NUR265 Advanced Concepts of Medical-Surgical
Nursing Guide Actual Exam 2026/2027 | Complete
Exam-Style Questions with Detailed Rationales | Pass
Guaranteed – A+ Graded
SECTION 1: Critical Care and Hemodynamic Monitoring (Questions 1–8)
Q1: A patient post-abdominal surgery has a CVP reading of 1 mmHg, blood pressure
88/52 mmHg, and urine output of 15 mL/hr. Which hemodynamic condition is the
priority to address?
A. Excessive systemic vascular resistance
B. Sympathetic nervous system overstimulation
C. Hypovolemia and decreased preload
D. Acute left ventricular failure
Correct Answer: C
Rationale: Correct because a CVP below the normal range of 2–6 mmHg combined with
hypotension and oliguria indicates inadequate venous return and preload, requiring fluid
resuscitation to restore perfusion.
Q2: A pulmonary artery catheter is wedged, yielding a pulmonary artery wedge pressure
(PAWP) of 20 mmHg. Which clinical interpretation is most accurate?
A. Normal left ventricular end-diastolic pressure
B. Hypovolemia requiring aggressive fluid loading
C. Elevated left ventricular preload suggesting fluid overload or left-sided heart failure
D. Pulmonary embolism with right heart strain
Correct Answer: C
Rationale: Correct because a PAWP exceeding 12 mmHg indicates elevated left atrial
pressure and left ventricular preload, commonly associated with fluid overload or
left-sided heart failure.
Q3: A patient has a cardiac output of 4.5 L/min and a body surface area of 1.8 m². What
is the calculated cardiac index?
A. 2.0 L/min/m²
B. 2.5 L/min/m²
,C. 8.1 L/min/m²
D. 4.5 L/min/m²
Correct Answer: B
Rationale: Correct because cardiac index is calculated by dividing cardiac output by
body surface area; 4.5 divided by 1.8 equals 2.5 L/min/m², which falls within the normal
range of 2.5–4.0 L/min/m².
Q4: A patient in septic shock has a mixed venous oxygen saturation (SvO₂) of 55%.
Which pathophysiological process is most likely occurring?
A. Decreased oxygen extraction by peripheral tissues
B. Adequate balance between oxygen delivery and consumption
C. Increased oxygen extraction exceeding oxygen delivery
D. Hyperdynamic circulation with arteriovenous shunting
Correct Answer: C
Rationale: Correct because an SvO₂ below 60% indicates that tissue oxygen extraction
has increased relative to oxygen delivery, reflecting inadequate perfusion and cellular
hypoxia in shock states.
Q5: A nurse notices the arterial pressure waveform displays a slurred upstroke, absent
dicrotic notch, and a systolic pressure reading lower than expected. Which action is the
priority?
A. Increase the pressurized flush system to 500 mmHg
B. Check for air bubbles, blood clots, or loose connections in the tubing system
C. Administer a 1-liter crystalloid bolus to increase preload
D. Remove the arterial catheter and insert a new site
Correct Answer: B
Rationale: Correct because a dampened waveform with slurred upstroke and absent
dicrotic notch indicates impaired dynamic response of the monitoring system, often
from air bubbles, clots, or loose connections, requiring system troubleshooting before
clinical decisions.
Q6: A patient on mechanical ventilation suddenly triggers a high-pressure alarm.
Assessment reveals absent breath sounds on the right and tracheal deviation to the left.
Which complication is suspected?
A. Right mainstem bronchus mucous plugging
, B. Left-sided tension pneumothorax
C. Right-sided tension pneumothorax
D. Accidental ventilator circuit disconnection
Correct Answer: C
Rationale: Correct because absent unilateral breath sounds with tracheal deviation away
from the affected side indicates a tension pneumothorax on the right, which increases
intrathoracic pressure and triggers the high-pressure alarm.
Q7: A patient post-CABG has the following hemodynamic profile: MAP 62 mmHg, CVP
14 mmHg, PAWP 20 mmHg, CI 1.8 L/min/m², SVR 1800 dynes/sec/cm⁻⁵. Which
intervention is the priority?
A. Administer a 500 mL crystalloid bolus
B. Initiate dobutamine and consider afterload reduction
C. Increase norepinephrine infusion
D. Administer furosemide 40 mg IV push
Correct Answer: B
Rationale: Correct because elevated filling pressures (CVP 14, PAWP 20) with a low
cardiac index (1.8) and high systemic vascular resistance indicate cardiogenic shock
where inotropic support and afterload reduction improve cardiac output.
Q8: A patient weighs 75 kg. A dopamine infusion is ordered at 5 mcg/kg/min. The
pharmacy supplies dopamine 400 mg in 250 mL D5W. At what rate in mL/hr should the
nurse set the infusion pump?
A. 11.25 mL/hr
B. 14.06 mL/hr
C. 18.75 mL/hr
D. 28.13 mL/hr
Correct Answer: B
Rationale: Correct because the concentration is 1600 mcg/mL; 5 mcg/kg/min for 75 kg
equals 375 mcg/min, which is 22,500 mcg/hr; dividing by 1600 mcg/mL yields 14.06
mL/hr.
SECTION 2: Advanced Cardiovascular Disorders (Questions 9–16)
Nursing Guide Actual Exam 2026/2027 | Complete
Exam-Style Questions with Detailed Rationales | Pass
Guaranteed – A+ Graded
SECTION 1: Critical Care and Hemodynamic Monitoring (Questions 1–8)
Q1: A patient post-abdominal surgery has a CVP reading of 1 mmHg, blood pressure
88/52 mmHg, and urine output of 15 mL/hr. Which hemodynamic condition is the
priority to address?
A. Excessive systemic vascular resistance
B. Sympathetic nervous system overstimulation
C. Hypovolemia and decreased preload
D. Acute left ventricular failure
Correct Answer: C
Rationale: Correct because a CVP below the normal range of 2–6 mmHg combined with
hypotension and oliguria indicates inadequate venous return and preload, requiring fluid
resuscitation to restore perfusion.
Q2: A pulmonary artery catheter is wedged, yielding a pulmonary artery wedge pressure
(PAWP) of 20 mmHg. Which clinical interpretation is most accurate?
A. Normal left ventricular end-diastolic pressure
B. Hypovolemia requiring aggressive fluid loading
C. Elevated left ventricular preload suggesting fluid overload or left-sided heart failure
D. Pulmonary embolism with right heart strain
Correct Answer: C
Rationale: Correct because a PAWP exceeding 12 mmHg indicates elevated left atrial
pressure and left ventricular preload, commonly associated with fluid overload or
left-sided heart failure.
Q3: A patient has a cardiac output of 4.5 L/min and a body surface area of 1.8 m². What
is the calculated cardiac index?
A. 2.0 L/min/m²
B. 2.5 L/min/m²
,C. 8.1 L/min/m²
D. 4.5 L/min/m²
Correct Answer: B
Rationale: Correct because cardiac index is calculated by dividing cardiac output by
body surface area; 4.5 divided by 1.8 equals 2.5 L/min/m², which falls within the normal
range of 2.5–4.0 L/min/m².
Q4: A patient in septic shock has a mixed venous oxygen saturation (SvO₂) of 55%.
Which pathophysiological process is most likely occurring?
A. Decreased oxygen extraction by peripheral tissues
B. Adequate balance between oxygen delivery and consumption
C. Increased oxygen extraction exceeding oxygen delivery
D. Hyperdynamic circulation with arteriovenous shunting
Correct Answer: C
Rationale: Correct because an SvO₂ below 60% indicates that tissue oxygen extraction
has increased relative to oxygen delivery, reflecting inadequate perfusion and cellular
hypoxia in shock states.
Q5: A nurse notices the arterial pressure waveform displays a slurred upstroke, absent
dicrotic notch, and a systolic pressure reading lower than expected. Which action is the
priority?
A. Increase the pressurized flush system to 500 mmHg
B. Check for air bubbles, blood clots, or loose connections in the tubing system
C. Administer a 1-liter crystalloid bolus to increase preload
D. Remove the arterial catheter and insert a new site
Correct Answer: B
Rationale: Correct because a dampened waveform with slurred upstroke and absent
dicrotic notch indicates impaired dynamic response of the monitoring system, often
from air bubbles, clots, or loose connections, requiring system troubleshooting before
clinical decisions.
Q6: A patient on mechanical ventilation suddenly triggers a high-pressure alarm.
Assessment reveals absent breath sounds on the right and tracheal deviation to the left.
Which complication is suspected?
A. Right mainstem bronchus mucous plugging
, B. Left-sided tension pneumothorax
C. Right-sided tension pneumothorax
D. Accidental ventilator circuit disconnection
Correct Answer: C
Rationale: Correct because absent unilateral breath sounds with tracheal deviation away
from the affected side indicates a tension pneumothorax on the right, which increases
intrathoracic pressure and triggers the high-pressure alarm.
Q7: A patient post-CABG has the following hemodynamic profile: MAP 62 mmHg, CVP
14 mmHg, PAWP 20 mmHg, CI 1.8 L/min/m², SVR 1800 dynes/sec/cm⁻⁵. Which
intervention is the priority?
A. Administer a 500 mL crystalloid bolus
B. Initiate dobutamine and consider afterload reduction
C. Increase norepinephrine infusion
D. Administer furosemide 40 mg IV push
Correct Answer: B
Rationale: Correct because elevated filling pressures (CVP 14, PAWP 20) with a low
cardiac index (1.8) and high systemic vascular resistance indicate cardiogenic shock
where inotropic support and afterload reduction improve cardiac output.
Q8: A patient weighs 75 kg. A dopamine infusion is ordered at 5 mcg/kg/min. The
pharmacy supplies dopamine 400 mg in 250 mL D5W. At what rate in mL/hr should the
nurse set the infusion pump?
A. 11.25 mL/hr
B. 14.06 mL/hr
C. 18.75 mL/hr
D. 28.13 mL/hr
Correct Answer: B
Rationale: Correct because the concentration is 1600 mcg/mL; 5 mcg/kg/min for 75 kg
equals 375 mcg/min, which is 22,500 mcg/hr; dividing by 1600 mcg/mL yields 14.06
mL/hr.
SECTION 2: Advanced Cardiovascular Disorders (Questions 9–16)
