NURS 480 Exam 3 V3 | NURS 480
Advanced Medical Surgical Health Nursing
| Actual Q&A with Rationale (NURS480
Exam 3) | West Coast University
1. A patient arrives in the emergency department with 50% total body surface area (TBSA)
burns. Using the Parkland formula (4 mL x kg x %TBSA), how much IV fluid should be
administered in the first 8 hours for a patient weighing 70 kg?
A. 2,800 mL
B. 7,000 mL
C. 14,000 mL
D. 3,500 mL
Answer: B
Rationale: The Parkland formula calculates total fluid for 24 hours as 4 mL x 70 kg x 50%
= 14,000 mL. Half of this total volume must be administered within the first 8 hours
following the burn injury. Therefore, 7,000 mL is the correct amount to be infused during
that initial window to prevent hypovolemic shock.
2. Which clinical manifestation is a hallmark sign of the progressive stage of shock?
A. Slightly increased heart rate
B. Metabolic acidosis and cold, clammy skin
,C. Respiratory alkalosis
D. Normal blood pressure
Answer: B
Rationale: In the progressive stage of shock, compensatory mechanisms begin to fail and
organ perfusion decreases significantly. Metabolic acidosis occurs as cells switch to
anaerobic metabolism, producing lactic acid. The skin becomes cold and clammy as blood is
shunted away from the periphery to vital organs.
3. A nurse is caring for a patient with Acute Respiratory Distress Syndrome (ARDS). Which
ventilator setting is specifically used to prevent alveolar collapse at the end of expiration?
A. Fraction of Inspired Oxygen (FiO2)
B. Tidal Volume (Vt)
C. Positive End-Expiratory Pressure (PEEP)
D. Inspiratory Flow Rate
Answer: C
Rationale: PEEP maintains pressure in the lungs at the end of expiration to keep alveoli
open and improve gas exchange. In ARDS, this is crucial because of the high risk of
atelectasis and surfactant loss. By keeping the alveoli inflated, PEEP allows for better
oxygenation and reduces the need for toxic levels of FiO2.
, 4. Which of the following is the priority assessment in the primary survey of a trauma
patient?
A. Airway patency with cervical spine immobilization
B. Neurological status using the Glasgow Coma Scale
C. Exposure and environmental control
D. Bilateral breath sounds and chest wall integrity
Answer: A
Rationale: The primary survey follows the ABCDE mnemonic, where ‘A’ stands for Airway.
Ensuring a patent airway while protecting the cervical spine is the first and most critical
step in trauma management. Failure to secure the airway can lead to rapid hypoxia and
death before other injuries can be addressed.
5. A patient in septic shock has a MAP of 55 mmHg despite fluid resuscitation. Which
vasopressor is considered the first-line choice for this patient?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Vasopressin
Answer: C
Advanced Medical Surgical Health Nursing
| Actual Q&A with Rationale (NURS480
Exam 3) | West Coast University
1. A patient arrives in the emergency department with 50% total body surface area (TBSA)
burns. Using the Parkland formula (4 mL x kg x %TBSA), how much IV fluid should be
administered in the first 8 hours for a patient weighing 70 kg?
A. 2,800 mL
B. 7,000 mL
C. 14,000 mL
D. 3,500 mL
Answer: B
Rationale: The Parkland formula calculates total fluid for 24 hours as 4 mL x 70 kg x 50%
= 14,000 mL. Half of this total volume must be administered within the first 8 hours
following the burn injury. Therefore, 7,000 mL is the correct amount to be infused during
that initial window to prevent hypovolemic shock.
2. Which clinical manifestation is a hallmark sign of the progressive stage of shock?
A. Slightly increased heart rate
B. Metabolic acidosis and cold, clammy skin
,C. Respiratory alkalosis
D. Normal blood pressure
Answer: B
Rationale: In the progressive stage of shock, compensatory mechanisms begin to fail and
organ perfusion decreases significantly. Metabolic acidosis occurs as cells switch to
anaerobic metabolism, producing lactic acid. The skin becomes cold and clammy as blood is
shunted away from the periphery to vital organs.
3. A nurse is caring for a patient with Acute Respiratory Distress Syndrome (ARDS). Which
ventilator setting is specifically used to prevent alveolar collapse at the end of expiration?
A. Fraction of Inspired Oxygen (FiO2)
B. Tidal Volume (Vt)
C. Positive End-Expiratory Pressure (PEEP)
D. Inspiratory Flow Rate
Answer: C
Rationale: PEEP maintains pressure in the lungs at the end of expiration to keep alveoli
open and improve gas exchange. In ARDS, this is crucial because of the high risk of
atelectasis and surfactant loss. By keeping the alveoli inflated, PEEP allows for better
oxygenation and reduces the need for toxic levels of FiO2.
, 4. Which of the following is the priority assessment in the primary survey of a trauma
patient?
A. Airway patency with cervical spine immobilization
B. Neurological status using the Glasgow Coma Scale
C. Exposure and environmental control
D. Bilateral breath sounds and chest wall integrity
Answer: A
Rationale: The primary survey follows the ABCDE mnemonic, where ‘A’ stands for Airway.
Ensuring a patent airway while protecting the cervical spine is the first and most critical
step in trauma management. Failure to secure the airway can lead to rapid hypoxia and
death before other injuries can be addressed.
5. A patient in septic shock has a MAP of 55 mmHg despite fluid resuscitation. Which
vasopressor is considered the first-line choice for this patient?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Vasopressin
Answer: C
