NUR 355 Exam 3 Newest Actual Exam Preparation With Complete Questions And
Correct Answers With Rationales | Already Graded A+||Brand New Version!!
Question 1
An 82-year-old female patient falls and sustains fractures to her left humerus and left proximal
femur. Which nursing action is most critical to effectively assess for the early development of
neurovascular damage and compartment syndrome?
A) Monitoring the patient's temperature for signs of infection
B) Evaluating the patient’s ability to perform range of motion on the unaffected limb
C) Carefully evaluating the patient’s complaints of pain, especially pain out of proportion to the
injury
D) Assessing the patient’s distal pulses every 8 hours
E) Checking the patient's capillary refill on the right hand
Correct Answer: C) Carefully evaluate the patients complaints of pain
Rationale: Pain is the earliest and most sensitive indicator of compartment syndrome.
Specifically, pain that is "out of proportion" to the severity of the injury or pain that is not
relieved by standard analgesics indicates rising intracompartmental pressure. While the "5
Ps" include pulselessness and pallor, these are late signs indicating that permanent damage
has likely already occurred. Early intervention depends on the subjective assessment of
increasing, unrelenting pain.
Question 2
A construction worker is admitted to the ED following a crush injury to his lower leg. His
Creatine Kinase (CK) level is found to be 72,000 U/L. The healthcare provider orders 0.9%
Normal Saline to infuse at 500 mL/hr. The nurse understands this aggressive fluid resuscitation is
primarily intended to prevent:
A) Cardiogenic shock
B) Acute renal failure
C) Pulmonary edema
D) Hepatic encephalopathy
E) Hypovolemic shock
Correct Answer: B) Acute renal failure
Rationale: Crush injuries lead to rhabdomyolysis, which is the breakdown of muscle tissue
, 2
that releases myoglobin into the bloodstream. Myoglobin is a large protein that is toxic to
the renal tubules and can physically obstruct the kidneys, leading to acute tubular necrosis
and acute renal failure. Aggressive IV fluid administration is necessary to "flush" the
kidneys, maintain high urine output, and prevent the crystallization of myoglobin in the
renal system.
Question 3
A soccer player is hit directly in the posterior flank by a ball and presents with 8/10 pain in the
area. Vitals are stable: BP 110/80, HR 98, RR 22. Which diagnostic method does the nurse
anticipate will be used to establish the specific location and extent of renal parenchymal damage?
A) KUB X-ray
B) Intravenous pyelogram (IVP)
C) CT scan of the abdomen and pelvis
D) Renal ultrasound
E) Urinalysis only
Correct Answer: C) CT scan of the abdomen and pelvis
Rationale: A CT scan with contrast is the gold standard for evaluating renal trauma in a
hemodynamically stable patient. It provides high-resolution imaging that allows the
healthcare team to visualize the extent of parenchymal lacerations, the presence of
hematomas, and the integrity of the vascular structures. This is more definitive than an
ultrasound or KUB in grading the severity of the kidney injury.
Question 4
A patient is experiencing a series of continuous seizures, one after another, without regaining
consciousness between episodes. The nurse would correctly document this life-threatening
condition as:
A) Postictal state
B) Tonic-clonic activity
C) Status epilepticus
D) Absence seizures
E) Focal onset seizures
, 3
Correct Answer: C) Status epilepticus
Rationale: Status epilepticus is a medical emergency defined as a seizure lasting longer than
5 minutes or repeated seizures where the patient does not return to their baseline
neurological state. The primary concern is cerebral hypoxia and permanent brain damage,
as well as systemic complications like rhabdomyolysis and metabolic acidosis. Immediate
pharmacological intervention with benzodiazepines is required.
Question 5
The nurse is evaluating a patient being treated for complications following multiple fractures.
Which of the following findings would the nurse identify as the most favorable indicator that a
fat embolism is resolving?
A) Patient is able to sit up in bed
B) Chest radiograph shows diffuse infiltrates
C) Clear chest radiograph
D) Patient's heart rate is 110 bpm
E) Presence of petechiae on the chest
Correct Answer: C) Clear chest radiograph
Rationale: A fat embolism syndrome (FES) often presents with respiratory distress and
"snowstorm" patterns on a chest X-ray due to pulmonary vascular clogging. A clear chest
radiograph indicates that the fat globules have been cleared or metabolized and that
pulmonary gas exchange is returning to normal, signifying a resolution of the life-
threatening respiratory component of the syndrome.
Question 6
A spinal cord injured patient is diaphoretic with a flushed face and neck, and complains of a
severe, throbbing headache. The nurse finds the HR is 40 bpm and BP is 230/100 mmHg. What
is the nurse's priority suspected diagnosis?
A) Spinal shock
B) Septic shock
C) Autonomic dysreflexia
, 4
D) Neurogenic shock
E) Acute migraine
Correct Answer: C) Autonomic dysreflexia
Rationale: Autonomic dysreflexia is a life-threatening emergency occurring in patients with
spinal cord injuries at T6 or above. It is triggered by a noxious stimulus below the level of
injury (such as a full bladder). This causes a massive sympathetic discharge resulting in
extreme hypertension. The body attempts to compensate via the vagus nerve, causing
bradycardia and vasodilation (flushing/sweating) above the level of injury.
Question 7
A nurse is caring for a patient suspected of having a fat embolism after a motor vehicle accident.
Which clinical observation suggests the most favorable outcome regarding the neurological
status of the patient?
A) Presence of a positive Babinski sign
B) Pupil size of 4mm and sluggish
C) Clear mentation
D) Patient follows simple commands with a 30-second delay
E) Patient is oriented to person only
Correct Answer: C) Clear mentation
Rationale: Fat embolisms can travel to the brain (cerebral fat embolism), causing confusion,
agitation, or coma. Clear mentation (the patient being alert, oriented, and thinking clearly)
is the most favorable indication that the fat globules have not caused significant cerebral
ischemia or that previous neurological deficits from the embolism are resolving.
Question 8
A patient with a comminuted fracture of the right lower extremity has a plaster cast applied. How
should the nurse position the leg during the first 24 to 48 hours to minimize edema?
A) Keep the leg flat on the bed
B) Place the leg in a dependent position
C) Elevate the leg on pillows continuously
Correct Answers With Rationales | Already Graded A+||Brand New Version!!
Question 1
An 82-year-old female patient falls and sustains fractures to her left humerus and left proximal
femur. Which nursing action is most critical to effectively assess for the early development of
neurovascular damage and compartment syndrome?
A) Monitoring the patient's temperature for signs of infection
B) Evaluating the patient’s ability to perform range of motion on the unaffected limb
C) Carefully evaluating the patient’s complaints of pain, especially pain out of proportion to the
injury
D) Assessing the patient’s distal pulses every 8 hours
E) Checking the patient's capillary refill on the right hand
Correct Answer: C) Carefully evaluate the patients complaints of pain
Rationale: Pain is the earliest and most sensitive indicator of compartment syndrome.
Specifically, pain that is "out of proportion" to the severity of the injury or pain that is not
relieved by standard analgesics indicates rising intracompartmental pressure. While the "5
Ps" include pulselessness and pallor, these are late signs indicating that permanent damage
has likely already occurred. Early intervention depends on the subjective assessment of
increasing, unrelenting pain.
Question 2
A construction worker is admitted to the ED following a crush injury to his lower leg. His
Creatine Kinase (CK) level is found to be 72,000 U/L. The healthcare provider orders 0.9%
Normal Saline to infuse at 500 mL/hr. The nurse understands this aggressive fluid resuscitation is
primarily intended to prevent:
A) Cardiogenic shock
B) Acute renal failure
C) Pulmonary edema
D) Hepatic encephalopathy
E) Hypovolemic shock
Correct Answer: B) Acute renal failure
Rationale: Crush injuries lead to rhabdomyolysis, which is the breakdown of muscle tissue
, 2
that releases myoglobin into the bloodstream. Myoglobin is a large protein that is toxic to
the renal tubules and can physically obstruct the kidneys, leading to acute tubular necrosis
and acute renal failure. Aggressive IV fluid administration is necessary to "flush" the
kidneys, maintain high urine output, and prevent the crystallization of myoglobin in the
renal system.
Question 3
A soccer player is hit directly in the posterior flank by a ball and presents with 8/10 pain in the
area. Vitals are stable: BP 110/80, HR 98, RR 22. Which diagnostic method does the nurse
anticipate will be used to establish the specific location and extent of renal parenchymal damage?
A) KUB X-ray
B) Intravenous pyelogram (IVP)
C) CT scan of the abdomen and pelvis
D) Renal ultrasound
E) Urinalysis only
Correct Answer: C) CT scan of the abdomen and pelvis
Rationale: A CT scan with contrast is the gold standard for evaluating renal trauma in a
hemodynamically stable patient. It provides high-resolution imaging that allows the
healthcare team to visualize the extent of parenchymal lacerations, the presence of
hematomas, and the integrity of the vascular structures. This is more definitive than an
ultrasound or KUB in grading the severity of the kidney injury.
Question 4
A patient is experiencing a series of continuous seizures, one after another, without regaining
consciousness between episodes. The nurse would correctly document this life-threatening
condition as:
A) Postictal state
B) Tonic-clonic activity
C) Status epilepticus
D) Absence seizures
E) Focal onset seizures
, 3
Correct Answer: C) Status epilepticus
Rationale: Status epilepticus is a medical emergency defined as a seizure lasting longer than
5 minutes or repeated seizures where the patient does not return to their baseline
neurological state. The primary concern is cerebral hypoxia and permanent brain damage,
as well as systemic complications like rhabdomyolysis and metabolic acidosis. Immediate
pharmacological intervention with benzodiazepines is required.
Question 5
The nurse is evaluating a patient being treated for complications following multiple fractures.
Which of the following findings would the nurse identify as the most favorable indicator that a
fat embolism is resolving?
A) Patient is able to sit up in bed
B) Chest radiograph shows diffuse infiltrates
C) Clear chest radiograph
D) Patient's heart rate is 110 bpm
E) Presence of petechiae on the chest
Correct Answer: C) Clear chest radiograph
Rationale: A fat embolism syndrome (FES) often presents with respiratory distress and
"snowstorm" patterns on a chest X-ray due to pulmonary vascular clogging. A clear chest
radiograph indicates that the fat globules have been cleared or metabolized and that
pulmonary gas exchange is returning to normal, signifying a resolution of the life-
threatening respiratory component of the syndrome.
Question 6
A spinal cord injured patient is diaphoretic with a flushed face and neck, and complains of a
severe, throbbing headache. The nurse finds the HR is 40 bpm and BP is 230/100 mmHg. What
is the nurse's priority suspected diagnosis?
A) Spinal shock
B) Septic shock
C) Autonomic dysreflexia
, 4
D) Neurogenic shock
E) Acute migraine
Correct Answer: C) Autonomic dysreflexia
Rationale: Autonomic dysreflexia is a life-threatening emergency occurring in patients with
spinal cord injuries at T6 or above. It is triggered by a noxious stimulus below the level of
injury (such as a full bladder). This causes a massive sympathetic discharge resulting in
extreme hypertension. The body attempts to compensate via the vagus nerve, causing
bradycardia and vasodilation (flushing/sweating) above the level of injury.
Question 7
A nurse is caring for a patient suspected of having a fat embolism after a motor vehicle accident.
Which clinical observation suggests the most favorable outcome regarding the neurological
status of the patient?
A) Presence of a positive Babinski sign
B) Pupil size of 4mm and sluggish
C) Clear mentation
D) Patient follows simple commands with a 30-second delay
E) Patient is oriented to person only
Correct Answer: C) Clear mentation
Rationale: Fat embolisms can travel to the brain (cerebral fat embolism), causing confusion,
agitation, or coma. Clear mentation (the patient being alert, oriented, and thinking clearly)
is the most favorable indication that the fat globules have not caused significant cerebral
ischemia or that previous neurological deficits from the embolism are resolving.
Question 8
A patient with a comminuted fracture of the right lower extremity has a plaster cast applied. How
should the nurse position the leg during the first 24 to 48 hours to minimize edema?
A) Keep the leg flat on the bed
B) Place the leg in a dependent position
C) Elevate the leg on pillows continuously
