NUR 265 (Latest 2025- 2026 Update) Advanced Concepts of Medical-Surgical
Nursing Guide
NUR 265 – Advanced Med-Surg Practice Q&As (Original)
Question 1
A patient with septic shock has a mean arterial pressure (MAP) of 52 mm Hg,
heart rate 122 bpm, and lactate of 4.8 mmol/L. Which intervention should the
nurse prioritize?
A. Administer broad-spectrum antibiotics
B. Start a norepinephrine infusion
C. Give a 500 mL fluid bolus of isotonic crystalloid
D. Obtain a central venous pressure (CVP) reading
Answer: C
Rationale: In septic shock, the Surviving Sepsis Campaign recommends early fluid
resuscitation (30 mL/kg crystalloid) for hypotension and lactate >4 mmol/L.
Antibiotics are critical but should follow fluid resuscitation. Norepinephrine is
added if hypotension persists after fluids. CVP is not a priority over immediate
fluid administration.
,Question 2
A nurse is caring for a patient with acute respiratory distress syndrome (ARDS) on
a ventilator. Which finding indicates that the condition is worsening?
A. PaO₂/FiO₂ ratio decreases from 250 to 180
B. Plateau pressure decreases from 32 to 28 cm H₂O
C. PaCO₂ increases from 38 to 42 mm Hg
D. Tidal volume remains at 6 mL/kg PBW
Answer: A
Rationale: ARDS severity is classified by PaO₂/FiO₂ ratio. A decrease from 250
(mild) to 180 (moderate) indicates worsening lung injury. Low tidal volume (6
mL/kg) is protective. Plateau pressure >30 is concerning, so a decrease is not
worsening. Mild PaCO₂ rise is expected with permissive hypercapnia.
Question 3
A patient with acute kidney injury (AKI) has a urine output of 80 mL over 8 hours,
potassium 6.2 mEq/L, and creatinine 3.1 mg/dL. Which intervention should the
nurse implement first?
A. Administer IV furosemide
B. Give IV calcium gluconate
,C. Start insulin and dextrose infusion
D. Prepare for emergent hemodialysis
Answer: B
Rationale: Potassium 6.2 with oliguria risks fatal dysrhythmias. IV calcium
gluconate stabilizes cardiac membranes immediately. Insulin + dextrose shifts
potassium intracellularly but takes longer. Furosemide is for volume overload, not
emergent hyperkalemia. Hemodialysis takes time to initiate.
Question 4
Which patient with disseminated intravascular coagulation (DIC) requires
immediate nursing intervention?
A. Platelets 48,000/mm³
B. PT 18 seconds (INR 1.8)
C. Fibrinogen 85 mg/dL
D. New-onset hematuria with back pain
Answer: D
Rationale: New hematuria + back pain in DIC suggests retroperitoneal bleeding or
adrenal hemorrhage, a life-threatening emergency. Low platelets, high PT, and
, low fibrinogen are expected in DIC but are not acute changes requiring immediate
intervention without bleeding signs.
Question 5
A nurse is monitoring a patient after a liver biopsy. Two hours later, the patient
reports severe right shoulder pain. Blood pressure is 100/60 mm Hg, heart rate
110 bpm. What should the nurse suspect?
A. Referred pain from the procedure
B. Intraperitoneal bleeding
C. Pneumothorax
D. Bile peritonitis
Answer: B
Rationale: Right shoulder pain after liver biopsy, especially with tachycardia and
borderline hypotension, suggests diaphragmatic irritation from intra-abdominal
bleeding. Referred pain alone should not cause hemodynamic changes.
Pneumothorax and bile peritonitis are less likely immediately post-biopsy.
Question 6
Nursing Guide
NUR 265 – Advanced Med-Surg Practice Q&As (Original)
Question 1
A patient with septic shock has a mean arterial pressure (MAP) of 52 mm Hg,
heart rate 122 bpm, and lactate of 4.8 mmol/L. Which intervention should the
nurse prioritize?
A. Administer broad-spectrum antibiotics
B. Start a norepinephrine infusion
C. Give a 500 mL fluid bolus of isotonic crystalloid
D. Obtain a central venous pressure (CVP) reading
Answer: C
Rationale: In septic shock, the Surviving Sepsis Campaign recommends early fluid
resuscitation (30 mL/kg crystalloid) for hypotension and lactate >4 mmol/L.
Antibiotics are critical but should follow fluid resuscitation. Norepinephrine is
added if hypotension persists after fluids. CVP is not a priority over immediate
fluid administration.
,Question 2
A nurse is caring for a patient with acute respiratory distress syndrome (ARDS) on
a ventilator. Which finding indicates that the condition is worsening?
A. PaO₂/FiO₂ ratio decreases from 250 to 180
B. Plateau pressure decreases from 32 to 28 cm H₂O
C. PaCO₂ increases from 38 to 42 mm Hg
D. Tidal volume remains at 6 mL/kg PBW
Answer: A
Rationale: ARDS severity is classified by PaO₂/FiO₂ ratio. A decrease from 250
(mild) to 180 (moderate) indicates worsening lung injury. Low tidal volume (6
mL/kg) is protective. Plateau pressure >30 is concerning, so a decrease is not
worsening. Mild PaCO₂ rise is expected with permissive hypercapnia.
Question 3
A patient with acute kidney injury (AKI) has a urine output of 80 mL over 8 hours,
potassium 6.2 mEq/L, and creatinine 3.1 mg/dL. Which intervention should the
nurse implement first?
A. Administer IV furosemide
B. Give IV calcium gluconate
,C. Start insulin and dextrose infusion
D. Prepare for emergent hemodialysis
Answer: B
Rationale: Potassium 6.2 with oliguria risks fatal dysrhythmias. IV calcium
gluconate stabilizes cardiac membranes immediately. Insulin + dextrose shifts
potassium intracellularly but takes longer. Furosemide is for volume overload, not
emergent hyperkalemia. Hemodialysis takes time to initiate.
Question 4
Which patient with disseminated intravascular coagulation (DIC) requires
immediate nursing intervention?
A. Platelets 48,000/mm³
B. PT 18 seconds (INR 1.8)
C. Fibrinogen 85 mg/dL
D. New-onset hematuria with back pain
Answer: D
Rationale: New hematuria + back pain in DIC suggests retroperitoneal bleeding or
adrenal hemorrhage, a life-threatening emergency. Low platelets, high PT, and
, low fibrinogen are expected in DIC but are not acute changes requiring immediate
intervention without bleeding signs.
Question 5
A nurse is monitoring a patient after a liver biopsy. Two hours later, the patient
reports severe right shoulder pain. Blood pressure is 100/60 mm Hg, heart rate
110 bpm. What should the nurse suspect?
A. Referred pain from the procedure
B. Intraperitoneal bleeding
C. Pneumothorax
D. Bile peritonitis
Answer: B
Rationale: Right shoulder pain after liver biopsy, especially with tachycardia and
borderline hypotension, suggests diaphragmatic irritation from intra-abdominal
bleeding. Referred pain alone should not cause hemodynamic changes.
Pneumothorax and bile peritonitis are less likely immediately post-biopsy.
Question 6
