NUR 265 Medical-Surgical Nursing Final Exam Study Guide 2026 Galen
1. A patient weighs 80 kg and has sustained partial-thickness burns to 30% of
their Total Body Surface Area (TBSA). Using the Parkland formula, how much
fluid should be administered in the first 8 hours?
A. 9,600 mL
B. 4,800 mL
C. 2,400 mL
D. 5,200 mL
Answer: B
Rationale: The Parkland formula is 4 mL x kg x % TBSA. Total fluid = 4 x 80 x 30 = 9,600
mL. Half of this (4,800 mL) is given in the first 8 hours.
2. Which clinical manifestation is a hallmark sign of the compensatory stage of
shock?
A. Narrowed pulse pressure
B. Metabolic acidosis
C. Refractory hypotension
D. Anuria
Answer: A
Rationale: In the compensatory stage, the body attempts to maintain cardiac output, often
resulting in increased diastolic pressure and narrowed pulse pressure due to sympathetic
nervous system activation.
,3. A patient in the ICU has a high-pressure alarm sounding on the ventilator.
Which action should the nurse take first?
A. Check for a leak in the ventilator circuit
B. Call the respiratory therapist immediately
C. Increase the oxygen concentration to 100%
D. Assess the patient’s breath sounds and need for suctioning
Answer: D
Rationale: High-pressure alarms are often caused by secretions, biting the tube, or
coughing. Assessing the patient’s airway and breath sounds is the priority.
4. Which of the following is the priority intervention for a patient in Diabetic
Ketoacidosis (DKA)?
A. Subcutaneous insulin injection
B. Intravenous fluid resuscitation with 0.9% Normal Saline
C. Intravenous potassium replacement
D. Administration of Bicarbonate
Answer: B
Rationale: The immediate priority in DKA is rehydration to restore perfusion and dilute
glucose levels. Insulin and electrolytes follow fluid stabilization.
5. In a mass casualty incident, which patient would be assigned a ‘Red Tag’?
A. A patient with a broken arm and stable vitals
B. A patient with a massive head injury and no respirations
C. A patient with a sucking chest wound and respiratory distress
D. A patient with a 2-cm laceration on the forehead
Answer: C
Rationale: Red tags are for immediate threats to life that are salvageable, such as airway or
breathing emergencies. Unresponsive patients with no respirations are usually tagged
black.
, 6. Which laboratory value is most indicative of the ‘Cold Phase’ of Septic Shock?
A. Increased Cardiac Output
B. Decreased Lactic Acid
C. Respiratory Alkalosis
D. High Serum Lactate levels
Answer: D
Rationale: The cold phase (late sepsis) involves hypoperfusion and anaerobic metabolism,
leading to a significant rise in lactic acid.
7. A patient with Chronic Kidney Disease (CKD) presents with a potassium level
of 6.8 mEq/L and peaked T-waves on the ECG. What is the priority medication?
A. Furosemide (Lasix)
B. Sodium Polystyrene Sulfonate (Kayexalate)
C. Erythropoietin
D. Calcium Gluconate
Answer: D
Rationale: Calcium Gluconate does not lower potassium but stabilizes the myocardial cell
membrane to prevent life-threatening arrhythmias.
8. What is the primary pathophysiology behind Acute Respiratory Distress
Syndrome (ARDS)?
A. Increased permeability of the alveolar-capillary membrane
B. Obstruction of the pulmonary artery by a clot
C. Destruction of the alveolar walls and loss of elasticity
D. Infection and inflammation within the pleural space
Answer: A
Rationale: ARDS is characterized by damage to the alveolar-capillary membrane, leading
to non-cardiogenic pulmonary edema and severe hypoxemia.
1. A patient weighs 80 kg and has sustained partial-thickness burns to 30% of
their Total Body Surface Area (TBSA). Using the Parkland formula, how much
fluid should be administered in the first 8 hours?
A. 9,600 mL
B. 4,800 mL
C. 2,400 mL
D. 5,200 mL
Answer: B
Rationale: The Parkland formula is 4 mL x kg x % TBSA. Total fluid = 4 x 80 x 30 = 9,600
mL. Half of this (4,800 mL) is given in the first 8 hours.
2. Which clinical manifestation is a hallmark sign of the compensatory stage of
shock?
A. Narrowed pulse pressure
B. Metabolic acidosis
C. Refractory hypotension
D. Anuria
Answer: A
Rationale: In the compensatory stage, the body attempts to maintain cardiac output, often
resulting in increased diastolic pressure and narrowed pulse pressure due to sympathetic
nervous system activation.
,3. A patient in the ICU has a high-pressure alarm sounding on the ventilator.
Which action should the nurse take first?
A. Check for a leak in the ventilator circuit
B. Call the respiratory therapist immediately
C. Increase the oxygen concentration to 100%
D. Assess the patient’s breath sounds and need for suctioning
Answer: D
Rationale: High-pressure alarms are often caused by secretions, biting the tube, or
coughing. Assessing the patient’s airway and breath sounds is the priority.
4. Which of the following is the priority intervention for a patient in Diabetic
Ketoacidosis (DKA)?
A. Subcutaneous insulin injection
B. Intravenous fluid resuscitation with 0.9% Normal Saline
C. Intravenous potassium replacement
D. Administration of Bicarbonate
Answer: B
Rationale: The immediate priority in DKA is rehydration to restore perfusion and dilute
glucose levels. Insulin and electrolytes follow fluid stabilization.
5. In a mass casualty incident, which patient would be assigned a ‘Red Tag’?
A. A patient with a broken arm and stable vitals
B. A patient with a massive head injury and no respirations
C. A patient with a sucking chest wound and respiratory distress
D. A patient with a 2-cm laceration on the forehead
Answer: C
Rationale: Red tags are for immediate threats to life that are salvageable, such as airway or
breathing emergencies. Unresponsive patients with no respirations are usually tagged
black.
, 6. Which laboratory value is most indicative of the ‘Cold Phase’ of Septic Shock?
A. Increased Cardiac Output
B. Decreased Lactic Acid
C. Respiratory Alkalosis
D. High Serum Lactate levels
Answer: D
Rationale: The cold phase (late sepsis) involves hypoperfusion and anaerobic metabolism,
leading to a significant rise in lactic acid.
7. A patient with Chronic Kidney Disease (CKD) presents with a potassium level
of 6.8 mEq/L and peaked T-waves on the ECG. What is the priority medication?
A. Furosemide (Lasix)
B. Sodium Polystyrene Sulfonate (Kayexalate)
C. Erythropoietin
D. Calcium Gluconate
Answer: D
Rationale: Calcium Gluconate does not lower potassium but stabilizes the myocardial cell
membrane to prevent life-threatening arrhythmias.
8. What is the primary pathophysiology behind Acute Respiratory Distress
Syndrome (ARDS)?
A. Increased permeability of the alveolar-capillary membrane
B. Obstruction of the pulmonary artery by a clot
C. Destruction of the alveolar walls and loss of elasticity
D. Infection and inflammation within the pleural space
Answer: A
Rationale: ARDS is characterized by damage to the alveolar-capillary membrane, leading
to non-cardiogenic pulmonary edema and severe hypoxemia.
