NUR 265 ADVANCED MEDICAL-
SURGICAL NURSING FINAL PREP
QUESTIONS AND ANSWERS WITH
VERIFIED SOLUTIONS 2026/2027
UPDATE. JUST RELEASED
1. A patient with ARDS is being mechanically ventilated with high PEEP. The nurse notes a
sudden drop in blood pressure and absent breath sounds on the right side. What is the
priority action?
A. Increase the PEEP setting to improve oxygenation
B. Obtain a stat arterial blood gas (ABG)
C. Prepare for immediate needle thoracostomy
D. Suction the endotracheal tube for possible mucus plug
Answer: C
Conceptual Explanation: High PEEP increases the risk of tension pneumothorax. Sudden
hypotension and absent breath sounds are hallmark signs, requiring immediate
decompression.
2. Which hemodynamic profile is most consistent with early septic shock?
A. Low CVP, Low SVR, High CO
,B. High CVP, High PCWP, Low CO
C. High SVR, Low CO, High PCWP
D. Low CO, Low SVR, Low PCWP
Answer: A
Conceptual Explanation: Early (hyperdynamic) septic shock involves vasodilation (low
SVR) and compensatory increased cardiac output (CO) with low filling pressures (CVP).
3. A patient weighs 80kg and has sustained 40% TBSA burns. Using the Parkland formula
(4mL/kg/%TBSA), how much fluid should be administered in the first 8 hours?
A. 12,800 mL
B. 9,600 mL
C. 3,200 mL
D. 6,400 mL
Answer: D
Conceptual Explanation: Total fluid = 4mL x 80kg x 40 = 12,800 mL. Half is given in the
first 8 hours: 12, = 6,400 mL.
4. Which ABG result indicates partially compensated respiratory acidosis?
A. pH 7.46, PaCO2 30, HCO3 20
B. pH 7.35, PaCO2 48, HCO3 28
, C. pH 7.32, PaCO2 50, HCO3 28
D. pH 7.25, PaCO2 55, HCO3 22
Answer: C
Conceptual Explanation: Partial compensation occurs when pH is still abnormal, but the
opposite system (bicarbonate) has moved outside normal range to correct it.
5. A patient with a head injury has a widening pulse pressure, bradycardia, and irregular
respirations. What does this ‘Cushing’s Triad’ indicate?
A. Developing Hypovolemic Shock
B. Early signs of neurogenic shock
C. Autonomic Dysreflexia
D. Brainstem herniation due to increased ICP
Answer: D
Conceptual Explanation: Cushing’s Triad is a late sign of increased intracranial pressure
indicating that brainstem herniation is imminent.
6. In the management of DKA, which lab value must be checked before starting an insulin
drip?
A. Serum Glucose
B. Serum Potassium
C. Serum Sodium
SURGICAL NURSING FINAL PREP
QUESTIONS AND ANSWERS WITH
VERIFIED SOLUTIONS 2026/2027
UPDATE. JUST RELEASED
1. A patient with ARDS is being mechanically ventilated with high PEEP. The nurse notes a
sudden drop in blood pressure and absent breath sounds on the right side. What is the
priority action?
A. Increase the PEEP setting to improve oxygenation
B. Obtain a stat arterial blood gas (ABG)
C. Prepare for immediate needle thoracostomy
D. Suction the endotracheal tube for possible mucus plug
Answer: C
Conceptual Explanation: High PEEP increases the risk of tension pneumothorax. Sudden
hypotension and absent breath sounds are hallmark signs, requiring immediate
decompression.
2. Which hemodynamic profile is most consistent with early septic shock?
A. Low CVP, Low SVR, High CO
,B. High CVP, High PCWP, Low CO
C. High SVR, Low CO, High PCWP
D. Low CO, Low SVR, Low PCWP
Answer: A
Conceptual Explanation: Early (hyperdynamic) septic shock involves vasodilation (low
SVR) and compensatory increased cardiac output (CO) with low filling pressures (CVP).
3. A patient weighs 80kg and has sustained 40% TBSA burns. Using the Parkland formula
(4mL/kg/%TBSA), how much fluid should be administered in the first 8 hours?
A. 12,800 mL
B. 9,600 mL
C. 3,200 mL
D. 6,400 mL
Answer: D
Conceptual Explanation: Total fluid = 4mL x 80kg x 40 = 12,800 mL. Half is given in the
first 8 hours: 12, = 6,400 mL.
4. Which ABG result indicates partially compensated respiratory acidosis?
A. pH 7.46, PaCO2 30, HCO3 20
B. pH 7.35, PaCO2 48, HCO3 28
, C. pH 7.32, PaCO2 50, HCO3 28
D. pH 7.25, PaCO2 55, HCO3 22
Answer: C
Conceptual Explanation: Partial compensation occurs when pH is still abnormal, but the
opposite system (bicarbonate) has moved outside normal range to correct it.
5. A patient with a head injury has a widening pulse pressure, bradycardia, and irregular
respirations. What does this ‘Cushing’s Triad’ indicate?
A. Developing Hypovolemic Shock
B. Early signs of neurogenic shock
C. Autonomic Dysreflexia
D. Brainstem herniation due to increased ICP
Answer: D
Conceptual Explanation: Cushing’s Triad is a late sign of increased intracranial pressure
indicating that brainstem herniation is imminent.
6. In the management of DKA, which lab value must be checked before starting an insulin
drip?
A. Serum Glucose
B. Serum Potassium
C. Serum Sodium
