NUR2755 Exam 1 Actual Exam Style V3 |
NUR 2755 Multidimensional Care IV / MDC
4 | Rasmussen
1. A patient arrives in the emergency department after a motor vehicle accident. The nurse
notes a deviated trachea, absent breath sounds on the left side, and hypotension. Which
action should the nurse prioritize?
A. Prepare for immediate needle thoracostomy
B. Obtain a portable chest X-ray
C. Administer a 1L bolus of Normal Saline
D. Insert a large-bore orogastric tube
Answer: A
Rationale: These clinical findings are classic indicators of a tension pneumothorax, which
is a life-threatening emergency. Immediate decompression via needle thoracostomy is
required to relieve pressure and restore cardiac output. Waiting for an X-ray could result in
cardiac arrest due to the shift in mediastinal structures.
2. A client with 45% total body surface area (TBSA) burns is in the resuscitative phase. Which
finding best indicates that fluid resuscitation is effective?
A. Heart rate of 110 beats per minute
B. Urine output of 0.5 mL/kg/hr
,C. Central venous pressure of 2 mmHg
D. Mean arterial pressure of 55 mmHg
Answer: B
Rationale: Urine output is the most reliable non-invasive indicator of organ perfusion and
fluid resuscitation adequacy in burn patients. The goal is typically 0.5 to 1.0 mL/kg/hr for
thermal burns. A heart rate of 110 or a MAP of 55 would suggest ongoing hypovolemia
rather than effective resuscitation.
3. Using the Parkland Formula, calculate the total fluid volume needed in the first 24 hours
for a 70kg patient with 50% TBSA burns.
A. 7,000 mL
B. 10,500 mL
C. 14,000 mL
D. 28,000 mL
Answer: C
Rationale: The Parkland Formula is calculated as 4 mL x kg x %TBSA. In this case, 4 mL x
70 kg x 50 equals 14,000 mL total for the first 24 hours. Half of this volume (7,000 mL)
must be administered within the first 8 hours post-injury.
, 4. A nurse is caring for a patient in septic shock. Which vasopressor is typically considered the
first-line choice to maintain a MAP >65 mmHg?
A. Epinephrine
B. Norepinephrine
C. Dopamine
D. Vasopressin
Answer: B
Rationale: Norepinephrine is the first-line vasopressor recommended by the Surviving
Sepsis Campaign for septic shock. It works primarily as an alpha-1 agonist to cause
vasoconstriction and increase systemic vascular resistance. While other agents may be
added, norepinephrine is preferred due to its efficacy and lower risk of dysrhythmias
compared to dopamine.
5. An elderly patient is admitted with a suspected ruptured abdominal aortic aneurysm. The
patient is pale, diaphoretic, and has a blood pressure of 82/40 mmHg. Which type of shock is
this patient experiencing?
A. Distributive Shock
B. Obstructive Shock
C. Hypovolemic Shock
D. Cardiogenic Shock
NUR 2755 Multidimensional Care IV / MDC
4 | Rasmussen
1. A patient arrives in the emergency department after a motor vehicle accident. The nurse
notes a deviated trachea, absent breath sounds on the left side, and hypotension. Which
action should the nurse prioritize?
A. Prepare for immediate needle thoracostomy
B. Obtain a portable chest X-ray
C. Administer a 1L bolus of Normal Saline
D. Insert a large-bore orogastric tube
Answer: A
Rationale: These clinical findings are classic indicators of a tension pneumothorax, which
is a life-threatening emergency. Immediate decompression via needle thoracostomy is
required to relieve pressure and restore cardiac output. Waiting for an X-ray could result in
cardiac arrest due to the shift in mediastinal structures.
2. A client with 45% total body surface area (TBSA) burns is in the resuscitative phase. Which
finding best indicates that fluid resuscitation is effective?
A. Heart rate of 110 beats per minute
B. Urine output of 0.5 mL/kg/hr
,C. Central venous pressure of 2 mmHg
D. Mean arterial pressure of 55 mmHg
Answer: B
Rationale: Urine output is the most reliable non-invasive indicator of organ perfusion and
fluid resuscitation adequacy in burn patients. The goal is typically 0.5 to 1.0 mL/kg/hr for
thermal burns. A heart rate of 110 or a MAP of 55 would suggest ongoing hypovolemia
rather than effective resuscitation.
3. Using the Parkland Formula, calculate the total fluid volume needed in the first 24 hours
for a 70kg patient with 50% TBSA burns.
A. 7,000 mL
B. 10,500 mL
C. 14,000 mL
D. 28,000 mL
Answer: C
Rationale: The Parkland Formula is calculated as 4 mL x kg x %TBSA. In this case, 4 mL x
70 kg x 50 equals 14,000 mL total for the first 24 hours. Half of this volume (7,000 mL)
must be administered within the first 8 hours post-injury.
, 4. A nurse is caring for a patient in septic shock. Which vasopressor is typically considered the
first-line choice to maintain a MAP >65 mmHg?
A. Epinephrine
B. Norepinephrine
C. Dopamine
D. Vasopressin
Answer: B
Rationale: Norepinephrine is the first-line vasopressor recommended by the Surviving
Sepsis Campaign for septic shock. It works primarily as an alpha-1 agonist to cause
vasoconstriction and increase systemic vascular resistance. While other agents may be
added, norepinephrine is preferred due to its efficacy and lower risk of dysrhythmias
compared to dopamine.
5. An elderly patient is admitted with a suspected ruptured abdominal aortic aneurysm. The
patient is pale, diaphoretic, and has a blood pressure of 82/40 mmHg. Which type of shock is
this patient experiencing?
A. Distributive Shock
B. Obstructive Shock
C. Hypovolemic Shock
D. Cardiogenic Shock
