NUR 265 MEDICAL-SURGICAL NURSING
EXAM 1 Actual Exam 2026 Complete
Questions and Answers | 100% Verified
Detailed Rationales - Pass Guaranteed - A+
Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular Disorders | Q1 – Q10
Section 2 | Respiratory Disorders | Q11 – Q20
Section 3 | Renal and Urinary Disorders | Q21 – Q30
Section 4 | Fluid, Electrolyte, and Acid-Base Balance | Q31 – Q40
Section 5 | Shock and Multisystem Failure | Q41 – Q50
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SECTION 1: CARDIOVASCULAR DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 67-year-old man is admitted to the cardiac unit with chest pain that began 2 hours ago
while he was mowing his lawn. He describes the pain as a crushing pressure radiating
to his left jaw and arm. His ECG shows ST-segment elevation in leads V1 through V4.
His troponin I is elevated at 4.2 ng/mL. Which type of myocardial infarction is this
patient most likely experiencing?
A. Non-ST-elevation myocardial infarction
B. ST-elevation myocardial infarction ✓ CORRECT
C. Unstable angina
D. Prinzmetal's angina
,Correct Answer: B
Rationale: ST-elevation in contiguous precordial leads with elevated troponin confirms
an ST-elevation myocardial infarction involving the anterior wall, which requires
emergent reperfusion therapy. The most tempting wrong answer is A because NSTEMI
presents with ST depression or T-wave inversion without ST elevation, and the ECG
pattern here is classic for STEMI. Rapid recognition of STEMI is critical, as
door-to-balloon time should be under 90 minutes to minimize myocardial damage and
improve survival.
Question 2 of 50
A 54-year-old woman with a history of hypertension presents to the emergency
department with sudden onset of severe tearing chest pain that radiates to her back.
Her blood pressure is 188/110 mmHg in her right arm and 142/88 mmHg in her left
arm. A chest X-ray shows a widened mediastinum. What is the nurse's priority
intervention?
A. Administer sublingual nitroglycerin for chest pain relief
B. Initiate IV beta-blockade to reduce shear stress on the aortic wall ✓ CORRECT
C. Administer thrombolytics for suspected myocardial infarction
D. Prepare the patient for immediate coronary angiography
Correct Answer: B
Rationale: The presentation is classic for aortic dissection, and IV beta-blockade is the
priority to reduce heart rate and blood pressure, thereby decreasing shear stress on the
aortic wall and preventing extension of the dissection. The most tempting wrong
answer is A because nitroglycerin can cause reflex tachycardia and hypotension, which
increases shear stress and may worsen the dissection. Aortic dissection carries a
mortality rate of 1–2% per hour if untreated, making rapid diagnosis and blood pressure
control essential before surgical intervention.
,Question 3 of 50
A 72-year-old man with heart failure is being discharged home on lisinopril, metoprolol,
and furosemide. During discharge teaching, the nurse emphasizes the importance of
daily weights. The patient asks why daily weights are necessary. What is the nurse's
best explanation?
A. Daily weights help monitor for medication toxicity
B. Daily weights detect fluid retention before symptoms worsen ✓ CORRECT
C. Daily weights are required for insurance reimbursement
D. Daily weights help determine if the patient needs potassium supplements
Correct Answer: B
Rationale: Daily weights are the most sensitive indicator of fluid status in heart failure,
as a gain of 2–3 pounds in 24 hours or 5 pounds in a week signals fluid retention that
may require diuretic adjustment before dyspnea or edema develops. The most tempting
wrong answer is A because while some heart failure medications have toxicities, daily
weights specifically monitor volume status, not drug levels or toxicity. Heart failure is
the leading cause of hospitalization in adults over 65, and patient self-monitoring with
daily weights is a cornerstone of preventing readmission.
Question 4 of 50
A 48-year-old man is recovering from coronary artery bypass graft surgery on
postoperative day 2. The nurse notices that his chest tube drainage has suddenly
increased to 250 mL in the past hour, and his blood pressure has dropped to 88/52
mmHg with a heart rate of 118 bpm. What is the nurse's priority action?
A. Administer morphine for pain control
B. Notify the surgeon and prepare for possible mediastinal exploration ✓ CORRECT
C. Increase the rate of his maintenance IV fluids
D. Remove the chest tube to relieve pressure
, Correct Answer: B
Rationale: Sudden increased chest tube output with hypotension and tachycardia
indicates postoperative hemorrhage, likely from a graft site or mediastinal vessel,
requiring immediate surgical evaluation and possible return to the operating room for
exploration. The most tempting wrong answer is C because while fluid resuscitation is
important, it does not address the source of bleeding, and delaying surgical intervention
can lead to cardiac tamponade and death. Postoperative hemorrhage after CABG
occurs in 3–5% of patients, and nurses must recognize the signs early, as rapid surgical
control is the only definitive treatment.
Question 5 of 50
A 61-year-old woman with atrial fibrillation is started on warfarin therapy. The nurse is
educating her about dietary considerations. Which food should the nurse advise the
patient to maintain consistent intake of?
A. Red meat
B. Leafy green vegetables ✓ CORRECT
C. Citrus fruits
D. Dairy products
Correct Answer: B
Rationale: Leafy green vegetables are high in vitamin K, which antagonizes warfarin's
effect, so consistent intake is essential to maintain a stable INR rather than avoiding
them entirely. The most tempting wrong answer is D because dairy products do not
significantly affect warfarin metabolism, and patients often mistakenly believe they
must avoid all dairy. Warfarin therapy requires careful dietary counseling, as sudden
changes in vitamin K intake can cause subtherapeutic anticoagulation and thrombosis
or supratherapeutic levels and bleeding.
Question 6 of 50
EXAM 1 Actual Exam 2026 Complete
Questions and Answers | 100% Verified
Detailed Rationales - Pass Guaranteed - A+
Graded
TABLE OF CONTENTS
Section 1 | Cardiovascular Disorders | Q1 – Q10
Section 2 | Respiratory Disorders | Q11 – Q20
Section 3 | Renal and Urinary Disorders | Q21 – Q30
Section 4 | Fluid, Electrolyte, and Acid-Base Balance | Q31 – Q40
Section 5 | Shock and Multisystem Failure | Q41 – Q50
══════════════════════════════════════
SECTION 1: CARDIOVASCULAR DISORDERS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 67-year-old man is admitted to the cardiac unit with chest pain that began 2 hours ago
while he was mowing his lawn. He describes the pain as a crushing pressure radiating
to his left jaw and arm. His ECG shows ST-segment elevation in leads V1 through V4.
His troponin I is elevated at 4.2 ng/mL. Which type of myocardial infarction is this
patient most likely experiencing?
A. Non-ST-elevation myocardial infarction
B. ST-elevation myocardial infarction ✓ CORRECT
C. Unstable angina
D. Prinzmetal's angina
,Correct Answer: B
Rationale: ST-elevation in contiguous precordial leads with elevated troponin confirms
an ST-elevation myocardial infarction involving the anterior wall, which requires
emergent reperfusion therapy. The most tempting wrong answer is A because NSTEMI
presents with ST depression or T-wave inversion without ST elevation, and the ECG
pattern here is classic for STEMI. Rapid recognition of STEMI is critical, as
door-to-balloon time should be under 90 minutes to minimize myocardial damage and
improve survival.
Question 2 of 50
A 54-year-old woman with a history of hypertension presents to the emergency
department with sudden onset of severe tearing chest pain that radiates to her back.
Her blood pressure is 188/110 mmHg in her right arm and 142/88 mmHg in her left
arm. A chest X-ray shows a widened mediastinum. What is the nurse's priority
intervention?
A. Administer sublingual nitroglycerin for chest pain relief
B. Initiate IV beta-blockade to reduce shear stress on the aortic wall ✓ CORRECT
C. Administer thrombolytics for suspected myocardial infarction
D. Prepare the patient for immediate coronary angiography
Correct Answer: B
Rationale: The presentation is classic for aortic dissection, and IV beta-blockade is the
priority to reduce heart rate and blood pressure, thereby decreasing shear stress on the
aortic wall and preventing extension of the dissection. The most tempting wrong
answer is A because nitroglycerin can cause reflex tachycardia and hypotension, which
increases shear stress and may worsen the dissection. Aortic dissection carries a
mortality rate of 1–2% per hour if untreated, making rapid diagnosis and blood pressure
control essential before surgical intervention.
,Question 3 of 50
A 72-year-old man with heart failure is being discharged home on lisinopril, metoprolol,
and furosemide. During discharge teaching, the nurse emphasizes the importance of
daily weights. The patient asks why daily weights are necessary. What is the nurse's
best explanation?
A. Daily weights help monitor for medication toxicity
B. Daily weights detect fluid retention before symptoms worsen ✓ CORRECT
C. Daily weights are required for insurance reimbursement
D. Daily weights help determine if the patient needs potassium supplements
Correct Answer: B
Rationale: Daily weights are the most sensitive indicator of fluid status in heart failure,
as a gain of 2–3 pounds in 24 hours or 5 pounds in a week signals fluid retention that
may require diuretic adjustment before dyspnea or edema develops. The most tempting
wrong answer is A because while some heart failure medications have toxicities, daily
weights specifically monitor volume status, not drug levels or toxicity. Heart failure is
the leading cause of hospitalization in adults over 65, and patient self-monitoring with
daily weights is a cornerstone of preventing readmission.
Question 4 of 50
A 48-year-old man is recovering from coronary artery bypass graft surgery on
postoperative day 2. The nurse notices that his chest tube drainage has suddenly
increased to 250 mL in the past hour, and his blood pressure has dropped to 88/52
mmHg with a heart rate of 118 bpm. What is the nurse's priority action?
A. Administer morphine for pain control
B. Notify the surgeon and prepare for possible mediastinal exploration ✓ CORRECT
C. Increase the rate of his maintenance IV fluids
D. Remove the chest tube to relieve pressure
, Correct Answer: B
Rationale: Sudden increased chest tube output with hypotension and tachycardia
indicates postoperative hemorrhage, likely from a graft site or mediastinal vessel,
requiring immediate surgical evaluation and possible return to the operating room for
exploration. The most tempting wrong answer is C because while fluid resuscitation is
important, it does not address the source of bleeding, and delaying surgical intervention
can lead to cardiac tamponade and death. Postoperative hemorrhage after CABG
occurs in 3–5% of patients, and nurses must recognize the signs early, as rapid surgical
control is the only definitive treatment.
Question 5 of 50
A 61-year-old woman with atrial fibrillation is started on warfarin therapy. The nurse is
educating her about dietary considerations. Which food should the nurse advise the
patient to maintain consistent intake of?
A. Red meat
B. Leafy green vegetables ✓ CORRECT
C. Citrus fruits
D. Dairy products
Correct Answer: B
Rationale: Leafy green vegetables are high in vitamin K, which antagonizes warfarin's
effect, so consistent intake is essential to maintain a stable INR rather than avoiding
them entirely. The most tempting wrong answer is D because dairy products do not
significantly affect warfarin metabolism, and patients often mistakenly believe they
must avoid all dairy. Warfarin therapy requires careful dietary counseling, as sudden
changes in vitamin K intake can cause subtherapeutic anticoagulation and thrombosis
or supratherapeutic levels and bleeding.
Question 6 of 50
