NUR 265 Exam 1 Medical Surgical Nursing
Galen College ACTUAL EXAM 2026/2027 |
Galen NUR 265 Med Surg | Verified Q&A |
Pass Guaranteed - A+ Graded
Section A: Multiple Choice (Questions 1–45)
Q1: A 68-year-old patient is admitted with dehydration secondary to vomiting and diarrhea for 3 days.
Vital signs: BP 92/58 mmHg, HR 118 bpm, RR 22/min, Temp 99.1°F (37.3°C). The nurse notes dry mucous
membranes and decreased skin turgor. Which of the following is the nurse's priority action?
A. Encourage oral fluid intake
B. Insert an indwelling urinary catheter
C. Initiate IV fluid replacement with isotonic solution. [CORRECT]
D. Administer an antiemetic as ordered
Correct Answer: C
Rationale: This patient demonstrates clinical signs of moderate-to-severe dehydration including
hypotension, tachycardia, and poor skin turgor. IV fluid replacement with an isotonic solution such as
0.9% NaCl or lactated Ringer's is the priority to restore intravascular volume, prevent hypovolemic
shock, and correct electrolyte imbalances before oral intake can be tolerated.
Q2: ABG results for a patient with COPD exacerbation: pH 7.28, PaCO₂ 58 mmHg, HCO₃ 30 mEq/L, PaO₂
62 mmHg. The nurse interprets these ABG results as which of the following?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis with partial metabolic compensation. [CORRECT]
D. Respiratory alkalosis
Correct Answer: C
Rationale: The pH of 7.28 indicates acidosis. The elevated PaCO₂ of 58 mmHg confirms a respiratory
cause, as carbon dioxide is the respiratory acid. The elevated HCO₃ of 30 mEq/L indicates the kidneys
,have begun compensating by retaining bicarbonate, but since the pH remains abnormal, compensation
is only partial rather than complete.
Q3: A postoperative day 2 patient after abdominal surgery reports increasing abdominal pain and
distension. The nurse auscultates absent bowel sounds in all four quadrants. The patient's last bowel
movement was preoperatively. Which finding requires immediate follow-up by the nurse?
A. Pain rated 6/10
B. Small amount of serosanguineous drainage on the dressing
C. Absent bowel sounds with abdominal distension. [CORRECT]
D. Temperature 99.4°F (37.4°C)
Correct Answer: C
Rationale: Absent bowel sounds combined with abdominal distension in a postoperative patient is
highly suggestive of paralytic ileus, a serious complication that can lead to bowel obstruction,
perforation, and peritonitis. Immediate notification of the provider and NPO status are required to
prevent further complications and potential surgical intervention.
Q4: A patient's laboratory results show sodium 128 mEq/L. The nurse observes the patient is lethargic
and confused. Which nursing intervention is the priority?
A. Restrict fluid intake to 500 mL per day
B. Initiate seizure precautions. [CORRECT]
C. Administer 3% saline IV push
D. Encourage increased salt intake
Correct Answer: B
Rationale: A sodium level of 128 mEq/L indicates moderate hyponatremia. The patient's altered mental
status (lethargy and confusion) places them at high risk for progression to seizures and cerebral edema.
Seizure precautions are the immediate priority to protect patient safety while the underlying electrolyte
imbalance is corrected under provider direction.
Q5: A patient receiving IV potassium chloride at 20 mEq/hr via peripheral line complains of burning pain
at the insertion site. The nurse notes the site is cool, pale, and edematous with fluid leaking around the
catheter. Which is the nurse's priority action?
A. Slow the infusion rate
B. Apply warm compresses
, C. Discontinue the IV and restart at a new site. [CORRECT]
D. Notify the provider immediately
Correct Answer: C
Rationale: The assessment findings of coolness, pallor, edema, and leakage at the IV site are classic signs
of infiltration. Potassium is a vesicant that causes tissue necrosis if it extravasates into subcutaneous
tissue. The immediate priority is to discontinue the infusion to prevent tissue damage, then restart at a
new site with appropriate dilution and monitoring.
Q6: A patient with heart failure develops crackles in bilateral lung bases, dyspnea, and weight gain of 4
lbs in 24 hours. Vital signs: BP 154/92 mmHg, HR 96 bpm, RR 26/min, SpO₂ 89% on room air. What is the
nurse's priority action?
A. Administer furosemide as ordered
B. Place the patient in high-Fowler's position and apply oxygen. [CORRECT]
C. Obtain a 12-lead EKG
D. Insert a Foley catheter
Correct Answer: B
Rationale: This patient is exhibiting signs of acute pulmonary edema and fluid overload with
compromised oxygenation (SpO₂ 89%). Following the ABC priority framework, the nurse must first
address airway and breathing by positioning the patient upright to reduce venous return to the heart
and administering supplemental oxygen to improve gas exchange before pharmacological interventions.
Q7: ABG results for a patient who has been vomiting for 48 hours: pH 7.50, PaCO₂ 48 mmHg, HCO₃ 36
mEq/L. The nurse interprets these results as:
A. Respiratory acidosis
B. Metabolic alkalosis. [CORRECT]
C. Respiratory alkalosis
D. Metabolic acidosis with respiratory compensation
Correct Answer: B
Rationale: The elevated pH of 7.50 indicates alkalosis. The elevated HCO₃ of 36 mEq/L confirms a
metabolic origin, as bicarbonate is the metabolic component. The slightly elevated PaCO₂ of 48 mmHg
represents the respiratory system's attempt to compensate by hypoventilating to retain CO₂, but
compensation is incomplete since the pH remains alkalotic.
Galen College ACTUAL EXAM 2026/2027 |
Galen NUR 265 Med Surg | Verified Q&A |
Pass Guaranteed - A+ Graded
Section A: Multiple Choice (Questions 1–45)
Q1: A 68-year-old patient is admitted with dehydration secondary to vomiting and diarrhea for 3 days.
Vital signs: BP 92/58 mmHg, HR 118 bpm, RR 22/min, Temp 99.1°F (37.3°C). The nurse notes dry mucous
membranes and decreased skin turgor. Which of the following is the nurse's priority action?
A. Encourage oral fluid intake
B. Insert an indwelling urinary catheter
C. Initiate IV fluid replacement with isotonic solution. [CORRECT]
D. Administer an antiemetic as ordered
Correct Answer: C
Rationale: This patient demonstrates clinical signs of moderate-to-severe dehydration including
hypotension, tachycardia, and poor skin turgor. IV fluid replacement with an isotonic solution such as
0.9% NaCl or lactated Ringer's is the priority to restore intravascular volume, prevent hypovolemic
shock, and correct electrolyte imbalances before oral intake can be tolerated.
Q2: ABG results for a patient with COPD exacerbation: pH 7.28, PaCO₂ 58 mmHg, HCO₃ 30 mEq/L, PaO₂
62 mmHg. The nurse interprets these ABG results as which of the following?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis with partial metabolic compensation. [CORRECT]
D. Respiratory alkalosis
Correct Answer: C
Rationale: The pH of 7.28 indicates acidosis. The elevated PaCO₂ of 58 mmHg confirms a respiratory
cause, as carbon dioxide is the respiratory acid. The elevated HCO₃ of 30 mEq/L indicates the kidneys
,have begun compensating by retaining bicarbonate, but since the pH remains abnormal, compensation
is only partial rather than complete.
Q3: A postoperative day 2 patient after abdominal surgery reports increasing abdominal pain and
distension. The nurse auscultates absent bowel sounds in all four quadrants. The patient's last bowel
movement was preoperatively. Which finding requires immediate follow-up by the nurse?
A. Pain rated 6/10
B. Small amount of serosanguineous drainage on the dressing
C. Absent bowel sounds with abdominal distension. [CORRECT]
D. Temperature 99.4°F (37.4°C)
Correct Answer: C
Rationale: Absent bowel sounds combined with abdominal distension in a postoperative patient is
highly suggestive of paralytic ileus, a serious complication that can lead to bowel obstruction,
perforation, and peritonitis. Immediate notification of the provider and NPO status are required to
prevent further complications and potential surgical intervention.
Q4: A patient's laboratory results show sodium 128 mEq/L. The nurse observes the patient is lethargic
and confused. Which nursing intervention is the priority?
A. Restrict fluid intake to 500 mL per day
B. Initiate seizure precautions. [CORRECT]
C. Administer 3% saline IV push
D. Encourage increased salt intake
Correct Answer: B
Rationale: A sodium level of 128 mEq/L indicates moderate hyponatremia. The patient's altered mental
status (lethargy and confusion) places them at high risk for progression to seizures and cerebral edema.
Seizure precautions are the immediate priority to protect patient safety while the underlying electrolyte
imbalance is corrected under provider direction.
Q5: A patient receiving IV potassium chloride at 20 mEq/hr via peripheral line complains of burning pain
at the insertion site. The nurse notes the site is cool, pale, and edematous with fluid leaking around the
catheter. Which is the nurse's priority action?
A. Slow the infusion rate
B. Apply warm compresses
, C. Discontinue the IV and restart at a new site. [CORRECT]
D. Notify the provider immediately
Correct Answer: C
Rationale: The assessment findings of coolness, pallor, edema, and leakage at the IV site are classic signs
of infiltration. Potassium is a vesicant that causes tissue necrosis if it extravasates into subcutaneous
tissue. The immediate priority is to discontinue the infusion to prevent tissue damage, then restart at a
new site with appropriate dilution and monitoring.
Q6: A patient with heart failure develops crackles in bilateral lung bases, dyspnea, and weight gain of 4
lbs in 24 hours. Vital signs: BP 154/92 mmHg, HR 96 bpm, RR 26/min, SpO₂ 89% on room air. What is the
nurse's priority action?
A. Administer furosemide as ordered
B. Place the patient in high-Fowler's position and apply oxygen. [CORRECT]
C. Obtain a 12-lead EKG
D. Insert a Foley catheter
Correct Answer: B
Rationale: This patient is exhibiting signs of acute pulmonary edema and fluid overload with
compromised oxygenation (SpO₂ 89%). Following the ABC priority framework, the nurse must first
address airway and breathing by positioning the patient upright to reduce venous return to the heart
and administering supplemental oxygen to improve gas exchange before pharmacological interventions.
Q7: ABG results for a patient who has been vomiting for 48 hours: pH 7.50, PaCO₂ 48 mmHg, HCO₃ 36
mEq/L. The nurse interprets these results as:
A. Respiratory acidosis
B. Metabolic alkalosis. [CORRECT]
C. Respiratory alkalosis
D. Metabolic acidosis with respiratory compensation
Correct Answer: B
Rationale: The elevated pH of 7.50 indicates alkalosis. The elevated HCO₃ of 36 mEq/L confirms a
metabolic origin, as bicarbonate is the metabolic component. The slightly elevated PaCO₂ of 48 mmHg
represents the respiratory system's attempt to compensate by hypoventilating to retain CO₂, but
compensation is incomplete since the pH remains alkalotic.
