NUR 425 Exam 2: Medical Surgical V3 - Arizona College
Updated and Latest Questions and Correct Answers with
Rationale
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is receiving mechanical ventilation with a
high level of Positive End-Expiratory Pressure (PEEP). The nurse notes a sudden drop in cardiac output.
Which physiological mechanism explains this finding?
A. Decreased alveolar recruitment leading to shunting
B. Increased intrathoracic pressure reducing venous return
C. Direct myocardial depression from high oxygen levels
D. Reduced systemic vascular resistance due to sedation
Ans: B
Explanation: High levels of PEEP increase intrathoracic pressure significantly during the respiratory
cycle. This increased pressure compresses the vena cava and decreases venous return to the heart.
Consequently, preload is reduced, which leads to a decrease in stroke volume and cardiac output. The
nurse must monitor for hypotension and signs of decreased organ perfusion in these patients. Adjusting
fluid volume or vasopressors may be necessary to maintain hemodynamic stability while using high
PEEP.
2. Using the Parkland Formula, calculate the total fluid requirement for the first 24 hours for a 70 kg patient
with 40% total body surface area (TBSA) burns.
A. 5,600 mL
B. 11,200 mL
C. 8,400 mL
,D. 2,800 mL
Ans: B
Explanation: The Parkland formula is calculated as 4 mL multiplied by the patient’s weight in kilograms
and the percentage of TBSA burned. For this patient, the calculation is 4 mL x 70 kg x 40, which equals
11,200 mL. Half of this total volume must be administered within the first eight hours after the burn
injury occurred. The remaining half is administered over the subsequent sixteen hours of the
resuscitation phase. Accurate calculation is critical to prevent hypovolemic shock and ensure adequate
tissue perfusion.
3. A patient in septic shock remains hypotensive after a 30 mL/kg fluid bolus. Which vasopressor is
considered the first-line choice for this patient?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Vasopressin
Ans: C
Explanation: Norepinephrine is the recommended first-line vasopressor for maintaining a Mean Arterial
Pressure (MAP) of at least 65 mmHg in septic shock. It works primarily as an alpha-1 agonist to increase
systemic vascular resistance through vasoconstriction. Unlike dopamine, it is associated with a lower
incidence of arrhythmias and improved survival rates in clinical trials. Vasopressin may be added later as
an adjunct if the initial response to norepinephrine is insufficient. Continuous monitoring of
hemodynamics and peripheral perfusion is mandatory during the administration of these potent
medications.
, 4. A patient with a spinal cord injury at the T4 level reports a severe headache and exhibits a blood pressure
of 190/110 mmHg. What is the nurse’s immediate priority action?
A. Administer an antihypertensive medication as ordered
B. Check the patient’s bladder for distention
C. Place the patient in a high-Fowler’s position
D. Document the findings and notify the physician
Ans: C
Explanation: The patient is exhibiting signs of autonomic dysreflexia, which is a medical emergency seen
in high-level spinal cord injuries. The first action should be to sit the patient upright to lower blood
pressure through orthostatic changes. After repositioning, the nurse should investigate and remove the
triggering stimulus, such as a full bladder or fecal impaction. Failure to act quickly can result in stroke,
seizures, or myocardial infarction. Once the patient is positioned and the stimulus is addressed,
pharmacological intervention may be considered if BP remains elevated.
5. In a patient with Acute Kidney Injury (AKI), which finding is most characteristic of the intrarenal (intrinsic)
phase of the condition?
A. A BUN to creatinine ratio of 20:1
B. Presence of tubular casts and debris in the urine sediment
C. Urine specific gravity greater than 1.030
D. Rapid response to intravenous fluid administration
Ans: B
Explanation: Intrarenal AKI involves direct damage to the kidney tissues, such as the tubules or
glomeruli. Tubular casts and epithelial cells are typically found in the urine because the damaged tubules
Updated and Latest Questions and Correct Answers with
Rationale
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is receiving mechanical ventilation with a
high level of Positive End-Expiratory Pressure (PEEP). The nurse notes a sudden drop in cardiac output.
Which physiological mechanism explains this finding?
A. Decreased alveolar recruitment leading to shunting
B. Increased intrathoracic pressure reducing venous return
C. Direct myocardial depression from high oxygen levels
D. Reduced systemic vascular resistance due to sedation
Ans: B
Explanation: High levels of PEEP increase intrathoracic pressure significantly during the respiratory
cycle. This increased pressure compresses the vena cava and decreases venous return to the heart.
Consequently, preload is reduced, which leads to a decrease in stroke volume and cardiac output. The
nurse must monitor for hypotension and signs of decreased organ perfusion in these patients. Adjusting
fluid volume or vasopressors may be necessary to maintain hemodynamic stability while using high
PEEP.
2. Using the Parkland Formula, calculate the total fluid requirement for the first 24 hours for a 70 kg patient
with 40% total body surface area (TBSA) burns.
A. 5,600 mL
B. 11,200 mL
C. 8,400 mL
,D. 2,800 mL
Ans: B
Explanation: The Parkland formula is calculated as 4 mL multiplied by the patient’s weight in kilograms
and the percentage of TBSA burned. For this patient, the calculation is 4 mL x 70 kg x 40, which equals
11,200 mL. Half of this total volume must be administered within the first eight hours after the burn
injury occurred. The remaining half is administered over the subsequent sixteen hours of the
resuscitation phase. Accurate calculation is critical to prevent hypovolemic shock and ensure adequate
tissue perfusion.
3. A patient in septic shock remains hypotensive after a 30 mL/kg fluid bolus. Which vasopressor is
considered the first-line choice for this patient?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Vasopressin
Ans: C
Explanation: Norepinephrine is the recommended first-line vasopressor for maintaining a Mean Arterial
Pressure (MAP) of at least 65 mmHg in septic shock. It works primarily as an alpha-1 agonist to increase
systemic vascular resistance through vasoconstriction. Unlike dopamine, it is associated with a lower
incidence of arrhythmias and improved survival rates in clinical trials. Vasopressin may be added later as
an adjunct if the initial response to norepinephrine is insufficient. Continuous monitoring of
hemodynamics and peripheral perfusion is mandatory during the administration of these potent
medications.
, 4. A patient with a spinal cord injury at the T4 level reports a severe headache and exhibits a blood pressure
of 190/110 mmHg. What is the nurse’s immediate priority action?
A. Administer an antihypertensive medication as ordered
B. Check the patient’s bladder for distention
C. Place the patient in a high-Fowler’s position
D. Document the findings and notify the physician
Ans: C
Explanation: The patient is exhibiting signs of autonomic dysreflexia, which is a medical emergency seen
in high-level spinal cord injuries. The first action should be to sit the patient upright to lower blood
pressure through orthostatic changes. After repositioning, the nurse should investigate and remove the
triggering stimulus, such as a full bladder or fecal impaction. Failure to act quickly can result in stroke,
seizures, or myocardial infarction. Once the patient is positioned and the stimulus is addressed,
pharmacological intervention may be considered if BP remains elevated.
5. In a patient with Acute Kidney Injury (AKI), which finding is most characteristic of the intrarenal (intrinsic)
phase of the condition?
A. A BUN to creatinine ratio of 20:1
B. Presence of tubular casts and debris in the urine sediment
C. Urine specific gravity greater than 1.030
D. Rapid response to intravenous fluid administration
Ans: B
Explanation: Intrarenal AKI involves direct damage to the kidney tissues, such as the tubules or
glomeruli. Tubular casts and epithelial cells are typically found in the urine because the damaged tubules
