NUR 265 Exam 1 V1, V2 and V3 Actual Exam 2026/2027:
Complete Exam-Style Questions with Detailed Rationales
| 100% Verified | Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Advanced Medical-Surgical Nursing Principles | Q1 – Q10
Section 2 | Critical Care and Emergency Nursing | Q11 – Q20
Section 3 | Complex Fluid and Electrolyte Imbalances | Q21 – Q30
Section 4 | Shock States and Hemodynamic Monitoring | Q31 – Q40
Section 5 | Multisystem Organ Dysfunction and End-of-Life Care | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
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SECTION 1: ADVANCED MEDICAL-SURGICAL NURSING PRINCIPLES Q1 – Q10
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Question 1 of 50
A 62-year-old patient is 24 hours post-op from an exploratory laparotomy with small
bowel resection. The nasogastric tube is set to low intermittent suction, and the patient
reports increasing abdominal distension without passage of flatus.
A. Auscultate bowel sounds in all four quadrants and document the character and
frequency. ✓ CORRECT
B. Advance the diet to clear liquids to stimulate peristalsis.
C. Remove the nasogastric tube to decrease patient discomfort.
D. Administer a Fleet enema to promote bowel evacuation.
Correct Answer: A
Rationale: Auscultating and documenting bowel sounds is the priority assessment to
differentiate between expected postoperative ileus and a potential obstruction.
Advancing the diet prematurely could worsen distension and increase the risk of emesis
,and aspiration. Postoperative patients require systematic abdominal assessment
before any intervention to restore gastrointestinal motility.
Question 2 of 50
A 58-year-old patient with type 2 diabetes presents with a Wagner grade 2 ulcer on the
plantar surface of the right foot. The wound bed is moist with pink granulation tissue
and moderate serosanguineous drainage.
A. Apply a total contact cast to offload the heel and ankle.
B. Provide a removable cast walker or specialized offloading shoe for the affected foot.
✓ CORRECT
C. Recommend bed rest with the foot elevated above heart level continuously.
D. Apply moist gauze dressings changed twice daily without offloading.
Correct Answer: B
Rationale: Offloading pressure from the plantar surface is the single most important
factor in healing diabetic foot ulcers, as continued pressure damages granulation
tissue. Total contact casts are effective but the heel is not the affected area, and a cast
walker specifically targets the forefoot and midfoot. Moist gauze alone without
offloading will not permit healing because mechanical trauma persists with each step.
Question 3 of 50
A 45-year-old patient receiving cyclophosphamide for breast cancer has an absolute
neutrophil count of 450 cells/mm³. The patient asks whether fresh flowers from the gift
shop can be placed at the bedside.
A. Allow the flowers as long as they are in a sealed glass vase with fresh water.
B. Permit artificial flowers only if they are dusted with antimicrobial spray daily.
C. Explain that both fresh and dried flowers are restricted due to fungal and bacterial
reservoirs. ✓ CORRECT
D. Allow the flowers if the patient promises not to touch the soil or water.
,Correct Answer: C
Rationale: Neutropenic patients must avoid flowers and plants because standing water
and soil harbor Aspergillus and gram-negative organisms that can cause life-threatening
infections. Artificial flowers are not the primary concern; the restriction applies to all
plant material in the immediate patient environment. Even minimal contact with
contaminated water or spores poses an unacceptable risk when the neutrophil count
falls below 500 cells/mm³.
Question 4 of 50
A 38-year-old patient is 8 hours post-op following total thyroidectomy for papillary
carcinoma. The patient reports perioral numbness and tingling in the fingertips. The
cardiac monitor shows a prolonged QT interval.
A. Administer oral calcium carbonate tablets with vitamin D immediately.
B. Increase the rate of the maintenance intravenous fluid to dilute electrolytes.
C. Apply a warm compress to the neck to improve regional blood flow to the parathyroid
glands.
D. Draw a stat ionized calcium level and prepare intravenous calcium gluconate. ✓
CORRECT
Correct Answer: D
Rationale: Perioral numbness and tingling after thyroidectomy are classic early signs of
hypocalcemia from parathyroid gland manipulation or accidental removal. Oral calcium
carbonate requires intact gastrointestinal absorption and will not address acute
symptomatic hypocalcemia with ECG changes. Intravenous calcium gluconate
stabilizes the cardiac membrane while awaiting laboratory confirmation, preventing
progression to tetany or laryngospasm.
Question 5 of 50
, A 71-year-old patient with severe COPD and a baseline PaO2 of 58 mmHg on room air
arrives in the emergency department with acute exacerbation. The respiratory rate is 28,
and the patient is using accessory muscles.
A. Apply a nasal cannula at 2 liters per minute and titrate to maintain SpO2 between
88% and 92%. ✓ CORRECT
B. Place a non-rebreather mask at 15 liters per minute to achieve an SpO2 greater than
95%.
C. Initiate bilevel positive airway pressure at an IPAP of 12 and EPAP of 5 immediately.
D. Administer 100% oxygen via high-flow nasal cannula at 40 liters per minute.
Correct Answer: A
Rationale: Patients with chronic CO2 retention depend on hypoxic drive for respiratory
stimulation, and excessive oxygen can precipitate hypercapnic respiratory failure. A
non-rebreather mask or high-flow 100% oxygen would suppress that drive and worsen
acidosis. Non-invasive ventilation is indicated for respiratory acidosis but only after
careful oxygen titration to the target range.
Question 6 of 50
A 67-year-old patient is 4 hours post-op transurethral resection of the prostate.
Continuous bladder irrigation is running through a three-way Foley catheter, and the
drainage bag contains bright red urine with occasional small clots.
A. Clamp the catheter for 30 minutes to allow the bladder to fill and force clot expulsion.
B. Increase the irrigation inflow rate to maintain light pink urine without manual
manipulation. ✓ CORRECT
C. Deflate the catheter balloon and irrigate the bladder with a Toomey syringe manually.
D. Remove the three-way catheter and replace it with a standard two-way Foley.
Correct Answer: B
Rationale: Increasing the inflow rate is the first-line intervention to prevent clot retention
and maintain patency after TURP without introducing infection risk. Clamping the
catheter allows clot accumulation and can cause bladder spasms or overdistension.
Complete Exam-Style Questions with Detailed Rationales
| 100% Verified | Pass Guaranteed – A+ Graded
TABLE OF CONTENTS
Section 1 | Advanced Medical-Surgical Nursing Principles | Q1 – Q10
Section 2 | Critical Care and Emergency Nursing | Q11 – Q20
Section 3 | Complex Fluid and Electrolyte Imbalances | Q21 – Q30
Section 4 | Shock States and Hemodynamic Monitoring | Q31 – Q40
Section 5 | Multisystem Organ Dysfunction and End-of-Life Care | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: ADVANCED MEDICAL-SURGICAL NURSING PRINCIPLES Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 62-year-old patient is 24 hours post-op from an exploratory laparotomy with small
bowel resection. The nasogastric tube is set to low intermittent suction, and the patient
reports increasing abdominal distension without passage of flatus.
A. Auscultate bowel sounds in all four quadrants and document the character and
frequency. ✓ CORRECT
B. Advance the diet to clear liquids to stimulate peristalsis.
C. Remove the nasogastric tube to decrease patient discomfort.
D. Administer a Fleet enema to promote bowel evacuation.
Correct Answer: A
Rationale: Auscultating and documenting bowel sounds is the priority assessment to
differentiate between expected postoperative ileus and a potential obstruction.
Advancing the diet prematurely could worsen distension and increase the risk of emesis
,and aspiration. Postoperative patients require systematic abdominal assessment
before any intervention to restore gastrointestinal motility.
Question 2 of 50
A 58-year-old patient with type 2 diabetes presents with a Wagner grade 2 ulcer on the
plantar surface of the right foot. The wound bed is moist with pink granulation tissue
and moderate serosanguineous drainage.
A. Apply a total contact cast to offload the heel and ankle.
B. Provide a removable cast walker or specialized offloading shoe for the affected foot.
✓ CORRECT
C. Recommend bed rest with the foot elevated above heart level continuously.
D. Apply moist gauze dressings changed twice daily without offloading.
Correct Answer: B
Rationale: Offloading pressure from the plantar surface is the single most important
factor in healing diabetic foot ulcers, as continued pressure damages granulation
tissue. Total contact casts are effective but the heel is not the affected area, and a cast
walker specifically targets the forefoot and midfoot. Moist gauze alone without
offloading will not permit healing because mechanical trauma persists with each step.
Question 3 of 50
A 45-year-old patient receiving cyclophosphamide for breast cancer has an absolute
neutrophil count of 450 cells/mm³. The patient asks whether fresh flowers from the gift
shop can be placed at the bedside.
A. Allow the flowers as long as they are in a sealed glass vase with fresh water.
B. Permit artificial flowers only if they are dusted with antimicrobial spray daily.
C. Explain that both fresh and dried flowers are restricted due to fungal and bacterial
reservoirs. ✓ CORRECT
D. Allow the flowers if the patient promises not to touch the soil or water.
,Correct Answer: C
Rationale: Neutropenic patients must avoid flowers and plants because standing water
and soil harbor Aspergillus and gram-negative organisms that can cause life-threatening
infections. Artificial flowers are not the primary concern; the restriction applies to all
plant material in the immediate patient environment. Even minimal contact with
contaminated water or spores poses an unacceptable risk when the neutrophil count
falls below 500 cells/mm³.
Question 4 of 50
A 38-year-old patient is 8 hours post-op following total thyroidectomy for papillary
carcinoma. The patient reports perioral numbness and tingling in the fingertips. The
cardiac monitor shows a prolonged QT interval.
A. Administer oral calcium carbonate tablets with vitamin D immediately.
B. Increase the rate of the maintenance intravenous fluid to dilute electrolytes.
C. Apply a warm compress to the neck to improve regional blood flow to the parathyroid
glands.
D. Draw a stat ionized calcium level and prepare intravenous calcium gluconate. ✓
CORRECT
Correct Answer: D
Rationale: Perioral numbness and tingling after thyroidectomy are classic early signs of
hypocalcemia from parathyroid gland manipulation or accidental removal. Oral calcium
carbonate requires intact gastrointestinal absorption and will not address acute
symptomatic hypocalcemia with ECG changes. Intravenous calcium gluconate
stabilizes the cardiac membrane while awaiting laboratory confirmation, preventing
progression to tetany or laryngospasm.
Question 5 of 50
, A 71-year-old patient with severe COPD and a baseline PaO2 of 58 mmHg on room air
arrives in the emergency department with acute exacerbation. The respiratory rate is 28,
and the patient is using accessory muscles.
A. Apply a nasal cannula at 2 liters per minute and titrate to maintain SpO2 between
88% and 92%. ✓ CORRECT
B. Place a non-rebreather mask at 15 liters per minute to achieve an SpO2 greater than
95%.
C. Initiate bilevel positive airway pressure at an IPAP of 12 and EPAP of 5 immediately.
D. Administer 100% oxygen via high-flow nasal cannula at 40 liters per minute.
Correct Answer: A
Rationale: Patients with chronic CO2 retention depend on hypoxic drive for respiratory
stimulation, and excessive oxygen can precipitate hypercapnic respiratory failure. A
non-rebreather mask or high-flow 100% oxygen would suppress that drive and worsen
acidosis. Non-invasive ventilation is indicated for respiratory acidosis but only after
careful oxygen titration to the target range.
Question 6 of 50
A 67-year-old patient is 4 hours post-op transurethral resection of the prostate.
Continuous bladder irrigation is running through a three-way Foley catheter, and the
drainage bag contains bright red urine with occasional small clots.
A. Clamp the catheter for 30 minutes to allow the bladder to fill and force clot expulsion.
B. Increase the irrigation inflow rate to maintain light pink urine without manual
manipulation. ✓ CORRECT
C. Deflate the catheter balloon and irrigate the bladder with a Toomey syringe manually.
D. Remove the three-way catheter and replace it with a standard two-way Foley.
Correct Answer: B
Rationale: Increasing the inflow rate is the first-line intervention to prevent clot retention
and maintain patency after TURP without introducing infection risk. Clamping the
catheter allows clot accumulation and can cause bladder spasms or overdistension.
