NUR 265 NUR265 Exam 4– Advanced Concepts of Medical-Surgical Nursing
Galen (Latest 20262027 Updates
Question 1
A client with acute respiratory distress syndrome (ARDS) has a PaO₂ of 54 mm Hg
on an FiO₂ of 0.80. Which intervention should the nurse anticipate?
A. Increase the FiO₂ to 1.00
B. Initiate prone positioning
C. Administer a bronchodilator
D. Prepare for tracheostomy
Answer: B
Rationale: Prone positioning improves ventilation-perfusion matching in ARDS
and is recommended for moderate to severe ARDS (PaO₂/FiO₂ ratio <150).
Increasing FiO₂ alone may not address the underlying pathophysiology.
Question 2
A client with status asthmaticus is receiving continuous albuterol nebulization.
Which assessment finding indicates the need to stop this treatment?
A. Heart rate of 120 bpm
B. Respiratory rate of 28 breaths/min
,C. Serum potassium of 3.2 mEq/L
D. Fine tremor in both hands
Answer: C
Rationale: Beta-2 agonists can cause hypokalemia due to intracellular shift. A
potassium of 3.2 is severe and increases arrhythmia risk. HR 120 and tremor are
expected.
Question 3
A client with a massive pulmonary embolism presents with hypotension and
jugular venous distension. Which medication is the priority?
A. Heparin bolus
B. Alteplase (tPA)
C. Nitroglycerin drip
D. Furosemide
Answer: B
Rationale: Massive PE with hypotension/shock indicates hemodynamic
compromise; thrombolytics (tPA) are first-line to reduce right ventricular
afterload.
,Question 4
A nurse is caring for a client with chest tubes following a right lower lobectomy.
The chest tube drainage system is disconnected from the suction source. Which
action is most appropriate?
A. Clamp the chest tube immediately
B. Reconnect to suction and notify provider
C. Place the end of the tubing in sterile water
D. Disconnect the chest tube from the patient
Answer: C
Rationale: If the drainage system is disconnected, place the open end in sterile
water to maintain a water seal and prevent air re-entry.
Question 5
A client with myasthenia gravis is admitted with dysphagia and ptosis. Which
medication should the nurse question if ordered?
A. Pyridostigmine (Mestinon)
B. Prednisone
C. Azathioprine
, D. Magnesium citrate
Answer: D
Rationale: Magnesium can worsen muscle weakness in myasthenia gravis by
impairing neuromuscular transmission.
Question 6
A client with a TBI has an ICP of 22 mm Hg and a CPP of 55 mm Hg. Which
intervention should the nurse perform first?
A. Elevate head of bed to 30 degrees
B. Administer mannitol IV
C. Notify the provider
D. Increase sedation
Answer: A
Rationale: Elevating HOB improves venous drainage, lowering ICP. This is
immediate and noninvasive. CPP <60 is concerning, but head elevation is first-line.
Question 7
Galen (Latest 20262027 Updates
Question 1
A client with acute respiratory distress syndrome (ARDS) has a PaO₂ of 54 mm Hg
on an FiO₂ of 0.80. Which intervention should the nurse anticipate?
A. Increase the FiO₂ to 1.00
B. Initiate prone positioning
C. Administer a bronchodilator
D. Prepare for tracheostomy
Answer: B
Rationale: Prone positioning improves ventilation-perfusion matching in ARDS
and is recommended for moderate to severe ARDS (PaO₂/FiO₂ ratio <150).
Increasing FiO₂ alone may not address the underlying pathophysiology.
Question 2
A client with status asthmaticus is receiving continuous albuterol nebulization.
Which assessment finding indicates the need to stop this treatment?
A. Heart rate of 120 bpm
B. Respiratory rate of 28 breaths/min
,C. Serum potassium of 3.2 mEq/L
D. Fine tremor in both hands
Answer: C
Rationale: Beta-2 agonists can cause hypokalemia due to intracellular shift. A
potassium of 3.2 is severe and increases arrhythmia risk. HR 120 and tremor are
expected.
Question 3
A client with a massive pulmonary embolism presents with hypotension and
jugular venous distension. Which medication is the priority?
A. Heparin bolus
B. Alteplase (tPA)
C. Nitroglycerin drip
D. Furosemide
Answer: B
Rationale: Massive PE with hypotension/shock indicates hemodynamic
compromise; thrombolytics (tPA) are first-line to reduce right ventricular
afterload.
,Question 4
A nurse is caring for a client with chest tubes following a right lower lobectomy.
The chest tube drainage system is disconnected from the suction source. Which
action is most appropriate?
A. Clamp the chest tube immediately
B. Reconnect to suction and notify provider
C. Place the end of the tubing in sterile water
D. Disconnect the chest tube from the patient
Answer: C
Rationale: If the drainage system is disconnected, place the open end in sterile
water to maintain a water seal and prevent air re-entry.
Question 5
A client with myasthenia gravis is admitted with dysphagia and ptosis. Which
medication should the nurse question if ordered?
A. Pyridostigmine (Mestinon)
B. Prednisone
C. Azathioprine
, D. Magnesium citrate
Answer: D
Rationale: Magnesium can worsen muscle weakness in myasthenia gravis by
impairing neuromuscular transmission.
Question 6
A client with a TBI has an ICP of 22 mm Hg and a CPP of 55 mm Hg. Which
intervention should the nurse perform first?
A. Elevate head of bed to 30 degrees
B. Administer mannitol IV
C. Notify the provider
D. Increase sedation
Answer: A
Rationale: Elevating HOB improves venous drainage, lowering ICP. This is
immediate and noninvasive. CPP <60 is concerning, but head elevation is first-line.
Question 7
