Advanced Medical-Surgical Nursing Exam 6 Practice
Questions 2026 UPDATED ACTUAL Questions and
CORRECT Answers
1. A patient in the early stages of septic shock exhibits which of the following
hemodynamic profiles?
A. Decreased cardiac output and increased systemic vascular resistance
B. Increased cardiac output and decreased systemic vascular resistance
C. Decreased central venous pressure and increased heart rate
D. Increased pulmonary artery wedge pressure and bradycardia
Answer: B
Rationale: Early or ‘warm’ septic shock is characterized by a hyperdynamic state with
increased cardiac output and decreased systemic vascular resistance (vasodilation).
2. Which assessment finding is part of Cushing’s Triad, indicating increased
intracranial pressure?
A. Tachycardia, hypotension, and tachypnea
B. Tachycardia, hypertension, and Cheyne-Stokes respirations
C. Bradycardia, hypotension, and shallow respirations
D. Bradycardia, hypertension with a widening pulse pressure, and irregular respirations
Answer: D
Rationale: Cushing’s triad consists of bradycardia, hypertension (specifically widening
pulse pressure), and irregular or slowed respirations, signifying late-stage brainstem
compression.
,3. Using the Parkland Formula, calculate the total fluid resuscitation needed in
the first 24 hours for a 70 kg patient with 40% TBSA burns.
A. 5,600 mL
B. 8,400 mL
C. 2,800 mL
D. 11,200 mL
Answer: D
Rationale: Parkland Formula: 4 mL x kg x %TBSA. Here, 4 x 70 x 40 = 11,200 mL.
4. A patient with a high-level spinal cord injury (T2) experiences sudden
hypertension, a pounding headache, and flushing above the level of injury.
What is the priority nursing action?
A. Administer an antihypertensive medication immediately
B. Assess for bladder distention or fecal impaction
C. Lower the head of the bed to the flat position
D. Notify the physician to order a STAT head CT
Answer: B
Rationale: These are classic signs of autonomic dysreflexia. The priority is to identify and
remove the triggering stimulus, most commonly a full bladder or bowel.
5. Which arterial blood gas (ABG) result is consistent with a patient in Diabetic
Ketoacidosis (DKA)?
A. pH 7.25, PaCO2 40, HCO3 16
B. pH 7.48, PaCO2 30, HCO3 22
C. pH 7.32, PaCO2 55, HCO3 28
D. pH 7.50, PaCO2 45, HCO3 34
Answer: A
Rationale: DKA causes metabolic acidosis. A pH < 7.35 and HCO3 < 22 with a low or
normal CO2 (depending on compensation) fits this profile.
, 6. A patient is being treated for Syndrome of Inappropriate Antidiuretic
Hormone (SIADH). Which laboratory value should the nurse expect?
A. Serum osmolality 310 mOsm/kg
B. Serum sodium 128 mEq/L
C. Urine specific gravity 1.002
D. Hematocrit 55%
Answer: B
Rationale: SIADH causes excessive water retention, leading to dilutional hyponatremia
(sodium < 135 mEq/L).
7. During the emergent phase of a burn injury, which electrolyte imbalance is
most commonly observed?
A. Hypokalemia
B. Hypercalcemia
C. Hyperkalemia
D. Hypomagnesemia
Answer: C
Rationale: In the emergent phase, cell destruction releases potassium into the
extracellular fluid, resulting in hyperkalemia.
8. A nurse is caring for a patient on a mechanical ventilator. The high-pressure
alarm sounds. Which of the following could be the cause?
A. A leak in the endotracheal tube cuff
B. Excessive secretions in the airway
C. The patient has disconnected from the ventilator
D. A spontaneous pneumothorax has resolved
Answer: B
Rationale: High-pressure alarms are triggered by increased resistance, such as secretions,
biting the tube, kinks, or decreased lung compliance.
Questions 2026 UPDATED ACTUAL Questions and
CORRECT Answers
1. A patient in the early stages of septic shock exhibits which of the following
hemodynamic profiles?
A. Decreased cardiac output and increased systemic vascular resistance
B. Increased cardiac output and decreased systemic vascular resistance
C. Decreased central venous pressure and increased heart rate
D. Increased pulmonary artery wedge pressure and bradycardia
Answer: B
Rationale: Early or ‘warm’ septic shock is characterized by a hyperdynamic state with
increased cardiac output and decreased systemic vascular resistance (vasodilation).
2. Which assessment finding is part of Cushing’s Triad, indicating increased
intracranial pressure?
A. Tachycardia, hypotension, and tachypnea
B. Tachycardia, hypertension, and Cheyne-Stokes respirations
C. Bradycardia, hypotension, and shallow respirations
D. Bradycardia, hypertension with a widening pulse pressure, and irregular respirations
Answer: D
Rationale: Cushing’s triad consists of bradycardia, hypertension (specifically widening
pulse pressure), and irregular or slowed respirations, signifying late-stage brainstem
compression.
,3. Using the Parkland Formula, calculate the total fluid resuscitation needed in
the first 24 hours for a 70 kg patient with 40% TBSA burns.
A. 5,600 mL
B. 8,400 mL
C. 2,800 mL
D. 11,200 mL
Answer: D
Rationale: Parkland Formula: 4 mL x kg x %TBSA. Here, 4 x 70 x 40 = 11,200 mL.
4. A patient with a high-level spinal cord injury (T2) experiences sudden
hypertension, a pounding headache, and flushing above the level of injury.
What is the priority nursing action?
A. Administer an antihypertensive medication immediately
B. Assess for bladder distention or fecal impaction
C. Lower the head of the bed to the flat position
D. Notify the physician to order a STAT head CT
Answer: B
Rationale: These are classic signs of autonomic dysreflexia. The priority is to identify and
remove the triggering stimulus, most commonly a full bladder or bowel.
5. Which arterial blood gas (ABG) result is consistent with a patient in Diabetic
Ketoacidosis (DKA)?
A. pH 7.25, PaCO2 40, HCO3 16
B. pH 7.48, PaCO2 30, HCO3 22
C. pH 7.32, PaCO2 55, HCO3 28
D. pH 7.50, PaCO2 45, HCO3 34
Answer: A
Rationale: DKA causes metabolic acidosis. A pH < 7.35 and HCO3 < 22 with a low or
normal CO2 (depending on compensation) fits this profile.
, 6. A patient is being treated for Syndrome of Inappropriate Antidiuretic
Hormone (SIADH). Which laboratory value should the nurse expect?
A. Serum osmolality 310 mOsm/kg
B. Serum sodium 128 mEq/L
C. Urine specific gravity 1.002
D. Hematocrit 55%
Answer: B
Rationale: SIADH causes excessive water retention, leading to dilutional hyponatremia
(sodium < 135 mEq/L).
7. During the emergent phase of a burn injury, which electrolyte imbalance is
most commonly observed?
A. Hypokalemia
B. Hypercalcemia
C. Hyperkalemia
D. Hypomagnesemia
Answer: C
Rationale: In the emergent phase, cell destruction releases potassium into the
extracellular fluid, resulting in hyperkalemia.
8. A nurse is caring for a patient on a mechanical ventilator. The high-pressure
alarm sounds. Which of the following could be the cause?
A. A leak in the endotracheal tube cuff
B. Excessive secretions in the airway
C. The patient has disconnected from the ventilator
D. A spontaneous pneumothorax has resolved
Answer: B
Rationale: High-pressure alarms are triggered by increased resistance, such as secretions,
biting the tube, kinks, or decreased lung compliance.
