NUR 265 Exam 3 V1 | NUR 265 Advanced Concepts
of Medical–Surgical Nursing | Actual Q&A with
Rationale (NUR 265 Exam 3) | Galen
1. Mr. Thompson, a 68-year-old patient with a history of urosepsis, is admitted to the ICU. His
blood pressure is 82/44 mmHg, heart rate is 122 bpm, and his serum lactate is 4.5 mmol/L.
After receiving a 30 mL/kg bolus of Normal Saline, his MAP remains 58 mmHg. Which
intervention is the nurse’s next priority?
A. Initiate a continuous infusion of Norepinephrine.
B. Administer a second 30 mL/kg fluid bolus.
C. Prepare the patient for immediate hemodialysis.
D. Administer a dose of IV Furosemide.
Correct Answer: A
Explanation: The patient is in septic shock, evidenced by persistent hypotension and
elevated lactate despite adequate fluid resuscitation. Per the Surviving Sepsis Campaign
guidelines, Norepinephrine is the first-line vasopressor to maintain a Mean Arterial
Pressure (MAP) of at least 65 mmHg. Delaying vasopressors in the presence of refractory
hypotension increases the risk of organ hypoperfusion and Multiple Organ Dysfunction
Syndrome (MODS).
,2. Mrs. Rodriguez is admitted to the burn unit with full-thickness burns covering her entire
chest, abdomen, and both anterior arms. Using the Rule of Nines, what is the estimated Total
Body Surface Area (TBSA) affected?
A. 18%
B. 27%
C. 36%
D. 45%
Correct Answer: B
Explanation: According to the Rule of Nines, the entire anterior trunk (chest and
abdomen) accounts for 18% of the TBSA. Each entire arm accounts for 9%, so the anterior
portion of both arms would total 9% (4.5% + 4.5%). Adding 18% and 9% results in a total
of 27% TBSA. Accurate calculation of TBSA is critical for determining fluid resuscitation
needs using formulas like the Parkland Formula.
3. A 55-year-old male, Mr. Henderson, is being treated for ARDS secondary to pneumonia.
Despite being on a ventilator with an FiO2 of 80% and a PEEP of 12 cm H2O, his PaO2 remains
at 54 mmHg. Which nursing intervention should be considered to improve oxygenation?
A. Place the patient in a prone position.
B. Increase the respiratory rate to 35 breaths per minute.
C. Decrease the PEEP to 5 cm H2O to reduce barotrauma.
D. Perform aggressive tracheal suctioning every 30 minutes.
,Correct Answer: A
Explanation: Prone positioning is an evidenced-based intervention for patients with
severe ARDS who exhibit refractory hypoxemia. This position improves oxygenation by
recruiting collapsed alveoli in the posterior lung segments and improving ventilation-
perfusion matching. The nurse must coordinate with a multidisciplinary team to safely
perform the prone maneuver while protecting the airway and pressure points.
4. Mr. Lee is in the emergent phase of a 45% TBSA burn injury. He weighs 70 kg. Using the
Parkland Formula (4 mL/kg/%TBSA), the nurse calculates the total fluid requirement for the
first 24 hours. How much fluid should be administered during the first 8 hours?
A. 6,300 mL
B. 12,600 mL
C. 3,150 mL
D. 5,400 mL
Correct Answer: A
Explanation: The Parkland Formula is calculated as 4 mL x 70 kg x 45 = 12,600 mL for the
first 24 hours. The protocol dictates that half of this total volume (6,300 mL) must be
administered within the first 8 hours from the time of the burn injury. The remaining half is
administered over the subsequent 16 hours to maintain adequate tissue perfusion and
prevent hypovolemic shock.
, 5. A patient with Multiple Organ Dysfunction Syndrome (MODS) exhibits oozing from IV sites,
petechiae, and a decreasing platelet count. The nurse notes a significantly elevated D-dimer
and prolonged Prothrombin Time (PT). Which complication is most likely occurring?
A. Disseminated Intravascular Coagulation (DIC)
B. Acute Hemolytic Transfusion Reaction
C. Heparin-Induced Thrombocytopenia (HIT)
D. Vitamin K Deficiency
Correct Answer: A
Explanation: DIC is a common and serious complication of MODS and sepsis, characterized
by systemic activation of the coagulation cascade. This leads to both microvascular thrombi
and the depletion of clotting factors and platelets, resulting in hemorrhage. Elevated D-
dimer levels and prolonged clotting times are diagnostic hallmarks of this condition,
requiring prompt identification and management of the underlying cause.
6. Sarah, a 30-year-old female, is brought to the ED following a motor vehicle accident. She
has absent breath sounds on the right side, tracheal deviation to the left, and severe
respiratory distress. What is the immediate priority for the nurse?
A. Obtain a portable chest X-ray to confirm placement.
B. Administer IV morphine for chest pain.
C. Prepare for needle decompression or chest tube insertion.
D. Start a second large-bore IV line.
of Medical–Surgical Nursing | Actual Q&A with
Rationale (NUR 265 Exam 3) | Galen
1. Mr. Thompson, a 68-year-old patient with a history of urosepsis, is admitted to the ICU. His
blood pressure is 82/44 mmHg, heart rate is 122 bpm, and his serum lactate is 4.5 mmol/L.
After receiving a 30 mL/kg bolus of Normal Saline, his MAP remains 58 mmHg. Which
intervention is the nurse’s next priority?
A. Initiate a continuous infusion of Norepinephrine.
B. Administer a second 30 mL/kg fluid bolus.
C. Prepare the patient for immediate hemodialysis.
D. Administer a dose of IV Furosemide.
Correct Answer: A
Explanation: The patient is in septic shock, evidenced by persistent hypotension and
elevated lactate despite adequate fluid resuscitation. Per the Surviving Sepsis Campaign
guidelines, Norepinephrine is the first-line vasopressor to maintain a Mean Arterial
Pressure (MAP) of at least 65 mmHg. Delaying vasopressors in the presence of refractory
hypotension increases the risk of organ hypoperfusion and Multiple Organ Dysfunction
Syndrome (MODS).
,2. Mrs. Rodriguez is admitted to the burn unit with full-thickness burns covering her entire
chest, abdomen, and both anterior arms. Using the Rule of Nines, what is the estimated Total
Body Surface Area (TBSA) affected?
A. 18%
B. 27%
C. 36%
D. 45%
Correct Answer: B
Explanation: According to the Rule of Nines, the entire anterior trunk (chest and
abdomen) accounts for 18% of the TBSA. Each entire arm accounts for 9%, so the anterior
portion of both arms would total 9% (4.5% + 4.5%). Adding 18% and 9% results in a total
of 27% TBSA. Accurate calculation of TBSA is critical for determining fluid resuscitation
needs using formulas like the Parkland Formula.
3. A 55-year-old male, Mr. Henderson, is being treated for ARDS secondary to pneumonia.
Despite being on a ventilator with an FiO2 of 80% and a PEEP of 12 cm H2O, his PaO2 remains
at 54 mmHg. Which nursing intervention should be considered to improve oxygenation?
A. Place the patient in a prone position.
B. Increase the respiratory rate to 35 breaths per minute.
C. Decrease the PEEP to 5 cm H2O to reduce barotrauma.
D. Perform aggressive tracheal suctioning every 30 minutes.
,Correct Answer: A
Explanation: Prone positioning is an evidenced-based intervention for patients with
severe ARDS who exhibit refractory hypoxemia. This position improves oxygenation by
recruiting collapsed alveoli in the posterior lung segments and improving ventilation-
perfusion matching. The nurse must coordinate with a multidisciplinary team to safely
perform the prone maneuver while protecting the airway and pressure points.
4. Mr. Lee is in the emergent phase of a 45% TBSA burn injury. He weighs 70 kg. Using the
Parkland Formula (4 mL/kg/%TBSA), the nurse calculates the total fluid requirement for the
first 24 hours. How much fluid should be administered during the first 8 hours?
A. 6,300 mL
B. 12,600 mL
C. 3,150 mL
D. 5,400 mL
Correct Answer: A
Explanation: The Parkland Formula is calculated as 4 mL x 70 kg x 45 = 12,600 mL for the
first 24 hours. The protocol dictates that half of this total volume (6,300 mL) must be
administered within the first 8 hours from the time of the burn injury. The remaining half is
administered over the subsequent 16 hours to maintain adequate tissue perfusion and
prevent hypovolemic shock.
, 5. A patient with Multiple Organ Dysfunction Syndrome (MODS) exhibits oozing from IV sites,
petechiae, and a decreasing platelet count. The nurse notes a significantly elevated D-dimer
and prolonged Prothrombin Time (PT). Which complication is most likely occurring?
A. Disseminated Intravascular Coagulation (DIC)
B. Acute Hemolytic Transfusion Reaction
C. Heparin-Induced Thrombocytopenia (HIT)
D. Vitamin K Deficiency
Correct Answer: A
Explanation: DIC is a common and serious complication of MODS and sepsis, characterized
by systemic activation of the coagulation cascade. This leads to both microvascular thrombi
and the depletion of clotting factors and platelets, resulting in hemorrhage. Elevated D-
dimer levels and prolonged clotting times are diagnostic hallmarks of this condition,
requiring prompt identification and management of the underlying cause.
6. Sarah, a 30-year-old female, is brought to the ED following a motor vehicle accident. She
has absent breath sounds on the right side, tracheal deviation to the left, and severe
respiratory distress. What is the immediate priority for the nurse?
A. Obtain a portable chest X-ray to confirm placement.
B. Administer IV morphine for chest pain.
C. Prepare for needle decompression or chest tube insertion.
D. Start a second large-bore IV line.
