid resuscitation.
8. In the emergent phase of burn care, which electrolyte abnormality is most
common?
A. Hypokalemia
B. Hypernatremia
C. Hyperkalemia
D. Hypocalcemia
Answer: C
Rationale: Potassium is released from damaged cells into the extracellular fluid, leading to
hyperkalemia during the first 24-48 hours.
, 9. A patient is admitted with Diabetic Ketoacidosis (DKA). Which IV fluid should
the nurse expect to hang once the blood glucose reaches 250 mg/dL?
A. 0.45% Normal Saline
B. 3% Hypertonic Saline
C. Lactated Ringer’s
D. 5% Dextrose in 0.45% Normal Saline
Answer: D
Rationale: Dextrose is added to the IV fluids once glucose drops to 250 mg/dL to prevent
hypoglycemia and cerebral edema during the transition.
10. Which assessment finding is a hallmark of a Tension Pneumothorax?
A. Hypertension
B. Increased breath sounds on the affected side
C. Bradycardia
D. Tracheal deviation toward the unaffected side
Answer: D
Rationale: Tension pneumothorax causes pressure to build in the pleural space, pushing
the mediastinum and trachea toward the opposite (unaffected) side.
11. A patient is suspected of having Disseminated Intravascular Coagulation
(DIC). Which lab result supports this?
A. Elevated Fibrinogen
B. Decreased Platelets
C. Decreased D-dimer
D. Shortened Prothrombin Time (PT)
Answer: B
Rationale: DIC is characterized by the consumption of clotting factors and platelets,
leading to low platelet counts and elevated D-dimer.
