NUR 265 Exam 2 | NUR 265 Advanced Medical-Surgical
Nursing | Questions and Answers with Rationales
2026/2027 Update
QUESTION 1
A patient is admitted with septic shock. Which initial fluid resuscitation strategy is
recommended by surviving sepsis guidelines?
A. 10 mL/kg of 0.9 percent normal saline over 1 hour
B. 30 mL/kg of crystalloids within the first 3 hours
C. 500 mL of 5 percent dextrose in water rapidly
D. Restriction of fluids until central venous pressure exceeds 12 mmHg
ANSWER: B
RATIONALE: The Surviving Sepsis Campaign guidelines recommend the rapid
administration of at least 30 mL/kg of crystalloid fluids within the first 3 hours of
resuscitation for patients with sepsis-induced hypoperfusion or septic shock.
QUESTION 2
Which clinical finding is characteristic of the compensatory stage of shock?
A. Bradycardia and hypotension
B. Anuria and cold, clammy skin
C. Tachypnea and cool, pale skin
D. Warm, flushed skin and bradypnea
ANSWER: C
RATIONALE: During the compensatory stage of shock, sympathetic nervous
system stimulation causes vasoconstriction, shunting blood to vital organs. This
results in cool, pale skin, tachypnea, tachycardia, and normal or slightly low blood
pressure.
,QUESTION 3
A client with cardiogenic shock secondary to acute myocardial infarction is
receiving a dobutamine infusion. What is the primary therapeutic effect of this
medication?
A. Vasoconstriction to increase systemic vascular resistance
B. Positive inotrophy to increase myocardial contractility and cardiac output
C. Negative chronotrophy to slow heart rate and decrease oxygen demand
D. Diuresis to reduce preload and pulmonary congestion
ANSWER: B
RATIONALE: Dobutamine is a beta-1 adrenergic agonist that exerts a positive
inotropic effect, increasing myocardial contractility and stroke volume, which
improves cardiac output in cardiogenic shock.
QUESTION 4
Which hemodynamic parameter indicates increased preload in the right side of
the heart?
A. Central venous pressure of 14 mmHg
B. Pulmonary artery wedge pressure of 6 mmHg
C. Systemic vascular resistance of 800 dynes per second per centimeter to the
negative fifth power
D. Cardiac index of 3.5 liters per minute per meter squared
ANSWER: A
RATIONALE: Central venous pressure measures right ventricular preload or right
atrial pressure. Normal CVP is 2 to 8 mmHg. A value of 14 mmHg indicates
elevated right-sided preload, often seen in fluid overload, right ventricular failure,
or cardiac tamponade.
QUESTION 5
,A client sustains thermal burns over 40 percent of total body surface area. Using
the Parkland formula, calculate the total fluid requirement in the first 24 hours for
a client weighing 80 kilograms.
A. 6,400 milliliters
B. 9,600 milliliters
C. 12,800 milliliters
D. 19,200 milliliters
ANSWER: C
RATIONALE: The Parkland formula is 4 mL multiplied by weight in kilograms
multiplied by percent TBSA burned. Calculation: 4 mL multiplied by 80 kg
multiplied by 40 equals 12,800 mL total crystalloid fluid in the first 24 hours, with
half given in the first 8 hours.
QUESTION 6
Which phase of burn care focuses primarily on wound closure, prevention of
contractures, and physical rehabilitation?
A. Emergent phase
B. Resuscitative phase
C. Acute phase
D. Prehospital phase
ANSWER: C
RATIONALE: The acute phase of burn care begins from the mobilization of
extracellular fluid and diuresis and continues until the burn wounds are closed or
healed. It focuses on infection control, nutritional support, wound care, and early
physical therapy to prevent contractures.
QUESTION 7
A client with a severe inhalation injury is intubated and placed on mechanical
ventilation. Which diagnostic test is most definitive for confirming the diagnosis of
inhalation injury?
, A. Chest radiograph
B. Arterial blood gases
C. Fiberoptic bronchoscopy
D. Carboxyhemoglobin level
ANSWER: C
RATIONALE: Fiberoptic bronchoscopy is the definitive diagnostic tool for
evaluating inhalation injuries, allowing direct visualization of the upper and lower
airways for erythema, edema, carbonaceous deposits, and ulceration.
QUESTION 8
A client with a traumatic brain injury has a mean arterial pressure of 90 mmHg
and an intracranial pressure of 22 mmHg. What is the calculated cerebral
perfusion pressure, and is it within the normal range?
A. 68 mmHg, which is normal
B. 68 mmHg, which is below the normal range
C. 112 mmHg, which is above the normal range
D. 45 mmHg, which is below the normal range
ANSWER: B
RATIONALE: Cerebral perfusion pressure is calculated by subtracting intracranial
pressure from mean arterial pressure (CPP equals MAP minus ICP). Calculation: 90
minus 22 equals 68 mmHg. The normal CPP range for adults is 70 to 100 mmHg.
Therefore, 68 mmHg is slightly low.
QUESTION 9
Which clinical manifestation is a component of Cushing's triad associated with
increased intracranial pressure?
A. Hypotension, tachycardia, and irregular respirations
B. Hypertension with widening pulse pressure, bradycardia, and bradypnea
C. Hypotension, bradycardia, and tachypnea
Nursing | Questions and Answers with Rationales
2026/2027 Update
QUESTION 1
A patient is admitted with septic shock. Which initial fluid resuscitation strategy is
recommended by surviving sepsis guidelines?
A. 10 mL/kg of 0.9 percent normal saline over 1 hour
B. 30 mL/kg of crystalloids within the first 3 hours
C. 500 mL of 5 percent dextrose in water rapidly
D. Restriction of fluids until central venous pressure exceeds 12 mmHg
ANSWER: B
RATIONALE: The Surviving Sepsis Campaign guidelines recommend the rapid
administration of at least 30 mL/kg of crystalloid fluids within the first 3 hours of
resuscitation for patients with sepsis-induced hypoperfusion or septic shock.
QUESTION 2
Which clinical finding is characteristic of the compensatory stage of shock?
A. Bradycardia and hypotension
B. Anuria and cold, clammy skin
C. Tachypnea and cool, pale skin
D. Warm, flushed skin and bradypnea
ANSWER: C
RATIONALE: During the compensatory stage of shock, sympathetic nervous
system stimulation causes vasoconstriction, shunting blood to vital organs. This
results in cool, pale skin, tachypnea, tachycardia, and normal or slightly low blood
pressure.
,QUESTION 3
A client with cardiogenic shock secondary to acute myocardial infarction is
receiving a dobutamine infusion. What is the primary therapeutic effect of this
medication?
A. Vasoconstriction to increase systemic vascular resistance
B. Positive inotrophy to increase myocardial contractility and cardiac output
C. Negative chronotrophy to slow heart rate and decrease oxygen demand
D. Diuresis to reduce preload and pulmonary congestion
ANSWER: B
RATIONALE: Dobutamine is a beta-1 adrenergic agonist that exerts a positive
inotropic effect, increasing myocardial contractility and stroke volume, which
improves cardiac output in cardiogenic shock.
QUESTION 4
Which hemodynamic parameter indicates increased preload in the right side of
the heart?
A. Central venous pressure of 14 mmHg
B. Pulmonary artery wedge pressure of 6 mmHg
C. Systemic vascular resistance of 800 dynes per second per centimeter to the
negative fifth power
D. Cardiac index of 3.5 liters per minute per meter squared
ANSWER: A
RATIONALE: Central venous pressure measures right ventricular preload or right
atrial pressure. Normal CVP is 2 to 8 mmHg. A value of 14 mmHg indicates
elevated right-sided preload, often seen in fluid overload, right ventricular failure,
or cardiac tamponade.
QUESTION 5
,A client sustains thermal burns over 40 percent of total body surface area. Using
the Parkland formula, calculate the total fluid requirement in the first 24 hours for
a client weighing 80 kilograms.
A. 6,400 milliliters
B. 9,600 milliliters
C. 12,800 milliliters
D. 19,200 milliliters
ANSWER: C
RATIONALE: The Parkland formula is 4 mL multiplied by weight in kilograms
multiplied by percent TBSA burned. Calculation: 4 mL multiplied by 80 kg
multiplied by 40 equals 12,800 mL total crystalloid fluid in the first 24 hours, with
half given in the first 8 hours.
QUESTION 6
Which phase of burn care focuses primarily on wound closure, prevention of
contractures, and physical rehabilitation?
A. Emergent phase
B. Resuscitative phase
C. Acute phase
D. Prehospital phase
ANSWER: C
RATIONALE: The acute phase of burn care begins from the mobilization of
extracellular fluid and diuresis and continues until the burn wounds are closed or
healed. It focuses on infection control, nutritional support, wound care, and early
physical therapy to prevent contractures.
QUESTION 7
A client with a severe inhalation injury is intubated and placed on mechanical
ventilation. Which diagnostic test is most definitive for confirming the diagnosis of
inhalation injury?
, A. Chest radiograph
B. Arterial blood gases
C. Fiberoptic bronchoscopy
D. Carboxyhemoglobin level
ANSWER: C
RATIONALE: Fiberoptic bronchoscopy is the definitive diagnostic tool for
evaluating inhalation injuries, allowing direct visualization of the upper and lower
airways for erythema, edema, carbonaceous deposits, and ulceration.
QUESTION 8
A client with a traumatic brain injury has a mean arterial pressure of 90 mmHg
and an intracranial pressure of 22 mmHg. What is the calculated cerebral
perfusion pressure, and is it within the normal range?
A. 68 mmHg, which is normal
B. 68 mmHg, which is below the normal range
C. 112 mmHg, which is above the normal range
D. 45 mmHg, which is below the normal range
ANSWER: B
RATIONALE: Cerebral perfusion pressure is calculated by subtracting intracranial
pressure from mean arterial pressure (CPP equals MAP minus ICP). Calculation: 90
minus 22 equals 68 mmHg. The normal CPP range for adults is 70 to 100 mmHg.
Therefore, 68 mmHg is slightly low.
QUESTION 9
Which clinical manifestation is a component of Cushing's triad associated with
increased intracranial pressure?
A. Hypotension, tachycardia, and irregular respirations
B. Hypertension with widening pulse pressure, bradycardia, and bradypnea
C. Hypotension, bradycardia, and tachypnea
