GALEN COLLEGE OF NURSING
Nur 265 Exam 1
Actual Questions and Answers
Official Practice Exam | 2026/2027 Edition
QUESTIONS MINUTES PASSING SCORE RECERTIFICATION
75 90 80% 2 Years
TABLE OF CONTENTS
Section 1: Cardiovascular and Hematologic Disorders (Q1-Q16)
Section 2: Respiratory Disorders (Q17-Q31)
Section 3: Neurological and Sensory Disorders (Q32-Q46)
Section 4: Renal and Urinary Disorders (Q47-Q61)
Section 5: Musculoskeletal and Integumentary Disorders (Q62-Q75)
Answer Key and Score Guide
EXAM INSTRUCTIONS
This practice exam contains 75 multiple-choice questions divided into 5 sections. You have 90 minutes to complete the exam.
A passing score of 80% (60 correct answers out of 75) is required. Each question has exactly one correct answer.
Read each scenario carefully before selecting your answer. All four choices are plausible; select the BEST answer.
Do not use any reference materials during the exam. Time yourself to simulate real exam conditions.
After completing the exam, check your answers against the Answer Key on the final page and review the rationales provided
for each question.
2026/2027 Edition | Galen College of Nursing | For educational and practice purposes only.
Nur 265 Exam 1 -- 2026/2027 | Passing Score: 80% | Page 1 of 42
,SECTION 1: CARDIOVASCULAR AND HEMATOLOGIC DISORDERS -- 2026/2027
Q1 Question 1 of 75
A 68-year-old man 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 V1 through V4. The nurse anticipates that the priority intervention
for this patient is which action?
A. Administering a beta-blocker to reduce myocardial oxygen demand and control heart rate
B. Initiating fibrinolytic therapy or preparing for percutaneous coronary intervention to
restore coronary artery patency and minimize myocardial necrosis
C. Administering morphine sulfate to reduce pain and decrease preload through venous dilation
D. Obtaining a complete lipid panel and cardiac enzyme panel before initiating any treatment
Correct Answer: B
Rationale:
ST-elevation myocardial infarction requires immediate reperfusion through fibrinolytics or PCI to restore
coronary patency and limit infarct size. Beta-blockers, morphine, and labs are important but secondary
to the time-critical need for reperfusion therapy.
Q2 Question 2 of 75
A 72-year-old woman with a history of atrial fibrillation is admitted with acute onset of left-sided
weakness, facial droop, and slurred speech that began 2 hours ago. Her CT scan shows no
hemorrhage. The nurse understands that the most time-sensitive intervention for this patient is
which action?
A. Starting anticoagulation therapy with heparin to prevent further clot formation in the
atria
B. Administering intravenous alteplase within the therapeutic window to dissolve the cerebral
thrombus and restore perfusion
C. Initiating antihypertensive therapy to reduce systolic blood pressure below 140 mmHg
D. Scheduling a carotid endarterectomy to remove plaque from the carotid arteries
Correct Answer: A
Rationale:
IV alteplase must be administered within 4.5 hours of symptom onset for ischemic stroke to dissolve
the clot and restore cerebral perfusion. Anticoagulation is contraindicated acutely, blood pressure
management supports but does not replace reperfusion, and surgery is not the acute intervention.
Nur 265 Exam 1 -- 2026/2027 | Passing Score: 80% | Page 2 of 42
,Q3 Question 3 of 75
A 58-year-old man with heart failure has been taking furosemide 40 mg daily for two weeks. He
now presents with muscle weakness, fatigue, and palpitations. His serum potassium is 2.8
mEq/L. The nurse recognizes that this hypokalemia increases the patient's risk for which
complication?
A. Deep vein thrombosis due to increased blood viscosity from hemoconcentration
B. Hepatic encephalopathy due to impaired ammonia metabolism in the setting of low potassium
C. Life-threatening cardiac dysrhythmias because hypokalemia increases myocardial
excitability and delays repolarization, predisposing to ventricular fibrillation and other
arrhythmias
D. Acute kidney injury due to reduced renal perfusion from hypokalemia-induced vasoconstriction
Correct Answer: C
Rationale:
Hypokalemia increases myocardial excitability and delays repolarization, creating a high risk for
life-threatening ventricular dysrhythmias including ventricular fibrillation. The cardiac risk is the most
immediate and dangerous complication, exceeding the risks of DVT, hepatic issues, or kidney injury.
Q4 Question 4 of 75
A 65-year-old woman with a mechanical mitral valve replacement is taking warfarin 5 mg daily.
Her INR is 3.5, and the therapeutic range for her condition is 2.5 to 3.5. She mentions she has
been eating large amounts of leafy green vegetables. The nurse should provide which guidance
regarding her diet and medication?
A. She should immediately stop taking warfarin until her INR returns to the lower end of the
therapeutic range
B. She should double her warfarin dose to compensate for the vitamin K in the leafy greens that
antagonize the anticoagulant effect
C. She should eliminate all leafy green vegetables from her diet to maintain a consistent INR
D. She should maintain a consistent intake of vitamin K-rich foods rather than making
sudden changes, because fluctuations in vitamin K intake can cause unpredictable INR
variations even within the therapeutic range
Correct Answer: D
Rationale:
Consistent vitamin K intake is key to maintaining stable INR levels on warfarin therapy. Sudden
increases or decreases in vitamin K consumption can cause unpredictable INR fluctuations. Stopping
warfarin or doubling the dose is dangerous, and complete elimination of greens is unnecessary and
nutritionally harmful.
Nur 265 Exam 1 -- 2026/2027 | Passing Score: 80% | Page 3 of 42
, Q5 Question 5 of 75
A 60-year-old man with a history of hypertension and hyperlipidemia presents with sudden onset
of severe, tearing chest pain radiating to his back. His blood pressure is 180/110 mmHg in the
right arm and 140/80 mmHg in the left arm. The nurse suspects an aortic dissection and should
anticipate which priority intervention?
A. Initiating intravenous beta-blocker therapy to reduce the force of cardiac contraction
and lower blood pressure, decreasing shear stress on the aortic wall
B. Administering thrombolytic therapy to dissolve the dissection flap and restore normal aortic
blood flow
C. Performing immediate synchronized cardioversion to stabilize the aortic wall through rhythm
control
D. Administering a fluid bolus of normal saline to increase intravascular volume and support
perfusion
Correct Answer: A
Rationale:
Aortic dissection requires immediate blood pressure reduction with IV beta-blockers to decrease shear
stress on the aortic wall and prevent propagation of the dissection. Thrombolytics would worsen
bleeding, cardioversion is not indicated, and fluid boluses would increase wall stress.
Q6 Question 6 of 75
A 55-year-old woman with a deep vein thrombosis in her right leg is started on enoxaparin and
warfarin therapy. The nurse explains that both medications are prescribed initially because
enoxaparin provides immediate anticoagulation while warfarin takes several days to achieve
therapeutic effect. The nurse should monitor which laboratory value to determine when warfarin
has reached therapeutic levels?
A. Activated partial thromboplastin time to monitor the direct effect of warfarin on the intrinsic
coagulation pathway
B. International normalized ratio, with a target range of 2.0 to 3.0 for this patient's
indication, to confirm that warfarin has achieved its anticoagulant effect
C. Platelet count to ensure that warfarin is not causing heparin-induced thrombocytopenia
D. Fibrin degradation products to confirm that the deep vein thrombosis is resolving under
warfarin therapy
Correct Answer: B
Rationale:
The INR monitors warfarin's anticoagulant effect, with a target of 2.0-3.0 for DVT treatment. aPTT
monitors heparin therapy rather than warfarin, platelet count monitors for HIT (a heparin complication),
and fibrin degradation products do not assess warfarin's therapeutic effect.
Nur 265 Exam 1 -- 2026/2027 | Passing Score: 80% | Page 4 of 42
Nur 265 Exam 1
Actual Questions and Answers
Official Practice Exam | 2026/2027 Edition
QUESTIONS MINUTES PASSING SCORE RECERTIFICATION
75 90 80% 2 Years
TABLE OF CONTENTS
Section 1: Cardiovascular and Hematologic Disorders (Q1-Q16)
Section 2: Respiratory Disorders (Q17-Q31)
Section 3: Neurological and Sensory Disorders (Q32-Q46)
Section 4: Renal and Urinary Disorders (Q47-Q61)
Section 5: Musculoskeletal and Integumentary Disorders (Q62-Q75)
Answer Key and Score Guide
EXAM INSTRUCTIONS
This practice exam contains 75 multiple-choice questions divided into 5 sections. You have 90 minutes to complete the exam.
A passing score of 80% (60 correct answers out of 75) is required. Each question has exactly one correct answer.
Read each scenario carefully before selecting your answer. All four choices are plausible; select the BEST answer.
Do not use any reference materials during the exam. Time yourself to simulate real exam conditions.
After completing the exam, check your answers against the Answer Key on the final page and review the rationales provided
for each question.
2026/2027 Edition | Galen College of Nursing | For educational and practice purposes only.
Nur 265 Exam 1 -- 2026/2027 | Passing Score: 80% | Page 1 of 42
,SECTION 1: CARDIOVASCULAR AND HEMATOLOGIC DISORDERS -- 2026/2027
Q1 Question 1 of 75
A 68-year-old man 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 V1 through V4. The nurse anticipates that the priority intervention
for this patient is which action?
A. Administering a beta-blocker to reduce myocardial oxygen demand and control heart rate
B. Initiating fibrinolytic therapy or preparing for percutaneous coronary intervention to
restore coronary artery patency and minimize myocardial necrosis
C. Administering morphine sulfate to reduce pain and decrease preload through venous dilation
D. Obtaining a complete lipid panel and cardiac enzyme panel before initiating any treatment
Correct Answer: B
Rationale:
ST-elevation myocardial infarction requires immediate reperfusion through fibrinolytics or PCI to restore
coronary patency and limit infarct size. Beta-blockers, morphine, and labs are important but secondary
to the time-critical need for reperfusion therapy.
Q2 Question 2 of 75
A 72-year-old woman with a history of atrial fibrillation is admitted with acute onset of left-sided
weakness, facial droop, and slurred speech that began 2 hours ago. Her CT scan shows no
hemorrhage. The nurse understands that the most time-sensitive intervention for this patient is
which action?
A. Starting anticoagulation therapy with heparin to prevent further clot formation in the
atria
B. Administering intravenous alteplase within the therapeutic window to dissolve the cerebral
thrombus and restore perfusion
C. Initiating antihypertensive therapy to reduce systolic blood pressure below 140 mmHg
D. Scheduling a carotid endarterectomy to remove plaque from the carotid arteries
Correct Answer: A
Rationale:
IV alteplase must be administered within 4.5 hours of symptom onset for ischemic stroke to dissolve
the clot and restore cerebral perfusion. Anticoagulation is contraindicated acutely, blood pressure
management supports but does not replace reperfusion, and surgery is not the acute intervention.
Nur 265 Exam 1 -- 2026/2027 | Passing Score: 80% | Page 2 of 42
,Q3 Question 3 of 75
A 58-year-old man with heart failure has been taking furosemide 40 mg daily for two weeks. He
now presents with muscle weakness, fatigue, and palpitations. His serum potassium is 2.8
mEq/L. The nurse recognizes that this hypokalemia increases the patient's risk for which
complication?
A. Deep vein thrombosis due to increased blood viscosity from hemoconcentration
B. Hepatic encephalopathy due to impaired ammonia metabolism in the setting of low potassium
C. Life-threatening cardiac dysrhythmias because hypokalemia increases myocardial
excitability and delays repolarization, predisposing to ventricular fibrillation and other
arrhythmias
D. Acute kidney injury due to reduced renal perfusion from hypokalemia-induced vasoconstriction
Correct Answer: C
Rationale:
Hypokalemia increases myocardial excitability and delays repolarization, creating a high risk for
life-threatening ventricular dysrhythmias including ventricular fibrillation. The cardiac risk is the most
immediate and dangerous complication, exceeding the risks of DVT, hepatic issues, or kidney injury.
Q4 Question 4 of 75
A 65-year-old woman with a mechanical mitral valve replacement is taking warfarin 5 mg daily.
Her INR is 3.5, and the therapeutic range for her condition is 2.5 to 3.5. She mentions she has
been eating large amounts of leafy green vegetables. The nurse should provide which guidance
regarding her diet and medication?
A. She should immediately stop taking warfarin until her INR returns to the lower end of the
therapeutic range
B. She should double her warfarin dose to compensate for the vitamin K in the leafy greens that
antagonize the anticoagulant effect
C. She should eliminate all leafy green vegetables from her diet to maintain a consistent INR
D. She should maintain a consistent intake of vitamin K-rich foods rather than making
sudden changes, because fluctuations in vitamin K intake can cause unpredictable INR
variations even within the therapeutic range
Correct Answer: D
Rationale:
Consistent vitamin K intake is key to maintaining stable INR levels on warfarin therapy. Sudden
increases or decreases in vitamin K consumption can cause unpredictable INR fluctuations. Stopping
warfarin or doubling the dose is dangerous, and complete elimination of greens is unnecessary and
nutritionally harmful.
Nur 265 Exam 1 -- 2026/2027 | Passing Score: 80% | Page 3 of 42
, Q5 Question 5 of 75
A 60-year-old man with a history of hypertension and hyperlipidemia presents with sudden onset
of severe, tearing chest pain radiating to his back. His blood pressure is 180/110 mmHg in the
right arm and 140/80 mmHg in the left arm. The nurse suspects an aortic dissection and should
anticipate which priority intervention?
A. Initiating intravenous beta-blocker therapy to reduce the force of cardiac contraction
and lower blood pressure, decreasing shear stress on the aortic wall
B. Administering thrombolytic therapy to dissolve the dissection flap and restore normal aortic
blood flow
C. Performing immediate synchronized cardioversion to stabilize the aortic wall through rhythm
control
D. Administering a fluid bolus of normal saline to increase intravascular volume and support
perfusion
Correct Answer: A
Rationale:
Aortic dissection requires immediate blood pressure reduction with IV beta-blockers to decrease shear
stress on the aortic wall and prevent propagation of the dissection. Thrombolytics would worsen
bleeding, cardioversion is not indicated, and fluid boluses would increase wall stress.
Q6 Question 6 of 75
A 55-year-old woman with a deep vein thrombosis in her right leg is started on enoxaparin and
warfarin therapy. The nurse explains that both medications are prescribed initially because
enoxaparin provides immediate anticoagulation while warfarin takes several days to achieve
therapeutic effect. The nurse should monitor which laboratory value to determine when warfarin
has reached therapeutic levels?
A. Activated partial thromboplastin time to monitor the direct effect of warfarin on the intrinsic
coagulation pathway
B. International normalized ratio, with a target range of 2.0 to 3.0 for this patient's
indication, to confirm that warfarin has achieved its anticoagulant effect
C. Platelet count to ensure that warfarin is not causing heparin-induced thrombocytopenia
D. Fibrin degradation products to confirm that the deep vein thrombosis is resolving under
warfarin therapy
Correct Answer: B
Rationale:
The INR monitors warfarin's anticoagulant effect, with a target of 2.0-3.0 for DVT treatment. aPTT
monitors heparin therapy rather than warfarin, platelet count monitors for HIT (a heparin complication),
and fibrin degradation products do not assess warfarin's therapeutic effect.
Nur 265 Exam 1 -- 2026/2027 | Passing Score: 80% | Page 4 of 42
