NUR 265 Advanced Concepts of Medical-Surgical
Nursing Exam 2 Questions & Verified Answers
2026/2027 | Galen Nursing Study Guide
• NUR 265 Advanced Concepts of Medical-Surgical Nursing Exam 2 — 200
verified Q&A covering all major exam topics, with bolded correct answers and
clear EXPERT RATIONALE to reinforce clinical reasoning.
• Use this guide by reading each question independently before checking the
answer — the EXPERT RATIONALE beneath each correct option will deepen
your understanding and help you retain concepts faster.
NUR 265 — ADVANCED CONCEPTS OF MEDICAL-SURGICAL NURSING
EXAM 2 | 200 MULTIPLE CHOICE QUESTIONS | GALEN NURSING STUDY GUIDE
2026/2027
1. A client with heart failure is prescribed furosemide (Lasix). Which
electrolyte imbalance should the nurse monitor for most closely?
A) Hypernatremia
B) Hyperkalemia
C) Hypercalcemia
D) Hypokalemia
E) Hypermagnesemia
Correct Answer: D) Hypokalemia
EXPERT RATIONALE: Furosemide is a loop diuretic that causes loss of potassium in
the urine. Hypokalemia is the most common and clinically significant electrolyte
imbalance associated with its use, and can lead to dangerous cardiac dysrhythmias.
2. A nurse assessing a client with left-sided heart failure expects to find which
clinical manifestation?
A) Peripheral edema
,B) Jugular vein distension
C) Ascites
D) Pulmonary crackles
E) Hepatomegaly
Correct Answer: D) Pulmonary crackles
EXPERT RATIONALE: Left-sided heart failure causes blood to back up into the
pulmonary circulation, resulting in pulmonary congestion and crackles (rales) on
auscultation. Right-sided failure causes systemic congestion (edema, JVD, hepatomegaly).
3. A client is admitted with an acute myocardial infarction (MI). Which enzyme
is the most specific cardiac biomarker used to confirm the diagnosis?
A) AST
B) LDH
C) CK-MB
D) Troponin I
E) Myoglobin
Correct Answer: D) Troponin I
EXPERT RATIONALE: Troponin I is the most cardiac-specific biomarker and remains
elevated for 7–10 days after an MI. It is the gold standard for diagnosing myocardial
injury.
4. A nurse is caring for a client with angina. Nitroglycerin is prescribed. How
should the nurse instruct the client to take sublingual nitroglycerin for chest
pain?
A) Take one tablet every hour until pain is relieved
B) Take two tablets simultaneously for faster relief
,C) Take one tablet every 5 minutes, up to 3 doses, then seek emergency care if
pain persists
D) Take one tablet and wait 30 minutes before seeking help
E) Take with food to prevent stomach upset
Correct Answer: C) Take one tablet every 5 minutes, up to 3 doses, then
seek emergency care if pain persists
EXPERT RATIONALE: The standard protocol for sublingual nitroglycerin is one tablet
every 5 minutes for a maximum of 3 doses. If chest pain is unrelieved after 3 doses (15
minutes), the client should call 911 as this may indicate a myocardial infarction.
5. A client with chronic kidney disease (CKD) has a serum potassium of 6.5
mEq/L. What is the nurse's priority intervention?
A) Encourage increased fluid intake
B) Administer oral potassium supplements
C) Place the client on continuous cardiac monitoring
D) Encourage a high-potassium diet
E) Administer IV calcium gluconate without a physician order
Correct Answer: C) Place the client on continuous cardiac monitoring
EXPERT RATIONALE: A potassium level of 6.5 mEq/L is severely elevated
(hyperkalemia) and poses a serious risk for life-threatening cardiac dysrhythmias. The
priority nursing action is continuous cardiac monitoring while awaiting further orders.
6. A client is receiving IV heparin for a pulmonary embolism. The aPTT result is
120 seconds (therapeutic range: 60–100 seconds). What is the nurse's priority
action?
A) Increase the heparin drip rate
B) Continue the current rate and reassess in 4 hours
, C) Hold the heparin and notify the provider
D) Administer protamine sulfate immediately
E) Switch to warfarin immediately
Correct Answer: C) Hold the heparin and notify the provider
EXPERT RATIONALE: An aPTT of 120 seconds is above the therapeutic range,
indicating the client is over-anticoagulated and at risk for bleeding. The nurse should
hold the infusion and notify the provider for further orders.
7. A nurse is teaching a client with type 2 diabetes about foot care. Which
statement by the client indicates a need for further teaching?
A) "I will inspect my feet daily."
B) "I will wear well-fitting shoes at all times."
C) "I will soak my feet in hot water every night."
D) "I will report any cuts or sores to my doctor."
E) "I will trim my toenails straight across."
Correct Answer: C) "I will soak my feet in hot water every night."
EXPERT RATIONALE: Soaking feet in hot water is dangerous for diabetic clients due
to peripheral neuropathy and impaired sensation, which can lead to burns. Feet should
be washed in warm (not hot) water and dried thoroughly.
8. A client with COPD is receiving oxygen therapy. What is the maximum
recommended oxygen flow rate to avoid suppressing the hypoxic drive?
A) 6–8 L/min
B) 4–6 L/min
C) 1–2 L/min
D) 10–12 L/min
Nursing Exam 2 Questions & Verified Answers
2026/2027 | Galen Nursing Study Guide
• NUR 265 Advanced Concepts of Medical-Surgical Nursing Exam 2 — 200
verified Q&A covering all major exam topics, with bolded correct answers and
clear EXPERT RATIONALE to reinforce clinical reasoning.
• Use this guide by reading each question independently before checking the
answer — the EXPERT RATIONALE beneath each correct option will deepen
your understanding and help you retain concepts faster.
NUR 265 — ADVANCED CONCEPTS OF MEDICAL-SURGICAL NURSING
EXAM 2 | 200 MULTIPLE CHOICE QUESTIONS | GALEN NURSING STUDY GUIDE
2026/2027
1. A client with heart failure is prescribed furosemide (Lasix). Which
electrolyte imbalance should the nurse monitor for most closely?
A) Hypernatremia
B) Hyperkalemia
C) Hypercalcemia
D) Hypokalemia
E) Hypermagnesemia
Correct Answer: D) Hypokalemia
EXPERT RATIONALE: Furosemide is a loop diuretic that causes loss of potassium in
the urine. Hypokalemia is the most common and clinically significant electrolyte
imbalance associated with its use, and can lead to dangerous cardiac dysrhythmias.
2. A nurse assessing a client with left-sided heart failure expects to find which
clinical manifestation?
A) Peripheral edema
,B) Jugular vein distension
C) Ascites
D) Pulmonary crackles
E) Hepatomegaly
Correct Answer: D) Pulmonary crackles
EXPERT RATIONALE: Left-sided heart failure causes blood to back up into the
pulmonary circulation, resulting in pulmonary congestion and crackles (rales) on
auscultation. Right-sided failure causes systemic congestion (edema, JVD, hepatomegaly).
3. A client is admitted with an acute myocardial infarction (MI). Which enzyme
is the most specific cardiac biomarker used to confirm the diagnosis?
A) AST
B) LDH
C) CK-MB
D) Troponin I
E) Myoglobin
Correct Answer: D) Troponin I
EXPERT RATIONALE: Troponin I is the most cardiac-specific biomarker and remains
elevated for 7–10 days after an MI. It is the gold standard for diagnosing myocardial
injury.
4. A nurse is caring for a client with angina. Nitroglycerin is prescribed. How
should the nurse instruct the client to take sublingual nitroglycerin for chest
pain?
A) Take one tablet every hour until pain is relieved
B) Take two tablets simultaneously for faster relief
,C) Take one tablet every 5 minutes, up to 3 doses, then seek emergency care if
pain persists
D) Take one tablet and wait 30 minutes before seeking help
E) Take with food to prevent stomach upset
Correct Answer: C) Take one tablet every 5 minutes, up to 3 doses, then
seek emergency care if pain persists
EXPERT RATIONALE: The standard protocol for sublingual nitroglycerin is one tablet
every 5 minutes for a maximum of 3 doses. If chest pain is unrelieved after 3 doses (15
minutes), the client should call 911 as this may indicate a myocardial infarction.
5. A client with chronic kidney disease (CKD) has a serum potassium of 6.5
mEq/L. What is the nurse's priority intervention?
A) Encourage increased fluid intake
B) Administer oral potassium supplements
C) Place the client on continuous cardiac monitoring
D) Encourage a high-potassium diet
E) Administer IV calcium gluconate without a physician order
Correct Answer: C) Place the client on continuous cardiac monitoring
EXPERT RATIONALE: A potassium level of 6.5 mEq/L is severely elevated
(hyperkalemia) and poses a serious risk for life-threatening cardiac dysrhythmias. The
priority nursing action is continuous cardiac monitoring while awaiting further orders.
6. A client is receiving IV heparin for a pulmonary embolism. The aPTT result is
120 seconds (therapeutic range: 60–100 seconds). What is the nurse's priority
action?
A) Increase the heparin drip rate
B) Continue the current rate and reassess in 4 hours
, C) Hold the heparin and notify the provider
D) Administer protamine sulfate immediately
E) Switch to warfarin immediately
Correct Answer: C) Hold the heparin and notify the provider
EXPERT RATIONALE: An aPTT of 120 seconds is above the therapeutic range,
indicating the client is over-anticoagulated and at risk for bleeding. The nurse should
hold the infusion and notify the provider for further orders.
7. A nurse is teaching a client with type 2 diabetes about foot care. Which
statement by the client indicates a need for further teaching?
A) "I will inspect my feet daily."
B) "I will wear well-fitting shoes at all times."
C) "I will soak my feet in hot water every night."
D) "I will report any cuts or sores to my doctor."
E) "I will trim my toenails straight across."
Correct Answer: C) "I will soak my feet in hot water every night."
EXPERT RATIONALE: Soaking feet in hot water is dangerous for diabetic clients due
to peripheral neuropathy and impaired sensation, which can lead to burns. Feet should
be washed in warm (not hot) water and dried thoroughly.
8. A client with COPD is receiving oxygen therapy. What is the maximum
recommended oxygen flow rate to avoid suppressing the hypoxic drive?
A) 6–8 L/min
B) 4–6 L/min
C) 1–2 L/min
D) 10–12 L/min
