NUR 265 Advanced Medical-Surgical Nursing Comprehensive Review
2026 |Galen College
1. A patient with a spinal cord injury at T4 reports a sudden, severe headache
and nasal congestion. The blood pressure is 190/110 mmHg. What is the priority
nursing action?
A. Administer prescribed antihypertensive medication
B. Perform a digital rectal exam to check for impaction
C. Check the urinary catheter for kinks or obstruction
D. Place the patient in a high-Fowler position
Answer: D
Rationale: The symptoms suggest autonomic dysreflexia. The first priority is to sit the
patient upright to lower blood pressure via orthostatic effect, followed by identifying the
cause.
2. When interpreting an ABG for a patient with COPD, the nurse notes: pH 7.33,
PaCO2 55, HCO3 28. Which acid-base imbalance is present?
A. Uncompensated metabolic acidosis
B. Uncompensated respiratory alkalosis
C. Fully compensated respiratory acidosis
D. Partially compensated respiratory acidosis
Answer: D
Rationale: The pH is low (acidosis), PaCO2 is high (respiratory cause), and HCO3 is
elevated, indicating the kidneys are attempting to compensate but the pH is not yet normal.
,3. A nurse is caring for a patient in the early stages of septic shock. Which
clinical finding is most expected?
A. Increased cardiac output and warm skin
B. Bradycardia
C. Cool, clammy skin
D. Decreased urine output and hypotension
Answer: A
Rationale: Early (hyperdynamic) septic shock is characterized by high cardiac output,
systemic vasodilation, and warm, flushed skin.
4. Which medication should the nurse anticipate administering to a patient with
a serum potassium level of 6.8 mEq/L and ECG changes?
A. Sodium polystyrene sulfonate orally
B. Calcium gluconate IV
C. Spironolactone
D. Magnesium sulfate IV
Answer: B
Rationale: Calcium gluconate is used emergently to stabilize the myocardial cell
membrane and prevent arrhythmias caused by hyperkalemia.
5. A patient’s hemodynamic monitor shows a Central Venous Pressure (CVP) of
1 mmHg. Which intervention is most appropriate?
A. Restricting oral fluid intake
B. Administering Furosemide IV
C. Titrating up a Norepinephrine drip
D. Administering a fluid bolus of 0.9% Normal Saline
Answer: D
Rationale: Normal CVP is 2-8 mmHg. A CVP of 1 indicates low preload (dehydration or
blood loss), requiring fluid resuscitation.
, 6. What is the primary goal of using Positive End-Expiratory Pressure (PEEP) in a
patient with ARDS?
A. To keep the alveoli open at the end of expiration to improve gas exchange
B. To prevent barotrauma from high tidal volumes
C. To increase the fraction of inspired oxygen (FiO2)
D. To reduce the risk of ventilator-associated pneumonia
Answer: A
Rationale: PEEP prevents alveolar collapse (atelectasis) and improves oxygenation,
allowing for lower FiO2 levels.
7. A patient with cirrhosis and esophageal varices is scheduled for a procedure.
Which laboratory result is the greatest concern?
A. Serum ammonia 50 mcg/dL
B. Total bilirubin 2.5 mg/dL
C. Serum albumin 3.0 g/dL
D. International Normalized Ratio (INR) of 3.8
Answer: D
Rationale: An INR of 3.8 indicates a high risk for spontaneous bleeding or hemorrhage,
which is life-threatening in the context of esophageal varices.
8. Which EKG rhythm is characterized by a ‘sawtooth’ pattern of P-waves?
A. Atrial Fibrillation
B. Atrial Flutter
C. Ventricular Tachycardia
D. Third-degree Heart Block
Answer: B
Rationale: Atrial Flutter is classic for having ‘F-waves’ that resemble a sawtooth pattern.
2026 |Galen College
1. A patient with a spinal cord injury at T4 reports a sudden, severe headache
and nasal congestion. The blood pressure is 190/110 mmHg. What is the priority
nursing action?
A. Administer prescribed antihypertensive medication
B. Perform a digital rectal exam to check for impaction
C. Check the urinary catheter for kinks or obstruction
D. Place the patient in a high-Fowler position
Answer: D
Rationale: The symptoms suggest autonomic dysreflexia. The first priority is to sit the
patient upright to lower blood pressure via orthostatic effect, followed by identifying the
cause.
2. When interpreting an ABG for a patient with COPD, the nurse notes: pH 7.33,
PaCO2 55, HCO3 28. Which acid-base imbalance is present?
A. Uncompensated metabolic acidosis
B. Uncompensated respiratory alkalosis
C. Fully compensated respiratory acidosis
D. Partially compensated respiratory acidosis
Answer: D
Rationale: The pH is low (acidosis), PaCO2 is high (respiratory cause), and HCO3 is
elevated, indicating the kidneys are attempting to compensate but the pH is not yet normal.
,3. A nurse is caring for a patient in the early stages of septic shock. Which
clinical finding is most expected?
A. Increased cardiac output and warm skin
B. Bradycardia
C. Cool, clammy skin
D. Decreased urine output and hypotension
Answer: A
Rationale: Early (hyperdynamic) septic shock is characterized by high cardiac output,
systemic vasodilation, and warm, flushed skin.
4. Which medication should the nurse anticipate administering to a patient with
a serum potassium level of 6.8 mEq/L and ECG changes?
A. Sodium polystyrene sulfonate orally
B. Calcium gluconate IV
C. Spironolactone
D. Magnesium sulfate IV
Answer: B
Rationale: Calcium gluconate is used emergently to stabilize the myocardial cell
membrane and prevent arrhythmias caused by hyperkalemia.
5. A patient’s hemodynamic monitor shows a Central Venous Pressure (CVP) of
1 mmHg. Which intervention is most appropriate?
A. Restricting oral fluid intake
B. Administering Furosemide IV
C. Titrating up a Norepinephrine drip
D. Administering a fluid bolus of 0.9% Normal Saline
Answer: D
Rationale: Normal CVP is 2-8 mmHg. A CVP of 1 indicates low preload (dehydration or
blood loss), requiring fluid resuscitation.
, 6. What is the primary goal of using Positive End-Expiratory Pressure (PEEP) in a
patient with ARDS?
A. To keep the alveoli open at the end of expiration to improve gas exchange
B. To prevent barotrauma from high tidal volumes
C. To increase the fraction of inspired oxygen (FiO2)
D. To reduce the risk of ventilator-associated pneumonia
Answer: A
Rationale: PEEP prevents alveolar collapse (atelectasis) and improves oxygenation,
allowing for lower FiO2 levels.
7. A patient with cirrhosis and esophageal varices is scheduled for a procedure.
Which laboratory result is the greatest concern?
A. Serum ammonia 50 mcg/dL
B. Total bilirubin 2.5 mg/dL
C. Serum albumin 3.0 g/dL
D. International Normalized Ratio (INR) of 3.8
Answer: D
Rationale: An INR of 3.8 indicates a high risk for spontaneous bleeding or hemorrhage,
which is life-threatening in the context of esophageal varices.
8. Which EKG rhythm is characterized by a ‘sawtooth’ pattern of P-waves?
A. Atrial Fibrillation
B. Atrial Flutter
C. Ventricular Tachycardia
D. Third-degree Heart Block
Answer: B
Rationale: Atrial Flutter is classic for having ‘F-waves’ that resemble a sawtooth pattern.
