BSN Advanced Medical-Surgical Nursing Final Exam
Practice 2026 UPDATED ACTUAL Questions and CORRECT
Answers
1. A patient in the ICU is diagnosed with septic shock. Which of the following
assessment findings would the nurse expect in the compensatory stage?
A. Increased heart rate and narrowed pulse pressure
B. Cold, clammy skin
C. Lethargy and decreased responsiveness
D. Respiratory acidosis
Answer: A
Rationale: In the compensatory stage of shock, the body attempts to maintain homeostasis
through the activation of the sympathetic nervous system, resulting in tachycardia and
vasoconstriction to maintain blood pressure.
2. A patient’s ABG results are pH 7.28, PaCO2 55 mmHg, and HCO3 26 mEq/L.
How should the nurse interpret these results?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Answer: A
Rationale: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg indicates a
respiratory cause, and since the bicarbonate is within normal limits, it is uncompensated
respiratory acidosis.
,3. What is the primary goal of Positive End-Expiratory Pressure (PEEP) in a
patient with ARDS?
A. To decrease the work of breathing
B. To prevent alveolar collapse and improve oxygenation
C. To increase the tidal volume
D. To prevent respiratory alkalosis
Answer: B
Rationale: PEEP provides pressure at the end of expiration to keep alveoli open, which
increases the surface area for gas exchange and improves arterial oxygenation in patients
with ARDS.
4. A nurse is monitoring a patient with a head injury. Which of the following is
an early sign of increased intracranial pressure (ICP)?
A. Decreased level of consciousness
B. Fixed and dilated pupils
C. Cushing’s triad
D. Decerebrate posturing
Answer: A
Rationale: The earliest and most sensitive indicator of increased ICP is a change in the
level of consciousness (LOC).
5. In the Parkland formula for burn resuscitation, how much of the calculated
fluid volume should be administered in the first 8 hours?
A. One-fourth
B. One-third
C. The entire amount
D. One-half
Answer: D
, Rationale: The Parkland formula dictates that half of the total 24-hour fluid requirement
be given in the first 8 hours following the burn injury.
6. Which laboratory value is the most specific indicator of acute pancreatitis?
A. Serum amylase
B. Serum lipase
C. Serum calcium
D. White blood cell count
Answer: B
Rationale: While both amylase and lipase rise in pancreatitis, lipase stays elevated longer
and is more specific to the pancreas.
7. A patient with a chest tube has continuous bubbling in the water-seal
chamber. What does this suggest?
A. The system is functioning normally
B. There is an air leak in the system
C. The lung has fully re-expanded
D. The suction is set too high
Answer: B
Rationale: Continuous bubbling in the water-seal chamber indicates a persistent air leak
either from the patient’s lung or within the drainage system itself.
8. Which medication is considered the first-line treatment for a patient in
ventricular fibrillation?
A. Atropine
B. Digoxin
C. Amiodarone
D. Epinephrine
Answer: D
Practice 2026 UPDATED ACTUAL Questions and CORRECT
Answers
1. A patient in the ICU is diagnosed with septic shock. Which of the following
assessment findings would the nurse expect in the compensatory stage?
A. Increased heart rate and narrowed pulse pressure
B. Cold, clammy skin
C. Lethargy and decreased responsiveness
D. Respiratory acidosis
Answer: A
Rationale: In the compensatory stage of shock, the body attempts to maintain homeostasis
through the activation of the sympathetic nervous system, resulting in tachycardia and
vasoconstriction to maintain blood pressure.
2. A patient’s ABG results are pH 7.28, PaCO2 55 mmHg, and HCO3 26 mEq/L.
How should the nurse interpret these results?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Answer: A
Rationale: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg indicates a
respiratory cause, and since the bicarbonate is within normal limits, it is uncompensated
respiratory acidosis.
,3. What is the primary goal of Positive End-Expiratory Pressure (PEEP) in a
patient with ARDS?
A. To decrease the work of breathing
B. To prevent alveolar collapse and improve oxygenation
C. To increase the tidal volume
D. To prevent respiratory alkalosis
Answer: B
Rationale: PEEP provides pressure at the end of expiration to keep alveoli open, which
increases the surface area for gas exchange and improves arterial oxygenation in patients
with ARDS.
4. A nurse is monitoring a patient with a head injury. Which of the following is
an early sign of increased intracranial pressure (ICP)?
A. Decreased level of consciousness
B. Fixed and dilated pupils
C. Cushing’s triad
D. Decerebrate posturing
Answer: A
Rationale: The earliest and most sensitive indicator of increased ICP is a change in the
level of consciousness (LOC).
5. In the Parkland formula for burn resuscitation, how much of the calculated
fluid volume should be administered in the first 8 hours?
A. One-fourth
B. One-third
C. The entire amount
D. One-half
Answer: D
, Rationale: The Parkland formula dictates that half of the total 24-hour fluid requirement
be given in the first 8 hours following the burn injury.
6. Which laboratory value is the most specific indicator of acute pancreatitis?
A. Serum amylase
B. Serum lipase
C. Serum calcium
D. White blood cell count
Answer: B
Rationale: While both amylase and lipase rise in pancreatitis, lipase stays elevated longer
and is more specific to the pancreas.
7. A patient with a chest tube has continuous bubbling in the water-seal
chamber. What does this suggest?
A. The system is functioning normally
B. There is an air leak in the system
C. The lung has fully re-expanded
D. The suction is set too high
Answer: B
Rationale: Continuous bubbling in the water-seal chamber indicates a persistent air leak
either from the patient’s lung or within the drainage system itself.
8. Which medication is considered the first-line treatment for a patient in
ventricular fibrillation?
A. Atropine
B. Digoxin
C. Amiodarone
D. Epinephrine
Answer: D
