NUR 265 Advanced Medical-Surgical Nursing Mega Pack 2026 |Galen
College
1. A patient presents to the Emergency Department with a pH of 7.32, PaCO2 of
50 mmHg, and HCO3 of 25 mEq/L. Which acid-base imbalance is occurring?
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Answer: A
Rationale: The pH is low (acidosis) and the PaCO2 is high (respiratory), while the
bicarbonate is within normal limits, indicating respiratory acidosis.
2. Which assessment finding is most characteristic of Cushing’s Triad in a patient
with increased intracranial pressure?
A. Tachycardia, hypertension, and tachypnea
B. Bradycardia, widening pulse pressure, and irregular respirations
C. Hypotension, bradycardia, and Cheyne-Stokes breathing
D. Tachycardia, hypotension, and shallow breathing
Answer: B
Rationale: Cushing’s Triad consists of bradycardia, widening pulse pressure (systolic
hypertension), and irregular respirations, signaling a late stage of increased ICP.
,3. During the emergent phase of a burn injury, which electrolyte imbalance is
most commonly expected?
A. Hyperkalemia
B. Hypercalcemia
C. Hypokalemia
D. Hyponatremia
Answer: A
Rationale: In the emergent phase, cell destruction releases potassium into the
extracellular fluid, leading to hyperkalemia.
4. A patient with a spinal cord injury at T4 reports a sudden, severe headache
and is found to have a blood pressure of 190/100 mmHg. What is the priority
nursing action?
A. Administer an antihypertensive medication
B. Check for bladder distention or fecal impaction
C. Place the patient in a supine position
D. Notify the healthcare provider immediately
Answer: B
Rationale: These are symptoms of autonomic dysreflexia. The priority is to identify and
remove the noxious stimulus, commonly a full bladder or bowel.
5. Which laboratory value is the most sensitive indicator of acute kidney injury
(AKI)?
A. Serum Creatinine
B. Blood Urea Nitrogen (BUN)
C. Glomerular Filtration Rate (GFR)
D. Urine Specific Gravity
Answer: A
,Rationale: Serum creatinine is more specific and sensitive to renal function changes than
BUN, which can be affected by diet and hydration.
6. A patient is diagnosed with ARDS. Which ventilator setting is specifically used
to prevent alveolar collapse at the end of expiration?
A. Positive End-Expiratory Pressure (PEEP)
B. Fraction of Inspired Oxygen (FiO2)
C. Tidal Volume
D. Inspiratory Rate
Answer: A
Rationale: PEEP maintains pressure in the lungs at the end of expiration to keep alveoli
open and improve gas exchange.
7. In the triage of a mass casualty event, which color tag is assigned to a patient
who has a patent airway but a compound fracture of the femur?
A. Red
B. Yellow
C. Green
D. Black
Answer: B
Rationale: Yellow tags are for ‘delayed’ patients who have serious injuries but are stable
enough to wait a short time for treatment.
8. A patient with Type 1 Diabetes presents with fruity breath, Kussmaul
respirations, and a blood glucose of 450 mg/dL. Which condition is most likely?
A. Diabetic Ketoacidosis (DKA)
B. Hypoglycemia
C. Hyperglycemic Hyperosmolar State (HHS)
D. Somogyi Effect
Answer: A
, Rationale: DKA is characterized by hyperglycemia, ketosis (fruity breath), and metabolic
acidosis (Kussmaul respirations).
9. What is the primary goal of administering Lactulose to a patient with cirrhosis
and hepatic encephalopathy?
A. To reduce abdominal girth
B. To improve protein metabolism
C. To prevent gastrointestinal bleeding
D. To decrease serum ammonia levels
Answer: D
Rationale: Lactulose promotes the excretion of ammonia through the stool to reduce
neurological symptoms of encephalopathy.
10. A patient in septic shock has a MAP of 55 mmHg despite fluid resuscitation.
Which medication is the first-line vasopressor of choice?
A. Norepinephrine
B. Dobutamine
C. Epinephrine
D. Atropine
Answer: A
Rationale: Norepinephrine (Levophed) is the recommended first-line vasopressor for
septic shock to maintain MAP.
11. A nurse is caring for a patient with a chest tube. Bubbling is noted in the
water seal chamber during expiration. How should the nurse interpret this?
A. The system has a leak.
B. This is a normal finding if there is a pneumothorax.
C. The suction is set too high.
D. The chest tube is occluded.
Answer: B
College
1. A patient presents to the Emergency Department with a pH of 7.32, PaCO2 of
50 mmHg, and HCO3 of 25 mEq/L. Which acid-base imbalance is occurring?
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Answer: A
Rationale: The pH is low (acidosis) and the PaCO2 is high (respiratory), while the
bicarbonate is within normal limits, indicating respiratory acidosis.
2. Which assessment finding is most characteristic of Cushing’s Triad in a patient
with increased intracranial pressure?
A. Tachycardia, hypertension, and tachypnea
B. Bradycardia, widening pulse pressure, and irregular respirations
C. Hypotension, bradycardia, and Cheyne-Stokes breathing
D. Tachycardia, hypotension, and shallow breathing
Answer: B
Rationale: Cushing’s Triad consists of bradycardia, widening pulse pressure (systolic
hypertension), and irregular respirations, signaling a late stage of increased ICP.
,3. During the emergent phase of a burn injury, which electrolyte imbalance is
most commonly expected?
A. Hyperkalemia
B. Hypercalcemia
C. Hypokalemia
D. Hyponatremia
Answer: A
Rationale: In the emergent phase, cell destruction releases potassium into the
extracellular fluid, leading to hyperkalemia.
4. A patient with a spinal cord injury at T4 reports a sudden, severe headache
and is found to have a blood pressure of 190/100 mmHg. What is the priority
nursing action?
A. Administer an antihypertensive medication
B. Check for bladder distention or fecal impaction
C. Place the patient in a supine position
D. Notify the healthcare provider immediately
Answer: B
Rationale: These are symptoms of autonomic dysreflexia. The priority is to identify and
remove the noxious stimulus, commonly a full bladder or bowel.
5. Which laboratory value is the most sensitive indicator of acute kidney injury
(AKI)?
A. Serum Creatinine
B. Blood Urea Nitrogen (BUN)
C. Glomerular Filtration Rate (GFR)
D. Urine Specific Gravity
Answer: A
,Rationale: Serum creatinine is more specific and sensitive to renal function changes than
BUN, which can be affected by diet and hydration.
6. A patient is diagnosed with ARDS. Which ventilator setting is specifically used
to prevent alveolar collapse at the end of expiration?
A. Positive End-Expiratory Pressure (PEEP)
B. Fraction of Inspired Oxygen (FiO2)
C. Tidal Volume
D. Inspiratory Rate
Answer: A
Rationale: PEEP maintains pressure in the lungs at the end of expiration to keep alveoli
open and improve gas exchange.
7. In the triage of a mass casualty event, which color tag is assigned to a patient
who has a patent airway but a compound fracture of the femur?
A. Red
B. Yellow
C. Green
D. Black
Answer: B
Rationale: Yellow tags are for ‘delayed’ patients who have serious injuries but are stable
enough to wait a short time for treatment.
8. A patient with Type 1 Diabetes presents with fruity breath, Kussmaul
respirations, and a blood glucose of 450 mg/dL. Which condition is most likely?
A. Diabetic Ketoacidosis (DKA)
B. Hypoglycemia
C. Hyperglycemic Hyperosmolar State (HHS)
D. Somogyi Effect
Answer: A
, Rationale: DKA is characterized by hyperglycemia, ketosis (fruity breath), and metabolic
acidosis (Kussmaul respirations).
9. What is the primary goal of administering Lactulose to a patient with cirrhosis
and hepatic encephalopathy?
A. To reduce abdominal girth
B. To improve protein metabolism
C. To prevent gastrointestinal bleeding
D. To decrease serum ammonia levels
Answer: D
Rationale: Lactulose promotes the excretion of ammonia through the stool to reduce
neurological symptoms of encephalopathy.
10. A patient in septic shock has a MAP of 55 mmHg despite fluid resuscitation.
Which medication is the first-line vasopressor of choice?
A. Norepinephrine
B. Dobutamine
C. Epinephrine
D. Atropine
Answer: A
Rationale: Norepinephrine (Levophed) is the recommended first-line vasopressor for
septic shock to maintain MAP.
11. A nurse is caring for a patient with a chest tube. Bubbling is noted in the
water seal chamber during expiration. How should the nurse interpret this?
A. The system has a leak.
B. This is a normal finding if there is a pneumothorax.
C. The suction is set too high.
D. The chest tube is occluded.
Answer: B
