NUR 2790 Exam 3 Actual Exam V3 | NUR 2790 Professional Nursing III
/ PN3 (NUR2790 Exam 3) | Rasmussen
1. A nurse is caring for a client in the emergent phase of a major burn covering 45% of the
Total Body Surface Area (TBSA). Which laboratory finding should the nurse expect during this
phase?
A. Hypokalemia
B. Hypernatremia
C. Elevated Hematocrit
D. Decreased Hemoglobin
Answer: C
Rationale: During the emergent phase of a burn, massive fluid shifts from the intravascular
space to the interstitial space occur, leading to hemoconcentration. This results in an
elevated hematocrit level due to the loss of plasma volume relative to red blood cells.
Additionally, hyperkalemia is expected due to cell destruction, rather than hypokalemia,
and hyponatremia occurs as sodium follows water into the interstitial space.
2. The nurse is assessing a patient with septic shock. Which hemodynamic parameter is most
consistent with the early (hyperdynamic) phase of septic shock?
A. Decreased Cardiac Output
B. Increased Systemic Vascular Resistance (SVR)
C. Increased Pulmonary Artery Wedge Pressure (PAWP)
D. Increased Cardiac Output
Answer: D
Rationale: In the early or ‘warm’ phase of septic shock, the body compensates for
vasodilation by increasing heart rate and stroke volume, leading to an increased cardiac
output. Systemic Vascular Resistance (SVR) is typically low due to massive peripheral
vasodilation caused by inflammatory mediators. This phase is characterized by flushed skin
and a high-bounding pulse before the patient progresses to the hypodynamic ‘cold’ phase.
3. A client is admitted to the emergency department with suspected neurogenic shock
following a spinal cord injury at T2. Which vital sign assessment is hallmark for this condition?
A. Bradycardia and Hypotension
B. Tachycardia and Hypertension
C. Tachycardia and Hypotension
,D. Bradycardia and Hypertension
Answer: A
Rationale: Neurogenic shock results from the loss of sympathetic tone, which leads to
massive vasodilation and an unopposed parasympathetic response. This causes the unique
combination of hypotension and bradycardia, whereas most other forms of shock present
with compensatory tachycardia. The nurse must prioritize stabilization of the spine and
cautious fluid resuscitation combined with vasopressors as needed.
4. Using the Parkland Formula, calculate the total fluid requirements for the first 24 hours for
a 70 kg patient with 50% TBSA burns. How much fluid should be administered in the first 8
hours?
A. 7,000 mL
B. 14,000 mL
C. 3,500 mL
D. 10,500 mL
Answer: A
Rationale: The Parkland Formula is 4 mL x kg x %TBSA (4 x 70 x 50 = 14,000 mL total).
According to the protocol, half of the total volume must be administered within the first 8
hours from the time of the injury. Therefore, 14, equals 7,000 mL to be infused in
the first 8-hour window.
5. An ICU nurse is monitoring a patient with Multiple Organ Dysfunction Syndrome (MODS).
Which finding indicates that the respiratory system is failing as part of the MODS
progression?
A. PaO2/FiO2 ratio of 450
B. PaO2/FiO2 ratio less than 200
C. Decreased peak airway pressures
D. Respiratory alkalosis on ABG
Answer: B
Rationale: A PaO2/FiO2 ratio of less than 200 is a classic sign of Acute Respiratory
Distress Syndrome (ARDS), which is often the first manifestation of MODS. This indicates
severe refractory hypoxemia and significant shunting within the lungs. The nurse must
anticipate the need for mechanical ventilation with Positive End-Expiratory Pressure
(PEEP) to improve oxygenation.
6. A nurse is triaging victims at the scene of a mass casualty explosion. Which client should be
assigned a ‘Red’ tag?
A. A client with a sucking chest wound and a respiratory rate of 34.
, B. A client with an open head injury, GCS of 3, and agonal respirations.
C. A client with a compound fracture of the femur and a pedal pulse.
D. A client with 10% partial-thickness burns on the arms.
Answer: A
Rationale: In the START triage system, ‘Red’ tags are for immediate life-threatening
injuries that are treatable, such as a sucking chest wound or airway obstruction. The client
with agonal respirations and a GCS of 3 would be tagged ‘Black’ (expectant), as their chance
of survival is minimal in a resource-limited setting. The compound fracture is ‘Yellow’
(delayed), and minor burns are ‘Green’ (walking wounded).
7. A client in cardiogenic shock has a Swan-Ganz catheter placed. Which reading would the
nurse expect to see?
A. PAWP of 4 mmHg
B. Cardiac Index of 1.5 L/min/m2
C. CVP of 2 mmHg
D. SVR of 600 dynes/sec/cm-5
Answer: B
Rationale: Cardiogenic shock is characterized by pump failure, resulting in a low Cardiac
Index (normal is 2.5-4.0 L/min/m2). Because the heart cannot effectively pump blood
forward, pressures ‘back up’ into the lungs and venous system, leading to an elevated
PAWP (usually >18 mmHg) and elevated CVP. SVR is typically high as the body attempts to
compensate for low output via vasoconstriction.
8. The nurse is providing discharge education to a client who survived a major burn. Which
statement by the client indicates a need for further teaching regarding scar management?
A. I can stop wearing the pressure garment once the itching stops.
B. I should apply moisturizing lotion to my healed skin frequently.
C. I will wear my pressure garments for 23 hours a day.
D. I must protect my new skin from direct sunlight for at least a year.
Answer: A
Rationale: Pressure garments must be worn consistently (23-24 hours a day) for 12 to 24
months to be effective in flattening scars and preventing hypertrophic growth. Itching is a
common side effect of healing but is not an indicator that the garment is no longer needed.
Protecting skin from the sun and moisturizing are correct actions to maintain the integrity
of the fragile new tissue.
/ PN3 (NUR2790 Exam 3) | Rasmussen
1. A nurse is caring for a client in the emergent phase of a major burn covering 45% of the
Total Body Surface Area (TBSA). Which laboratory finding should the nurse expect during this
phase?
A. Hypokalemia
B. Hypernatremia
C. Elevated Hematocrit
D. Decreased Hemoglobin
Answer: C
Rationale: During the emergent phase of a burn, massive fluid shifts from the intravascular
space to the interstitial space occur, leading to hemoconcentration. This results in an
elevated hematocrit level due to the loss of plasma volume relative to red blood cells.
Additionally, hyperkalemia is expected due to cell destruction, rather than hypokalemia,
and hyponatremia occurs as sodium follows water into the interstitial space.
2. The nurse is assessing a patient with septic shock. Which hemodynamic parameter is most
consistent with the early (hyperdynamic) phase of septic shock?
A. Decreased Cardiac Output
B. Increased Systemic Vascular Resistance (SVR)
C. Increased Pulmonary Artery Wedge Pressure (PAWP)
D. Increased Cardiac Output
Answer: D
Rationale: In the early or ‘warm’ phase of septic shock, the body compensates for
vasodilation by increasing heart rate and stroke volume, leading to an increased cardiac
output. Systemic Vascular Resistance (SVR) is typically low due to massive peripheral
vasodilation caused by inflammatory mediators. This phase is characterized by flushed skin
and a high-bounding pulse before the patient progresses to the hypodynamic ‘cold’ phase.
3. A client is admitted to the emergency department with suspected neurogenic shock
following a spinal cord injury at T2. Which vital sign assessment is hallmark for this condition?
A. Bradycardia and Hypotension
B. Tachycardia and Hypertension
C. Tachycardia and Hypotension
,D. Bradycardia and Hypertension
Answer: A
Rationale: Neurogenic shock results from the loss of sympathetic tone, which leads to
massive vasodilation and an unopposed parasympathetic response. This causes the unique
combination of hypotension and bradycardia, whereas most other forms of shock present
with compensatory tachycardia. The nurse must prioritize stabilization of the spine and
cautious fluid resuscitation combined with vasopressors as needed.
4. Using the Parkland Formula, calculate the total fluid requirements for the first 24 hours for
a 70 kg patient with 50% TBSA burns. How much fluid should be administered in the first 8
hours?
A. 7,000 mL
B. 14,000 mL
C. 3,500 mL
D. 10,500 mL
Answer: A
Rationale: The Parkland Formula is 4 mL x kg x %TBSA (4 x 70 x 50 = 14,000 mL total).
According to the protocol, half of the total volume must be administered within the first 8
hours from the time of the injury. Therefore, 14, equals 7,000 mL to be infused in
the first 8-hour window.
5. An ICU nurse is monitoring a patient with Multiple Organ Dysfunction Syndrome (MODS).
Which finding indicates that the respiratory system is failing as part of the MODS
progression?
A. PaO2/FiO2 ratio of 450
B. PaO2/FiO2 ratio less than 200
C. Decreased peak airway pressures
D. Respiratory alkalosis on ABG
Answer: B
Rationale: A PaO2/FiO2 ratio of less than 200 is a classic sign of Acute Respiratory
Distress Syndrome (ARDS), which is often the first manifestation of MODS. This indicates
severe refractory hypoxemia and significant shunting within the lungs. The nurse must
anticipate the need for mechanical ventilation with Positive End-Expiratory Pressure
(PEEP) to improve oxygenation.
6. A nurse is triaging victims at the scene of a mass casualty explosion. Which client should be
assigned a ‘Red’ tag?
A. A client with a sucking chest wound and a respiratory rate of 34.
, B. A client with an open head injury, GCS of 3, and agonal respirations.
C. A client with a compound fracture of the femur and a pedal pulse.
D. A client with 10% partial-thickness burns on the arms.
Answer: A
Rationale: In the START triage system, ‘Red’ tags are for immediate life-threatening
injuries that are treatable, such as a sucking chest wound or airway obstruction. The client
with agonal respirations and a GCS of 3 would be tagged ‘Black’ (expectant), as their chance
of survival is minimal in a resource-limited setting. The compound fracture is ‘Yellow’
(delayed), and minor burns are ‘Green’ (walking wounded).
7. A client in cardiogenic shock has a Swan-Ganz catheter placed. Which reading would the
nurse expect to see?
A. PAWP of 4 mmHg
B. Cardiac Index of 1.5 L/min/m2
C. CVP of 2 mmHg
D. SVR of 600 dynes/sec/cm-5
Answer: B
Rationale: Cardiogenic shock is characterized by pump failure, resulting in a low Cardiac
Index (normal is 2.5-4.0 L/min/m2). Because the heart cannot effectively pump blood
forward, pressures ‘back up’ into the lungs and venous system, leading to an elevated
PAWP (usually >18 mmHg) and elevated CVP. SVR is typically high as the body attempts to
compensate for low output via vasoconstriction.
8. The nurse is providing discharge education to a client who survived a major burn. Which
statement by the client indicates a need for further teaching regarding scar management?
A. I can stop wearing the pressure garment once the itching stops.
B. I should apply moisturizing lotion to my healed skin frequently.
C. I will wear my pressure garments for 23 hours a day.
D. I must protect my new skin from direct sunlight for at least a year.
Answer: A
Rationale: Pressure garments must be worn consistently (23-24 hours a day) for 12 to 24
months to be effective in flattening scars and preventing hypertrophic growth. Itching is a
common side effect of healing but is not an indicator that the garment is no longer needed.
Protecting skin from the sun and moisturizing are correct actions to maintain the integrity
of the fragile new tissue.
