NURS 480 Exam 3 V2 | NURS 480
Advanced Medical Surgical Health Nursing
| Actual Q&A with Rationale (NURS480
Exam 3) | West Coast University
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is placed on mechanical
ventilation with High-Level Positive End-Expiratory Pressure (PEEP). What is the primary
hemodynamic complication the nurse should monitor for?
A. Increased systemic vascular resistance
B. Increased pulmonary artery wedge pressure
C. Decreased cardiac output
D. Hypertension
Answer: C
Rationale: High levels of PEEP increase intrathoracic pressure, which can compress the
heart and great vessels. This leads to decreased venous return (preload) and a subsequent
drop in cardiac output. The nurse must monitor for hypotension and signs of decreased
organ perfusion when PEEP is titrated upward.
,2. A nurse is caring for a patient who suffered a 40 percent total body surface area (TBSA)
burn 4 hours ago. The patient weighs 70 kg. Using the Parkland formula (4mL/kg/%TBSA),
what is the hourly IV rate for the first 8 hours?
A. 1400 mL/hr
B. 700 mL/hr
C. 350 mL/hr
D. 525 mL/hr
Answer: B
Rationale: The total volume for 24 hours is calculated as 4mL x 70kg x 40% = 11,200 mL.
Half of this volume (5,600 mL) must be infused within the first 8 hours of the burn injury.
Dividing 5,600 mL by 8 hours results in an hourly infusion rate of 700 mL/hr.
3. Which clinical manifestation is considered a classic early sign of septic shock that
differentiates it from other types of shock?
A. Warm, flushed skin
B. Bradypnea
C. Cold and clammy skin
D. Increased central venous pressure
Answer: A
,Rationale: In the early hyperdynamic phase of septic shock, massive vasodilation occurs,
resulting in warm and flushed skin. This is distinct from hypovolemic or cardiogenic shock,
where compensatory vasoconstriction leads to cold, pale, and clammy skin. The nurse
should recognize this ‘warm shock’ phase as an indicator of systemic infection and
inflammatory response.
4. A patient in the Intensive Care Unit has a Pulmonary Artery Catheter. The nurse notes a
Central Venous Pressure (CVP) of 1 mmHg and a Mean Arterial Pressure (MAP) of 55 mmHg.
Which intervention should the nurse anticipate first?
A. Administration of Furosemide
B. Dopamine at 5 mcg/kg/min
C. Starting a Norepinephrine drip
D. Rapid infusion of 0.9 percent Normal Saline
Answer: D
Rationale: A CVP of 1 mmHg (normal 2-8 mmHg) and a low MAP indicate significant
hypovolemia. The priority intervention is to restore intravascular volume before
considering vasopressors or inotropes. Initial fluid resuscitation with crystalloids is the
standard of care to improve preload and cardiac output.
, 5. A trauma patient arrives in the Emergency Department after a motor vehicle accident.
According to the ATLS Primary Survey, what is the nurse’s priority action after ensuring a
patent airway with stabilization of the cervical spine?
A. Check for peripheral pulses
B. Assess Glasgow Coma Scale
C. Remove all clothing to inspect for injuries
D. Assess breathing and ventilation
Answer: D
Rationale: The Primary Survey follows the ABCDE sequence: Airway, Breathing,
Circulation, Disability, and Exposure. Once the airway is secured and the C-spine is
protected, the nurse must immediately assess breathing to identify life-threatening
conditions like tension pneumothorax. Circulation is assessed only after breathing is
confirmed to be adequate or has been addressed.
6. Which laboratory result is the most specific indicator that a patient is transitioning from
sepsis to Disseminated Intravascular Coagulation (DIC)?
A. Decreased white blood cell count
B. Elevated Fibrin Degradation Products (FDPs)
C. Increased Hemoglobin
D. Decreased Prothrombin Time (PT)
Advanced Medical Surgical Health Nursing
| Actual Q&A with Rationale (NURS480
Exam 3) | West Coast University
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is placed on mechanical
ventilation with High-Level Positive End-Expiratory Pressure (PEEP). What is the primary
hemodynamic complication the nurse should monitor for?
A. Increased systemic vascular resistance
B. Increased pulmonary artery wedge pressure
C. Decreased cardiac output
D. Hypertension
Answer: C
Rationale: High levels of PEEP increase intrathoracic pressure, which can compress the
heart and great vessels. This leads to decreased venous return (preload) and a subsequent
drop in cardiac output. The nurse must monitor for hypotension and signs of decreased
organ perfusion when PEEP is titrated upward.
,2. A nurse is caring for a patient who suffered a 40 percent total body surface area (TBSA)
burn 4 hours ago. The patient weighs 70 kg. Using the Parkland formula (4mL/kg/%TBSA),
what is the hourly IV rate for the first 8 hours?
A. 1400 mL/hr
B. 700 mL/hr
C. 350 mL/hr
D. 525 mL/hr
Answer: B
Rationale: The total volume for 24 hours is calculated as 4mL x 70kg x 40% = 11,200 mL.
Half of this volume (5,600 mL) must be infused within the first 8 hours of the burn injury.
Dividing 5,600 mL by 8 hours results in an hourly infusion rate of 700 mL/hr.
3. Which clinical manifestation is considered a classic early sign of septic shock that
differentiates it from other types of shock?
A. Warm, flushed skin
B. Bradypnea
C. Cold and clammy skin
D. Increased central venous pressure
Answer: A
,Rationale: In the early hyperdynamic phase of septic shock, massive vasodilation occurs,
resulting in warm and flushed skin. This is distinct from hypovolemic or cardiogenic shock,
where compensatory vasoconstriction leads to cold, pale, and clammy skin. The nurse
should recognize this ‘warm shock’ phase as an indicator of systemic infection and
inflammatory response.
4. A patient in the Intensive Care Unit has a Pulmonary Artery Catheter. The nurse notes a
Central Venous Pressure (CVP) of 1 mmHg and a Mean Arterial Pressure (MAP) of 55 mmHg.
Which intervention should the nurse anticipate first?
A. Administration of Furosemide
B. Dopamine at 5 mcg/kg/min
C. Starting a Norepinephrine drip
D. Rapid infusion of 0.9 percent Normal Saline
Answer: D
Rationale: A CVP of 1 mmHg (normal 2-8 mmHg) and a low MAP indicate significant
hypovolemia. The priority intervention is to restore intravascular volume before
considering vasopressors or inotropes. Initial fluid resuscitation with crystalloids is the
standard of care to improve preload and cardiac output.
, 5. A trauma patient arrives in the Emergency Department after a motor vehicle accident.
According to the ATLS Primary Survey, what is the nurse’s priority action after ensuring a
patent airway with stabilization of the cervical spine?
A. Check for peripheral pulses
B. Assess Glasgow Coma Scale
C. Remove all clothing to inspect for injuries
D. Assess breathing and ventilation
Answer: D
Rationale: The Primary Survey follows the ABCDE sequence: Airway, Breathing,
Circulation, Disability, and Exposure. Once the airway is secured and the C-spine is
protected, the nurse must immediately assess breathing to identify life-threatening
conditions like tension pneumothorax. Circulation is assessed only after breathing is
confirmed to be adequate or has been addressed.
6. Which laboratory result is the most specific indicator that a patient is transitioning from
sepsis to Disseminated Intravascular Coagulation (DIC)?
A. Decreased white blood cell count
B. Elevated Fibrin Degradation Products (FDPs)
C. Increased Hemoglobin
D. Decreased Prothrombin Time (PT)
