SCHOOL OF NURSING
NUR 265 Exam 2
Two Updated Versions (V1 and V2)
Official Practice Exam -- 2026/2027 Edition
100%% Correct Answers with Detailed Rationales
Questions and Answers
Questions: 100 Minutes: 120 Passing Score: 80%% Versions: V1/V2
Table of Contents
Section 1: Cardiovascular and Hematologic Disorders (Q1 -- Q17)
Section 2: Respiratory and Pulmonary Disorders (Q18 -- Q34)
Section 3: Neurological and Sensory Disorders (Q35 -- Q51)
Section 4: Renal and Urinary Disorders (Q52 -- Q68)
Section 5: Musculoskeletal and Integumentary Disorders (Q69 -- Q84)
Section 6: Oncologic and Endocrine Disorders (Q85 -- Q100)
Instructions
This practice exam contains 100 multiple-choice questions divided into 6 sections covering advanced
medical-surgical nursing topics. You have 120 minutes to complete the exam. Select the single best answer for
each question. A score of 80%% or higher is required to pass. Review the rationale for each answer to strengthen
your understanding of key concepts covered on NUR 265 Exam 2.
,Section 1: Cardiovascular and Hematologic Disorders -- 2026/2027
Q1 Question 1 of 100
A 67-year-old male presents to the emergency department with crushing substernal chest
pain radiating to his left arm, diaphoresis, and nausea that began 45 minutes ago. His ECG
shows ST-segment elevation in leads II, III, and aVF. The nurse anticipates which immediate
collaborative intervention?
A. Serial cardiac enzyme monitoring without intervention
B. Fibrinolytic therapy or percutaneous coronary intervention
C. Administration of beta-blockers as monotherapy
D. Immediate coronary artery bypass graft surgery
Correct Answer: B
Rationale:
Fibrinolytic therapy or PCI is the standard immediate intervention for STEMI to restore coronary blood
flow and minimize myocardial damage. Serial monitoring alone delays critical reperfusion, beta-blocker
monotherapy does not address the occlusion, and CABG is reserved for cases not amenable to PCI or
fibrinolysis.
Q2 Question 2 of 100
A 72-year-old female with a history of atrial fibrillation is admitted with new-onset right-sided
weakness and aphasia. A CT scan confirms an acute ischemic stroke. The nurse
understands that this complication of atrial fibrillation is primarily caused by which
pathophysiologic mechanism?
A. Thrombus formation in the left atrium due to stasis of blood
B. Vasospasm of the cerebral arteries from erratic conduction
C. Hemorrhagic conversion of atrial fibrillation rhythms
D. Direct embolization from the ventricular wall
Correct Answer: B
Rationale:
Atrial fibrillation causes stasis of blood in the left atrium, particularly in the left atrial appendage,
promoting thrombus formation that can embolize to the cerebral circulation. Vasospasm is not a typical
mechanism, hemorrhagic conversion occurs after ischemic injury, and ventricular wall thrombi are
associated with ventricular dysfunction, not atrial fibrillation.
NUR 265 Exam 2 -- 2026/2027 | Passing Score: 80% | Page 2 of 1
,Q3 Question 3 of 100
A 58-year-old male with a mechanical mitral valve replacement presents with an INR of 1.4
on his routine laboratory draw. His target INR is 2.5 to 3.5. The nurse recognizes that this
subtherapeutic INR places the patient at greatest risk for which complication?
A. Thromboembolic event such as valve thrombosis or stroke
B. Major hemorrhage from valve dysfunction
C. Hemolytic anemia from mechanical shear stress
D. Infective endocarditis from bacterial seeding
Correct Answer: C
Rationale:
A subtherapeutic INR in a patient with a mechanical valve significantly increases the risk of
thromboembolic events, including valve thrombosis and stroke, because anticoagulation is inadequate.
Hemorrhage occurs with supratherapeutic INR, hemolytic anemia is a chronic complication of
mechanical valves, and endocarditis is related to infection, not anticoagulation status.
Q4 Question 4 of 100
A 63-year-old female is admitted with acute decompensated heart failure and presents with
bilateral crackles throughout the lung fields, jugular venous distension, and 3+ pitting edema
in both lower extremities. Which hemodynamic parameter would the nurse expect to find in
this patient?
A. Elevated pulmonary capillary wedge pressure
B. Decreased right atrial pressure
C. Reduced systemic vascular resistance
D. Decreased left ventricular end-diastolic pressure
Correct Answer: D
Rationale:
Acute decompensated heart failure with pulmonary and systemic congestion is characterized by
elevated PCWP due to the left ventricle's inability to effectively pump blood forward, causing backward
pressure buildup. Right atrial pressure would be elevated, SVR is typically increased as a compensatory
response, and LVEDP is elevated rather than decreased.
NUR 265 Exam 2 -- 2026/2027 | Passing Score: 80% | Page 3 of 1
, Q5 Question 5 of 100
A 55-year-old male with hypertension and type 2 diabetes is found to have a low-density
lipoprotein level of 162 mg/dL on his annual physical examination. Based on current
guidelines for high-risk patients, which LDL target should the nurse educate this patient
about?
A. Below 130 mg/dL as the standard target for all adults
B. Below 70 mg/dL for very high-risk patients with diabetes and hypertension
C. Below 100 mg/dL for moderate-risk patients only
D. Below 160 mg/dL since no additional risk factors modify targets
Correct Answer: B
Rationale:
Current ACC/AHA guidelines recommend an LDL target below 70 mg/dL for very high-risk patients,
which includes those with diabetes plus additional risk factors like hypertension. The 100 mg/dL target
applies to moderate-risk patients, and 130-160 mg/dL targets are insufficient for patients with this risk
profile.
Q6 Question 6 of 100
A 44-year-old female presents with unilateral leg swelling, warmth, and tenderness in her
right calf three weeks after an abdominal hysterectomy. A D-dimer assay is elevated and
Doppler ultrasound confirms a deep vein thrombosis. Which factor in Virchow's triad is most
directly related to her postoperative status?
A. Venous stasis from immobility during and after surgery
B. Endothelial injury from the surgical procedure
C. Hypercoagulability from the inflammatory response to surgery
D. All three factors equally contribute in postoperative patients
Correct Answer: B
Rationale:
Postoperative immobility primarily contributes to venous stasis, one of the three components of
Virchow's triad, as decreased muscle contraction impairs venous return. While endothelial injury and
hypercoagulability also occur after surgery, the period of immobility most directly causes stasis-related
thrombosis.
NUR 265 Exam 2 -- 2026/2027 | Passing Score: 80% | Page 4 of 1
NUR 265 Exam 2
Two Updated Versions (V1 and V2)
Official Practice Exam -- 2026/2027 Edition
100%% Correct Answers with Detailed Rationales
Questions and Answers
Questions: 100 Minutes: 120 Passing Score: 80%% Versions: V1/V2
Table of Contents
Section 1: Cardiovascular and Hematologic Disorders (Q1 -- Q17)
Section 2: Respiratory and Pulmonary Disorders (Q18 -- Q34)
Section 3: Neurological and Sensory Disorders (Q35 -- Q51)
Section 4: Renal and Urinary Disorders (Q52 -- Q68)
Section 5: Musculoskeletal and Integumentary Disorders (Q69 -- Q84)
Section 6: Oncologic and Endocrine Disorders (Q85 -- Q100)
Instructions
This practice exam contains 100 multiple-choice questions divided into 6 sections covering advanced
medical-surgical nursing topics. You have 120 minutes to complete the exam. Select the single best answer for
each question. A score of 80%% or higher is required to pass. Review the rationale for each answer to strengthen
your understanding of key concepts covered on NUR 265 Exam 2.
,Section 1: Cardiovascular and Hematologic Disorders -- 2026/2027
Q1 Question 1 of 100
A 67-year-old male presents to the emergency department with crushing substernal chest
pain radiating to his left arm, diaphoresis, and nausea that began 45 minutes ago. His ECG
shows ST-segment elevation in leads II, III, and aVF. The nurse anticipates which immediate
collaborative intervention?
A. Serial cardiac enzyme monitoring without intervention
B. Fibrinolytic therapy or percutaneous coronary intervention
C. Administration of beta-blockers as monotherapy
D. Immediate coronary artery bypass graft surgery
Correct Answer: B
Rationale:
Fibrinolytic therapy or PCI is the standard immediate intervention for STEMI to restore coronary blood
flow and minimize myocardial damage. Serial monitoring alone delays critical reperfusion, beta-blocker
monotherapy does not address the occlusion, and CABG is reserved for cases not amenable to PCI or
fibrinolysis.
Q2 Question 2 of 100
A 72-year-old female with a history of atrial fibrillation is admitted with new-onset right-sided
weakness and aphasia. A CT scan confirms an acute ischemic stroke. The nurse
understands that this complication of atrial fibrillation is primarily caused by which
pathophysiologic mechanism?
A. Thrombus formation in the left atrium due to stasis of blood
B. Vasospasm of the cerebral arteries from erratic conduction
C. Hemorrhagic conversion of atrial fibrillation rhythms
D. Direct embolization from the ventricular wall
Correct Answer: B
Rationale:
Atrial fibrillation causes stasis of blood in the left atrium, particularly in the left atrial appendage,
promoting thrombus formation that can embolize to the cerebral circulation. Vasospasm is not a typical
mechanism, hemorrhagic conversion occurs after ischemic injury, and ventricular wall thrombi are
associated with ventricular dysfunction, not atrial fibrillation.
NUR 265 Exam 2 -- 2026/2027 | Passing Score: 80% | Page 2 of 1
,Q3 Question 3 of 100
A 58-year-old male with a mechanical mitral valve replacement presents with an INR of 1.4
on his routine laboratory draw. His target INR is 2.5 to 3.5. The nurse recognizes that this
subtherapeutic INR places the patient at greatest risk for which complication?
A. Thromboembolic event such as valve thrombosis or stroke
B. Major hemorrhage from valve dysfunction
C. Hemolytic anemia from mechanical shear stress
D. Infective endocarditis from bacterial seeding
Correct Answer: C
Rationale:
A subtherapeutic INR in a patient with a mechanical valve significantly increases the risk of
thromboembolic events, including valve thrombosis and stroke, because anticoagulation is inadequate.
Hemorrhage occurs with supratherapeutic INR, hemolytic anemia is a chronic complication of
mechanical valves, and endocarditis is related to infection, not anticoagulation status.
Q4 Question 4 of 100
A 63-year-old female is admitted with acute decompensated heart failure and presents with
bilateral crackles throughout the lung fields, jugular venous distension, and 3+ pitting edema
in both lower extremities. Which hemodynamic parameter would the nurse expect to find in
this patient?
A. Elevated pulmonary capillary wedge pressure
B. Decreased right atrial pressure
C. Reduced systemic vascular resistance
D. Decreased left ventricular end-diastolic pressure
Correct Answer: D
Rationale:
Acute decompensated heart failure with pulmonary and systemic congestion is characterized by
elevated PCWP due to the left ventricle's inability to effectively pump blood forward, causing backward
pressure buildup. Right atrial pressure would be elevated, SVR is typically increased as a compensatory
response, and LVEDP is elevated rather than decreased.
NUR 265 Exam 2 -- 2026/2027 | Passing Score: 80% | Page 3 of 1
, Q5 Question 5 of 100
A 55-year-old male with hypertension and type 2 diabetes is found to have a low-density
lipoprotein level of 162 mg/dL on his annual physical examination. Based on current
guidelines for high-risk patients, which LDL target should the nurse educate this patient
about?
A. Below 130 mg/dL as the standard target for all adults
B. Below 70 mg/dL for very high-risk patients with diabetes and hypertension
C. Below 100 mg/dL for moderate-risk patients only
D. Below 160 mg/dL since no additional risk factors modify targets
Correct Answer: B
Rationale:
Current ACC/AHA guidelines recommend an LDL target below 70 mg/dL for very high-risk patients,
which includes those with diabetes plus additional risk factors like hypertension. The 100 mg/dL target
applies to moderate-risk patients, and 130-160 mg/dL targets are insufficient for patients with this risk
profile.
Q6 Question 6 of 100
A 44-year-old female presents with unilateral leg swelling, warmth, and tenderness in her
right calf three weeks after an abdominal hysterectomy. A D-dimer assay is elevated and
Doppler ultrasound confirms a deep vein thrombosis. Which factor in Virchow's triad is most
directly related to her postoperative status?
A. Venous stasis from immobility during and after surgery
B. Endothelial injury from the surgical procedure
C. Hypercoagulability from the inflammatory response to surgery
D. All three factors equally contribute in postoperative patients
Correct Answer: B
Rationale:
Postoperative immobility primarily contributes to venous stasis, one of the three components of
Virchow's triad, as decreased muscle contraction impairs venous return. While endothelial injury and
hypercoagulability also occur after surgery, the period of immobility most directly causes stasis-related
thrombosis.
NUR 265 Exam 2 -- 2026/2027 | Passing Score: 80% | Page 4 of 1
