GALEN COLLEGE OF NURSING
NUR 265
EXAM 1
Medical-Surgical Nursing
CONTAINS
• 120–150 unique NCLEX-style medical-surgical nursing
questions
• High-yield questions focused on what students are most likely to
be tested on
• Multiple-choice and Select-All-That-Apply (SATA) questions
• Clearly marked Correct Answers for every question
• Detailed, exam-focused rationales explaining clinical reasoning
• Priority nursing actions and ABC/safety decision-making
• Laboratory value interpretation and trend analysis
,A client is admitted to the intensive care unit with a diagnosis of Acute Respiratory Distress Syndrome
(ARDS). The nurse is reviewing the ventilator settings and notes the presence of Positive End-
Expiratory Pressure (PEEP) set at 10 cm H2O. What is the primary physiological rationale for the nurse
to understand regarding the use of PEEP in this client?
A) PEEP increases the rate of gas exchange across the alveolar membrane.
B) PEEP prevents the alveoli from collapsing during exhalation.
C) PEEP reduces the workload of the diaphragm by fully ventilating the client.
D) PEEP pushes secretions into the large airways for easier suctioning.
Correct Answer: B) PEEP prevents the alveoli from collapsing during exhalation.
Rationale:
ARDS is characterized by widespread inflammation and injury to the alveolar-capillary membrane,
leading to increased permeability pulmonary edema and alveolar collapse (atelectasis). PEEP (Positive
End-Expiratory Pressure) is a critical ventilator setting for ARDS because it maintains positive pressure
in the lungs at the end of expiration. This pressure prevents the alveoli from collapsing, keeping them
open for gas exchange. By recruiting and stabilizing these alveoli, PEEP improves oxygenation and
allows the use of lower concentrations of inspired oxygen (FiO2) to reduce oxygen toxicity.
Option A is incorrect because PEEP primarily improves oxygenation by maintaining alveolar volume, not
by directly increasing the rate of gas exchange (diffusion). Option C is incorrect because while mechanical
ventilation in general reduces diaphragmatic work, the specific purpose of PEEP is alveolar recruitment,
not muscle rest. Option D is incorrect because PEEP does not facilitate secretion removal; in fact, high
levels of PEEP can sometimes impede venous return and does not have a mucolytic or mobilizing effect.
The nurse is caring for a client with a diagnosis of Addison’s Disease (Primary Adrenal Insufficiency).
During the morning assessment, the client reports feeling "extremely weak" and "dizzy." The nurse
notes the client’s blood pressure is 85/50 mm Hg, heart rate is 115/min, and the client has
hyperpigmentation of the skin and mucous membranes. Which laboratory value should the nurse
anticipate finding?
A) Serum Potassium 3.0 mEq/L.
B) Serum Sodium 128 mEq/L.
C) Blood Glucose 160 mg/dL.
D) Serum Calcium 5.0 mg/dL.
,Correct Answer: B) Serum Sodium 128 mEq/L.
Rationale:
Addison’s Disease involves the destruction of the adrenal cortex, leading to a deficiency of
mineralocorticoids (aldosterone) and glucocorticoids (cortisol). Aldosterone deficiency causes the
kidneys to retain potassium and excrete sodium and water. Consequently, the client will present with
hyponatremia (low sodium) and hyperkalemia (high potassium). The client's symptoms of hypotension
(85/50), dizziness, and weakness are direct results of the volume depletion from the sodium and water
loss. The hyperpigmentation (bronze skin) is a hallmark sign caused by the elevated pituitary ACTH
(melanocyte-stimulating hormone) due to the lack of negative feedback from cortisol.
Option A is incorrect because the client would be expected to have hyperkalemia, not hypokalemia, due
to aldosterone deficiency. Option C is incorrect because cortisol deficiency (glucocorticoid) can lead to
hypoglycemia, not hyperglycemia, as cortisol is normally gluconeogenic. Option D is incorrect because
while calcium levels can be affected, severe hypocalcemia is not a primary diagnostic hallmark of this
condition compared to the electrolyte shifts of sodium and potassium.
The nurse is monitoring a client with Chronic Kidney Disease (CKD) Stage 4 who is scheduled for
dialysis access planning. The client asks, "Why can't I just take pills to treat my kidney failure?" Which
explanation by the nurse is most accurate regarding the role of dialysis?
A) Dialysis replaces the hormonal function of the kidneys by producing erythropoietin.
B) Dialysis removes excess nitrogenous wastes and regulates fluid volume that the kidneys can no
longer handle.
C) Dialysis filters the blood in the small intestine to absorb toxins before they reach the heart.
D) Dialysis is required to reduce the size of the kidneys so they can function more efficiently.
Correct Answer: B) Dialysis removes excess nitrogenous wastes and regulates fluid volume
that the kidneys can no longer handle.
Rationale:
As CKD progresses to end-stage renal disease (ESRD), the kidneys lose their ability to filter nitrogenous
waste products (such as blood urea nitrogen and creatinine), regulate electrolytes, and maintain fluid
, balance. Dialysis acts as an artificial kidney to perform these functions. Hemodialysis involves
pumping blood through a dialyzer (artificial kidney) where waste products diffuse across a
semipermeable membrane into a dialysate solution, and excess fluid is removed via ultrafiltration.
Peritoneal dialysis uses the peritoneal membrane as a filter.
Option A is incorrect because dialysis does not replace the endocrine function of the kidneys. Medications
(synthetic erythropoietin) are required to replace hormone production. Option C is incorrect because
dialysis filters the blood directly, usually via a machine (hemodialysis) or the abdominal cavity
(peritoneal), not the small intestine. Option D is incorrect because dialysis does not change the size of the
kidneys; it acts as an external substitute for lost function.
A client who is 2 days post-myocardial infarction suddenly becomes confused, develops cool, clammy
skin, and a blood pressure of 80/50 mm Hg. The nurse auscultates a new pericardial friction rub. The
nurse recognizes these findings as indicative of which complication?
A) Ventricular Aneurysm.
B) Dressler Syndrome.
C) Cardiogenic Shock.
D) Ruptured Papillary Muscle.
Correct Answer: C) Cardiogenic Shock.
Rationale:
The client is displaying classic signs of Cardiogenic Shock: hypotension (80/50), confusion (due to
decreased cerebral perfusion), and cool, clammy skin (due to peripheral vasoconstriction). While a
pericardial friction rub might suggest Dressler syndrome or pericarditis, the combination of severe
hypotension and altered mental status in the acute phase (2 days post-MI) points to pump failure
(Cardiogenic Shock). The "confusion" indicates hypoperfusion of the brain, and the "cool, clammy"
skin indicates compensatory vasoconstriction and poor cardiac output.
Option A (Ventricular Aneurysm) typically presents with arrhythmias, heart failure, or embolic
phenomena, not acute shock with these specific signs in this immediate timeframe. Option B (Dressler
Syndrome) typically occurs weeks to months post-MI and involves fever, pleuritis, and pericarditis, but
shock is not the primary immediate feature. Option D (Ruptured Papillary Muscle) causes acute mitral
regurgitation, leading to pulmonary edema (crackles), which are not mentioned here, though
NUR 265
EXAM 1
Medical-Surgical Nursing
CONTAINS
• 120–150 unique NCLEX-style medical-surgical nursing
questions
• High-yield questions focused on what students are most likely to
be tested on
• Multiple-choice and Select-All-That-Apply (SATA) questions
• Clearly marked Correct Answers for every question
• Detailed, exam-focused rationales explaining clinical reasoning
• Priority nursing actions and ABC/safety decision-making
• Laboratory value interpretation and trend analysis
,A client is admitted to the intensive care unit with a diagnosis of Acute Respiratory Distress Syndrome
(ARDS). The nurse is reviewing the ventilator settings and notes the presence of Positive End-
Expiratory Pressure (PEEP) set at 10 cm H2O. What is the primary physiological rationale for the nurse
to understand regarding the use of PEEP in this client?
A) PEEP increases the rate of gas exchange across the alveolar membrane.
B) PEEP prevents the alveoli from collapsing during exhalation.
C) PEEP reduces the workload of the diaphragm by fully ventilating the client.
D) PEEP pushes secretions into the large airways for easier suctioning.
Correct Answer: B) PEEP prevents the alveoli from collapsing during exhalation.
Rationale:
ARDS is characterized by widespread inflammation and injury to the alveolar-capillary membrane,
leading to increased permeability pulmonary edema and alveolar collapse (atelectasis). PEEP (Positive
End-Expiratory Pressure) is a critical ventilator setting for ARDS because it maintains positive pressure
in the lungs at the end of expiration. This pressure prevents the alveoli from collapsing, keeping them
open for gas exchange. By recruiting and stabilizing these alveoli, PEEP improves oxygenation and
allows the use of lower concentrations of inspired oxygen (FiO2) to reduce oxygen toxicity.
Option A is incorrect because PEEP primarily improves oxygenation by maintaining alveolar volume, not
by directly increasing the rate of gas exchange (diffusion). Option C is incorrect because while mechanical
ventilation in general reduces diaphragmatic work, the specific purpose of PEEP is alveolar recruitment,
not muscle rest. Option D is incorrect because PEEP does not facilitate secretion removal; in fact, high
levels of PEEP can sometimes impede venous return and does not have a mucolytic or mobilizing effect.
The nurse is caring for a client with a diagnosis of Addison’s Disease (Primary Adrenal Insufficiency).
During the morning assessment, the client reports feeling "extremely weak" and "dizzy." The nurse
notes the client’s blood pressure is 85/50 mm Hg, heart rate is 115/min, and the client has
hyperpigmentation of the skin and mucous membranes. Which laboratory value should the nurse
anticipate finding?
A) Serum Potassium 3.0 mEq/L.
B) Serum Sodium 128 mEq/L.
C) Blood Glucose 160 mg/dL.
D) Serum Calcium 5.0 mg/dL.
,Correct Answer: B) Serum Sodium 128 mEq/L.
Rationale:
Addison’s Disease involves the destruction of the adrenal cortex, leading to a deficiency of
mineralocorticoids (aldosterone) and glucocorticoids (cortisol). Aldosterone deficiency causes the
kidneys to retain potassium and excrete sodium and water. Consequently, the client will present with
hyponatremia (low sodium) and hyperkalemia (high potassium). The client's symptoms of hypotension
(85/50), dizziness, and weakness are direct results of the volume depletion from the sodium and water
loss. The hyperpigmentation (bronze skin) is a hallmark sign caused by the elevated pituitary ACTH
(melanocyte-stimulating hormone) due to the lack of negative feedback from cortisol.
Option A is incorrect because the client would be expected to have hyperkalemia, not hypokalemia, due
to aldosterone deficiency. Option C is incorrect because cortisol deficiency (glucocorticoid) can lead to
hypoglycemia, not hyperglycemia, as cortisol is normally gluconeogenic. Option D is incorrect because
while calcium levels can be affected, severe hypocalcemia is not a primary diagnostic hallmark of this
condition compared to the electrolyte shifts of sodium and potassium.
The nurse is monitoring a client with Chronic Kidney Disease (CKD) Stage 4 who is scheduled for
dialysis access planning. The client asks, "Why can't I just take pills to treat my kidney failure?" Which
explanation by the nurse is most accurate regarding the role of dialysis?
A) Dialysis replaces the hormonal function of the kidneys by producing erythropoietin.
B) Dialysis removes excess nitrogenous wastes and regulates fluid volume that the kidneys can no
longer handle.
C) Dialysis filters the blood in the small intestine to absorb toxins before they reach the heart.
D) Dialysis is required to reduce the size of the kidneys so they can function more efficiently.
Correct Answer: B) Dialysis removes excess nitrogenous wastes and regulates fluid volume
that the kidneys can no longer handle.
Rationale:
As CKD progresses to end-stage renal disease (ESRD), the kidneys lose their ability to filter nitrogenous
waste products (such as blood urea nitrogen and creatinine), regulate electrolytes, and maintain fluid
, balance. Dialysis acts as an artificial kidney to perform these functions. Hemodialysis involves
pumping blood through a dialyzer (artificial kidney) where waste products diffuse across a
semipermeable membrane into a dialysate solution, and excess fluid is removed via ultrafiltration.
Peritoneal dialysis uses the peritoneal membrane as a filter.
Option A is incorrect because dialysis does not replace the endocrine function of the kidneys. Medications
(synthetic erythropoietin) are required to replace hormone production. Option C is incorrect because
dialysis filters the blood directly, usually via a machine (hemodialysis) or the abdominal cavity
(peritoneal), not the small intestine. Option D is incorrect because dialysis does not change the size of the
kidneys; it acts as an external substitute for lost function.
A client who is 2 days post-myocardial infarction suddenly becomes confused, develops cool, clammy
skin, and a blood pressure of 80/50 mm Hg. The nurse auscultates a new pericardial friction rub. The
nurse recognizes these findings as indicative of which complication?
A) Ventricular Aneurysm.
B) Dressler Syndrome.
C) Cardiogenic Shock.
D) Ruptured Papillary Muscle.
Correct Answer: C) Cardiogenic Shock.
Rationale:
The client is displaying classic signs of Cardiogenic Shock: hypotension (80/50), confusion (due to
decreased cerebral perfusion), and cool, clammy skin (due to peripheral vasoconstriction). While a
pericardial friction rub might suggest Dressler syndrome or pericarditis, the combination of severe
hypotension and altered mental status in the acute phase (2 days post-MI) points to pump failure
(Cardiogenic Shock). The "confusion" indicates hypoperfusion of the brain, and the "cool, clammy"
skin indicates compensatory vasoconstriction and poor cardiac output.
Option A (Ventricular Aneurysm) typically presents with arrhythmias, heart failure, or embolic
phenomena, not acute shock with these specific signs in this immediate timeframe. Option B (Dressler
Syndrome) typically occurs weeks to months post-MI and involves fever, pleuritis, and pericarditis, but
shock is not the primary immediate feature. Option D (Ruptured Papillary Muscle) causes acute mitral
regurgitation, leading to pulmonary edema (crackles), which are not mentioned here, though
