NUR 265 Exam 2 V3 | NUR 265 Advanced Concepts
of Medical–Surgical Nursing | Actual Q&A with
Rationale (NUR 265 Exam 2) | Galen
1. Mr. Henderson, a 62-year-old patient with a history of congestive heart failure, presents
with a serum creatinine that has risen from 1.1 to 2.8 mg/dL within 24 hours. The nurse notes
a urine output of 15 mL/hr and a blood pressure of 88/54 mmHg. What is the most likely
classification of this patient’s acute kidney injury (AKI)?
A. Intra-renal injury due to nephrotoxic medications.
B. Pre-renal injury due to decreased cardiac output.
C. Post-renal injury due to prostatic hypertrophy.
D. Chronic kidney disease stage 3.
Correct Answer: B
Explanation: The patient’s hypotension and heart failure history suggest decreased renal
perfusion, which is the hallmark of pre-renal AKI. Intra-renal injury involves damage to the
kidney tissue itself, and post-renal refers to obstruction of flow. The rapid rise in creatinine
and low urine output indicate an acute rather than chronic process.
,2. A 35-year-old female patient, Ms. Lopez, is admitted to the burn unit with 40% total body
surface area (TBSA) thermal burns. Using the Parkland formula (4 mL/kg/%TBSA), the nurse
calculates the total 24-hour fluid requirement for this 70 kg patient to be 11,200 mL. How
much fluid should be administered in the first 8 hours post-injury?
A. 5,600 mL
B. 2,800 mL
C. 4,200 mL
D. 1,400 mL
Correct Answer: A
Explanation: According to the Parkland formula, half of the total calculated volume must
be administered within the first 8 hours from the time of injury. For this patient, half of
11,200 mL is 5,600 mL. The remaining 50% is then distributed over the subsequent 16
hours.
3. The nurse is caring for Mr. Thompson, who is in the resuscitative phase of a major burn
injury. Which electrolyte abnormality is the nurse most likely to observe in the first 24 hours?
A. Hypokalemia due to fluid resuscitation.
B. Hyperkalemia due to cell lysis.
C. Hypernatremia due to fluid loss.
D. Hypocalcemia due to vitamin D deficiency.
, Correct Answer: B
Explanation: During the initial resuscitative phase of a burn, massive cell destruction
releases intracellular potassium into the extracellular space. This leads to hyperkalemia,
which requires close cardiac monitoring. Sodium levels usually decrease during this time as
sodium follows water into the interstitial space (third spacing).
4. Ms. Garcia is being treated for septic shock. Despite adequate fluid resuscitation of 30
mL/kg, her mean arterial pressure (MAP) remains 55 mmHg, and her serum lactate is 4.5
mmol/L. Which medication should the nurse anticipate administering first?
A. Dobutamine
B. Norepinephrine
C. Nitroprusside
D. Furosemide
Correct Answer: B
Explanation: Norepinephrine is the first-line vasopressor for septic shock that is
unresponsive to fluid resuscitation. It works to increase systemic vascular resistance and
improve MAP. Dobutamine is typically used for cardiogenic shock or low cardiac output,
not as the primary vasopressor in sepsis.
of Medical–Surgical Nursing | Actual Q&A with
Rationale (NUR 265 Exam 2) | Galen
1. Mr. Henderson, a 62-year-old patient with a history of congestive heart failure, presents
with a serum creatinine that has risen from 1.1 to 2.8 mg/dL within 24 hours. The nurse notes
a urine output of 15 mL/hr and a blood pressure of 88/54 mmHg. What is the most likely
classification of this patient’s acute kidney injury (AKI)?
A. Intra-renal injury due to nephrotoxic medications.
B. Pre-renal injury due to decreased cardiac output.
C. Post-renal injury due to prostatic hypertrophy.
D. Chronic kidney disease stage 3.
Correct Answer: B
Explanation: The patient’s hypotension and heart failure history suggest decreased renal
perfusion, which is the hallmark of pre-renal AKI. Intra-renal injury involves damage to the
kidney tissue itself, and post-renal refers to obstruction of flow. The rapid rise in creatinine
and low urine output indicate an acute rather than chronic process.
,2. A 35-year-old female patient, Ms. Lopez, is admitted to the burn unit with 40% total body
surface area (TBSA) thermal burns. Using the Parkland formula (4 mL/kg/%TBSA), the nurse
calculates the total 24-hour fluid requirement for this 70 kg patient to be 11,200 mL. How
much fluid should be administered in the first 8 hours post-injury?
A. 5,600 mL
B. 2,800 mL
C. 4,200 mL
D. 1,400 mL
Correct Answer: A
Explanation: According to the Parkland formula, half of the total calculated volume must
be administered within the first 8 hours from the time of injury. For this patient, half of
11,200 mL is 5,600 mL. The remaining 50% is then distributed over the subsequent 16
hours.
3. The nurse is caring for Mr. Thompson, who is in the resuscitative phase of a major burn
injury. Which electrolyte abnormality is the nurse most likely to observe in the first 24 hours?
A. Hypokalemia due to fluid resuscitation.
B. Hyperkalemia due to cell lysis.
C. Hypernatremia due to fluid loss.
D. Hypocalcemia due to vitamin D deficiency.
, Correct Answer: B
Explanation: During the initial resuscitative phase of a burn, massive cell destruction
releases intracellular potassium into the extracellular space. This leads to hyperkalemia,
which requires close cardiac monitoring. Sodium levels usually decrease during this time as
sodium follows water into the interstitial space (third spacing).
4. Ms. Garcia is being treated for septic shock. Despite adequate fluid resuscitation of 30
mL/kg, her mean arterial pressure (MAP) remains 55 mmHg, and her serum lactate is 4.5
mmol/L. Which medication should the nurse anticipate administering first?
A. Dobutamine
B. Norepinephrine
C. Nitroprusside
D. Furosemide
Correct Answer: B
Explanation: Norepinephrine is the first-line vasopressor for septic shock that is
unresponsive to fluid resuscitation. It works to increase systemic vascular resistance and
improve MAP. Dobutamine is typically used for cardiogenic shock or low cardiac output,
not as the primary vasopressor in sepsis.
