NUR 253 EXAM 4 - ADVANCED
MEDICAL SURGICAL NURSING
QUESTIONS & ANSWERS (VERIFIED
ANSWERS) WITH EXPERT
EXPLANATIONS | 2026 – 2027 UPDATE
(PDF) GALEN COLLEGE OF NURSING
1. A patient in the progressive stage of shock is exhibiting a trend of increasing serum lactate
levels. Which physiological process does this finding primarily reflect?
A. Improved glucose utilization by the mitochondria
B. Increased anaerobic metabolism due to inadequate tissue perfusion
C. Reduced renal clearance of metabolic byproducts
D. Adequate compensatory mechanisms maintain cellular oxygenation
Answer: B
Conceptual Explanation: In the progressive stage of shock, compensatory mechanisms
fail, leading to significant tissue hypoxia. Cells switch to anaerobic metabolism, which
produces lactic acid as a byproduct, raising serum lactate levels.
,2. A client arrives in the ER with partial-thickness burns to the entire left arm and the entire
anterior trunk. Using the Rule of Nines, what is the estimated Total Body Surface Area (TBSA)
burned?
A. 27%
B. 18%
C. 36%
D. 45%
Answer: A
Conceptual Explanation: According to the Rule of Nines: the entire arm is 9% and the
anterior trunk is 18%. Total = 9% + 18% = 27%.
3. The nurse is caring for a patient with septic shock. Which hemodynamic parameter is most
characteristic of the ‘hyperdynamic’ or ‘warm’ phase of septic shock?
A. High Systemic Vascular Resistance (SVR)
B. High Cardiac Index (CI) with Low Systemic Vascular Resistance (SVR)
C. Increased Central Venous Pressure (CVP)
D. Low Cardiac Output (CO)
Answer: B
, Conceptual Explanation: Early septic shock (warm phase) is characterized by
vasodilation, resulting in low SVR, and a compensatory increase in Cardiac Output/Index to
maintain perfusion.
4. A patient weighing 80 kg has sustained 50% TBSA burns. Using the Parkland Formula (4
mL/kg/%TBSA), how much fluid should the nurse administer in the first 8 hours?
A. 16,000 mL
B. 4,000 mL
C. 8,000 mL
D. 10,000 mL
Answer: C
Conceptual Explanation: Parkland Formula: 4 mL x 80 kg x 50% = 16,000 mL total for 24
hours. The first half (8,000 mL) is given over the first 8 hours.
5. Which assessment finding is the most sensitive indicator of early compensatory shock in a
post-operative patient?
A. A drop in Systolic Blood Pressure below 90 mmHg
B. Narrowing pulse pressure and mild tachycardia
C. Cold, clammy skin and cyanosis
D. Urine output of 10 mL per hour
Answer: B
MEDICAL SURGICAL NURSING
QUESTIONS & ANSWERS (VERIFIED
ANSWERS) WITH EXPERT
EXPLANATIONS | 2026 – 2027 UPDATE
(PDF) GALEN COLLEGE OF NURSING
1. A patient in the progressive stage of shock is exhibiting a trend of increasing serum lactate
levels. Which physiological process does this finding primarily reflect?
A. Improved glucose utilization by the mitochondria
B. Increased anaerobic metabolism due to inadequate tissue perfusion
C. Reduced renal clearance of metabolic byproducts
D. Adequate compensatory mechanisms maintain cellular oxygenation
Answer: B
Conceptual Explanation: In the progressive stage of shock, compensatory mechanisms
fail, leading to significant tissue hypoxia. Cells switch to anaerobic metabolism, which
produces lactic acid as a byproduct, raising serum lactate levels.
,2. A client arrives in the ER with partial-thickness burns to the entire left arm and the entire
anterior trunk. Using the Rule of Nines, what is the estimated Total Body Surface Area (TBSA)
burned?
A. 27%
B. 18%
C. 36%
D. 45%
Answer: A
Conceptual Explanation: According to the Rule of Nines: the entire arm is 9% and the
anterior trunk is 18%. Total = 9% + 18% = 27%.
3. The nurse is caring for a patient with septic shock. Which hemodynamic parameter is most
characteristic of the ‘hyperdynamic’ or ‘warm’ phase of septic shock?
A. High Systemic Vascular Resistance (SVR)
B. High Cardiac Index (CI) with Low Systemic Vascular Resistance (SVR)
C. Increased Central Venous Pressure (CVP)
D. Low Cardiac Output (CO)
Answer: B
, Conceptual Explanation: Early septic shock (warm phase) is characterized by
vasodilation, resulting in low SVR, and a compensatory increase in Cardiac Output/Index to
maintain perfusion.
4. A patient weighing 80 kg has sustained 50% TBSA burns. Using the Parkland Formula (4
mL/kg/%TBSA), how much fluid should the nurse administer in the first 8 hours?
A. 16,000 mL
B. 4,000 mL
C. 8,000 mL
D. 10,000 mL
Answer: C
Conceptual Explanation: Parkland Formula: 4 mL x 80 kg x 50% = 16,000 mL total for 24
hours. The first half (8,000 mL) is given over the first 8 hours.
5. Which assessment finding is the most sensitive indicator of early compensatory shock in a
post-operative patient?
A. A drop in Systolic Blood Pressure below 90 mmHg
B. Narrowing pulse pressure and mild tachycardia
C. Cold, clammy skin and cyanosis
D. Urine output of 10 mL per hour
Answer: B
