Advanced Medical-Surgical Nursing Practice Exam 3
UPDATED ACTUAL Questions and CORRECT Answers
1. A patient with a 40% total body surface area (TBSA) burn is in the emergent
phase. Using the Parkland formula (4mL/kg/%TBSA), if the patient weighs 70kg,
how much fluid should be administered in the first 8 hours?
A. 5,600 mL
B. 2,800 mL
C. 11,200 mL
D. 4,200 mL
Answer: A
Rationale: Total fluid = 4mL x 70kg x 40 = 11,200 mL. Half of this (5,600 mL) is given in
the first 8 hours, and the remaining half over the next 16 hours.
2. A nurse is assessing a patient with a head injury and notes a widening pulse
pressure, bradycardia, and irregular respirations. What does this clinical triad
indicate?
A. Virchow’s Triad
B. Cushing’s Triad
C. Beck’s Triad
D. Whipple’s Triad
Answer: B
Rationale: Cushing’s Triad (widening pulse pressure, bradycardia, and irregular
respirations) is a late sign of increased intracranial pressure (ICP).
,3. Which arterial blood gas (ABG) result is most consistent with a patient in
early Diabetic Ketoacidosis (DKA)?
A. pH 7.48, PaCO2 32, HCO3 22
B. pH 7.30, PaCO2 30, HCO3 18
C. pH 7.32, PaCO2 48, HCO3 26
D. pH 7.50, PaCO2 40, HCO3 30
Answer: B
Rationale: DKA causes metabolic acidosis. Option A shows a low pH and low bicarbonate,
with partial compensation (low PaCO2).
4. A patient with Acute Respiratory Distress Syndrome (ARDS) is placed on
mechanical ventilation with High Positive End-Expiratory Pressure (PEEP). What
is the primary purpose of PEEP in ARDS?
A. To prevent alveolar collapse and improve oxygenation
B. To increase tidal volume
C. To decrease the work of breathing
D. To decrease the risk of barotrauma
Answer: A
Rationale: PEEP maintains pressure in the airways at the end of expiration to keep alveoli
open, improving gas exchange in ARDS.
5. Which laboratory value is the most sensitive indicator of acute kidney injury
(AKI) in a critically ill patient?
A. Blood Urea Nitrogen (BUN)
B. Glomerular Filtration Rate (GFR)
C. Serum Creatinine
D. Urine Specific Gravity
Answer: B
, Rationale: While creatinine is commonly used, GFR (calculated or measured) is the best
overall indicator of kidney function and injury stage.
6. The nurse is caring for a patient in the ICU with a diagnosis of Septic Shock.
Which hemodynamic finding is expected during the early (hyperdynamic)
phase?
A. Decreased Cardiac Output
B. Increased Systemic Vascular Resistance (SVR)
C. Increased Cardiac Output
D. Bradycardia
Answer: C
Rationale: Early septic shock is characterized by ‘warm’ shock, where cardiac output is
increased and SVR is decreased due to vasodilation.
7. A patient is admitted with a Glasgow Coma Scale (GCS) score of 7. How
should the nurse interpret this score?
A. Mild brain injury
B. Moderate brain injury
C. Severe brain injury
D. Brain death
Answer: C
Rationale: A GCS score of 8 or less is generally indicative of a severe brain injury and
usually requires intubation.
UPDATED ACTUAL Questions and CORRECT Answers
1. A patient with a 40% total body surface area (TBSA) burn is in the emergent
phase. Using the Parkland formula (4mL/kg/%TBSA), if the patient weighs 70kg,
how much fluid should be administered in the first 8 hours?
A. 5,600 mL
B. 2,800 mL
C. 11,200 mL
D. 4,200 mL
Answer: A
Rationale: Total fluid = 4mL x 70kg x 40 = 11,200 mL. Half of this (5,600 mL) is given in
the first 8 hours, and the remaining half over the next 16 hours.
2. A nurse is assessing a patient with a head injury and notes a widening pulse
pressure, bradycardia, and irregular respirations. What does this clinical triad
indicate?
A. Virchow’s Triad
B. Cushing’s Triad
C. Beck’s Triad
D. Whipple’s Triad
Answer: B
Rationale: Cushing’s Triad (widening pulse pressure, bradycardia, and irregular
respirations) is a late sign of increased intracranial pressure (ICP).
,3. Which arterial blood gas (ABG) result is most consistent with a patient in
early Diabetic Ketoacidosis (DKA)?
A. pH 7.48, PaCO2 32, HCO3 22
B. pH 7.30, PaCO2 30, HCO3 18
C. pH 7.32, PaCO2 48, HCO3 26
D. pH 7.50, PaCO2 40, HCO3 30
Answer: B
Rationale: DKA causes metabolic acidosis. Option A shows a low pH and low bicarbonate,
with partial compensation (low PaCO2).
4. A patient with Acute Respiratory Distress Syndrome (ARDS) is placed on
mechanical ventilation with High Positive End-Expiratory Pressure (PEEP). What
is the primary purpose of PEEP in ARDS?
A. To prevent alveolar collapse and improve oxygenation
B. To increase tidal volume
C. To decrease the work of breathing
D. To decrease the risk of barotrauma
Answer: A
Rationale: PEEP maintains pressure in the airways at the end of expiration to keep alveoli
open, improving gas exchange in ARDS.
5. Which laboratory value is the most sensitive indicator of acute kidney injury
(AKI) in a critically ill patient?
A. Blood Urea Nitrogen (BUN)
B. Glomerular Filtration Rate (GFR)
C. Serum Creatinine
D. Urine Specific Gravity
Answer: B
, Rationale: While creatinine is commonly used, GFR (calculated or measured) is the best
overall indicator of kidney function and injury stage.
6. The nurse is caring for a patient in the ICU with a diagnosis of Septic Shock.
Which hemodynamic finding is expected during the early (hyperdynamic)
phase?
A. Decreased Cardiac Output
B. Increased Systemic Vascular Resistance (SVR)
C. Increased Cardiac Output
D. Bradycardia
Answer: C
Rationale: Early septic shock is characterized by ‘warm’ shock, where cardiac output is
increased and SVR is decreased due to vasodilation.
7. A patient is admitted with a Glasgow Coma Scale (GCS) score of 7. How
should the nurse interpret this score?
A. Mild brain injury
B. Moderate brain injury
C. Severe brain injury
D. Brain death
Answer: C
Rationale: A GCS score of 8 or less is generally indicative of a severe brain injury and
usually requires intubation.
