Galen NUR 265 Medical-Surgical Nursing (TESTED
QUESTIONS, CLINICALLY RELEVANT
SCENARIOS & APPLICATION-LEVEL ITEMS)
Exam 3
1. A trauma patient has hypotension, distended neck veins, absent left breath sounds, and severe respiratory distress.
Which type of shock is most likely?
A. Neurogenic shock from isolated lumbar strain.
B. Obstructive shock from tension pneumothorax.
C. Endocrine shock from hypothyroidism.
D. Hypovolemic shock from dehydration only.
Correct Answer: B. Obstructive shock from tension pneumothorax.
Rationale: Tension pneumothorax impairs venous return and cardiac output, producing obstructive shock. Immediate chest decompression
is required in an unstable patient.
2. A patient opens eyes to speech, speaks confused sentences, and localizes painful stimulation. What is the Glasgow
Coma Scale score?
A. 8.
B. 12.
C. 14.
D. 10.
Correct Answer: B. 12.
Rationale: Eye opening to speech scores 3, confused verbal response scores 4, and localizing pain scores 5. The total GCS is 12.
3. Why can a patient with a high spinal cord injury have difficulty regulating body temperature?
A. Impaired autonomic control below the level of injury reduces normal vasomotor and sweating responses.
B. Every spinal cord injury causes chronic infection and fever.
C. Temperature regulation depends only on skeletal muscle strength.
D. The spinal injury causes the thyroid gland to stop functioning immediately.
Correct Answer: A. Impaired autonomic control below the level of injury reduces normal vasomotor and sweating
responses.
Rationale: High spinal cord injury can disrupt sympathetic responses that normally conserve or dissipate heat. Environmental temperature
and core temperature therefore require careful monitoring.
, 4. Which principle is central to treatment of disseminated intravascular coagulation?
A. Delay sepsis treatment until coagulation tests normalize.
B. Administer vitamin K alone as definitive therapy for all DIC.
C. Treat the underlying cause while supporting bleeding or thrombosis complications as clinically indicated.
D. Ignore the trigger and give platelets to every patient regardless of bleeding.
Correct Answer: C. Treat the underlying cause while supporting bleeding or thrombosis complications as clinically
indicated.
Rationale: DIC improves only when its driving process, such as sepsis, trauma, or obstetric catastrophe, is controlled. Blood components
are used selectively for significant bleeding or procedures, not solely to normalize laboratory values.
5. Which hemodynamic pattern most strongly suggests neurogenic shock after a cervical spinal cord injury?
A. Normal blood pressure with isolated fever.
B. Hypotension with marked tachycardia and cool clammy skin from blood loss.
C. Hypertension with pulmonary edema and elevated filling pressures.
D. Hypotension with bradycardia and warm, dry skin.
Correct Answer: D. Hypotension with bradycardia and warm, dry skin.
Rationale: Loss of sympathetic tone causes vasodilation and relative bradycardia in neurogenic shock. This differs from most hypovolemic
states, which produce compensatory tachycardia and cool vasoconstricted skin.
6. A patient with a circumferential full-thickness chest burn develops increasing ventilatory pressures and reduced chest
excursion. Which intervention may be required urgently?
A. Tight circumferential bandaging.
B. Escharotomy to relieve restrictive chest-wall pressure.
C. Delaying assessment until the eschar separates naturally.
D. Immediate oral feeding as the only treatment.
Correct Answer: B. Escharotomy to relieve restrictive chest-wall pressure.
Rationale: Rigid circumferential eschar can restrict chest expansion as edema develops. Escharotomy may be needed to restore
ventilation; limb burns can similarly compromise distal circulation.
7. A patient with Guillain-Barre syndrome reports increasing difficulty taking a deep breath. Which assessment is most
important to trend?
A. Daily abdominal girth only.
B. Visual acuity only.
C. Serial respiratory muscle strength such as vital capacity along with oxygenation and clinical work of breathing.
D. Serum bilirubin only.
Correct Answer: C. Serial respiratory muscle strength such as vital capacity along with oxygenation and clinical work of
breathing.
Rationale: Respiratory failure can develop rapidly in GBS and may precede major oxygen desaturation. Serial bedside respiratory
measurements and clinical assessment help identify the need for ventilatory support.
QUESTIONS, CLINICALLY RELEVANT
SCENARIOS & APPLICATION-LEVEL ITEMS)
Exam 3
1. A trauma patient has hypotension, distended neck veins, absent left breath sounds, and severe respiratory distress.
Which type of shock is most likely?
A. Neurogenic shock from isolated lumbar strain.
B. Obstructive shock from tension pneumothorax.
C. Endocrine shock from hypothyroidism.
D. Hypovolemic shock from dehydration only.
Correct Answer: B. Obstructive shock from tension pneumothorax.
Rationale: Tension pneumothorax impairs venous return and cardiac output, producing obstructive shock. Immediate chest decompression
is required in an unstable patient.
2. A patient opens eyes to speech, speaks confused sentences, and localizes painful stimulation. What is the Glasgow
Coma Scale score?
A. 8.
B. 12.
C. 14.
D. 10.
Correct Answer: B. 12.
Rationale: Eye opening to speech scores 3, confused verbal response scores 4, and localizing pain scores 5. The total GCS is 12.
3. Why can a patient with a high spinal cord injury have difficulty regulating body temperature?
A. Impaired autonomic control below the level of injury reduces normal vasomotor and sweating responses.
B. Every spinal cord injury causes chronic infection and fever.
C. Temperature regulation depends only on skeletal muscle strength.
D. The spinal injury causes the thyroid gland to stop functioning immediately.
Correct Answer: A. Impaired autonomic control below the level of injury reduces normal vasomotor and sweating
responses.
Rationale: High spinal cord injury can disrupt sympathetic responses that normally conserve or dissipate heat. Environmental temperature
and core temperature therefore require careful monitoring.
, 4. Which principle is central to treatment of disseminated intravascular coagulation?
A. Delay sepsis treatment until coagulation tests normalize.
B. Administer vitamin K alone as definitive therapy for all DIC.
C. Treat the underlying cause while supporting bleeding or thrombosis complications as clinically indicated.
D. Ignore the trigger and give platelets to every patient regardless of bleeding.
Correct Answer: C. Treat the underlying cause while supporting bleeding or thrombosis complications as clinically
indicated.
Rationale: DIC improves only when its driving process, such as sepsis, trauma, or obstetric catastrophe, is controlled. Blood components
are used selectively for significant bleeding or procedures, not solely to normalize laboratory values.
5. Which hemodynamic pattern most strongly suggests neurogenic shock after a cervical spinal cord injury?
A. Normal blood pressure with isolated fever.
B. Hypotension with marked tachycardia and cool clammy skin from blood loss.
C. Hypertension with pulmonary edema and elevated filling pressures.
D. Hypotension with bradycardia and warm, dry skin.
Correct Answer: D. Hypotension with bradycardia and warm, dry skin.
Rationale: Loss of sympathetic tone causes vasodilation and relative bradycardia in neurogenic shock. This differs from most hypovolemic
states, which produce compensatory tachycardia and cool vasoconstricted skin.
6. A patient with a circumferential full-thickness chest burn develops increasing ventilatory pressures and reduced chest
excursion. Which intervention may be required urgently?
A. Tight circumferential bandaging.
B. Escharotomy to relieve restrictive chest-wall pressure.
C. Delaying assessment until the eschar separates naturally.
D. Immediate oral feeding as the only treatment.
Correct Answer: B. Escharotomy to relieve restrictive chest-wall pressure.
Rationale: Rigid circumferential eschar can restrict chest expansion as edema develops. Escharotomy may be needed to restore
ventilation; limb burns can similarly compromise distal circulation.
7. A patient with Guillain-Barre syndrome reports increasing difficulty taking a deep breath. Which assessment is most
important to trend?
A. Daily abdominal girth only.
B. Visual acuity only.
C. Serial respiratory muscle strength such as vital capacity along with oxygenation and clinical work of breathing.
D. Serum bilirubin only.
Correct Answer: C. Serial respiratory muscle strength such as vital capacity along with oxygenation and clinical work of
breathing.
Rationale: Respiratory failure can develop rapidly in GBS and may precede major oxygen desaturation. Serial bedside respiratory
measurements and clinical assessment help identify the need for ventilatory support.
