Exam 2 NU265/ NU 265: Advanced Concepts Of Medical-Surgical Nursing | Complete 100% Updated 2025/26.

Exam 2 NU265/ NU 265: Advanced Concepts Of Medical-Surgical Nursing | Complete 100% Updated 2025/26. Question #1 The nurse is assessing a client who is suspected of having a pulmonary embolism (PE). Which of the following findings is consistent with this diagnosis? (Options not visible in the provided PDF excerpt) Question #2 The nurse is caring for a client who is 4 days postoperative and suddenly develops difficulty breathing and sharp chest pain. The nurse has called the rapid response team (RRT), raised the head of the bed (HOB), and applied oxygen to the client. Which action(s) from the box below should the nurse take next? Auscultate the client's lung sounds. Initiate continuous cardiac monitoring. Prepare to administer intravenous (IV) alteplase. Connect the client to a continuous pulse oximeter. Apply bilateral antiembolism stockings to the legs. a. 1,4,5 b. 1,2,4,6 c. 2,3,5,6 d. 3,4,6 Question #3 The nurse has provided discharge teaching to a client who developed a pulmonary embolism (PE) following a surgical procedure. The client will be taking newly prescribed warfarin at home. Which of the following client statements indicates a correct understanding of the teaching? a. "Hard candy can be used if I develop a dry mouth while taking warfarin." b. "The warfarin will continue to break up the clot over the next several months." c. "I should avoid anything rectally, such as enemas or suppositories." d. "I will take this medication for about 1-2 months." Question #4 The nurse is caring for a client who appears to have developed a pulmonary embolism (PE). Which of the following arterial blood gas (ABG) results would the nurse expect the client to initially have? a. pH = 7.31 ; PaO₂ = 73 mmHg ; PaCO₂ = 50 mmHg ; HCO₃⁻ = 22 mEq/L ; SO₂ = 85% b. pH = 7.50 ; PaO₂ = 79 mmHg ; PaCO₂ = 32 mmHg ; HCO₃⁻ = 23 mEq/L ; SO₂ = 88% c. pH = 7.35 ; PaO₂ = 63 mmHg ; PaCO₂ = 42 mmHg ; HCO₃⁻ = 26 mEq/L ; SO₂ = 84% d. pH = 7.45 ; PaO₂ = 70 mmHg ; PaCO₂ = 38 mmHg ; HCO₃⁻ = 28 mEq/L ; SO₂ = 86% Question #5 The nurse is caring for the following assigned clients. The nurse should first see the client who has a. diabetes insipidus (DI), polyuria, and a sodium level of 146 mEq/L. b. hyperthyroidism and a blood pressure of 138/80 mm Hg. c. received a heparin infusion for the last 10 days and has a platelet count of 90,000. d. Cushing's disease and a capillary blood glucose level of 142 mg/dL. Question #6 The nurse is caring for a client who has a chest tube. Which assessment finding(s) from the box below requires the nurse to immediately notify the primary health care provider (PHCP)? Continuous bubbling in the suction control chamber. Tracheal deviation. Tidalizing in the water seal chamber with breathing. 100 mL of drainage within an hour. Visibility of the eyelets of the chest tube. Low water level in the water seal chamber. a. 2,4,5 b. 1,2,4,6 c. 2,3,6 d. 1,3,6 Question #7 The nurse is assessing a client who had a chest tube placed 36 hours ago for the treatment of a pneumothorax. The nurse observes continuous bubbling in the water seal chamber. Which of the following actions should the nurse take? a. Turn off the suction, assess the lung sounds, and turn the suction back on. b. Inform the primary health care provider (PHCP) that there is a leak in the system. c. Ensure that the drainage system is off the floor and hanging on the bed frame. d. Document that the chest tube drainage system is operating properly. Question #8 The nurse working in the emergency department (ED) is caring for a client who was in a boating crash 3 hours ago and has the following data: (Image present, no text options given) The nurse concludes that the client is developing (Options not visible in text) Question #9 The nurse is assessing clients for the risk of developing acute respiratory distress syndrome (ARDS). The nurse should identify at greatest risk the client who a. has sepsis and is receiving nutrition via a continuous tube feeding. b. has thyroid cancer and is receiving outpatient radiation therapy. c. had a myocardial infarction (MI) and is receiving thrombolytic therapy. d. had an outpatient laparoscopic cholecystectomy and is taking prescribed opioid analgesics. Question #10 The nurse working on a medical-surgical unit is caring for assigned clients. It indicates appropriate clinical judgment if the nurse initially assesses the client who has a. a right lower lobe pneumonia and has fine crackles auscultated over the affected area. b. a tracheostomy and has a moderate amount of purulent drainage on the tracheostomy dressing. c. a left lung abscess and has increased tactile fremitus over the affected area of the lung. d. an arterial oxygen (PaO₂) level of 59 mm Hg while receiving 100% oxygen. Question #11 The nurse is caring for a client who developed acute respiratory distress syndrome (ARDS) and has been placed on mechanical ventilation. Which of the following is a priority action for the nurse to take? a. Obtain a specialty bed that will turn the client. b. Determine how best to communicate with the client. c. Consult physical therapy for passive range of motion (ROM). d. Initiate prescribed total parenteral nutrition (TPN). Question #12 The nurse has attended a continuing education program on interdisciplinary care. It would indicate a correct understanding of the program if the nurse identifies that an interdisciplinary conference would be most important for the client who is a. 59 years old, was recently diagnosed with hyperthyroidism, and is scheduled for a total thyroidectomy. b. 46 years old, lives with a spouse and two teenage children, and developed a pulmonary embolism (PE) following outpatient surgery. c. 34 years old, is a single parent, was involved in a motor vehicle crash, and sustained a left hemothorax. d. 21 years old, is a college student, and has been receiving mechanical ventilation for 14 days for the treatment of acute respiratory distress syndrome (ARDS). Question #13 The nurse working in the emergency department (ED) is assessing a client who has a left pneumothorax. Which of the following assessment findings should the nurse expect? a. Limited chest expansion. b. Flattened neck veins. c. Blood-tinged sputum. d. Auscultation of a pleural friction rub. Question #14 The nurse is caring for a client who is receiving mechanical ventilation. It indicates a correct understanding about managing a client on a ventilator if the nurse: a. promotes secretion removal by instilling normal saline (NS) solution into the endotracheal (ET) tube prior to suctioning. b. obtains a prescription to decrease the client's positive end-expiratory pressure (PEEP) if the low-pressure alarm frequently sounds. c. notifies the respiratory therapist if the client is not taking spontaneous breaths while in the assist-control (AC) mode. d. determines if the client needs to be suctioned when the high-pressure alarm sounds. Question #15 The nurse is caring for a client who is receiving mechanical ventilation via an endotracheal (ET) tube and is unable to speak. The client's family is frightened that the client has a permanent loss of their voice. Which of the following responses should the nurse make? a. "Try to remain calm. Everything is going to be alright." b. "The loss could be permanent due to vocal cord damage." c. "I'll get speech therapy to work with client on voice exercises." d. "The tube is causing a temporary loss of the voice." Question #16 The nurse has been made aware of the following client situations. The nurse should initially follow up with the client who is receiving a. a continuous IV infusion of heparin sodium at 1,500 units/hr and has a partial thromboplastin time (PTT) that is two times the control value. b. treatment for a pulmonary embolism (PE) and has petechiae over the chest and axilla. c. mechanical ventilation with positive end-expiratory pressure (PEEP) and develops left tracheal deviation. d. oxygen via a partial rebreather mask and the reservoir bag is noted to be two-thirds full during inspiration and expiration. Question #17 The nurse is reviewing chest radiography (x-ray) results on an assigned client. The x-ray reveals 3 rib fractures. Based on these findings, the nurse should a. place suction set up at the bedside. b. immobilize the ribs with a binder. c. plan to sedate the client for intubation. d. prepare the client for immediate surgery. Question #18 The nurse is caring for a client who has been admitted for suspected diabetes insipidus (DI). Which of the following assessment findings is a priority for the nurse to follow up on? a. A temperature of 99.2° F with a pulse oximeter reading of 92% on room air. b. A pulse of 126 with a blood pressure of 88/62 mm Hg. c. Urine output of 2 L in 24 hours with a urine specific gravity of 1.038. d. Bounding peripheral pulses with a decrease in thirst. Question #19 The nurse has taught a client who has diabetes insipidus (DI) about self-care at home. Which of the following client statements indicates a need for further teaching? a. "I will test my urine daily for ketones and report any positive findings." b. "I will wear a medical alert bracelet that identifies my disorder and what medications I am taking." c. "I will take an additional dose of medication if I have an increase in thirst and urination." d. "I will be sure to have a water bottle and my medications with me at all times." Question #20 The nurse is providing discharge instructions to a client who has permanent diabetes insipidus (DI). Which of the following client statements would indicate a correct understanding of the discharge instructions? a. "I should limit the amount of fluids that I drink after 8:00 PM." b. "I should report if I develop increased thirst or urination." c. "I will have a home health nurse visit once a week to check my urine specific gravity." d. "I need to check my urine for ketones if my blood sugar level is high." Question #21 The nurse is caring for a client who has developed diabetes insipidus (DI). Which of the following should the nurse correlate to the development of this condition? a. Long-term steroid use. b. Chronic lung disease. c. Recent craniotomy. d. Adrenalectomy. Question #22 The nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone (SIADH) and a serum sodium level of 114 mEq/L. Which of the following actions is most important for the nurse take? a. Handle the client gently by using a turning sheet. b. Reduce environmental noise and lighting. c. Consult the dietician regarding foods that are low in sodium. d. Delegate measurement of intake and output to the unlicensed assistive personnel (UAP). Question #23 The nurse is reviewing the below data for a client who has syndrome of inappropriate antidiuretic hormone (SIADH): Chief complaint: Fell and hit head 2 days ago Neurological status: Reports a dull headache, drowsy Temperature: 97.8° F Pulse: 100 Respirations: 18 Blood pressure: 140/95 mm Hg Sodium level: 120 mEq/L 24-hour intake: 3500 mL 24-hour output: 1500 mL Which of the following actions should the nurse take first? (Options not visible in PDF) Question #24 The nurse is performing a health history on a 45-year-old female client who is suspected of having Cushing's syndrome. Which of the following questions would be a priority for the nurse to ask the client? a. "What prescribed medications do you take?" b. "Are you more sensitive to warm or cool temperatures?" c. "How have you been sleeping over the last two weeks?" d. "How much weight have you gained in the past year?" Question #25 The nurse has taught a client who has Cushing's disease about changes in dietary habits. Which of the following meal choices would indicate a need for further teaching? a. Baked pork chop, steamed asparagus, and a glass of milk. b. Grilled salmon, rice with broccoli, and a glass of iced tea. c. Bacon, lettuce, and tomato sandwich on wheat toast and a glass of apple juice. d. Roasted chicken, oven-roasted potatoes, and a glass of water. Question #26 The nurse is assessing clients for the risk of developing Cushing’s syndrome. The nurse should identify at greatest risk, the client who is a a. 55-year-old male and was recently diagnosed with hypothyroidism. b. 44-year-old female and has frequent exacerbations of chronic obstructive pulmonary disease (COPD). c. 33-year-old female, has a goiter, and is receiving propylthiouracil (PTU). d. 22-year-old male, and recently had a craniotomy and is receiving desmopressin. Question #27 The nurse working in the emergency department (ED) is caring for a client who has Addison's disease and was brought in by emergency medical services (EMS). The client has the following admission data: Temperature: 101.8°F Pulse: 64 Respirations: 22 Blood pressure: 94/56 mm Hg ECG: Atrial fibrillation (AF) Potassium level: 6.2 mEq/L Sodium level: 122 mEq/L Reports of nausea Which of the following actions by the nurse is the priority? (Options not visible in PDF) Question #28 The nurse is caring for a client who has adrenal insufficiency and is experiencing an exacerbation. Which of the following actions should the nurse plan to take? a. Keep the lights in the client's room dim. b. Encourage the client to eat foods high in calcium. c. Monitor the client's potassium level. d. Administer prescribed antihypertensive medication. Question #29 The nurse is caring for a client who was admitted with a pheochromocytoma. Which of the following assessment findings should the nurse expect in this client? a. Polyuria. b. Palpitations. c. Cold intolerance. d. Lightheadedness. Question #30 The nurse preceptor is observing a newly hired nurse care for a client with suspected pheochromocytoma. Which of the following actions by the newly hired nurse requires the nurse preceptor to intervene? a. Avoiding palpation and percussion of the client's abdomen. b. Alternating arms when taking the client's blood pressure. c. Assessing the client's diet for red wine and aged cheeses. d. Limiting visitors while the client is sleeping. Question #31 The nurse is assessing a client who has Graves disease and notes that the client's temperature has increased by 1° F. After notifying the primary health care provider (PHCP), the nurse should first a. dim the lights in the room. b. assess for any changes in vision. c. administer prescribed oral antithyroid. d. check for a positive Trousseau sign. Question #32 The nurse has instructed a male client with hyperthyroidism who is scheduled to receive radioactive iodine (RAI) therapy. Which of the following client statements indicates a correct understanding of the instructions? (Options not visible in PDF) Question #33 The nurse is caring for a client who is 12 hours postoperative from a total thyroidectomy and has developed stridor. Which of the following actions should the nurse take? a. Encourage the client to take slow deep breaths. b. Set up oral suctioning equipment at the bedside. c. Hyperextend the client's neck and apply oxygen via simple mask. d. Prepare the client for an emergency tracheostomy. Question #34 The nurse has instructed a female client who has hyperthyroidism about a newly prescribed medication, methimazole. Which of the following client statements indicates a need for further teaching? a. "I will need to monitor for any weight gain while taking this medication." b. "I should avoid crowds and people who are flushes while taking this medication." c. "I might have a heat intolerance or hot flashes while taking this medication." d. "I will notify my doctor if I become pregnant while taking this medication." Question #35 The nurse has become aware of the following client situations. It would be a priority for the nurse to follow up with the client who a. has syndrome of inappropriate antidiuretic hormone secretion (SIADH) and continues to have a sodium level of 119 mEq/L. b. had a subtotal thyroidectomy 12 hours ago and reports tingling of the fingers. c. has hyperparathyroidism and received prescribed furosemide one hour ago. d. has hypothyroidism and is reporting the last bowel movement was three days ago. Question #36 The nurse is caring for a 35-year-old female client who has the following data: Difficulty with memory Facial edema Dry skin Amenorrhea Pulse: 60 Decreased peripheral pulses Blood glucose: 64 mg/dL Sodium level of 135 mEq/L Weight gain of 5 lbs in 1 week Which of the following complications should the nurse suspect that the client is experiencing? a. Myxedema coma. b. Thyroid storm. c. Diabetes insipidus (DI). d. Syndrome of inappropriate antidiuretic hormone (SIADH). Question #37 The nurse is caring for a client recently diagnosed with hypothyroidism and is receiving initial doses of levothyroxine. During the initiation of this medication therapy, it is a priority for the nurse to assess the client for the development of (Options not visible in PDF) Question #38 The nurse is teaching a client who has hypothyroidism about self-management. Which of the following should the nurse include in the teaching plan? a. Avoid the use of any fiber supplements with thyroid replacement medications. b. Thyroid replacement medications should be taken with food to avoid gastrointestinal (GI) upset. c. Eat foods that are high in calcium but low in phosphorus to prevent hypocalcemia. d. Maintain the prescribed fluid restriction to prevent fluid overload. Question #39 The nurse is developing a plan of care for a client who has hyperparathyroidism and an increased calcium level of 12.0 mg/dL. Which of the following prescriptions should the nurse question? a. Encourage increased intake of oral fluids. b. Obtain baseline electrocardiogram (ECG). c. Hydrochlorothiazide 25 mg IV twice a day. d. Perform neurologic assessment every 4 hours. Question #40 The nurse is caring for a client who has hyperparathyroidism. It requires follow up if the client a. reports tingling of the mouth. b. develops epigastric pain. c. has a weight gain of 1 pound in 1 week. d. has a loose bowel movement. Question #42 The nurse is admitting a client who has hyperglycemic-hyperosmolar state (HHS). Which of the following complications is the client at increased risk for developing? a. Infection. b. Pancreatitis. c. Hemorrhage. d. Dehydration. Question #43 The nurse is caring for a client who is being treated for hyperglycemic-hyperosmolar state (HHS). The client has been receiving intravenous normal saline (NS) and is now adequately rehydrated. Which of the following interventions should the nurse be prepared to implement next? a. Initiate a prescribed insulin drip. b. Determine the client's potassium level. c. Obtain arterial blood gas (ABG) levels. d. Determine the client's bicarbonate level. Question #44 The nurse is preparing to administer a regular insulin IV bolus to a client who has hyperglycemic-hyperosmolar state (HHS). The primary health care provider (PHCP) has prescribed an initial bolus dose of 0.1 unit/kg. The client weighs 120 lbs. How much regular insulin should the nurse administer to the client as an IV bolus? Round to the nearest whole number. a. 5 units b. 6 units c. 7 units d. 8 units Question #45 The nurse is caring for a client who is being treated for hyperglycemic-hyperosmolar state (HHS). Which of the following findings indicates to the nurse that treatment needs to be adjusted? a. Serum potassium level has increased from 2.8 to 3.2 mEq/L. b. Serum osmolarity has increased from 320 to 400 mOsm/L. c. Glasgow coma score (GCS) has increased by 2 points over the last 3 hours. d. Urine remains negative for ketones over the last 4 hours. Question #46 The nurse is reviewing prescriptions for newly admitted clients. It would require immediate follow up by the nurse if the primary health care provider (PHCP) prescribes a. a glycosylated hemoglobin (HgbA1C) level for a client admitted with diabetic ketoacidosis (DKA). b. a 24-hour urine collection for catecholamine levels for a client with a suspected pheochromocytoma. c. a fluid restriction of 500 to 600 mL/24 hours for a client who has syndrome of inappropriate antidiuretic hormone secretion (SIADH). d. 3% NaCl at 100 mL/hr for a client receiving treatment for hyperglycemic-hyperosmolar state (HHS). Question #47 The nurse is caring for a client who has diabetic ketoacidosis (DKA). Which of the following should the nurse expect to assess in this client? a. Shallow, slow respirations that alternate with periods of apnea. b. Arterial blood gas (ABG) results of pH 7.22, PaCO2 42 mm Hg, HCO3- 15 mEq/L. c. A 20 mm Hg increase in systolic blood pressure when changing from a lying to sitting position. d. Emotional changes with irrational and combative behavior. Question #48 The nurse is teaching a client who is newly diagnosed with diabetes mellitus (type 1) about sick day rules. Which of the instructions from the box below should the nurse include? Check blood glucose levels every 4 hours. Hold insulin injections if vomiting occurs. Get plenty of rest and sleep. Drink 8-12 oz of sugar-free liquids every hour, while awake. Attempt to eat meals at regular times. Test urine for ketones with every void if blood glucose is greater than 200 mg/dL. a. 1,4,5 b. 2,3,4,5,6 c. 1,3,4,5 d. 2,3,6 Question #49 The nurse is caring for a client diagnosed with diabetic ketoacidosis (DKA). The nurse performs a shift assessment, reviews the client's laboratory values, and notes new prescriptions as outlined below: Pulse: 120 Respirations: 28 Blood pressure: 90/62 mm Hg Urine output: 160 mL in the last 8 hours Potassium level: 5.3 mEq/L Blood glucose level: 350 mg/dL Increase IV fluid rate to 10 mL/kg/hr Which of the following actions should the nurse take next? a. Initiate a sodium bicarbonate drip of 50 mEq/L. b. Increase the rate of IV fluids as prescribed. c. Check capillary blood glucose level in 15 minutes. d. Lower the head of the bed (HOB) to 15 degrees. Question #50 The nurse has provided discharge instructions to a client who is postoperative from a transsphenoidal hypophysectomy. Which of the following client statements indicates a need for further teaching? a. "I will keep food on the upper shelves, so I don't have to bend over." b. "I will not be able to brush my teeth with a toothbrush for about 2 weeks." c. "I will wash the incision every day with hydrogen peroxide and cover with a dressing." d. "I will need to avoid blowing my nose until my doctor says I can."