NUR 265 Exam 3 V2 | NUR 265 Advanced Concepts
of Medical–Surgical Nursing | Actual Q&A with
Rationale (NUR 265 Exam 3) | Galen
1. Mr. Harrison, a 68-year-old patient with a history of heart failure, is admitted to the ICU
with suspected septic shock. His vital signs are: BP 82/44 mmHg, HR 122 bpm, RR 28 bpm, and
Temp 102.2°F. After 2 liters of normal saline, his MAP remains 58 mmHg. Which medication
should the nurse prepare to administer next?
A. Dobutamine infusion
B. Atropine IV push
C. Nitroprusside infusion
D. Norepinephrine infusion
Correct Answer: D
Explanation: Norepinephrine is the first-line vasopressor for septic shock that is
refractory to fluid resuscitation to maintain a MAP of at least 65 mmHg. Dobutamine is
typically reserved for cardiogenic shock or septic shock with low cardiac output despite
adequate MAP. Nitroprusside would worsen hypotension, and Atropine is indicated for
symptomatic bradycardia, not tachycardia associated with shock.
,2. A 45-year-old female, Ms. Rodriguez, was rescued from a house fire and has sustained
partial-thickness burns to her chest, abdomen, and both anterior arms. Using the Rule of
Nines, what is the estimated total body surface area (TBSA) affected?
A. 27%
B. 18%
C. 36%
D. 45%
Correct Answer: A
Explanation: According to the Rule of Nines, the anterior trunk (chest and abdomen)
accounts for 18%. Each entire arm is 9%, so the anterior portion of both arms equals 9%
total (4.5% + 4.5%). Adding 18% and 9% results in a total of 27% TBSA. Accurate TBSA
calculation is critical for determining fluid resuscitation needs using the Parkland formula.
3. Mr. Thompson is being treated for Acute Respiratory Distress Syndrome (ARDS) and is
currently on mechanical ventilation with a PEEP of 15 cm H2O. The nurse notes a sudden drop
in blood pressure and absent breath sounds on the right side. What is the nurse’s priority
action?
A. Increase the FiO2 to 100%
B. Suction the endotracheal tube
C. Obtain a stat arterial blood gas (ABG)
D. Prepare for immediate needle decompression
,Correct Answer: D
Explanation: High levels of PEEP increase the risk of barotrauma, which can lead to a
tension pneumothorax. A sudden drop in BP combined with absent unilateral breath
sounds is a classic sign of this life-threatening complication. Immediate needle
decompression followed by chest tube insertion is necessary to relieve the pressure and re-
expand the lung.
4. Ms. Jenkins is in the ICU with Multiple Organ Dysfunction Syndrome (MODS). Which
laboratory finding most strongly suggests that the patient is progressing to the hematologic
stage of MODS?
A. Increased Serum Creatinine
B. Decreased Platelet count and increased D-dimer
C. Elevated Alanine Aminotransferase (ALT)
D. Decreased Serum Albumin
Correct Answer: B
Explanation: Disseminated Intravascular Coagulation (DIC) is a common manifestation of
hematologic failure in MODS. Laboratory indicators include low platelets, low fibrinogen,
and elevated D-dimer or fibrin degradation products. While other labs reflect renal or
hepatic dysfunction, the coagulation profile specifically identifies hematologic involvement.
, 5. A 55-year-old male, Mr. Lee, is admitted with severe acute pancreatitis and is at risk for
Acute Kidney Injury (AKI). The nurse notes a urine output of 200 mL over the last 12 hours.
Which phase of AKI is this patient most likely entering?
A. Onset Phase
B. Recovery Phase
C. Diuretic Phase
D. Oliguric Phase
Correct Answer: D
Explanation: The oliguric phase is characterized by a urine output of less than 400 mL per
day. Mr. Lee’s output of 200 mL in 12 hours suggests a 24-hour total near 400 mL,
indicating significant renal impairment. This phase is also associated with metabolic
acidosis and electrolyte imbalances such as hyperkalemia.
6. A patient with 40% TBSA burns is in the emergent phase of care. He weighs 80 kg. Using the
Parkland formula (4 mL/kg/%TBSA), how much Lactated Ringer’s should be infused during the
first 8 hours post-injury?
A. 3,200 mL
B. 1,600 mL
C. 12,800 mL
D. 6,400 mL
of Medical–Surgical Nursing | Actual Q&A with
Rationale (NUR 265 Exam 3) | Galen
1. Mr. Harrison, a 68-year-old patient with a history of heart failure, is admitted to the ICU
with suspected septic shock. His vital signs are: BP 82/44 mmHg, HR 122 bpm, RR 28 bpm, and
Temp 102.2°F. After 2 liters of normal saline, his MAP remains 58 mmHg. Which medication
should the nurse prepare to administer next?
A. Dobutamine infusion
B. Atropine IV push
C. Nitroprusside infusion
D. Norepinephrine infusion
Correct Answer: D
Explanation: Norepinephrine is the first-line vasopressor for septic shock that is
refractory to fluid resuscitation to maintain a MAP of at least 65 mmHg. Dobutamine is
typically reserved for cardiogenic shock or septic shock with low cardiac output despite
adequate MAP. Nitroprusside would worsen hypotension, and Atropine is indicated for
symptomatic bradycardia, not tachycardia associated with shock.
,2. A 45-year-old female, Ms. Rodriguez, was rescued from a house fire and has sustained
partial-thickness burns to her chest, abdomen, and both anterior arms. Using the Rule of
Nines, what is the estimated total body surface area (TBSA) affected?
A. 27%
B. 18%
C. 36%
D. 45%
Correct Answer: A
Explanation: According to the Rule of Nines, the anterior trunk (chest and abdomen)
accounts for 18%. Each entire arm is 9%, so the anterior portion of both arms equals 9%
total (4.5% + 4.5%). Adding 18% and 9% results in a total of 27% TBSA. Accurate TBSA
calculation is critical for determining fluid resuscitation needs using the Parkland formula.
3. Mr. Thompson is being treated for Acute Respiratory Distress Syndrome (ARDS) and is
currently on mechanical ventilation with a PEEP of 15 cm H2O. The nurse notes a sudden drop
in blood pressure and absent breath sounds on the right side. What is the nurse’s priority
action?
A. Increase the FiO2 to 100%
B. Suction the endotracheal tube
C. Obtain a stat arterial blood gas (ABG)
D. Prepare for immediate needle decompression
,Correct Answer: D
Explanation: High levels of PEEP increase the risk of barotrauma, which can lead to a
tension pneumothorax. A sudden drop in BP combined with absent unilateral breath
sounds is a classic sign of this life-threatening complication. Immediate needle
decompression followed by chest tube insertion is necessary to relieve the pressure and re-
expand the lung.
4. Ms. Jenkins is in the ICU with Multiple Organ Dysfunction Syndrome (MODS). Which
laboratory finding most strongly suggests that the patient is progressing to the hematologic
stage of MODS?
A. Increased Serum Creatinine
B. Decreased Platelet count and increased D-dimer
C. Elevated Alanine Aminotransferase (ALT)
D. Decreased Serum Albumin
Correct Answer: B
Explanation: Disseminated Intravascular Coagulation (DIC) is a common manifestation of
hematologic failure in MODS. Laboratory indicators include low platelets, low fibrinogen,
and elevated D-dimer or fibrin degradation products. While other labs reflect renal or
hepatic dysfunction, the coagulation profile specifically identifies hematologic involvement.
, 5. A 55-year-old male, Mr. Lee, is admitted with severe acute pancreatitis and is at risk for
Acute Kidney Injury (AKI). The nurse notes a urine output of 200 mL over the last 12 hours.
Which phase of AKI is this patient most likely entering?
A. Onset Phase
B. Recovery Phase
C. Diuretic Phase
D. Oliguric Phase
Correct Answer: D
Explanation: The oliguric phase is characterized by a urine output of less than 400 mL per
day. Mr. Lee’s output of 200 mL in 12 hours suggests a 24-hour total near 400 mL,
indicating significant renal impairment. This phase is also associated with metabolic
acidosis and electrolyte imbalances such as hyperkalemia.
6. A patient with 40% TBSA burns is in the emergent phase of care. He weighs 80 kg. Using the
Parkland formula (4 mL/kg/%TBSA), how much Lactated Ringer’s should be infused during the
first 8 hours post-injury?
A. 3,200 mL
B. 1,600 mL
C. 12,800 mL
D. 6,400 mL
