NUR 265 NUR265 Exam 2– Advanced Concepts of Medical-Surgical Nursing
Galen (Latest 20262027 Updates .
Question 1
A patient with septic shock has a mean arterial pressure (MAP) of 52 mm Hg
despite fluid resuscitation. Which vasopressor is the initial drug of choice?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Vasopressin
Answer: C. Norepinephrine
Rationale: Current Surviving Sepsis Campaign guidelines recommend
norepinephrine as the first-line vasopressor in septic shock to increase MAP to
≥65 mm Hg.
Question 2
A client with acute respiratory distress syndrome (ARDS) is on a ventilator with a
tidal volume of 6 mL/kg ideal body weight. What is the primary goal of this low
tidal volume strategy?
A. Increase oxygenation
,B. Prevent ventilator-induced lung injury
C. Decrease cardiac output
D. Improve CO₂ clearance
Answer: B. Prevent ventilator-induced lung injury
Rationale: Low tidal volume (6 mL/kg) reduces alveolar overdistention and
barotrauma, lowering mortality in ARDS.
Question 3
A patient with diabetic ketoacidosis (DKA) has a serum potassium of 2.8 mEq/L.
Before starting an insulin drip, what must the nurse do?
A. Begin insulin immediately to shift potassium into cells
B. Hold insulin and give potassium replacement first
C. Administer sodium bicarbonate
D. Start a potassium-sparing diuretic
Answer: B. Hold insulin and give potassium replacement first
Rationale: Insulin drives potassium into cells and can worsen hypokalemia,
increasing risk of dysrhythmias. Potassium should be repleted before insulin
infusion.
,Question 4
A postoperative day 2 patient suddenly develops shortness of breath, tachycardia,
and O₂ saturation of 84%. What is the priority action?
A. Obtain a chest x-ray
B. Administer heparin
C. Apply oxygen and assess for DVT signs
D. Prepare for intubation
Answer: C. Apply oxygen and assess for DVT signs
Rationale: Suspected pulmonary embolism requires immediate oxygen
administration and further assessment; heparin may be indicated after
confirmation.
Question 5
Which finding in a patient with increased intracranial pressure (ICP) is most
concerning?
A. Glasgow Coma Scale (GCS) of 14
B. Pupils equal and reactive
C. Systolic blood pressure of 170 mm Hg with bradycardia
, D. Temperature of 37.5°C
Answer: C. Systolic BP 170 mm Hg with bradycardia
Rationale: Cushing’s triad (hypertension, bradycardia, irregular respirations)
indicates severe increased ICP and impending herniation.
Question 6
A patient on continuous renal replacement therapy (CRRT) has a filter pressure
alarm. The nurse should first:
A. Increase blood flow rate
B. Turn patient to side
C. Assess for kinks in the catheter
D. Administer saline bolus through filter
Answer: C. Assess for kinks in the catheter
Rationale: High filter pressure often results from obstruction in the venous return
line or catheter kinking; always check circuit first.
Question 7
Galen (Latest 20262027 Updates .
Question 1
A patient with septic shock has a mean arterial pressure (MAP) of 52 mm Hg
despite fluid resuscitation. Which vasopressor is the initial drug of choice?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Vasopressin
Answer: C. Norepinephrine
Rationale: Current Surviving Sepsis Campaign guidelines recommend
norepinephrine as the first-line vasopressor in septic shock to increase MAP to
≥65 mm Hg.
Question 2
A client with acute respiratory distress syndrome (ARDS) is on a ventilator with a
tidal volume of 6 mL/kg ideal body weight. What is the primary goal of this low
tidal volume strategy?
A. Increase oxygenation
,B. Prevent ventilator-induced lung injury
C. Decrease cardiac output
D. Improve CO₂ clearance
Answer: B. Prevent ventilator-induced lung injury
Rationale: Low tidal volume (6 mL/kg) reduces alveolar overdistention and
barotrauma, lowering mortality in ARDS.
Question 3
A patient with diabetic ketoacidosis (DKA) has a serum potassium of 2.8 mEq/L.
Before starting an insulin drip, what must the nurse do?
A. Begin insulin immediately to shift potassium into cells
B. Hold insulin and give potassium replacement first
C. Administer sodium bicarbonate
D. Start a potassium-sparing diuretic
Answer: B. Hold insulin and give potassium replacement first
Rationale: Insulin drives potassium into cells and can worsen hypokalemia,
increasing risk of dysrhythmias. Potassium should be repleted before insulin
infusion.
,Question 4
A postoperative day 2 patient suddenly develops shortness of breath, tachycardia,
and O₂ saturation of 84%. What is the priority action?
A. Obtain a chest x-ray
B. Administer heparin
C. Apply oxygen and assess for DVT signs
D. Prepare for intubation
Answer: C. Apply oxygen and assess for DVT signs
Rationale: Suspected pulmonary embolism requires immediate oxygen
administration and further assessment; heparin may be indicated after
confirmation.
Question 5
Which finding in a patient with increased intracranial pressure (ICP) is most
concerning?
A. Glasgow Coma Scale (GCS) of 14
B. Pupils equal and reactive
C. Systolic blood pressure of 170 mm Hg with bradycardia
, D. Temperature of 37.5°C
Answer: C. Systolic BP 170 mm Hg with bradycardia
Rationale: Cushing’s triad (hypertension, bradycardia, irregular respirations)
indicates severe increased ICP and impending herniation.
Question 6
A patient on continuous renal replacement therapy (CRRT) has a filter pressure
alarm. The nurse should first:
A. Increase blood flow rate
B. Turn patient to side
C. Assess for kinks in the catheter
D. Administer saline bolus through filter
Answer: C. Assess for kinks in the catheter
Rationale: High filter pressure often results from obstruction in the venous return
line or catheter kinking; always check circuit first.
Question 7
