Medical-Surgical Nursing
II Advanced Clinical Concepts Exam 1
Exam 1 • Practice Questions & Rationales
UPDATE
Actual Questions & Verified Answers
with Detailed Clinical Rationales
Practice Questions with Rationales
Nursing Program
Medical-Surgical Nursing
✓ 100% Verified Answers
✓ Complete Rationales Included
Exam (elaborations)
Instant PDF Download • Ready for Study
,Medical-Surgical Nursing II: Advanced Clinical Concepts Exam 1 2026/2027 UPDATED – Galen
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is receiving mechanical
ventilation with High-Frequency Oscillatory Ventilation. Which assessment finding most
indicates a deterioration in the patient’s status?
A. Development of a new onset of subcutaneous emphysema
B. Mean airway pressure of 25 cm H2O
C. SpO2 remaining at 92% on 80% FiO2
D. Respiratory rate matching the oscillator frequency
Answer: A
Rationale: Subcutaneous emphysema in a patient on high-pressure ventilation like HFOV
suggests a pneumothorax or air leak, which is a life-threatening complication in ARDS
patients.
2. Using the Parkland formula, calculate the initial fluid resuscitation for a 75 kg patient with
full-thickness burns covering 40% of their Total Body Surface Area (TBSA). How much fluid
should be administered in the first 8 hours?
A. 3,000 mL
B. 12,000 mL
C. 6,000 mL
, D. 4,500 mL
Answer: C
Rationale: Parkland Formula: 4 mL x kg x % TBSA. Total = 4 x 75 x 40 = 12,000 mL. Half is
given in the first 8 hours: 12, = 6,000 mL.
3. A patient in the ICU has a Pulmonary Artery Catheter. The nurse notes a Pulmonary
Capillary Wedge Pressure (PCWP) of 22 mmHg and a Cardiac Index (CI) of 1.8 L/min/m2.
Which condition is most likely?
A. Hypovolemic Shock
B. Anaphylactic Shock
C. Septic Shock
D. Cardiogenic Shock
Answer: D
Rationale: Cardiogenic shock is characterized by an elevated PCWP (indicating fluid
backup in the left heart) and a low Cardiac Index (indicating poor pump function).
4. A patient with a traumatic brain injury (TBI) has an intracranial pressure (ICP) of 24 mmHg.
Which nursing intervention is the highest priority?
A. Maintaining the head of the bed at 30 to 45 degrees in a neutral position
B. Clustering nursing care to allow for periods of rest
C. Performing vigorous deep suctioning to clear the airway every 2 hours
II Advanced Clinical Concepts Exam 1
Exam 1 • Practice Questions & Rationales
UPDATE
Actual Questions & Verified Answers
with Detailed Clinical Rationales
Practice Questions with Rationales
Nursing Program
Medical-Surgical Nursing
✓ 100% Verified Answers
✓ Complete Rationales Included
Exam (elaborations)
Instant PDF Download • Ready for Study
,Medical-Surgical Nursing II: Advanced Clinical Concepts Exam 1 2026/2027 UPDATED – Galen
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is receiving mechanical
ventilation with High-Frequency Oscillatory Ventilation. Which assessment finding most
indicates a deterioration in the patient’s status?
A. Development of a new onset of subcutaneous emphysema
B. Mean airway pressure of 25 cm H2O
C. SpO2 remaining at 92% on 80% FiO2
D. Respiratory rate matching the oscillator frequency
Answer: A
Rationale: Subcutaneous emphysema in a patient on high-pressure ventilation like HFOV
suggests a pneumothorax or air leak, which is a life-threatening complication in ARDS
patients.
2. Using the Parkland formula, calculate the initial fluid resuscitation for a 75 kg patient with
full-thickness burns covering 40% of their Total Body Surface Area (TBSA). How much fluid
should be administered in the first 8 hours?
A. 3,000 mL
B. 12,000 mL
C. 6,000 mL
, D. 4,500 mL
Answer: C
Rationale: Parkland Formula: 4 mL x kg x % TBSA. Total = 4 x 75 x 40 = 12,000 mL. Half is
given in the first 8 hours: 12, = 6,000 mL.
3. A patient in the ICU has a Pulmonary Artery Catheter. The nurse notes a Pulmonary
Capillary Wedge Pressure (PCWP) of 22 mmHg and a Cardiac Index (CI) of 1.8 L/min/m2.
Which condition is most likely?
A. Hypovolemic Shock
B. Anaphylactic Shock
C. Septic Shock
D. Cardiogenic Shock
Answer: D
Rationale: Cardiogenic shock is characterized by an elevated PCWP (indicating fluid
backup in the left heart) and a low Cardiac Index (indicating poor pump function).
4. A patient with a traumatic brain injury (TBI) has an intracranial pressure (ICP) of 24 mmHg.
Which nursing intervention is the highest priority?
A. Maintaining the head of the bed at 30 to 45 degrees in a neutral position
B. Clustering nursing care to allow for periods of rest
C. Performing vigorous deep suctioning to clear the airway every 2 hours
