NR341/NR 341 Exam 4 V2 | Complex Adult Health
Q&A with Rationale | Chamberlain University
1. A patient with 45% TBSA burns weighs 80 kg. Using the Parkland formula, calculate the
total volume of Lactated Ringer’s solution required in the first 24 hours.
A. 7,200 mL
B. 14,400 mL
C. 28,800 mL
D. 10,800 mL
Correct Answer: B
Explanation: The Parkland formula is calculated as 4 mL x weight (kg) x % TBSA. For this
patient, the calculation is 4 x 80 x 45, which equals 14,400 mL. This total volume is then
divided, with half given in the first 8 hours and the remainder over the next 16 hours.
2. During the resuscitative phase of burn injury, which electrolyte abnormality is the nurse
most likely to observe?
A. Hypokalemia
B. Hypernatremia
C. Hyperkalemia
D. Hypocalcemia
,Correct Answer: C
Explanation: Hyperkalemia occurs during the initial burn phase due to massive cellular
destruction and the release of potassium into the extracellular space. This electrolyte shift
requires careful monitoring of the patient’s EKG for peaked T-waves. As the patient enters
the diuresis phase, potassium levels may drop, requiring a change in the plan of care.
3. A patient arrives at the emergency department with suspected carbon monoxide poisoning
after a house fire. Which diagnostic finding is most indicative of this condition?
A. SpO2 of 98% on room air
B. PaO2 of 90 mmHg on ABG
C. Respiratory rate of 24 breaths/minute
D. Carboxyhemoglobin level of 15%
Correct Answer: D
Explanation: Carboxyhemoglobin levels above 10% are diagnostic of carbon monoxide
poisoning. Pulse oximetry is unreliable in these cases because the sensor cannot
distinguish between oxyhemoglobin and carboxyhemoglobin. Treatment typically involves
the administration of 100% high-flow oxygen to displace the carbon monoxide from
hemoglobin.
4. Which clinical finding suggests that a patient with a spinal cord injury at the T6 level is
experiencing autonomic dysreflexia?
A. Bradycardia and severe hypertension
, B. Hypotension and tachycardia
C. Flaccid paralysis below the level of injury
D. Lower extremity diaphoresis
Correct Answer: A
Explanation: Autonomic dysreflexia is a medical emergency characterized by a sudden
rise in blood pressure and compensatory bradycardia. It is typically triggered by a noxious
stimulus such as a distended bladder or fecal impaction. The nurse must immediately
elevate the head of the bed to 90 degrees and identify the source of the stimulus.
5. A patient in septic shock has been receiving large volumes of crystalloids. Which
hemodynamic parameter would indicate to the nurse that fluid resuscitation has been
successful?
A. Urine output of 20 mL/hour
B. Mean Arterial Pressure (MAP) of 55 mmHg
C. Heart rate of 110 beats/minute
D. Central Venous Pressure (CVP) of 10 mmHg
Correct Answer: D
Explanation: A CVP of 8-12 mmHg is often targeted in the management of sepsis to ensure
adequate preload. Successful resuscitation is also evidenced by a MAP of at least 65 mmHg
Q&A with Rationale | Chamberlain University
1. A patient with 45% TBSA burns weighs 80 kg. Using the Parkland formula, calculate the
total volume of Lactated Ringer’s solution required in the first 24 hours.
A. 7,200 mL
B. 14,400 mL
C. 28,800 mL
D. 10,800 mL
Correct Answer: B
Explanation: The Parkland formula is calculated as 4 mL x weight (kg) x % TBSA. For this
patient, the calculation is 4 x 80 x 45, which equals 14,400 mL. This total volume is then
divided, with half given in the first 8 hours and the remainder over the next 16 hours.
2. During the resuscitative phase of burn injury, which electrolyte abnormality is the nurse
most likely to observe?
A. Hypokalemia
B. Hypernatremia
C. Hyperkalemia
D. Hypocalcemia
,Correct Answer: C
Explanation: Hyperkalemia occurs during the initial burn phase due to massive cellular
destruction and the release of potassium into the extracellular space. This electrolyte shift
requires careful monitoring of the patient’s EKG for peaked T-waves. As the patient enters
the diuresis phase, potassium levels may drop, requiring a change in the plan of care.
3. A patient arrives at the emergency department with suspected carbon monoxide poisoning
after a house fire. Which diagnostic finding is most indicative of this condition?
A. SpO2 of 98% on room air
B. PaO2 of 90 mmHg on ABG
C. Respiratory rate of 24 breaths/minute
D. Carboxyhemoglobin level of 15%
Correct Answer: D
Explanation: Carboxyhemoglobin levels above 10% are diagnostic of carbon monoxide
poisoning. Pulse oximetry is unreliable in these cases because the sensor cannot
distinguish between oxyhemoglobin and carboxyhemoglobin. Treatment typically involves
the administration of 100% high-flow oxygen to displace the carbon monoxide from
hemoglobin.
4. Which clinical finding suggests that a patient with a spinal cord injury at the T6 level is
experiencing autonomic dysreflexia?
A. Bradycardia and severe hypertension
, B. Hypotension and tachycardia
C. Flaccid paralysis below the level of injury
D. Lower extremity diaphoresis
Correct Answer: A
Explanation: Autonomic dysreflexia is a medical emergency characterized by a sudden
rise in blood pressure and compensatory bradycardia. It is typically triggered by a noxious
stimulus such as a distended bladder or fecal impaction. The nurse must immediately
elevate the head of the bed to 90 degrees and identify the source of the stimulus.
5. A patient in septic shock has been receiving large volumes of crystalloids. Which
hemodynamic parameter would indicate to the nurse that fluid resuscitation has been
successful?
A. Urine output of 20 mL/hour
B. Mean Arterial Pressure (MAP) of 55 mmHg
C. Heart rate of 110 beats/minute
D. Central Venous Pressure (CVP) of 10 mmHg
Correct Answer: D
Explanation: A CVP of 8-12 mmHg is often targeted in the management of sepsis to ensure
adequate preload. Successful resuscitation is also evidenced by a MAP of at least 65 mmHg
