NSG233/NSG 233 Exam 2 V3 | Medical-
Surgical Nursing III Q&A with Rationale |
Herzing University
1. A patient is admitted to the emergency department with 40% total body surface area
(TBSA) burns. Using the Parkland formula (4mL/kg/%TBSA), the patient weighs 70 kg. How
much fluid should the nurse administer in the first 8 hours?
A. 5,600 mL
B. 2,800 mL
C. 11,200 mL
D. 4,200 mL
Correct Answer: A
Rationale: The total fluid for 24 hours is calculated as 4mL x 70kg x 40 = 11,200 mL.
According to the Parkland formula, half of the total volume must be administered in the
first 8 hours. Therefore, 11,200 divided by 2 equals 5,600 mL to be infused during the
initial 8-hour period.
2. A nurse is caring for a patient in septic shock. Which of the following clinical findings
indicates the ‘warm’ or hyperdynamic phase of shock?
A. Flushed, warm skin and high cardiac output
B. Decreased cardiac output
,C. Cool, clammy skin
D. Oliguria and bradycardia
Correct Answer: A
Rationale: In the early or hyperdynamic phase of septic shock, peripheral vasodilation
occurs, leading to warm, flushed skin. The body compensates for low systemic vascular
resistance by increasing cardiac output. As the shock progresses to the cold phase, the skin
becomes cool and mottled due to decreased perfusion.
3. Which arterial blood gas (ABG) result is most consistent with a patient experiencing early-
stage respiratory failure and hyperventilation?
A. pH 7.48, PaCO2 30, HCO3 23
B. pH 7.30, PaCO2 50, HCO3 24
C. pH 7.35, PaCO2 40, HCO3 24
D. pH 7.25, PaCO2 35, HCO3 18
Correct Answer: A
Rationale: Respiratory alkalosis (pH > 7.45 and PaCO2 < 35) is commonly seen in early
respiratory distress due to tachypnea and blowing off CO2. Option A represents respiratory
acidosis, which occurs later as the patient tires. Option D represents metabolic acidosis,
typically associated with renal failure or shock.
, 4. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22 mmHg.
Which nursing intervention is prioritized to manage this elevation?
A. Perform vigorous suctioning every hour
B. Encourage the patient to perform the Valsalva maneuver
C. Maintain the head of the bed at 30 to 45 degrees
D. Group all nursing activities together to save time
Correct Answer: C
Rationale: Elevating the head of the bed promotes venous drainage from the head, which
helps decrease intracranial pressure. Activities like suctioning and the Valsalva maneuver
can significantly increase ICP and should be avoided or minimized. Nursing care should be
spaced out to prevent sustained spikes in ICP caused by overstimulation.
5. What is the primary goal of using Positive End-Expiratory Pressure (PEEP) in a patient with
ARDS?
A. To prevent alveolar collapse and improve oxygenation
B. To decrease the work of breathing by increasing tidal volume
C. To increase the fraction of inspired oxygen (FiO2) to 100%
D. To manage metabolic acidosis
Correct Answer: A
Surgical Nursing III Q&A with Rationale |
Herzing University
1. A patient is admitted to the emergency department with 40% total body surface area
(TBSA) burns. Using the Parkland formula (4mL/kg/%TBSA), the patient weighs 70 kg. How
much fluid should the nurse administer in the first 8 hours?
A. 5,600 mL
B. 2,800 mL
C. 11,200 mL
D. 4,200 mL
Correct Answer: A
Rationale: The total fluid for 24 hours is calculated as 4mL x 70kg x 40 = 11,200 mL.
According to the Parkland formula, half of the total volume must be administered in the
first 8 hours. Therefore, 11,200 divided by 2 equals 5,600 mL to be infused during the
initial 8-hour period.
2. A nurse is caring for a patient in septic shock. Which of the following clinical findings
indicates the ‘warm’ or hyperdynamic phase of shock?
A. Flushed, warm skin and high cardiac output
B. Decreased cardiac output
,C. Cool, clammy skin
D. Oliguria and bradycardia
Correct Answer: A
Rationale: In the early or hyperdynamic phase of septic shock, peripheral vasodilation
occurs, leading to warm, flushed skin. The body compensates for low systemic vascular
resistance by increasing cardiac output. As the shock progresses to the cold phase, the skin
becomes cool and mottled due to decreased perfusion.
3. Which arterial blood gas (ABG) result is most consistent with a patient experiencing early-
stage respiratory failure and hyperventilation?
A. pH 7.48, PaCO2 30, HCO3 23
B. pH 7.30, PaCO2 50, HCO3 24
C. pH 7.35, PaCO2 40, HCO3 24
D. pH 7.25, PaCO2 35, HCO3 18
Correct Answer: A
Rationale: Respiratory alkalosis (pH > 7.45 and PaCO2 < 35) is commonly seen in early
respiratory distress due to tachypnea and blowing off CO2. Option A represents respiratory
acidosis, which occurs later as the patient tires. Option D represents metabolic acidosis,
typically associated with renal failure or shock.
, 4. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22 mmHg.
Which nursing intervention is prioritized to manage this elevation?
A. Perform vigorous suctioning every hour
B. Encourage the patient to perform the Valsalva maneuver
C. Maintain the head of the bed at 30 to 45 degrees
D. Group all nursing activities together to save time
Correct Answer: C
Rationale: Elevating the head of the bed promotes venous drainage from the head, which
helps decrease intracranial pressure. Activities like suctioning and the Valsalva maneuver
can significantly increase ICP and should be avoided or minimized. Nursing care should be
spaced out to prevent sustained spikes in ICP caused by overstimulation.
5. What is the primary goal of using Positive End-Expiratory Pressure (PEEP) in a patient with
ARDS?
A. To prevent alveolar collapse and improve oxygenation
B. To decrease the work of breathing by increasing tidal volume
C. To increase the fraction of inspired oxygen (FiO2) to 100%
D. To manage metabolic acidosis
Correct Answer: A
