Exam 1: NUR 209 Medical-Surgical Nursing II
2026/2027 |Newly Released| Fortis College
50 Questions & Answers |Grade A+
100% Correct Rationales | Complete Study Guide
Guaranteed Pass
Q1: A 32-year-old male is brought to the emergency department after a house fire. He has full-
thickness burns covering the entire anterior torso, the entire right arm, and the anterior half of the
left leg. Using the adult Rule of Nines, what percentage of his total body surface area (TBSA) is
burned?
A. 22.5%
B. 31.5%
C. 36%
D. 40.5%
Correct Answer: C
Rationale: The adult Rule of Nines assigns 18% to the anterior torso, 9% to an entire arm, and
9% to the anterior half of one leg, yielding a total of 36% TBSA. First-degree burns are excluded
from Parkland calculations; only partial-thickness and full-thickness burns are counted. Correct
because 18% + 9% + 9% = 36%, which directly determines the fluid resuscitation volume this
patient will require.
Q2: A 58-year-old female is transported to the ED following a motor vehicle collision. She has
lost approximately 1,500 mL of blood. Her blood pressure is 88/52 mmHg, heart rate is 128 bpm,
respiratory rate is 24 breaths/min, and her skin is cool and clammy. Which type of shock is this
patient most likely experiencing?
A. Hypovolemic shock
B. Cardiogenic shock
C. Septic shock
D. Neurogenic shock
Correct Answer: A
,Rationale: Significant hemorrhage causes a profound decrease in intravascular volume, which
reduces venous return and preload to the right ventricle. The clinical presentation of hypotension,
tachycardia, tachypnea, and cool clammy skin is the classic triad of hypovolemic shock resulting
from inadequate tissue perfusion. Correct because the pathophysiology of hemorrhagic loss
leading to decreased cardiac output and compromised tissue oxygenation defines hypovolemic
shock.
Q3: A 67-year-old male with chronic hypertension presents with sudden, severe, tearing chest
pain that radiates directly into his interscapular area. His blood pressure is 198/110 mmHg in the
right arm and 160/94 mmHg in the left arm. Which intervention is the priority before any
surgical correction?
A. Immediate fluid bolus of 1,000 mL Normal Saline
B. Initiation of dobutamine infusion
C. Emergency needle decompression
D. IV beta-blocker administration for blood pressure control
Correct Answer: D
Rationale: Aortic dissection creates a tear in the intima that allows blood to shear through the
medial layer, and uncontrolled hypertension dramatically increases wall stress and rupture risk.
IV beta-blockers such as esmolol or labetalol are the priority pharmacologic intervention because
they reduce both heart rate and blood pressure, thereby decreasing the force of ventricular
ejection (dP/dt) on the damaged aortic wall. Correct because beta-blockade must be achieved
before surgical intervention to prevent intraoperative extension of the dissection or free rupture.
Q4: A 45-year-old patient asks the nurse to examine a skin lesion on his back. The lesion is 8
mm in diameter, has irregular notched borders, and contains multiple shades of brown, black,
and red within the same mole. Which ABCDE criterion is most specifically demonstrated by the
presence of multiple colors within this single lesion?
A. Asymmetry
B. Color variation
C. Diameter
D. Evolution
Correct Answer: B
Rationale: The ABCDE criteria for melanoma screening are standardized assessment tools that
guide nurses and providers toward early detection of malignant transformation. Color variation
refers to the presence of multiple pigments—including shades of brown, black, tan, red, white, or
, blue—within one lesion, which indicates dysplastic melanocytic activity. Correct because the
description of multiple colors within the same lesion maps directly to the C criterion and
warrants immediate referral for biopsy.
Q5: A 62-year-old patient with acute kidney injury has a BUN of 48 mg/dL and a serum
creatinine of 2.1 mg/dL. Which BUN-to-creatinine ratio is most consistent with a prerenal cause
of this patient's kidney injury?
A. Greater than 20:1
B. Approximately 10:1
C. Less than 10:1
D. Exactly 5:1
Correct Answer: A
Rationale: Prerenal acute kidney injury results from decreased renal perfusion, which causes a
disproportionate rise in BUN relative to creatinine due to enhanced tubular reabsorption of urea.
A BUN-to-creatinine ratio exceeding 20:1 is the classic laboratory hallmark of prerenal azotemia
because the kidneys avidly reclaim urea in response to low flow states. Correct because the
calculated ratio of approximately 23:1 strongly supports a prerenal etiology such as
hypovolemia, heart failure, or shock.
Q6: A 28-year-old patient is brought to the ED with partial- and full-thickness burns sustained in
a kitchen fire approximately 45 minutes ago. Which initial nursing actions are appropriate during
the primary survey and emergent stabilization phase? Select all that apply.
A. Apply ice packs to the burned areas to reduce tissue damage
B. Establish two large-bore IV lines through unburned skin if possible
C. Remove all rings, watches, belts, and constrictive clothing
D. Break intact blisters to assess wound depth and promote drainage
E. Cover burns with clean, dry, sterile sheets
Correct Answer: B, C, E
Rationale: Establishing two large-bore IV lines ensures immediate vascular access for fluid
resuscitation per the Parkland Formula and allows for blood product administration if needed.
Removing constrictive items is essential because rapid edema formation during the emergent
phase can create a tourniquet effect that compromises distal circulation. Covering burns with
clean dry sterile sheets prevents contamination, reduces evaporative heat loss, and minimizes
pain stimulus from air exposure. Correct because these three interventions represent the
2026/2027 |Newly Released| Fortis College
50 Questions & Answers |Grade A+
100% Correct Rationales | Complete Study Guide
Guaranteed Pass
Q1: A 32-year-old male is brought to the emergency department after a house fire. He has full-
thickness burns covering the entire anterior torso, the entire right arm, and the anterior half of the
left leg. Using the adult Rule of Nines, what percentage of his total body surface area (TBSA) is
burned?
A. 22.5%
B. 31.5%
C. 36%
D. 40.5%
Correct Answer: C
Rationale: The adult Rule of Nines assigns 18% to the anterior torso, 9% to an entire arm, and
9% to the anterior half of one leg, yielding a total of 36% TBSA. First-degree burns are excluded
from Parkland calculations; only partial-thickness and full-thickness burns are counted. Correct
because 18% + 9% + 9% = 36%, which directly determines the fluid resuscitation volume this
patient will require.
Q2: A 58-year-old female is transported to the ED following a motor vehicle collision. She has
lost approximately 1,500 mL of blood. Her blood pressure is 88/52 mmHg, heart rate is 128 bpm,
respiratory rate is 24 breaths/min, and her skin is cool and clammy. Which type of shock is this
patient most likely experiencing?
A. Hypovolemic shock
B. Cardiogenic shock
C. Septic shock
D. Neurogenic shock
Correct Answer: A
,Rationale: Significant hemorrhage causes a profound decrease in intravascular volume, which
reduces venous return and preload to the right ventricle. The clinical presentation of hypotension,
tachycardia, tachypnea, and cool clammy skin is the classic triad of hypovolemic shock resulting
from inadequate tissue perfusion. Correct because the pathophysiology of hemorrhagic loss
leading to decreased cardiac output and compromised tissue oxygenation defines hypovolemic
shock.
Q3: A 67-year-old male with chronic hypertension presents with sudden, severe, tearing chest
pain that radiates directly into his interscapular area. His blood pressure is 198/110 mmHg in the
right arm and 160/94 mmHg in the left arm. Which intervention is the priority before any
surgical correction?
A. Immediate fluid bolus of 1,000 mL Normal Saline
B. Initiation of dobutamine infusion
C. Emergency needle decompression
D. IV beta-blocker administration for blood pressure control
Correct Answer: D
Rationale: Aortic dissection creates a tear in the intima that allows blood to shear through the
medial layer, and uncontrolled hypertension dramatically increases wall stress and rupture risk.
IV beta-blockers such as esmolol or labetalol are the priority pharmacologic intervention because
they reduce both heart rate and blood pressure, thereby decreasing the force of ventricular
ejection (dP/dt) on the damaged aortic wall. Correct because beta-blockade must be achieved
before surgical intervention to prevent intraoperative extension of the dissection or free rupture.
Q4: A 45-year-old patient asks the nurse to examine a skin lesion on his back. The lesion is 8
mm in diameter, has irregular notched borders, and contains multiple shades of brown, black,
and red within the same mole. Which ABCDE criterion is most specifically demonstrated by the
presence of multiple colors within this single lesion?
A. Asymmetry
B. Color variation
C. Diameter
D. Evolution
Correct Answer: B
Rationale: The ABCDE criteria for melanoma screening are standardized assessment tools that
guide nurses and providers toward early detection of malignant transformation. Color variation
refers to the presence of multiple pigments—including shades of brown, black, tan, red, white, or
, blue—within one lesion, which indicates dysplastic melanocytic activity. Correct because the
description of multiple colors within the same lesion maps directly to the C criterion and
warrants immediate referral for biopsy.
Q5: A 62-year-old patient with acute kidney injury has a BUN of 48 mg/dL and a serum
creatinine of 2.1 mg/dL. Which BUN-to-creatinine ratio is most consistent with a prerenal cause
of this patient's kidney injury?
A. Greater than 20:1
B. Approximately 10:1
C. Less than 10:1
D. Exactly 5:1
Correct Answer: A
Rationale: Prerenal acute kidney injury results from decreased renal perfusion, which causes a
disproportionate rise in BUN relative to creatinine due to enhanced tubular reabsorption of urea.
A BUN-to-creatinine ratio exceeding 20:1 is the classic laboratory hallmark of prerenal azotemia
because the kidneys avidly reclaim urea in response to low flow states. Correct because the
calculated ratio of approximately 23:1 strongly supports a prerenal etiology such as
hypovolemia, heart failure, or shock.
Q6: A 28-year-old patient is brought to the ED with partial- and full-thickness burns sustained in
a kitchen fire approximately 45 minutes ago. Which initial nursing actions are appropriate during
the primary survey and emergent stabilization phase? Select all that apply.
A. Apply ice packs to the burned areas to reduce tissue damage
B. Establish two large-bore IV lines through unburned skin if possible
C. Remove all rings, watches, belts, and constrictive clothing
D. Break intact blisters to assess wound depth and promote drainage
E. Cover burns with clean, dry, sterile sheets
Correct Answer: B, C, E
Rationale: Establishing two large-bore IV lines ensures immediate vascular access for fluid
resuscitation per the Parkland Formula and allows for blood product administration if needed.
Removing constrictive items is essential because rapid edema formation during the emergent
phase can create a tourniquet effect that compromises distal circulation. Covering burns with
clean dry sterile sheets prevents contamination, reduces evaporative heat loss, and minimizes
pain stimulus from air exposure. Correct because these three interventions represent the
