GALEN COLLEGE OF NURSING
NUR 265 Exam 4
Questions and Answers
Official Practice Exam -- 2026/2027 Edition
100% Correct -- Verified Answers with Rationales
Questions Minutes Passing Score Format
75 90 80% MCQ
Table of Contents
Section 1: Hematologic and Lymphatic Disorders (15 questions)
Section 2: Acute and Chronic Renal Disorders (15 questions)
Section 3: Burns and Integumentary Disorders (15 questions)
Section 4: Shock and Multiple Organ Dysfunction Syndrome (15 questions)
Section 5: Emergency, Disaster, and Trauma Nursing (15 questions)
Instructions
Read each question carefully. Select the single best answer from the four options provided.
Each question presents a clinical scenario followed by four plausible choices.
The correct answer is printed in green, followed by a detailed rationale.
A passing score of 80% requires at least 60 correct answers out of 75 questions.
You have 90 minutes to complete this examination. Manage your time accordingly.
NUR 265 Exam 4 -- 2026/2027 | Passing Score: 80% | Page 1 of 40
, Section 1: Hematologic and Lymphatic Disorders -- 2026/2027
Q1 Question 1 of 75
A 62-year-old male presents to the emergency department with fatigue, pallor, and dyspnea on
exertion for the past three weeks. His hemoglobin is 7.2 g/dL and his MCV is 78 fL. What is the
most likely diagnosis for this patient based on these findings?
A. Iron deficiency anemia
B. Vitamin B12 deficiency anemia
C. Aplastic anemia
D. Hemolytic anemia
Correct Answer: A
Rationale:
The combination of low hemoglobin and a low MCV (microcytic) is the hallmark of iron deficiency anemia.
Vitamin B12 deficiency produces a macrocytic anemia (high MCV), while aplastic and hemolytic anemias
typically present with normocytic or macrocytic indices.
Q2 Question 2 of 75
A 45-year-old woman undergoing chemotherapy for breast cancer develops a fever of 101.8 F
with an absolute neutrophil count of 400. Which nursing intervention is the highest priority for
this patient at this time?
A. Administer prescribed antipyretics and reassess temperature in one hour
B. Initiate broad-spectrum IV antibiotics within one hour of presentation
C. Obtain blood cultures from two separate sites before any medications
D. Place the patient in a protective isolation room with positive pressure
Correct Answer: B
Rationale:
Febrile neutropenia is a medical emergency requiring immediate broad-spectrum IV antibiotics, ideally within
one hour, to prevent sepsis and death. While blood cultures should be obtained, antibiotic administration must
not be delayed. Protective isolation is secondary to immediate antimicrobial therapy.
NUR 265 Exam 4 -- 2026/2027 | Passing Score: 80% | Page 2 of 40
,Q3 Question 3 of 75
A 34-year-old African American man reports sudden onset of severe pain in his lower back
and joints after a long flight. He has a history of recurrent painful episodes since childhood. A
peripheral blood smear shows sickle-shaped red blood cells. What acute condition is this
patient experiencing?
A. Vaso-occlusive crisis
B. Aplastic crisis
C. Hemolytic crisis
D. Sequestration crisis
Correct Answer: A
Rationale:
Vaso-occlusive crisis is the most common complication of sickle cell disease, caused by sickled cells
obstructing microvasculature and producing severe pain in the back, joints, and extremities. Hemolytic crisis
involves rapid RBC destruction, aplastic crisis involves bone marrow suppression, and sequestration crisis
involves massive splenic pooling of blood.
Q4 Question 4 of 75
A 58-year-old male with chronic lymphocytic leukemia presents with massive, painless
cervical lymphadenopathy, night sweats, and a 15-pound weight loss over two months. His
WBC count is 120,000/mm3. Which complication should the nurse monitor for most closely in
this patient?
A. Deep vein thrombosis from hyperviscosity
B. Pathologic fractures from bone involvement
C. Meningeal irritation from central nervous system infiltration
D. Tumor lysis syndrome from rapid cell turnover
Correct Answer: D
Rationale:
Tumor lysis syndrome is a life-threatening complication of rapidly proliferating hematologic malignancies,
caused by massive cell lysis releasing potassium, phosphate, and uric acid. With a WBC of 120,000/mm3 and
symptomatic disease, this patient is at high risk and requires aggressive hydration and monitoring.
NUR 265 Exam 4 -- 2026/2027 | Passing Score: 80% | Page 3 of 40
, Q5 Question 5 of 75
A 70-year-old female is admitted with a hemoglobin of 5.8 g/dL, reticulocyte count of 12%,
elevated LDH, and decreased haptoglobin. The nurse observes that her sclerae are icteric.
What type of anemia do these laboratory findings most strongly indicate?
A. Hemolytic anemia
B. Iron deficiency anemia
C. Megaloblastic anemia
D. Sickle cell anemia
Correct Answer: A
Rationale:
Elevated LDH, decreased haptoglobin, an elevated reticulocyte count, and jaundice are the classic laboratory
constellation of hemolytic anemia, indicating RBC destruction exceeding bone marrow compensation. Iron
deficiency shows low reticulocytes, and megaloblastic anemia shows macrocytosis with low reticulocytes.
Q6 Question 6 of 75
A 50-year-old male with hemophilia A presents with severe knee pain and swelling after a
minor twisting injury. His factor VIII level is less than 1%. Which treatment should the nurse
prepare to administer as the most definitive intervention?
A. Fresh frozen plasma at 15 mL/kg
B. Recombinant factor VIII concentrate
C. Desmopressin acetate intravenously
D. Cryoprecipitate pooled from multiple donors
Correct Answer: B
Rationale:
Recombinant factor VIII concentrate is the treatment of choice for acute bleeding in hemophilia A with factor
VIII levels below 1%, as it directly replaces the deficient clotting factor. Desmopressin is only effective in mild
hemophilia A (factor VIII levels above 5%). FFP and cryoprecipitate are less specific and carry higher infection
risk.
NUR 265 Exam 4 -- 2026/2027 | Passing Score: 80% | Page 4 of 40
NUR 265 Exam 4
Questions and Answers
Official Practice Exam -- 2026/2027 Edition
100% Correct -- Verified Answers with Rationales
Questions Minutes Passing Score Format
75 90 80% MCQ
Table of Contents
Section 1: Hematologic and Lymphatic Disorders (15 questions)
Section 2: Acute and Chronic Renal Disorders (15 questions)
Section 3: Burns and Integumentary Disorders (15 questions)
Section 4: Shock and Multiple Organ Dysfunction Syndrome (15 questions)
Section 5: Emergency, Disaster, and Trauma Nursing (15 questions)
Instructions
Read each question carefully. Select the single best answer from the four options provided.
Each question presents a clinical scenario followed by four plausible choices.
The correct answer is printed in green, followed by a detailed rationale.
A passing score of 80% requires at least 60 correct answers out of 75 questions.
You have 90 minutes to complete this examination. Manage your time accordingly.
NUR 265 Exam 4 -- 2026/2027 | Passing Score: 80% | Page 1 of 40
, Section 1: Hematologic and Lymphatic Disorders -- 2026/2027
Q1 Question 1 of 75
A 62-year-old male presents to the emergency department with fatigue, pallor, and dyspnea on
exertion for the past three weeks. His hemoglobin is 7.2 g/dL and his MCV is 78 fL. What is the
most likely diagnosis for this patient based on these findings?
A. Iron deficiency anemia
B. Vitamin B12 deficiency anemia
C. Aplastic anemia
D. Hemolytic anemia
Correct Answer: A
Rationale:
The combination of low hemoglobin and a low MCV (microcytic) is the hallmark of iron deficiency anemia.
Vitamin B12 deficiency produces a macrocytic anemia (high MCV), while aplastic and hemolytic anemias
typically present with normocytic or macrocytic indices.
Q2 Question 2 of 75
A 45-year-old woman undergoing chemotherapy for breast cancer develops a fever of 101.8 F
with an absolute neutrophil count of 400. Which nursing intervention is the highest priority for
this patient at this time?
A. Administer prescribed antipyretics and reassess temperature in one hour
B. Initiate broad-spectrum IV antibiotics within one hour of presentation
C. Obtain blood cultures from two separate sites before any medications
D. Place the patient in a protective isolation room with positive pressure
Correct Answer: B
Rationale:
Febrile neutropenia is a medical emergency requiring immediate broad-spectrum IV antibiotics, ideally within
one hour, to prevent sepsis and death. While blood cultures should be obtained, antibiotic administration must
not be delayed. Protective isolation is secondary to immediate antimicrobial therapy.
NUR 265 Exam 4 -- 2026/2027 | Passing Score: 80% | Page 2 of 40
,Q3 Question 3 of 75
A 34-year-old African American man reports sudden onset of severe pain in his lower back
and joints after a long flight. He has a history of recurrent painful episodes since childhood. A
peripheral blood smear shows sickle-shaped red blood cells. What acute condition is this
patient experiencing?
A. Vaso-occlusive crisis
B. Aplastic crisis
C. Hemolytic crisis
D. Sequestration crisis
Correct Answer: A
Rationale:
Vaso-occlusive crisis is the most common complication of sickle cell disease, caused by sickled cells
obstructing microvasculature and producing severe pain in the back, joints, and extremities. Hemolytic crisis
involves rapid RBC destruction, aplastic crisis involves bone marrow suppression, and sequestration crisis
involves massive splenic pooling of blood.
Q4 Question 4 of 75
A 58-year-old male with chronic lymphocytic leukemia presents with massive, painless
cervical lymphadenopathy, night sweats, and a 15-pound weight loss over two months. His
WBC count is 120,000/mm3. Which complication should the nurse monitor for most closely in
this patient?
A. Deep vein thrombosis from hyperviscosity
B. Pathologic fractures from bone involvement
C. Meningeal irritation from central nervous system infiltration
D. Tumor lysis syndrome from rapid cell turnover
Correct Answer: D
Rationale:
Tumor lysis syndrome is a life-threatening complication of rapidly proliferating hematologic malignancies,
caused by massive cell lysis releasing potassium, phosphate, and uric acid. With a WBC of 120,000/mm3 and
symptomatic disease, this patient is at high risk and requires aggressive hydration and monitoring.
NUR 265 Exam 4 -- 2026/2027 | Passing Score: 80% | Page 3 of 40
, Q5 Question 5 of 75
A 70-year-old female is admitted with a hemoglobin of 5.8 g/dL, reticulocyte count of 12%,
elevated LDH, and decreased haptoglobin. The nurse observes that her sclerae are icteric.
What type of anemia do these laboratory findings most strongly indicate?
A. Hemolytic anemia
B. Iron deficiency anemia
C. Megaloblastic anemia
D. Sickle cell anemia
Correct Answer: A
Rationale:
Elevated LDH, decreased haptoglobin, an elevated reticulocyte count, and jaundice are the classic laboratory
constellation of hemolytic anemia, indicating RBC destruction exceeding bone marrow compensation. Iron
deficiency shows low reticulocytes, and megaloblastic anemia shows macrocytosis with low reticulocytes.
Q6 Question 6 of 75
A 50-year-old male with hemophilia A presents with severe knee pain and swelling after a
minor twisting injury. His factor VIII level is less than 1%. Which treatment should the nurse
prepare to administer as the most definitive intervention?
A. Fresh frozen plasma at 15 mL/kg
B. Recombinant factor VIII concentrate
C. Desmopressin acetate intravenously
D. Cryoprecipitate pooled from multiple donors
Correct Answer: B
Rationale:
Recombinant factor VIII concentrate is the treatment of choice for acute bleeding in hemophilia A with factor
VIII levels below 1%, as it directly replaces the deficient clotting factor. Desmopressin is only effective in mild
hemophilia A (factor VIII levels above 5%). FFP and cryoprecipitate are less specific and carry higher infection
risk.
NUR 265 Exam 4 -- 2026/2027 | Passing Score: 80% | Page 4 of 40
