NUR 265 Exam 3 V1 | NUR 265 Advanced Concepts
of Medical–Surgical Nursing | Actual Q&A with
Rationale (NUR 265 Exam 3) | Galen
1. A 62-year-old male patient, Mr. Henderson, is admitted to the ICU with a diagnosis of
septic shock. His blood pressure is 82/44 mmHg, heart rate is 126 bpm, and his serum lactate
is 6.2 mmol/L. Following the administration of 30 mL/kg of isotonic crystalloids, his MAP
remains 58 mmHg. Which intervention should the nurse anticipate next?
A. Initiate a Norepinephrine infusion to maintain MAP ≥ 65 mmHg.
B. Administer an additional 2L bolus of 0.45% normal saline.
C. Start a Dobutamine drip to increase cardiac contractility.
D. Administer high-dose corticosteroids to reduce systemic inflammation.
Correct Answer: A
Explanation: According to the Surviving Sepsis Campaign guidelines, Norepinephrine is
the first-choice vasopressor when fluid resuscitation fails to achieve a MAP of at least 65
mmHg. The patient has already received the recommended 30 mL/kg fluid bolus without
adequate response, indicating refractory shock. Dobutamine is typically reserved for
patients with persistent hypoperfusion despite adequate MAP and fluid status.
,2. Mrs. Bennett is a 55-year-old patient being treated for Acute Respiratory Distress
Syndrome (ARDS) and is currently on mechanical ventilation. The ventilator settings include a
PEEP of 15 cm H2O. The nurse notes a sudden drop in SpO2 from 94% to 82% and a significant
increase in peak inspiratory pressure (PIP). Which complication should the nurse assess for
immediately?
A. Tension pneumothorax.
B. Ventilator-associated pneumonia.
C. Pulmonary edema.
D. Endotracheal tube cuff leak.
Correct Answer: A
Explanation: High levels of PEEP significantly increase the risk of barotrauma, which can
lead to a tension pneumothorax. Sudden desaturation combined with increased peak
inspiratory pressures is a classic indicator of air trapping in the pleural space. The nurse
must quickly assess for absent breath sounds on the affected side and tracheal deviation.
3. A 24-year-old female, Sarah, was involved in a motor vehicle accident and sustained a T4
spinal cord injury. She reports a sudden, throbbing headache and her blood pressure is
210/108 mmHg. Her face is flushed, and she is sweating profusely above the level of the
injury. What is the priority nursing action?
A. Palpate the bladder for distention and check the urinary catheter.
B. Administer a prescribed PRN dose of hydralazine.
,C. Place the patient in a supine position to stabilize the spine.
D. Notify the physician of a potential intracranial hemorrhage.
Correct Answer: A
Explanation: The patient is exhibiting signs of autonomic dysreflexia, which is a medical
emergency in patients with SCI at or above T6. The most common trigger is bladder
distention due to a kinked catheter or fecal impaction. The nurse should immediately sit
the patient upright to lower BP and then identify and remove the noxious stimulus, such as
emptying the bladder.
4. Mr. Thompson, a 70-year-old male with a history of heart failure, is admitted with
cardiogenic shock. The nurse is monitoring his hemodynamics via a pulmonary artery
catheter. The readings show a Pulmonary Capillary Wedge Pressure (PCWP) of 24 mmHg and
a Cardiac Index (CI) of 1.8 L/min/m2. Which medication is most appropriate for this patient?
A. Furosemide (Lasix).
B. Norepinephrine (Levophed).
C. Metoprolol (Lopressor).
D. Dobutamine (Dobutrex).
Correct Answer: D
Explanation: Cardiogenic shock is characterized by pump failure, resulting in a low cardiac
index and elevated PCWP (reflecting pulmonary congestion). Dobutamine is an inotrope
that increases myocardial contractility and cardiac output, which is essential for these
, hemodynamics. Beta-blockers like Metoprolol would further decrease contractility and are
contraindicated in the acute phase of cardiogenic shock.
5. A patient with severe acute pancreatitis, Mr. Davis, develops sudden shortness of breath
and tachypnea. The arterial blood gas (ABG) shows: pH 7.30, PaCO2 32 mmHg, PaO2 55
mmHg, and HCO3 18 mmHg on 100% oxygen via non-rebreather mask. The chest X-ray
reveals bilateral ‘white-out’ infiltrates. What is the most likely diagnosis?
A. Congestive heart failure.
B. Pulmonary embolism.
C. Aspiration pneumonia.
D. Acute Respiratory Distress Syndrome (ARDS).
Correct Answer: D
Explanation: Pancreatitis is a major risk factor for ARDS due to the systemic release of
inflammatory mediators that damage the alveolar-capillary membrane. The ABG shows
refractory hypoxemia (low PaO2 despite high FiO2) and the X-ray is characteristic of ARDS.
The absence of cardiomegaly on X-ray helps differentiate ARDS from heart failure.
6. A patient is admitted to the emergency department after a house fire with burns covering
40% of his Total Body Surface Area (TBSA). He weighs 80 kg. Using the Parkland Formula
(4mL/kg/%TBSA), how much fluid should the nurse administer in the first 8 hours of
treatment?
A. 12,800 mL
of Medical–Surgical Nursing | Actual Q&A with
Rationale (NUR 265 Exam 3) | Galen
1. A 62-year-old male patient, Mr. Henderson, is admitted to the ICU with a diagnosis of
septic shock. His blood pressure is 82/44 mmHg, heart rate is 126 bpm, and his serum lactate
is 6.2 mmol/L. Following the administration of 30 mL/kg of isotonic crystalloids, his MAP
remains 58 mmHg. Which intervention should the nurse anticipate next?
A. Initiate a Norepinephrine infusion to maintain MAP ≥ 65 mmHg.
B. Administer an additional 2L bolus of 0.45% normal saline.
C. Start a Dobutamine drip to increase cardiac contractility.
D. Administer high-dose corticosteroids to reduce systemic inflammation.
Correct Answer: A
Explanation: According to the Surviving Sepsis Campaign guidelines, Norepinephrine is
the first-choice vasopressor when fluid resuscitation fails to achieve a MAP of at least 65
mmHg. The patient has already received the recommended 30 mL/kg fluid bolus without
adequate response, indicating refractory shock. Dobutamine is typically reserved for
patients with persistent hypoperfusion despite adequate MAP and fluid status.
,2. Mrs. Bennett is a 55-year-old patient being treated for Acute Respiratory Distress
Syndrome (ARDS) and is currently on mechanical ventilation. The ventilator settings include a
PEEP of 15 cm H2O. The nurse notes a sudden drop in SpO2 from 94% to 82% and a significant
increase in peak inspiratory pressure (PIP). Which complication should the nurse assess for
immediately?
A. Tension pneumothorax.
B. Ventilator-associated pneumonia.
C. Pulmonary edema.
D. Endotracheal tube cuff leak.
Correct Answer: A
Explanation: High levels of PEEP significantly increase the risk of barotrauma, which can
lead to a tension pneumothorax. Sudden desaturation combined with increased peak
inspiratory pressures is a classic indicator of air trapping in the pleural space. The nurse
must quickly assess for absent breath sounds on the affected side and tracheal deviation.
3. A 24-year-old female, Sarah, was involved in a motor vehicle accident and sustained a T4
spinal cord injury. She reports a sudden, throbbing headache and her blood pressure is
210/108 mmHg. Her face is flushed, and she is sweating profusely above the level of the
injury. What is the priority nursing action?
A. Palpate the bladder for distention and check the urinary catheter.
B. Administer a prescribed PRN dose of hydralazine.
,C. Place the patient in a supine position to stabilize the spine.
D. Notify the physician of a potential intracranial hemorrhage.
Correct Answer: A
Explanation: The patient is exhibiting signs of autonomic dysreflexia, which is a medical
emergency in patients with SCI at or above T6. The most common trigger is bladder
distention due to a kinked catheter or fecal impaction. The nurse should immediately sit
the patient upright to lower BP and then identify and remove the noxious stimulus, such as
emptying the bladder.
4. Mr. Thompson, a 70-year-old male with a history of heart failure, is admitted with
cardiogenic shock. The nurse is monitoring his hemodynamics via a pulmonary artery
catheter. The readings show a Pulmonary Capillary Wedge Pressure (PCWP) of 24 mmHg and
a Cardiac Index (CI) of 1.8 L/min/m2. Which medication is most appropriate for this patient?
A. Furosemide (Lasix).
B. Norepinephrine (Levophed).
C. Metoprolol (Lopressor).
D. Dobutamine (Dobutrex).
Correct Answer: D
Explanation: Cardiogenic shock is characterized by pump failure, resulting in a low cardiac
index and elevated PCWP (reflecting pulmonary congestion). Dobutamine is an inotrope
that increases myocardial contractility and cardiac output, which is essential for these
, hemodynamics. Beta-blockers like Metoprolol would further decrease contractility and are
contraindicated in the acute phase of cardiogenic shock.
5. A patient with severe acute pancreatitis, Mr. Davis, develops sudden shortness of breath
and tachypnea. The arterial blood gas (ABG) shows: pH 7.30, PaCO2 32 mmHg, PaO2 55
mmHg, and HCO3 18 mmHg on 100% oxygen via non-rebreather mask. The chest X-ray
reveals bilateral ‘white-out’ infiltrates. What is the most likely diagnosis?
A. Congestive heart failure.
B. Pulmonary embolism.
C. Aspiration pneumonia.
D. Acute Respiratory Distress Syndrome (ARDS).
Correct Answer: D
Explanation: Pancreatitis is a major risk factor for ARDS due to the systemic release of
inflammatory mediators that damage the alveolar-capillary membrane. The ABG shows
refractory hypoxemia (low PaO2 despite high FiO2) and the X-ray is characteristic of ARDS.
The absence of cardiomegaly on X-ray helps differentiate ARDS from heart failure.
6. A patient is admitted to the emergency department after a house fire with burns covering
40% of his Total Body Surface Area (TBSA). He weighs 80 kg. Using the Parkland Formula
(4mL/kg/%TBSA), how much fluid should the nurse administer in the first 8 hours of
treatment?
A. 12,800 mL
