NUR 265 Final Exam V2 | NUR 265 Advanced
Concepts of Medical–Surgical Nursing | Actual Q&A
with Rationale (NUR 265 Final Exam) | Galen
1. A 58-year-old male patient is admitted to the ICU with acute respiratory distress syndrome
(ARDS). His current ventilator settings are FiO2 80%, PEEP 12 cm H2O, and Tidal Volume 450
mL. The latest ABG shows a PaO2 of 56 mmHg. What is the calculated P/F ratio for this
patient?
A. 70
B. 214
C. 112
D. 44
Correct Answer: A
Explanation: The P/F ratio is calculated by dividing the PaO2 (56) by the FiO2 expressed
as a decimal (0.80), which equals 70. A P/F ratio below 100 indicates severe ARDS
according to the Berlin Definition. This clinical finding necessitates immediate
collaboration with the medical team to consider rescue strategies such as prone positioning
or neuromuscular blockade.
,2. Mrs. Gable is being treated for septic shock in the Intensive Care Unit. Despite receiving 30
mL/kg of isotonic crystalloids, her mean arterial pressure (MAP) remains at 58 mmHg and her
serum lactate is 4.2 mmol/L. Which medication should the nurse anticipate administering
next?
A. Norepinephrine
B. Dobutamine
C. Nitroglycerin
D. Atropine
Correct Answer: A
Explanation: Norepinephrine is the first-line vasopressor recommended by the Surviving
Sepsis Campaign for patients who remain hypotensive after adequate fluid resuscitation.
The goal is to maintain a MAP of at least 65 mmHg to ensure adequate organ perfusion. The
nurse must monitor the infusion site closely for extravasation and assess peripheral
perfusion regularly.
3. A patient with a T6 spinal cord injury reports a sudden, throbbing headache and nasal
congestion. The nurse notes the patient is flushed above the level of the injury and has a
blood pressure of 210/108 mmHg. What is the priority nursing action?
A. Administer a PRN dose of hydralazine
B. Perform a digital rectal exam to check for impaction
C. Place the patient in a high-Fowler’s position
,D. Catheterize the patient to empty the bladder
Correct Answer: C
Explanation: The patient is exhibiting classic signs of autonomic dysreflexia, a medical
emergency in spinal cord injury patients. Elevating the head of the bed to a high-Fowler’s
position is the immediate priority to help lower blood pressure through orthostatic
changes. After positioning, the nurse should then identify and eliminate the triggering
stimulus, such as a distended bladder or impacted bowel.
4. Mr. Henderson is admitted with Diabetic Ketoacidosis (DKA). His initial laboratory results
show a blood glucose of 550 mg/dL, an arterial pH of 7.15, and a serum potassium level of 3.3
mEq/L. Which action should the nurse take first?
A. Start a continuous intravenous insulin infusion at 0.1 units/kg/hr
B. Administer a bolus of 10 units of regular insulin intravenously
C. Initiate potassium replacement therapy as prescribed
D. Administer 50 mEq of sodium bicarbonate intravenously
Correct Answer: C
Explanation: In DKA management, potassium must be replaced before starting insulin if
the serum potassium level is below 3.3 mEq/L. Starting insulin will drive potassium into
the cells, potentially causing life-threatening hypokalemia. The nurse must ensure
adequate renal function before potassium administration and monitor cardiac rhythm
continuously.
, 5. An 80-kg patient is admitted to the burn unit with second- and third-degree burns covering
40% of the total body surface area (TBSA). Using the Parkland formula, calculate the total
volume of fluid resuscitation required in the first 24 hours.
A. 12,800 mL
B. 6,400 mL
C. 3,200 mL
D. 16,000 mL
Correct Answer: A
Explanation: The Parkland formula calculates fluid requirements as 4 mL x weight in kg x
% TBSA burned. For this patient, the calculation is 4 mL x 80 kg x 40 = 12,800 mL. Half of
this total volume (6,400 mL) must be administered within the first 8 hours post-injury.
6. A patient with a traumatic brain injury (TBI) has an intracranial pressure (ICP) of 24 mmHg.
The nurse is preparing to administer Mannitol 20%. Which assessment finding would indicate
the medication is effective?
A. Presence of Babinski reflex
B. Decreased heart rate and increased blood pressure
C. Stabilization of the Glasgow Coma Scale score
D. Increased urine output and decreased ICP
Correct Answer: D
Concepts of Medical–Surgical Nursing | Actual Q&A
with Rationale (NUR 265 Final Exam) | Galen
1. A 58-year-old male patient is admitted to the ICU with acute respiratory distress syndrome
(ARDS). His current ventilator settings are FiO2 80%, PEEP 12 cm H2O, and Tidal Volume 450
mL. The latest ABG shows a PaO2 of 56 mmHg. What is the calculated P/F ratio for this
patient?
A. 70
B. 214
C. 112
D. 44
Correct Answer: A
Explanation: The P/F ratio is calculated by dividing the PaO2 (56) by the FiO2 expressed
as a decimal (0.80), which equals 70. A P/F ratio below 100 indicates severe ARDS
according to the Berlin Definition. This clinical finding necessitates immediate
collaboration with the medical team to consider rescue strategies such as prone positioning
or neuromuscular blockade.
,2. Mrs. Gable is being treated for septic shock in the Intensive Care Unit. Despite receiving 30
mL/kg of isotonic crystalloids, her mean arterial pressure (MAP) remains at 58 mmHg and her
serum lactate is 4.2 mmol/L. Which medication should the nurse anticipate administering
next?
A. Norepinephrine
B. Dobutamine
C. Nitroglycerin
D. Atropine
Correct Answer: A
Explanation: Norepinephrine is the first-line vasopressor recommended by the Surviving
Sepsis Campaign for patients who remain hypotensive after adequate fluid resuscitation.
The goal is to maintain a MAP of at least 65 mmHg to ensure adequate organ perfusion. The
nurse must monitor the infusion site closely for extravasation and assess peripheral
perfusion regularly.
3. A patient with a T6 spinal cord injury reports a sudden, throbbing headache and nasal
congestion. The nurse notes the patient is flushed above the level of the injury and has a
blood pressure of 210/108 mmHg. What is the priority nursing action?
A. Administer a PRN dose of hydralazine
B. Perform a digital rectal exam to check for impaction
C. Place the patient in a high-Fowler’s position
,D. Catheterize the patient to empty the bladder
Correct Answer: C
Explanation: The patient is exhibiting classic signs of autonomic dysreflexia, a medical
emergency in spinal cord injury patients. Elevating the head of the bed to a high-Fowler’s
position is the immediate priority to help lower blood pressure through orthostatic
changes. After positioning, the nurse should then identify and eliminate the triggering
stimulus, such as a distended bladder or impacted bowel.
4. Mr. Henderson is admitted with Diabetic Ketoacidosis (DKA). His initial laboratory results
show a blood glucose of 550 mg/dL, an arterial pH of 7.15, and a serum potassium level of 3.3
mEq/L. Which action should the nurse take first?
A. Start a continuous intravenous insulin infusion at 0.1 units/kg/hr
B. Administer a bolus of 10 units of regular insulin intravenously
C. Initiate potassium replacement therapy as prescribed
D. Administer 50 mEq of sodium bicarbonate intravenously
Correct Answer: C
Explanation: In DKA management, potassium must be replaced before starting insulin if
the serum potassium level is below 3.3 mEq/L. Starting insulin will drive potassium into
the cells, potentially causing life-threatening hypokalemia. The nurse must ensure
adequate renal function before potassium administration and monitor cardiac rhythm
continuously.
, 5. An 80-kg patient is admitted to the burn unit with second- and third-degree burns covering
40% of the total body surface area (TBSA). Using the Parkland formula, calculate the total
volume of fluid resuscitation required in the first 24 hours.
A. 12,800 mL
B. 6,400 mL
C. 3,200 mL
D. 16,000 mL
Correct Answer: A
Explanation: The Parkland formula calculates fluid requirements as 4 mL x weight in kg x
% TBSA burned. For this patient, the calculation is 4 mL x 80 kg x 40 = 12,800 mL. Half of
this total volume (6,400 mL) must be administered within the first 8 hours post-injury.
6. A patient with a traumatic brain injury (TBI) has an intracranial pressure (ICP) of 24 mmHg.
The nurse is preparing to administer Mannitol 20%. Which assessment finding would indicate
the medication is effective?
A. Presence of Babinski reflex
B. Decreased heart rate and increased blood pressure
C. Stabilization of the Glasgow Coma Scale score
D. Increased urine output and decreased ICP
Correct Answer: D
