NUR 265 Final Exam V2 | NUR 265 Advanced
Concepts of Medical–Surgical Nursing | Actual Q&A
with Rationale (NUR 265 Final Exam) | Galen
1. A 42-year-old patient weighing 70 kg is admitted to the burn unit with 40% TBSA partial
and full-thickness burns. Using the Parkland formula (4 mL/kg/% TBSA), what is the hourly
rate of Lactated Ringer’s for the first 8 hours?
A. 350 mL/hr
B. 700 mL/hr
C. 11,200 mL/hr
D. 1,400 mL/hr
Correct Answer: B
Explanation: The Parkland formula calculates total fluid for 24 hours as 4 mL x 70 kg x
40% = 11,200 mL. Half of this volume (5,600 mL) must be administered in the first 8 hours
from the time of injury. Dividing 5,600 mL by 8 hours results in an infusion rate of 700
mL/hr.
2. A patient in the ICU is diagnosed with septic shock. The nurse notes a serum lactate level of
4.2 mmol/L and a mean arterial pressure (MAP) of 58 mmHg despite a 30 mL/kg fluid bolus.
Which medication should the nurse anticipate administering next?
A. Dopamine
B. Norepinephrine
,C. Nitroprusside
D. Furosemide
Correct Answer: B
Explanation: Norepinephrine is the first-line vasopressor for septic shock when fluid
resuscitation fails to maintain a MAP of at least 65 mmHg. It increases systemic vascular
resistance through alpha-1 adrenergic stimulation. The elevated lactate indicates
persistent tissue hypoperfusion requiring immediate vasoactive support.
3. A patient with Acute Respiratory Distress Syndrome (ARDS) is receiving mechanical
ventilation. The nurse notes the PEEP is set to 15 cm H2O. Which complication should the
nurse monitor for most closely?
A. Oxygen toxicity
B. Respiratory alkalosis
C. Increased cardiac output
D. Pneumothorax
Correct Answer: D
Explanation: High levels of Positive End-Expiratory Pressure (PEEP) increase the risk of
barotrauma, which can lead to a pneumothorax or subcutaneous emphysema. While PEEP
improves oxygenation by keeping alveoli open, it also increases intrathoracic pressure,
which can decrease venous return and cardiac output. The nurse must frequently assess
breath sounds and hemodynamic stability.
,4. The nurse is caring for a patient with a traumatic brain injury (TBI). The patient’s heart rate
is 50 bpm, blood pressure is 180/60 mmHg, and respirations are irregular. What is the nurse’s
immediate priority?
A. Administering a beta-blocker to lower blood pressure
B. Checking the patient’s temperature for infection
C. Increasing the IV fluid rate to treat bradycardia
D. Notify the provider of Cushing’s triad
Correct Answer: D
Explanation: Cushing’s triad consists of bradycardia, hypertension with a widened pulse
pressure, and irregular respirations, indicating late-stage increased intracranial pressure
(ICP) and impending brain herniation. This is a neurosurgical emergency that requires
immediate intervention. The nurse should prepare for measures to reduce ICP, such as
administering mannitol or hypertonic saline.
5. A patient with chronic liver failure develops hepatic encephalopathy. The provider orders
lactulose. Which finding indicates the medication is achieving its therapeutic effect?
A. Increase in serum bilirubin levels
B. Decrease in abdominal girth
C. Improvement in the patient’s Glasgow Coma Scale (GCS) score
D. Passing one soft stool every two days
, Correct Answer: C
Explanation: Lactulose works by trapping ammonia in the gut and facilitating its excretion
through bowel movements, thereby reducing neurotoxic levels in the blood. A decrease in
serum ammonia levels leads to improved mental status and consciousness, reflected in an
improved GCS score. The goal is typically 2 to 3 soft stools per day to ensure effective
ammonia clearance.
6. A client is admitted with Diabetic Ketoacidosis (DKA). The initial labs show a blood glucose
of 550 mg/dL and a potassium level of 3.2 mEq/L. Which action should the nurse take first?
A. Initiate a 0.9% Normal Saline bolus
B. Administer 40 mEq of potassium chloride intravenously
C. Administer a bolus of 50% Dextrose
D. Start an intravenous insulin infusion at 0.1 units/kg/hr
Correct Answer: A
Explanation: The first priority in DKA is volume resuscitation with isotonic fluids to
restore perfusion and dilute glucose. While insulin is needed to stop ketosis, it should not
be started until potassium is at least 3.3 mEq/L, as insulin causes potassium to shift into
cells, potentially worsening hypokalemia and causing arrhythmias. Fluid resuscitation must
be initiated before or concurrently with electrolyte replacement.
Concepts of Medical–Surgical Nursing | Actual Q&A
with Rationale (NUR 265 Final Exam) | Galen
1. A 42-year-old patient weighing 70 kg is admitted to the burn unit with 40% TBSA partial
and full-thickness burns. Using the Parkland formula (4 mL/kg/% TBSA), what is the hourly
rate of Lactated Ringer’s for the first 8 hours?
A. 350 mL/hr
B. 700 mL/hr
C. 11,200 mL/hr
D. 1,400 mL/hr
Correct Answer: B
Explanation: The Parkland formula calculates total fluid for 24 hours as 4 mL x 70 kg x
40% = 11,200 mL. Half of this volume (5,600 mL) must be administered in the first 8 hours
from the time of injury. Dividing 5,600 mL by 8 hours results in an infusion rate of 700
mL/hr.
2. A patient in the ICU is diagnosed with septic shock. The nurse notes a serum lactate level of
4.2 mmol/L and a mean arterial pressure (MAP) of 58 mmHg despite a 30 mL/kg fluid bolus.
Which medication should the nurse anticipate administering next?
A. Dopamine
B. Norepinephrine
,C. Nitroprusside
D. Furosemide
Correct Answer: B
Explanation: Norepinephrine is the first-line vasopressor for septic shock when fluid
resuscitation fails to maintain a MAP of at least 65 mmHg. It increases systemic vascular
resistance through alpha-1 adrenergic stimulation. The elevated lactate indicates
persistent tissue hypoperfusion requiring immediate vasoactive support.
3. A patient with Acute Respiratory Distress Syndrome (ARDS) is receiving mechanical
ventilation. The nurse notes the PEEP is set to 15 cm H2O. Which complication should the
nurse monitor for most closely?
A. Oxygen toxicity
B. Respiratory alkalosis
C. Increased cardiac output
D. Pneumothorax
Correct Answer: D
Explanation: High levels of Positive End-Expiratory Pressure (PEEP) increase the risk of
barotrauma, which can lead to a pneumothorax or subcutaneous emphysema. While PEEP
improves oxygenation by keeping alveoli open, it also increases intrathoracic pressure,
which can decrease venous return and cardiac output. The nurse must frequently assess
breath sounds and hemodynamic stability.
,4. The nurse is caring for a patient with a traumatic brain injury (TBI). The patient’s heart rate
is 50 bpm, blood pressure is 180/60 mmHg, and respirations are irregular. What is the nurse’s
immediate priority?
A. Administering a beta-blocker to lower blood pressure
B. Checking the patient’s temperature for infection
C. Increasing the IV fluid rate to treat bradycardia
D. Notify the provider of Cushing’s triad
Correct Answer: D
Explanation: Cushing’s triad consists of bradycardia, hypertension with a widened pulse
pressure, and irregular respirations, indicating late-stage increased intracranial pressure
(ICP) and impending brain herniation. This is a neurosurgical emergency that requires
immediate intervention. The nurse should prepare for measures to reduce ICP, such as
administering mannitol or hypertonic saline.
5. A patient with chronic liver failure develops hepatic encephalopathy. The provider orders
lactulose. Which finding indicates the medication is achieving its therapeutic effect?
A. Increase in serum bilirubin levels
B. Decrease in abdominal girth
C. Improvement in the patient’s Glasgow Coma Scale (GCS) score
D. Passing one soft stool every two days
, Correct Answer: C
Explanation: Lactulose works by trapping ammonia in the gut and facilitating its excretion
through bowel movements, thereby reducing neurotoxic levels in the blood. A decrease in
serum ammonia levels leads to improved mental status and consciousness, reflected in an
improved GCS score. The goal is typically 2 to 3 soft stools per day to ensure effective
ammonia clearance.
6. A client is admitted with Diabetic Ketoacidosis (DKA). The initial labs show a blood glucose
of 550 mg/dL and a potassium level of 3.2 mEq/L. Which action should the nurse take first?
A. Initiate a 0.9% Normal Saline bolus
B. Administer 40 mEq of potassium chloride intravenously
C. Administer a bolus of 50% Dextrose
D. Start an intravenous insulin infusion at 0.1 units/kg/hr
Correct Answer: A
Explanation: The first priority in DKA is volume resuscitation with isotonic fluids to
restore perfusion and dilute glucose. While insulin is needed to stop ketosis, it should not
be started until potassium is at least 3.3 mEq/L, as insulin causes potassium to shift into
cells, potentially worsening hypokalemia and causing arrhythmias. Fluid resuscitation must
be initiated before or concurrently with electrolyte replacement.
