Exam 1: NUR 209 Medical-Surgical Nursing I I
2026/2027 |Newly Released| Fortis College
50 Questions & Answers |Grade A+
100% Correct Rationales | Complete Study Guide
Guaranteed Pass
Q1: A 28-year-old male is brought to the ED after a kitchen grease fire. He
has partial-thickness burns covering his entire head, his entire right arm, and
his entire left arm. Using the adult Rule of Nines, what percentage of his total
body surface area (TBSA) is burned?
A. 18%
B. 9%
C. 27%
D. 36%
Correct Answer: C
Rationale: Correct because the adult Rule of Nines assigns 9% to the entire
head and 9% to each entire arm, so 9% + 9% + 9% equals 27% TBSA
burned. This patient's presentation is consistent with partial-thickness burns
that are counted in TBSA calculations, whereas superficial first-degree burns
are excluded from fluid resuscitation estimates. The priority nursing
implication is to use this 27% TBSA figure to calculate Parkland Formula fluid
requirements and to communicate severity to the burn team.
Q2: A 45-year-old female presents to the ED following a motor vehicle
collision with significant blood loss from a femur fracture. Her blood pressure
,is 82/50 mmHg, heart rate is 128 bpm, respiratory rate is 24 breaths/min,
and her skin is cool and clammy. Which intervention is the nurse's priority?
A. Initiate aggressive fluid resuscitation with isotonic crystalloids
B. Administer vasopressors before any fluid bolus
C. Apply tight compression bandages to all four extremities
D. Position the patient in high Fowler's position
Correct Answer: A
Rationale: Correct because this patient's presentation is consistent with
hypovolemic shock caused by significant hemorrhage, and the priority
intervention is aggressive fluid resuscitation using isotonic crystalloids such
as Normal Saline or Lactated Ringer's to restore intravascular volume and
tissue perfusion. The pathophysiology involves decreased preload from blood
loss leading to reduced cardiac output, which must be corrected with volume
replacement before vasopressors can be effective. The nurse must also
monitor urine output, aiming for 0.5–1 mL/kg/hr, as an indicator of adequate
renal perfusion and successful resuscitation.
Q3: A 68-year-old male with chronic hypertension arrives in the ED reporting
sudden, severe, tearing chest pain that radiates directly to his interscapular
area. His right arm blood pressure is 180/110 mmHg and his left arm blood
pressure is 110/70 mmHg. What is the priority nursing intervention?
A. Prepare the patient for immediate surgical correction without delay
B. Administer IV morphine sulfate and reassess in 30 minutes
C. Initiate aggressive fluid resuscitation with Normal Saline boluses
D. Begin IV beta-blocker therapy to reduce shear stress on the aortic wall
Correct Answer: D
Rationale: Correct because this patient's presentation is consistent with
aortic dissection, evidenced by the classic tearing chest pain radiating to the
back and a marked pulse deficit between arms exceeding 20 mmHg. The
priority medical goal before surgical correction is emergency blood pressure
,control using IV beta-blockers such as esmolol or labetalol to reduce heart
rate below 60 bpm and systolic blood pressure to 100–120 mmHg, thereby
decreasing dP/dt shear stress on the torn intima. Aggressive fluid
resuscitation is contraindicated because it would increase cardiac output and
worsen the dissection, while beta-blockade stabilizes the patient for
definitive surgical or endovascular repair.
Q4: A patient receiving cyclophosphamide chemotherapy has an absolute
neutrophil count (ANC) of 400/mm³. Which nursing action is most appropriate
upon receiving this laboratory result?
A. Allow the patient to receive fresh flowers from family members
B. Place the patient on neutropenic precautions with a private room
C. Encourage the patient to eat a raw vegetable salad for nutrition
D. Permit visits from grandchildren with mild upper respiratory symptoms
Correct Answer: B
Rationale: Correct because an ANC below 500/mm³ places this patient at
severe risk for infection, and neutropenic precautions with a private room are
mandatory to minimize exposure to environmental pathogens. The
pathophysiology of chemotherapy-induced bone marrow suppression
destroys rapidly dividing hematopoietic stem cells, leading to neutropenia,
which is the most common cause of chemotherapy-related death due to
overwhelming infection. The nurse must also enforce a low-bacteria diet,
prohibit fresh flowers and plants, restrict sick visitors, and teach the patient
to report any fever greater than 100.4°F immediately, as febrile neutropenia
constitutes a medical emergency requiring STAT blood cultures and broad-
spectrum antibiotics.
, Q5: A 55-year-old male is admitted with acute kidney injury following severe
dehydration from prolonged diarrhea. His BUN is 48 mg/dL and serum
creatinine is 2.1 mg/dL. What BUN:creatinine ratio supports a prerenal cause
for this patient's AKI?
A. Greater than 20:1
B. Approximately 10:1
C. Less than 5:1
D. Exactly 15:1
Correct Answer: A
Rationale: Correct because prerenal acute kidney injury results from
decreased renal perfusion, which causes disproportionate BUN elevation
relative to creatinine due to enhanced tubular reabsorption of urea,
producing a BUN:creatinine ratio greater than 20:1. This patient's
presentation is consistent with hypovolemia from GI losses, which reduces
glomerular filtration rate without causing intrinsic tubular damage. The nurse
must initiate aggressive fluid resuscitation, monitor strict intake and output,
and watch for progression to intrarenal failure if renal hypoperfusion persists
and causes acute tubular necrosis.
Q6: A 32-year-old female is admitted to the burn unit after sustaining flame
burns to her torso and upper extremities. Which initial nursing actions are
appropriate during the emergent phase? Select all that apply.
A. Establish two large-bore IV lines through unburned skin if possible
B. Secure a patent airway and administer 100% humidified oxygen
C. Remove all rings, watches, belts, and constrictive clothing immediately
D. Apply ice packs directly to burned extremities to reduce tissue damage
E. Verify the exact time of injury to calculate fluid resuscitation needs
Correct Answer: A, B, C, E
Rationale: Correct because initial burn stabilization requires establishing
two large-bore IV lines for fluid resuscitation, securing the airway with 100%
2026/2027 |Newly Released| Fortis College
50 Questions & Answers |Grade A+
100% Correct Rationales | Complete Study Guide
Guaranteed Pass
Q1: A 28-year-old male is brought to the ED after a kitchen grease fire. He
has partial-thickness burns covering his entire head, his entire right arm, and
his entire left arm. Using the adult Rule of Nines, what percentage of his total
body surface area (TBSA) is burned?
A. 18%
B. 9%
C. 27%
D. 36%
Correct Answer: C
Rationale: Correct because the adult Rule of Nines assigns 9% to the entire
head and 9% to each entire arm, so 9% + 9% + 9% equals 27% TBSA
burned. This patient's presentation is consistent with partial-thickness burns
that are counted in TBSA calculations, whereas superficial first-degree burns
are excluded from fluid resuscitation estimates. The priority nursing
implication is to use this 27% TBSA figure to calculate Parkland Formula fluid
requirements and to communicate severity to the burn team.
Q2: A 45-year-old female presents to the ED following a motor vehicle
collision with significant blood loss from a femur fracture. Her blood pressure
,is 82/50 mmHg, heart rate is 128 bpm, respiratory rate is 24 breaths/min,
and her skin is cool and clammy. Which intervention is the nurse's priority?
A. Initiate aggressive fluid resuscitation with isotonic crystalloids
B. Administer vasopressors before any fluid bolus
C. Apply tight compression bandages to all four extremities
D. Position the patient in high Fowler's position
Correct Answer: A
Rationale: Correct because this patient's presentation is consistent with
hypovolemic shock caused by significant hemorrhage, and the priority
intervention is aggressive fluid resuscitation using isotonic crystalloids such
as Normal Saline or Lactated Ringer's to restore intravascular volume and
tissue perfusion. The pathophysiology involves decreased preload from blood
loss leading to reduced cardiac output, which must be corrected with volume
replacement before vasopressors can be effective. The nurse must also
monitor urine output, aiming for 0.5–1 mL/kg/hr, as an indicator of adequate
renal perfusion and successful resuscitation.
Q3: A 68-year-old male with chronic hypertension arrives in the ED reporting
sudden, severe, tearing chest pain that radiates directly to his interscapular
area. His right arm blood pressure is 180/110 mmHg and his left arm blood
pressure is 110/70 mmHg. What is the priority nursing intervention?
A. Prepare the patient for immediate surgical correction without delay
B. Administer IV morphine sulfate and reassess in 30 minutes
C. Initiate aggressive fluid resuscitation with Normal Saline boluses
D. Begin IV beta-blocker therapy to reduce shear stress on the aortic wall
Correct Answer: D
Rationale: Correct because this patient's presentation is consistent with
aortic dissection, evidenced by the classic tearing chest pain radiating to the
back and a marked pulse deficit between arms exceeding 20 mmHg. The
priority medical goal before surgical correction is emergency blood pressure
,control using IV beta-blockers such as esmolol or labetalol to reduce heart
rate below 60 bpm and systolic blood pressure to 100–120 mmHg, thereby
decreasing dP/dt shear stress on the torn intima. Aggressive fluid
resuscitation is contraindicated because it would increase cardiac output and
worsen the dissection, while beta-blockade stabilizes the patient for
definitive surgical or endovascular repair.
Q4: A patient receiving cyclophosphamide chemotherapy has an absolute
neutrophil count (ANC) of 400/mm³. Which nursing action is most appropriate
upon receiving this laboratory result?
A. Allow the patient to receive fresh flowers from family members
B. Place the patient on neutropenic precautions with a private room
C. Encourage the patient to eat a raw vegetable salad for nutrition
D. Permit visits from grandchildren with mild upper respiratory symptoms
Correct Answer: B
Rationale: Correct because an ANC below 500/mm³ places this patient at
severe risk for infection, and neutropenic precautions with a private room are
mandatory to minimize exposure to environmental pathogens. The
pathophysiology of chemotherapy-induced bone marrow suppression
destroys rapidly dividing hematopoietic stem cells, leading to neutropenia,
which is the most common cause of chemotherapy-related death due to
overwhelming infection. The nurse must also enforce a low-bacteria diet,
prohibit fresh flowers and plants, restrict sick visitors, and teach the patient
to report any fever greater than 100.4°F immediately, as febrile neutropenia
constitutes a medical emergency requiring STAT blood cultures and broad-
spectrum antibiotics.
, Q5: A 55-year-old male is admitted with acute kidney injury following severe
dehydration from prolonged diarrhea. His BUN is 48 mg/dL and serum
creatinine is 2.1 mg/dL. What BUN:creatinine ratio supports a prerenal cause
for this patient's AKI?
A. Greater than 20:1
B. Approximately 10:1
C. Less than 5:1
D. Exactly 15:1
Correct Answer: A
Rationale: Correct because prerenal acute kidney injury results from
decreased renal perfusion, which causes disproportionate BUN elevation
relative to creatinine due to enhanced tubular reabsorption of urea,
producing a BUN:creatinine ratio greater than 20:1. This patient's
presentation is consistent with hypovolemia from GI losses, which reduces
glomerular filtration rate without causing intrinsic tubular damage. The nurse
must initiate aggressive fluid resuscitation, monitor strict intake and output,
and watch for progression to intrarenal failure if renal hypoperfusion persists
and causes acute tubular necrosis.
Q6: A 32-year-old female is admitted to the burn unit after sustaining flame
burns to her torso and upper extremities. Which initial nursing actions are
appropriate during the emergent phase? Select all that apply.
A. Establish two large-bore IV lines through unburned skin if possible
B. Secure a patent airway and administer 100% humidified oxygen
C. Remove all rings, watches, belts, and constrictive clothing immediately
D. Apply ice packs directly to burned extremities to reduce tissue damage
E. Verify the exact time of injury to calculate fluid resuscitation needs
Correct Answer: A, B, C, E
Rationale: Correct because initial burn stabilization requires establishing
two large-bore IV lines for fluid resuscitation, securing the airway with 100%
