NUR 265 Exam 1 V1 | NUR 265 Advanced Concepts
of Medical–Surgical Nursing | Actual Q&A with
Rationale (NUR 265 Exam 1) | Galen
1. A 65-year-old male with a history of COPD is admitted to the progressive care unit with
increased dyspnea and productive cough. His arterial blood gas (ABG) results are: pH 7.28,
PaCO2 56 mmHg, HCO3 26 mEq/L, and PaO2 62 mmHg. How should the nurse interpret these
findings?
A. Uncompensated metabolic acidosis
B. Partially compensated metabolic alkalosis
C. Fully compensated respiratory acidosis
D. Uncompensated respiratory acidosis
Correct Answer: D
Explanation: The pH of 7.28 indicates acidosis as it is below the normal range of 7.35-7.45.
The PaCO2 is elevated at 56 mmHg, which is consistent with the acidic pH, identifying the
cause as respiratory. Because the HCO3 remains within the normal range of 22-26 mEq/L,
no compensation has occurred yet.
2. A 45-year-old patient weighing 70 kg is brought to the emergency department after
suffering full-thickness burns to the chest, abdomen, and both anterior arms. According to
the Rule of Nines, what is the calculated Total Body Surface Area (TBSA) burned?
A. 18%
,B. 45%
C. 36%
D. 27%
Correct Answer: D
Explanation: The Rule of Nines assigns 18% to the anterior torso (9% for the chest and
9% for the abdomen). Each entire arm is 9%, so both anterior arms combined account for
9% (4.5% each). Summing these gives 18% + 9% = 27% TBSA.
3. Using the Parkland Formula (4 mL/kg/%TBSA), calculate the total fluid resuscitation
required in the first 24 hours for a 70 kg patient with a 27% TBSA burn. What volume should
be administered in the first 8 hours?
A. 7,560 mL
B. 3,780 mL
C. 1,890 mL
D. 5,420 mL
Correct Answer: B
Explanation: The calculation is 4 mL x 70 kg x 27 = 7,560 mL for the total 24-hour period.
The Parkland formula dictates that half of this total volume must be given in the first 8
hours. Therefore, 7,560 divided by 2 equals 3,780 mL.
,4. A patient in the emergent phase of a burn injury presents with a serum potassium level of
6.2 mEq/L. Which pathophysiological process best explains this finding?
A. Excessive renal excretion of potassium due to diuresis
B. Metabolic alkalosis causing a shift of potassium into the cells
C. Massive cell destruction releasing intracellular potassium into the extracellular space
D. Over-resuscitation with potassium-containing intravenous fluids
Correct Answer: C
Explanation: During the emergent phase of a burn, the physical destruction of cells
releases large amounts of intracellular potassium into the bloodstream. This typically
results in hyperkalemia during the first 24 to 48 hours. The nurse must monitor for cardiac
arrhythmias associated with this electrolyte shift.
5. A nurse is caring for a patient who was rescued from a house fire. The patient has soot
around the nose and mouth, a hoarse voice, and singed nasal hairs. What is the priority
nursing intervention?
A. Obtain an arterial blood gas to check for carboxyhemoglobin
B. Apply silvadene cream to facial burns
C. Prepare for immediate endotracheal intubation
D. Administer humidified oxygen via a non-rebreather mask
Correct Answer: C
, Explanation: Soot, hoarseness, and singed nasal hairs are classic indicators of an
inhalation injury and impending airway edema. Because airway swelling can progress
rapidly, securing the airway via intubation is the immediate priority. Delayed intubation
may become impossible as the upper airway swells.
6. A patient in the ICU is being treated for septic shock. The current assessment findings
include a blood pressure of 82/40 mmHg, a heart rate of 120 bpm, and a lactate level of 4.5
mmol/L despite fluid resuscitation. Which medication should the nurse expect to initiate
next?
A. Furosemide
B. Atropine
C. Nitroprusside
D. Norepinephrine
Correct Answer: D
Explanation: Norepinephrine is the first-line vasopressor for septic shock that is
unresponsive to fluid resuscitation. It acts by increasing systemic vascular resistance and
blood pressure. The goal is to maintain a mean arterial pressure (MAP) above 65 mmHg to
ensure tissue perfusion.
of Medical–Surgical Nursing | Actual Q&A with
Rationale (NUR 265 Exam 1) | Galen
1. A 65-year-old male with a history of COPD is admitted to the progressive care unit with
increased dyspnea and productive cough. His arterial blood gas (ABG) results are: pH 7.28,
PaCO2 56 mmHg, HCO3 26 mEq/L, and PaO2 62 mmHg. How should the nurse interpret these
findings?
A. Uncompensated metabolic acidosis
B. Partially compensated metabolic alkalosis
C. Fully compensated respiratory acidosis
D. Uncompensated respiratory acidosis
Correct Answer: D
Explanation: The pH of 7.28 indicates acidosis as it is below the normal range of 7.35-7.45.
The PaCO2 is elevated at 56 mmHg, which is consistent with the acidic pH, identifying the
cause as respiratory. Because the HCO3 remains within the normal range of 22-26 mEq/L,
no compensation has occurred yet.
2. A 45-year-old patient weighing 70 kg is brought to the emergency department after
suffering full-thickness burns to the chest, abdomen, and both anterior arms. According to
the Rule of Nines, what is the calculated Total Body Surface Area (TBSA) burned?
A. 18%
,B. 45%
C. 36%
D. 27%
Correct Answer: D
Explanation: The Rule of Nines assigns 18% to the anterior torso (9% for the chest and
9% for the abdomen). Each entire arm is 9%, so both anterior arms combined account for
9% (4.5% each). Summing these gives 18% + 9% = 27% TBSA.
3. Using the Parkland Formula (4 mL/kg/%TBSA), calculate the total fluid resuscitation
required in the first 24 hours for a 70 kg patient with a 27% TBSA burn. What volume should
be administered in the first 8 hours?
A. 7,560 mL
B. 3,780 mL
C. 1,890 mL
D. 5,420 mL
Correct Answer: B
Explanation: The calculation is 4 mL x 70 kg x 27 = 7,560 mL for the total 24-hour period.
The Parkland formula dictates that half of this total volume must be given in the first 8
hours. Therefore, 7,560 divided by 2 equals 3,780 mL.
,4. A patient in the emergent phase of a burn injury presents with a serum potassium level of
6.2 mEq/L. Which pathophysiological process best explains this finding?
A. Excessive renal excretion of potassium due to diuresis
B. Metabolic alkalosis causing a shift of potassium into the cells
C. Massive cell destruction releasing intracellular potassium into the extracellular space
D. Over-resuscitation with potassium-containing intravenous fluids
Correct Answer: C
Explanation: During the emergent phase of a burn, the physical destruction of cells
releases large amounts of intracellular potassium into the bloodstream. This typically
results in hyperkalemia during the first 24 to 48 hours. The nurse must monitor for cardiac
arrhythmias associated with this electrolyte shift.
5. A nurse is caring for a patient who was rescued from a house fire. The patient has soot
around the nose and mouth, a hoarse voice, and singed nasal hairs. What is the priority
nursing intervention?
A. Obtain an arterial blood gas to check for carboxyhemoglobin
B. Apply silvadene cream to facial burns
C. Prepare for immediate endotracheal intubation
D. Administer humidified oxygen via a non-rebreather mask
Correct Answer: C
, Explanation: Soot, hoarseness, and singed nasal hairs are classic indicators of an
inhalation injury and impending airway edema. Because airway swelling can progress
rapidly, securing the airway via intubation is the immediate priority. Delayed intubation
may become impossible as the upper airway swells.
6. A patient in the ICU is being treated for septic shock. The current assessment findings
include a blood pressure of 82/40 mmHg, a heart rate of 120 bpm, and a lactate level of 4.5
mmol/L despite fluid resuscitation. Which medication should the nurse expect to initiate
next?
A. Furosemide
B. Atropine
C. Nitroprusside
D. Norepinephrine
Correct Answer: D
Explanation: Norepinephrine is the first-line vasopressor for septic shock that is
unresponsive to fluid resuscitation. It acts by increasing systemic vascular resistance and
blood pressure. The goal is to maintain a mean arterial pressure (MAP) above 65 mmHg to
ensure tissue perfusion.
