GALEN NUR 242 MED SURG EXAM 3
ADVANCED PRACTICE QUESTIONS
AND ANSWERS
1. A patient in the ICU develops a sudden onset of chest pain and dyspnea. The ABG shows pH
7.32, PaCO2 48, HCO3 24, and PaO2 55. What is the priority nursing intervention?
A. Administer a bolus of intravenous fluids
B. Administer sodium bicarbonate intravenously
C. Place the patient in the Trendelenburg position
D. Increase the oxygen flow rate and prepare for intubation
Answer: D
Conceptual Explanation: The ABG indicates respiratory acidosis with severe hypoxemia,
suggesting potential respiratory failure or a large pulmonary embolism. Priority is
oxygenation and airway management.
2. Which assessment finding is most indicative of the ‘Cold’ or late stage of septic shock?
A. Hyperthermia and flushed skin
B. Bounding pulses and tachycardia
,C. Hypothermia and mottled, cool extremities
D. Increased urinary output
Answer: C
Conceptual Explanation: In late (hypodynamic) septic shock, cardiac output drops,
leading to vasoconstriction, cool/mottled skin, and hypothermia.
3. A client with full-thickness burns to 40% of the body is in the emergent phase. Which
laboratory result should the nurse expect?
A. Hypernatremia
B. Hyperkalemia
C. Decreased hematocrit
D. Hypokalemia
Answer: B
Conceptual Explanation: Massive cell destruction in the emergent phase of burns releases
potassium into the extracellular fluid, resulting in hyperkalemia.
4. Using the Parkland formula, calculate the total fluid volume needed in the first 24 hours for
a 70 kg patient with 50% TBSA burns.
A. 14,000 mL
B. 7,000 mL
C. 28,000 mL
, D. 10,500 mL
Answer: A
Conceptual Explanation: Parkland formula: 4mL x kg x %TBSA. 4 x 70 x 50 = 14,000 mL.
5. A patient’s EKG shows a sawtooth pattern with a rapid atrial rate of 300 bpm and a
ventricular rate of 75 bpm. This rhythm is identified as:
A. Atrial Fibrillation
B. Ventricular Tachycardia
C. Premature Atrial Contractions
D. Atrial Flutter
Answer: D
Conceptual Explanation: Atrial flutter is characterized by a ‘sawtooth’ P-wave pattern and
a regular or irregular block.
6. A nurse is caring for a patient with a spinal cord injury at T3. The patient reports a
pounding headache and has a BP of 190/100. What is the first action?
A. Administer hydralazine IV
B. Lower the head of the bed to a flat position
C. Check the patient’s bladder for distension
D. Assess for a fecal impaction
ADVANCED PRACTICE QUESTIONS
AND ANSWERS
1. A patient in the ICU develops a sudden onset of chest pain and dyspnea. The ABG shows pH
7.32, PaCO2 48, HCO3 24, and PaO2 55. What is the priority nursing intervention?
A. Administer a bolus of intravenous fluids
B. Administer sodium bicarbonate intravenously
C. Place the patient in the Trendelenburg position
D. Increase the oxygen flow rate and prepare for intubation
Answer: D
Conceptual Explanation: The ABG indicates respiratory acidosis with severe hypoxemia,
suggesting potential respiratory failure or a large pulmonary embolism. Priority is
oxygenation and airway management.
2. Which assessment finding is most indicative of the ‘Cold’ or late stage of septic shock?
A. Hyperthermia and flushed skin
B. Bounding pulses and tachycardia
,C. Hypothermia and mottled, cool extremities
D. Increased urinary output
Answer: C
Conceptual Explanation: In late (hypodynamic) septic shock, cardiac output drops,
leading to vasoconstriction, cool/mottled skin, and hypothermia.
3. A client with full-thickness burns to 40% of the body is in the emergent phase. Which
laboratory result should the nurse expect?
A. Hypernatremia
B. Hyperkalemia
C. Decreased hematocrit
D. Hypokalemia
Answer: B
Conceptual Explanation: Massive cell destruction in the emergent phase of burns releases
potassium into the extracellular fluid, resulting in hyperkalemia.
4. Using the Parkland formula, calculate the total fluid volume needed in the first 24 hours for
a 70 kg patient with 50% TBSA burns.
A. 14,000 mL
B. 7,000 mL
C. 28,000 mL
, D. 10,500 mL
Answer: A
Conceptual Explanation: Parkland formula: 4mL x kg x %TBSA. 4 x 70 x 50 = 14,000 mL.
5. A patient’s EKG shows a sawtooth pattern with a rapid atrial rate of 300 bpm and a
ventricular rate of 75 bpm. This rhythm is identified as:
A. Atrial Fibrillation
B. Ventricular Tachycardia
C. Premature Atrial Contractions
D. Atrial Flutter
Answer: D
Conceptual Explanation: Atrial flutter is characterized by a ‘sawtooth’ P-wave pattern and
a regular or irregular block.
6. A nurse is caring for a patient with a spinal cord injury at T3. The patient reports a
pounding headache and has a BP of 190/100. What is the first action?
A. Administer hydralazine IV
B. Lower the head of the bed to a flat position
C. Check the patient’s bladder for distension
D. Assess for a fecal impaction
