NUR 265 Exam 4 V3 | NUR 265 Advanced Concepts of Medical–
Surgical Nursing | Actual Q&A with Rationale (NUR 265 Exam 4) |
Galen
1. A 45-year-old male patient, Mr. David Miller, is admitted to the emergency department
after an industrial explosion. He has sustained partial and full-thickness burns to his entire
left arm, his anterior trunk, and his left leg. Using the Rule of Nines, what is the estimated
percentage of Total Body Surface Area (TBSA) burned?
A. 27%
B. 45%
C. 36%
D. 54%
Answer: B
Rationale: According to the Rule of Nines, the entire left arm accounts for 9%, the anterior
trunk accounts for 18%, and the entire left leg accounts for 18%. Adding these together (9
+ 18 + 18) results in a total of 45% TBSA. Accurate calculation of TBSA is critical for
determining fluid resuscitation requirements using the Parkland formula.
2. Mrs. Sarah Jenkins, a 68-year-old patient with a history of heart failure, is being treated for
septic shock. The nurse notes a Mean Arterial Pressure (MAP) of 58 mmHg despite adequate
fluid resuscitation. Which vasopressor is typically considered the first-line choice for this
patient?
A. Norepinephrine
B. Epinephrine
C. Dopamine
D. Phenylephrine
Answer: A
Rationale: Norepinephrine is the first-line vasopressor recommended for septic shock to
maintain a MAP of at least 65 mmHg. It provides potent alpha-adrenergic vasoconstriction
and modest beta-1 effects to improve perfusion. The nurse must monitor the patient
closely for signs of peripheral ischemia and ensure the medication is administered through
a central line.
,3. A patient, Mr. Robert Thompson, arrives at the trauma center following a motor vehicle
accident. He presents with paradoxical chest wall movement and severe respiratory distress.
Which intervention should the nurse prioritize?
A. Application of a bulky dressing over the site
B. Administration of intravenous morphine for pain
C. Preparation for immediate endotracheal intubation
D. Insertion of a large-bore needle for decompression
Answer: C
Rationale: Paradoxical chest wall movement is a hallmark sign of flail chest, which often
leads to significant respiratory failure and hypoxemia. While pain management is
important, the priority is to stabilize the airway and provide positive pressure ventilation
to correct the underlying respiratory distress. Endotracheal intubation and mechanical
ventilation provide the necessary internal splinting for the flail segment.
4. A 30-year-old female patient, Ms. Linda Carter, is in the emergent phase of a 50% TBSA
burn injury. Her weight is 70 kg. Using the Parkland formula (4 mL/kg/%TBSA), what should
be the hourly infusion rate for the first 8 hours of resuscitation?
A. 875 mL/hr
B. 437.5 mL/hr
C. 1,050 mL/hr
D. 1,750 mL/hr
Answer: A
Rationale: The Parkland formula calculates total fluid for 24 hours: 4 mL x 70 kg x 50 =
14,000 mL. Half of this total (7,000 mL) must be given in the first 8 hours from the time of
injury. Dividing 7,000 mL by 8 hours results in an infusion rate of 875 mL/hr.
5. During the assessment of a patient in the compensatory stage of shock, which clinical
finding should the nurse expect to observe?
A. Anuria and absent bowel sounds
B. Metabolic acidosis and lethargy
C. Hypotension and bradycardia
D. Narrowing pulse pressure and cool, clammy skin
Answer: D
Rationale: In the compensatory stage, the body attempts to maintain homeostasis through
the activation of the sympathetic nervous system, leading to vasoconstriction and
, increased heart rate. A narrowing pulse pressure is an early indicator of decreased stroke
volume. Cool, clammy skin results from the shunting of blood away from the skin to vital
organs.
6. Mr. James White is being treated for a severe burn injury. On the third day post-injury, he
develops coffee-ground emesis and abdominal distension. Which complication does the
nurse suspect?
A. Small bowel obstruction
B. Acute pancreatitis
C. Curling’s ulcer
D. Ischemic colitis
Answer: C
Rationale: Curling’s ulcer is an acute gastroduodenal ulcer that occurs following severe
burn injuries due to reduced mucosal blood flow and increased gastric acid production. The
presence of coffee-ground emesis indicates an upper gastrointestinal bleed. Prophylactic
treatment with H2 blockers or proton pump inhibitors is standard practice to prevent this
complication.
7. A patient is admitted with suspected neurogenic shock following a high-level spinal cord
injury. Which hemodynamic profile supports this diagnosis?
A. BP 80/40, HR 120, CVP 12
B. BP 160/90, HR 50, CVP 2
C. BP 90/60, HR 110, CVP 8
D. BP 82/38, HR 48, CVP 1
Answer: D
Rationale: Neurogenic shock is characterized by the loss of sympathetic tone, leading to
massive vasodilation and bradycardia. Unlike other forms of shock where the heart rate
increases to compensate for low blood pressure, neurogenic shock presents with
hypotension and bradycardia. Low Central Venous Pressure (CVP) reflects the relative
hypovolemia caused by venous pooling.
8. In a mass casualty incident (MCI), a nurse is performing triage using the START method. A
victim is found with a respiratory rate of 34 breaths/min, a radial pulse that is absent, and the
inability to follow simple commands. Which color tag should the nurse assign?
A. Green
B. Yellow
C. Black
Surgical Nursing | Actual Q&A with Rationale (NUR 265 Exam 4) |
Galen
1. A 45-year-old male patient, Mr. David Miller, is admitted to the emergency department
after an industrial explosion. He has sustained partial and full-thickness burns to his entire
left arm, his anterior trunk, and his left leg. Using the Rule of Nines, what is the estimated
percentage of Total Body Surface Area (TBSA) burned?
A. 27%
B. 45%
C. 36%
D. 54%
Answer: B
Rationale: According to the Rule of Nines, the entire left arm accounts for 9%, the anterior
trunk accounts for 18%, and the entire left leg accounts for 18%. Adding these together (9
+ 18 + 18) results in a total of 45% TBSA. Accurate calculation of TBSA is critical for
determining fluid resuscitation requirements using the Parkland formula.
2. Mrs. Sarah Jenkins, a 68-year-old patient with a history of heart failure, is being treated for
septic shock. The nurse notes a Mean Arterial Pressure (MAP) of 58 mmHg despite adequate
fluid resuscitation. Which vasopressor is typically considered the first-line choice for this
patient?
A. Norepinephrine
B. Epinephrine
C. Dopamine
D. Phenylephrine
Answer: A
Rationale: Norepinephrine is the first-line vasopressor recommended for septic shock to
maintain a MAP of at least 65 mmHg. It provides potent alpha-adrenergic vasoconstriction
and modest beta-1 effects to improve perfusion. The nurse must monitor the patient
closely for signs of peripheral ischemia and ensure the medication is administered through
a central line.
,3. A patient, Mr. Robert Thompson, arrives at the trauma center following a motor vehicle
accident. He presents with paradoxical chest wall movement and severe respiratory distress.
Which intervention should the nurse prioritize?
A. Application of a bulky dressing over the site
B. Administration of intravenous morphine for pain
C. Preparation for immediate endotracheal intubation
D. Insertion of a large-bore needle for decompression
Answer: C
Rationale: Paradoxical chest wall movement is a hallmark sign of flail chest, which often
leads to significant respiratory failure and hypoxemia. While pain management is
important, the priority is to stabilize the airway and provide positive pressure ventilation
to correct the underlying respiratory distress. Endotracheal intubation and mechanical
ventilation provide the necessary internal splinting for the flail segment.
4. A 30-year-old female patient, Ms. Linda Carter, is in the emergent phase of a 50% TBSA
burn injury. Her weight is 70 kg. Using the Parkland formula (4 mL/kg/%TBSA), what should
be the hourly infusion rate for the first 8 hours of resuscitation?
A. 875 mL/hr
B. 437.5 mL/hr
C. 1,050 mL/hr
D. 1,750 mL/hr
Answer: A
Rationale: The Parkland formula calculates total fluid for 24 hours: 4 mL x 70 kg x 50 =
14,000 mL. Half of this total (7,000 mL) must be given in the first 8 hours from the time of
injury. Dividing 7,000 mL by 8 hours results in an infusion rate of 875 mL/hr.
5. During the assessment of a patient in the compensatory stage of shock, which clinical
finding should the nurse expect to observe?
A. Anuria and absent bowel sounds
B. Metabolic acidosis and lethargy
C. Hypotension and bradycardia
D. Narrowing pulse pressure and cool, clammy skin
Answer: D
Rationale: In the compensatory stage, the body attempts to maintain homeostasis through
the activation of the sympathetic nervous system, leading to vasoconstriction and
, increased heart rate. A narrowing pulse pressure is an early indicator of decreased stroke
volume. Cool, clammy skin results from the shunting of blood away from the skin to vital
organs.
6. Mr. James White is being treated for a severe burn injury. On the third day post-injury, he
develops coffee-ground emesis and abdominal distension. Which complication does the
nurse suspect?
A. Small bowel obstruction
B. Acute pancreatitis
C. Curling’s ulcer
D. Ischemic colitis
Answer: C
Rationale: Curling’s ulcer is an acute gastroduodenal ulcer that occurs following severe
burn injuries due to reduced mucosal blood flow and increased gastric acid production. The
presence of coffee-ground emesis indicates an upper gastrointestinal bleed. Prophylactic
treatment with H2 blockers or proton pump inhibitors is standard practice to prevent this
complication.
7. A patient is admitted with suspected neurogenic shock following a high-level spinal cord
injury. Which hemodynamic profile supports this diagnosis?
A. BP 80/40, HR 120, CVP 12
B. BP 160/90, HR 50, CVP 2
C. BP 90/60, HR 110, CVP 8
D. BP 82/38, HR 48, CVP 1
Answer: D
Rationale: Neurogenic shock is characterized by the loss of sympathetic tone, leading to
massive vasodilation and bradycardia. Unlike other forms of shock where the heart rate
increases to compensate for low blood pressure, neurogenic shock presents with
hypotension and bradycardia. Low Central Venous Pressure (CVP) reflects the relative
hypovolemia caused by venous pooling.
8. In a mass casualty incident (MCI), a nurse is performing triage using the START method. A
victim is found with a respiratory rate of 34 breaths/min, a radial pulse that is absent, and the
inability to follow simple commands. Which color tag should the nurse assign?
A. Green
B. Yellow
C. Black
