NURS 480 Exam 2 V2 | NURS 480
Advanced Medical Surgical Health Nursing
| Actual Q&A with Rationale (NURS480
Exam 2) | West Coast University
1. A nurse is caring for a patient in the early stages of septic shock. Which of the following
hemodynamic findings should the nurse anticipate?
A. Increased systemic vascular resistance (SVR)
B. Decreased cardiac output (CO)
C. Increased cardiac output (CO)
D. Increased pulmonary capillary wedge pressure (PCWP)
Answer: C
Rationale: In the hyperdynamic or ‘warm’ phase of septic shock, the body attempts to
compensate for massive vasodilation by increasing heart rate and stroke volume. This
leads to a temporary rise in cardiac output despite the underlying distributive pathology.
As the condition progresses, the patient will eventually enter the hypodynamic phase
where output falls.
2. A patient arrives in the emergency department with partial-thickness burns over 40% of
their body. Using the Parkland formula, what is the most critical monitoring parameter for
fluid resuscitation efficacy?
A. Mean arterial pressure above 90 mmHg
,B. Serum sodium levels within normal range
C. Central venous pressure of 12 mmHg
D. Urine output of 0.5 to 1.0 mL/kg/hr
Answer: D
Rationale: Urine output is the primary clinical indicator that reflects the adequacy of fluid
resuscitation and organ perfusion in burn patients. While blood pressure is important, it
may be affected by catecholamine release rather than volume status alone. Consistently
achieving the target range of 0.5 to 1.0 mL/kg/hr helps prevent acute kidney injury during
the emergent phase.
3. Which clinical manifestation is a hallmark sign of neurogenic shock following a high-level
spinal cord injury?
A. Bradycardia and hypotension
B. Cool, clammy extremities
C. Increased systemic vascular resistance
D. Tachycardia and hypertension
Answer: A
Rationale: Neurogenic shock is unique among shock states because it involves the loss of
sympathetic tone, leading to parasympathetic dominance. This results in the classic
combination of low blood pressure due to vasodilation and a slow heart rate due to the lack
, of sympathetic stimulation. Other forms of shock typically present with compensatory
tachycardia.
4. A patient with ARDS is receiving mechanical ventilation with High PEEP settings. The nurse
understands that the primary goal of PEEP in this patient is to:
A. Decrease the work of breathing
B. Increase the respiratory rate
C. Prevent alveolar collapse at the end of expiration
D. Reduce the risk of barotrauma
Answer: C
Rationale: Positive End-Expiratory Pressure (PEEP) keeps the alveoli open during the
expiratory phase, which increases the surface area for gas exchange. This is essential in
ARDS where surfactant is lost and alveoli are prone to atelectasis. By maintaining alveolar
recruitment, PEEP helps improve oxygenation and allows for lower FiO2 settings.
5. The nurse is monitoring a patient for Disseminated Intravascular Coagulation (DIC). Which
laboratory result is most suggestive of this condition?
A. Decreased Prothrombin Time (PT)
B. Increased D-dimer levels
C. Increased Fibrinogen levels
D. Increased platelet count
Advanced Medical Surgical Health Nursing
| Actual Q&A with Rationale (NURS480
Exam 2) | West Coast University
1. A nurse is caring for a patient in the early stages of septic shock. Which of the following
hemodynamic findings should the nurse anticipate?
A. Increased systemic vascular resistance (SVR)
B. Decreased cardiac output (CO)
C. Increased cardiac output (CO)
D. Increased pulmonary capillary wedge pressure (PCWP)
Answer: C
Rationale: In the hyperdynamic or ‘warm’ phase of septic shock, the body attempts to
compensate for massive vasodilation by increasing heart rate and stroke volume. This
leads to a temporary rise in cardiac output despite the underlying distributive pathology.
As the condition progresses, the patient will eventually enter the hypodynamic phase
where output falls.
2. A patient arrives in the emergency department with partial-thickness burns over 40% of
their body. Using the Parkland formula, what is the most critical monitoring parameter for
fluid resuscitation efficacy?
A. Mean arterial pressure above 90 mmHg
,B. Serum sodium levels within normal range
C. Central venous pressure of 12 mmHg
D. Urine output of 0.5 to 1.0 mL/kg/hr
Answer: D
Rationale: Urine output is the primary clinical indicator that reflects the adequacy of fluid
resuscitation and organ perfusion in burn patients. While blood pressure is important, it
may be affected by catecholamine release rather than volume status alone. Consistently
achieving the target range of 0.5 to 1.0 mL/kg/hr helps prevent acute kidney injury during
the emergent phase.
3. Which clinical manifestation is a hallmark sign of neurogenic shock following a high-level
spinal cord injury?
A. Bradycardia and hypotension
B. Cool, clammy extremities
C. Increased systemic vascular resistance
D. Tachycardia and hypertension
Answer: A
Rationale: Neurogenic shock is unique among shock states because it involves the loss of
sympathetic tone, leading to parasympathetic dominance. This results in the classic
combination of low blood pressure due to vasodilation and a slow heart rate due to the lack
, of sympathetic stimulation. Other forms of shock typically present with compensatory
tachycardia.
4. A patient with ARDS is receiving mechanical ventilation with High PEEP settings. The nurse
understands that the primary goal of PEEP in this patient is to:
A. Decrease the work of breathing
B. Increase the respiratory rate
C. Prevent alveolar collapse at the end of expiration
D. Reduce the risk of barotrauma
Answer: C
Rationale: Positive End-Expiratory Pressure (PEEP) keeps the alveoli open during the
expiratory phase, which increases the surface area for gas exchange. This is essential in
ARDS where surfactant is lost and alveoli are prone to atelectasis. By maintaining alveolar
recruitment, PEEP helps improve oxygenation and allows for lower FiO2 settings.
5. The nurse is monitoring a patient for Disseminated Intravascular Coagulation (DIC). Which
laboratory result is most suggestive of this condition?
A. Decreased Prothrombin Time (PT)
B. Increased D-dimer levels
C. Increased Fibrinogen levels
D. Increased platelet count
