NUR 265 Exam 3 V3 | NUR 265 Advanced Concepts
of Medical–Surgical Nursing | Actual Q&A with
Rationale (NUR 265 Exam 3) | Galen
1. A 45-year-old male patient weighing 80 kg is admitted to the burn unit with 40% Total
Body Surface Area (TBSA) thermal burns. Using the Parkland Formula (4 mL/kg/%TBSA), the
nurse calculates the total fluid resuscitation for the first 24 hours. How many milliliters
should be administered in the first 8 hours?
A. 3,200 mL
B. 6,400 mL
C. 12,800 mL
D. 9,600 mL
Correct Answer: B
Explanation: The Parkland Formula calculates total 24-hour fluid as 4 mL x weight in kg x
% TBSA, which equals 4 x 80 x 40 = 12,800 mL. Half of this total volume must be
administered in the first 8 hours following the injury. Therefore, 12,800 divided by 2
results in 6,400 mL to be infused during the first 8-hour window.
,2. A patient in the intensive care unit is being treated for septic shock. Despite adequate fluid
resuscitation with 3 liters of normal saline, the patient’s mean arterial pressure (MAP)
remains 58 mmHg and serum lactate is 5.2 mmol/L. Which medication should the nurse
anticipate administering next?
A. Dobutamine
B. Nitroglycerin
C. Norepinephrine
D. Furosemide
Correct Answer: C
Explanation: Norepinephrine is the first-line vasopressor for septic shock when fluid
resuscitation fails to achieve a MAP of 65 mmHg or higher. It works by increasing systemic
vascular resistance through alpha-1 adrenergic stimulation. Dobutamine is typically
reserved for cardiogenic shock or low cardiac output states, not as the primary vasopressor
in sepsis.
3. An adult female patient is brought to the emergency department after a motor vehicle
accident. The nurse observes tracheal deviation to the right, absent breath sounds on the left,
and extreme respiratory distress. What is the nurse’s immediate priority action?
A. Obtain a portable chest X-ray
B. Prepare for emergency endotracheal intubation
C. Administer high-flow oxygen via nasal cannula
,D. Assist with needle thoracostomy
Correct Answer: D
Explanation: The clinical findings of tracheal deviation and absent breath sounds suggest a
tension pneumothorax, which is a life-threatening emergency. Needle thoracostomy
(decompression) must be performed immediately to relieve intrapleural pressure before a
chest tube is placed. Delaying for an X-ray can lead to obstructive shock and cardiac arrest.
4. A patient with acute kidney injury (AKI) is in the oliguric phase. The nurse notes the patient
has developed tall, peaked T-waves on the EKG and a serum potassium level of 6.8 mEq/L.
Which order should the nurse implement first?
A. Administer sodium polystyrene sulfonate (Kayexalate) orally
B. Initiate 10 units of regular insulin with 50% Dextrose IV
C. Prepare the patient for urgent hemodialysis
D. Administer intravenous Calcium Gluconate
Correct Answer: D
Explanation: Intravenous Calcium Gluconate is the priority because it stabilizes the
myocardial cell membrane to prevent lethal arrhythmias associated with severe
hyperkalemia. While insulin and dextrose help shift potassium into cells, they do not
provide immediate cardiac protection. Kayexalate and dialysis are effective but take longer
to reduce the potassium level than the immediate effect of calcium on the heart.
, 5. The nurse is caring for a patient who sustained full-thickness burns to the chest and
abdomen. The patient is now exhibiting rapid, shallow respirations and decreased chest
expansion. Which procedure does the nurse anticipate?
A. Escharotomy
B. Fasciotomy
C. Debridement
D. Skin grafting
Correct Answer: A
Explanation: Full-thickness (third-degree) burns create a tough, inelastic leathery tissue
called eschar. When this occurs circumferentially around the chest or abdomen, it can
restrict lung expansion and cause respiratory failure. An escharotomy is a surgical incision
through the eschar to relieve pressure and allow for adequate ventilation.
6. A patient with Multiple Organ Dysfunction Syndrome (MODS) is showing signs of liver
failure. Which laboratory value most specifically indicates that the liver’s biosynthetic
function is significantly impaired in the context of MODS?
A. Increased Alanine Aminotransferase (ALT)
B. Prolonged Prothrombin Time (PT/INR)
C. Increased Serum Bilirubin
D. Decreased Serum Albumin
of Medical–Surgical Nursing | Actual Q&A with
Rationale (NUR 265 Exam 3) | Galen
1. A 45-year-old male patient weighing 80 kg is admitted to the burn unit with 40% Total
Body Surface Area (TBSA) thermal burns. Using the Parkland Formula (4 mL/kg/%TBSA), the
nurse calculates the total fluid resuscitation for the first 24 hours. How many milliliters
should be administered in the first 8 hours?
A. 3,200 mL
B. 6,400 mL
C. 12,800 mL
D. 9,600 mL
Correct Answer: B
Explanation: The Parkland Formula calculates total 24-hour fluid as 4 mL x weight in kg x
% TBSA, which equals 4 x 80 x 40 = 12,800 mL. Half of this total volume must be
administered in the first 8 hours following the injury. Therefore, 12,800 divided by 2
results in 6,400 mL to be infused during the first 8-hour window.
,2. A patient in the intensive care unit is being treated for septic shock. Despite adequate fluid
resuscitation with 3 liters of normal saline, the patient’s mean arterial pressure (MAP)
remains 58 mmHg and serum lactate is 5.2 mmol/L. Which medication should the nurse
anticipate administering next?
A. Dobutamine
B. Nitroglycerin
C. Norepinephrine
D. Furosemide
Correct Answer: C
Explanation: Norepinephrine is the first-line vasopressor for septic shock when fluid
resuscitation fails to achieve a MAP of 65 mmHg or higher. It works by increasing systemic
vascular resistance through alpha-1 adrenergic stimulation. Dobutamine is typically
reserved for cardiogenic shock or low cardiac output states, not as the primary vasopressor
in sepsis.
3. An adult female patient is brought to the emergency department after a motor vehicle
accident. The nurse observes tracheal deviation to the right, absent breath sounds on the left,
and extreme respiratory distress. What is the nurse’s immediate priority action?
A. Obtain a portable chest X-ray
B. Prepare for emergency endotracheal intubation
C. Administer high-flow oxygen via nasal cannula
,D. Assist with needle thoracostomy
Correct Answer: D
Explanation: The clinical findings of tracheal deviation and absent breath sounds suggest a
tension pneumothorax, which is a life-threatening emergency. Needle thoracostomy
(decompression) must be performed immediately to relieve intrapleural pressure before a
chest tube is placed. Delaying for an X-ray can lead to obstructive shock and cardiac arrest.
4. A patient with acute kidney injury (AKI) is in the oliguric phase. The nurse notes the patient
has developed tall, peaked T-waves on the EKG and a serum potassium level of 6.8 mEq/L.
Which order should the nurse implement first?
A. Administer sodium polystyrene sulfonate (Kayexalate) orally
B. Initiate 10 units of regular insulin with 50% Dextrose IV
C. Prepare the patient for urgent hemodialysis
D. Administer intravenous Calcium Gluconate
Correct Answer: D
Explanation: Intravenous Calcium Gluconate is the priority because it stabilizes the
myocardial cell membrane to prevent lethal arrhythmias associated with severe
hyperkalemia. While insulin and dextrose help shift potassium into cells, they do not
provide immediate cardiac protection. Kayexalate and dialysis are effective but take longer
to reduce the potassium level than the immediate effect of calcium on the heart.
, 5. The nurse is caring for a patient who sustained full-thickness burns to the chest and
abdomen. The patient is now exhibiting rapid, shallow respirations and decreased chest
expansion. Which procedure does the nurse anticipate?
A. Escharotomy
B. Fasciotomy
C. Debridement
D. Skin grafting
Correct Answer: A
Explanation: Full-thickness (third-degree) burns create a tough, inelastic leathery tissue
called eschar. When this occurs circumferentially around the chest or abdomen, it can
restrict lung expansion and cause respiratory failure. An escharotomy is a surgical incision
through the eschar to relieve pressure and allow for adequate ventilation.
6. A patient with Multiple Organ Dysfunction Syndrome (MODS) is showing signs of liver
failure. Which laboratory value most specifically indicates that the liver’s biosynthetic
function is significantly impaired in the context of MODS?
A. Increased Alanine Aminotransferase (ALT)
B. Prolonged Prothrombin Time (PT/INR)
C. Increased Serum Bilirubin
D. Decreased Serum Albumin
