NSG233/NSG 233 Final Exam V3 | Medical-
Surgical Nursing III Q&A with Rationale |
Herzing University
1. A nurse is caring for a patient with ARDS who is on mechanical ventilation with PEEP.
Which finding should the nurse prioritize as a potential complication of high PEEP?
A. Subcutaneous emphysema
B. Elevated blood pressure
C. Decreased urine output
D. Hyperactive bowel sounds
Correct Answer: A
Rationale: High levels of Positive End-Expiratory Pressure (PEEP) can lead to barotrauma,
which may manifest as subcutaneous emphysema or pneumothorax. The increased
intrathoracic pressure can also cause decreased venous return, leading to decreased
cardiac output. The nurse must assess the chest for symmetry and palpate for crepitus to
ensure patient safety.
2. The nurse is calculating the fluid resuscitation for a burn patient using the Parkland
Formula. The patient weighs 80 kg and has 40% TBSA burns. How much fluid should be
administered in the first 8 hours?
A. 6,400 mL
,B. 12,800 mL
C. 3,200 mL
D. 1,600 mL
Correct Answer: A
Rationale: The Parkland Formula calculates the total 24-hour fluid requirement as 4 mL x
weight (kg) x % TBSA. For this patient, the total is 4 x 80 x 40 = 12,800 mL. Half of this total
volume, which is 6,400 mL, must be administered within the first 8 hours following the
injury.
3. A patient in the ICU is showing signs of septic shock. Which of the following interventions
should the nurse implement first according to the Surviving Sepsis Bundle?
A. Measure serum lactate level
B. Administer broad-spectrum antibiotics
C. Start vasopressors to maintain MAP
D. Obtain blood cultures
Correct Answer: A
Rationale: The initial step in the sepsis bundle is to measure the serum lactate level to
assess for tissue hypoperfusion. Following this, blood cultures should be obtained before
starting broad-spectrum antibiotics. Rapid administration of fluids is also a priority to
stabilize the patient’s hemodynamic status.
, 4. A patient’s ECG monitor displays ventricular fibrillation. What is the priority nursing
action?
A. Perform synchronized cardioversion
B. Administer a bolus of Amiodarone
C. Initiate immediate defibrillation
D. Check for a carotid pulse for 10 seconds
Correct Answer: C
Rationale: Ventricular fibrillation is a lethal rhythm that requires immediate
unsynchronized defibrillation to restore a perfusing rhythm. While CPR is started
immediately if a defibrillator is not available, the priority is to shock the patient as soon as
possible. Synchronized cardioversion is used for rhythms with a pulse, such as atrial
fibrillation or stable VT.
5. A nurse is monitoring a patient with increased intracranial pressure (ICP). Which of the
following signs constitutes Cushing’s Triad?
A. Tachycardia, hypotension, and tachypnea
B. Tachycardia, hypertension, and Kussmaul respirations
C. Bradycardia, hypotension, and Cheyne-Stokes respirations
D. Bradycardia, hypertension with a widening pulse pressure, and irregular respirations
Correct Answer: D
Surgical Nursing III Q&A with Rationale |
Herzing University
1. A nurse is caring for a patient with ARDS who is on mechanical ventilation with PEEP.
Which finding should the nurse prioritize as a potential complication of high PEEP?
A. Subcutaneous emphysema
B. Elevated blood pressure
C. Decreased urine output
D. Hyperactive bowel sounds
Correct Answer: A
Rationale: High levels of Positive End-Expiratory Pressure (PEEP) can lead to barotrauma,
which may manifest as subcutaneous emphysema or pneumothorax. The increased
intrathoracic pressure can also cause decreased venous return, leading to decreased
cardiac output. The nurse must assess the chest for symmetry and palpate for crepitus to
ensure patient safety.
2. The nurse is calculating the fluid resuscitation for a burn patient using the Parkland
Formula. The patient weighs 80 kg and has 40% TBSA burns. How much fluid should be
administered in the first 8 hours?
A. 6,400 mL
,B. 12,800 mL
C. 3,200 mL
D. 1,600 mL
Correct Answer: A
Rationale: The Parkland Formula calculates the total 24-hour fluid requirement as 4 mL x
weight (kg) x % TBSA. For this patient, the total is 4 x 80 x 40 = 12,800 mL. Half of this total
volume, which is 6,400 mL, must be administered within the first 8 hours following the
injury.
3. A patient in the ICU is showing signs of septic shock. Which of the following interventions
should the nurse implement first according to the Surviving Sepsis Bundle?
A. Measure serum lactate level
B. Administer broad-spectrum antibiotics
C. Start vasopressors to maintain MAP
D. Obtain blood cultures
Correct Answer: A
Rationale: The initial step in the sepsis bundle is to measure the serum lactate level to
assess for tissue hypoperfusion. Following this, blood cultures should be obtained before
starting broad-spectrum antibiotics. Rapid administration of fluids is also a priority to
stabilize the patient’s hemodynamic status.
, 4. A patient’s ECG monitor displays ventricular fibrillation. What is the priority nursing
action?
A. Perform synchronized cardioversion
B. Administer a bolus of Amiodarone
C. Initiate immediate defibrillation
D. Check for a carotid pulse for 10 seconds
Correct Answer: C
Rationale: Ventricular fibrillation is a lethal rhythm that requires immediate
unsynchronized defibrillation to restore a perfusing rhythm. While CPR is started
immediately if a defibrillator is not available, the priority is to shock the patient as soon as
possible. Synchronized cardioversion is used for rhythms with a pulse, such as atrial
fibrillation or stable VT.
5. A nurse is monitoring a patient with increased intracranial pressure (ICP). Which of the
following signs constitutes Cushing’s Triad?
A. Tachycardia, hypotension, and tachypnea
B. Tachycardia, hypertension, and Kussmaul respirations
C. Bradycardia, hypotension, and Cheyne-Stokes respirations
D. Bradycardia, hypertension with a widening pulse pressure, and irregular respirations
Correct Answer: D
