NUR 265 Exam 1 V3 | NUR 265 Advanced Concepts
of Medical–Surgical Nursing | Actual Q&A with
Rationale (NUR 265 Exam 1) | Galen
1. Mr. Harrison is admitted to the Intensive Care Unit with a diagnosis of Septic Shock. His
current vital signs are BP 84/42 mmHg, HR 128 bpm, RR 26 bpm, and Temp 102.4°F. A lactate
level is drawn and returns at 5.2 mmol/L. Which intervention should the nurse prioritize first
according to the Sepsis Bundle guidelines?
A. Initiate Norepinephrine infusion to maintain MAP > 65 mmHg.
B. Administer a 30 mL/kg crystalloid bolus.
C. Obtain blood cultures from two different sites.
D. Administer broad-spectrum antibiotics.
Correct Answer: B
Explanation: According to the Surviving Sepsis Campaign, the immediate priority for a
patient with hypotension and a lactate > 4 mmol/L is fluid resuscitation with 30 mL/kg of
crystalloids. This helps restore intravascular volume and improve tissue perfusion before
escalating to vasopressors. While blood cultures and antibiotics are essential components
of the bundle, volume expansion is the initial step in stabilizing a hemodynamically
unstable patient in the first hour.
,2. A 45-year-old female, Mrs. Thompson, arrived in the Emergency Department after a house
fire. She has soot around her nose, a brassy cough, and is starting to use accessory muscles
for breathing. Which action by the nurse is the most critical?
A. Calculate the Total Body Surface Area (TBSA) using the Rule of Nines.
B. Start a large-bore IV and begin Parkland Formula fluid resuscitation.
C. Apply Silver Sulfadiazine to visible skin burns.
D. Prepare for immediate endotracheal intubation.
Correct Answer: D
Explanation: The presence of soot, a brassy cough, and respiratory distress suggests an
inhalation injury and impending airway obstruction due to edema. Maintaining airway
patency is the highest priority in the emergent phase of burn care, taking precedence over
fluid resuscitation or wound care. Once the airway is secured, the nurse can proceed with
other life-saving measures such as fluid management.
3. A patient is being treated for Cardiogenic Shock following an acute myocardial infarction.
The nurse notes the Pulmonary Capillary Wedge Pressure (PCWP) has increased from 14
mmHg to 22 mmHg, and the Cardiac Index (CI) is 1.7 L/min/m². Which medication order
should the nurse anticipate?
A. Vasopressin infusion.
B. 0.9% Normal Saline bolus.
C. Dobutamine infusion.
,D. Atropine intravenous push.
Correct Answer: C
Explanation: Cardiogenic shock is characterized by pump failure, leading to a low cardiac
index and high filling pressures like the PCWP. Dobutamine is a positive inotrope that
increases myocardial contractility and cardiac output while potentially decreasing
afterload. Administering a fluid bolus would be contraindicated as it would further increase
the PCWP and exacerbate pulmonary edema.
4. Mr. Davis, weighing 80 kg, sustained 40% TBSA partial-thickness burns at 10:00 AM. He
arrives at the Burn Center at 12:00 PM. Using the Parkland Formula (4mL/kg/%TBSA), at what
rate should the nurse set the IV pump to deliver the first half of the fluid over the remaining 6
hours of the first 8-hour period?
A. 1,067 mL/hr
B. 800 mL/hr
C. 533 mL/hr
D. 1,280 mL/hr
Correct Answer: A
Explanation: Total fluid = 4mL x 80kg x 40% = 12,800 mL. Half of this (6,400 mL) must be
given in the first 8 hours from the time of injury. Since 2 hours have already passed, the
6,400 mL must be infused over the next 6 hours (6, = 1,066.67 mL/hr). Monitoring
hourly urine output is essential to ensure the adequacy of this resuscitation rate.
, 5. A patient in the ICU with Acute Respiratory Distress Syndrome (ARDS) is receiving
mechanical ventilation with a PEEP of 15 cm H2O. The nurse notices the patient’s blood
pressure drops from 120/80 to 90/60 mmHg. What is the most likely physiological cause?
A. Increased pulmonary vascular resistance.
B. Shift of the oxyhemoglobin dissociation curve to the left.
C. Development of a tension pneumothorax.
D. Decreased venous return to the heart.
Correct Answer: D
Explanation: High levels of Positive End-Expiratory Pressure (PEEP) increase
intrathoracic pressure, which compresses the vena cava and decreases venous return
(preload). This leads to a subsequent decrease in cardiac output and systemic blood
pressure. The nurse must monitor hemodynamics closely when PEEP levels are titrated
upward.
6. The nurse is caring for a patient who is in the refractory stage of shock. Which finding is
most consistent with this stage?
A. Hyperventilation and respiratory alkalosis.
B. Multi-organ dysfunction and profound acidemia.
C. Responsiveness to fluid resuscitation and vasopressors.
D. Map drop of 10 mmHg from baseline.
of Medical–Surgical Nursing | Actual Q&A with
Rationale (NUR 265 Exam 1) | Galen
1. Mr. Harrison is admitted to the Intensive Care Unit with a diagnosis of Septic Shock. His
current vital signs are BP 84/42 mmHg, HR 128 bpm, RR 26 bpm, and Temp 102.4°F. A lactate
level is drawn and returns at 5.2 mmol/L. Which intervention should the nurse prioritize first
according to the Sepsis Bundle guidelines?
A. Initiate Norepinephrine infusion to maintain MAP > 65 mmHg.
B. Administer a 30 mL/kg crystalloid bolus.
C. Obtain blood cultures from two different sites.
D. Administer broad-spectrum antibiotics.
Correct Answer: B
Explanation: According to the Surviving Sepsis Campaign, the immediate priority for a
patient with hypotension and a lactate > 4 mmol/L is fluid resuscitation with 30 mL/kg of
crystalloids. This helps restore intravascular volume and improve tissue perfusion before
escalating to vasopressors. While blood cultures and antibiotics are essential components
of the bundle, volume expansion is the initial step in stabilizing a hemodynamically
unstable patient in the first hour.
,2. A 45-year-old female, Mrs. Thompson, arrived in the Emergency Department after a house
fire. She has soot around her nose, a brassy cough, and is starting to use accessory muscles
for breathing. Which action by the nurse is the most critical?
A. Calculate the Total Body Surface Area (TBSA) using the Rule of Nines.
B. Start a large-bore IV and begin Parkland Formula fluid resuscitation.
C. Apply Silver Sulfadiazine to visible skin burns.
D. Prepare for immediate endotracheal intubation.
Correct Answer: D
Explanation: The presence of soot, a brassy cough, and respiratory distress suggests an
inhalation injury and impending airway obstruction due to edema. Maintaining airway
patency is the highest priority in the emergent phase of burn care, taking precedence over
fluid resuscitation or wound care. Once the airway is secured, the nurse can proceed with
other life-saving measures such as fluid management.
3. A patient is being treated for Cardiogenic Shock following an acute myocardial infarction.
The nurse notes the Pulmonary Capillary Wedge Pressure (PCWP) has increased from 14
mmHg to 22 mmHg, and the Cardiac Index (CI) is 1.7 L/min/m². Which medication order
should the nurse anticipate?
A. Vasopressin infusion.
B. 0.9% Normal Saline bolus.
C. Dobutamine infusion.
,D. Atropine intravenous push.
Correct Answer: C
Explanation: Cardiogenic shock is characterized by pump failure, leading to a low cardiac
index and high filling pressures like the PCWP. Dobutamine is a positive inotrope that
increases myocardial contractility and cardiac output while potentially decreasing
afterload. Administering a fluid bolus would be contraindicated as it would further increase
the PCWP and exacerbate pulmonary edema.
4. Mr. Davis, weighing 80 kg, sustained 40% TBSA partial-thickness burns at 10:00 AM. He
arrives at the Burn Center at 12:00 PM. Using the Parkland Formula (4mL/kg/%TBSA), at what
rate should the nurse set the IV pump to deliver the first half of the fluid over the remaining 6
hours of the first 8-hour period?
A. 1,067 mL/hr
B. 800 mL/hr
C. 533 mL/hr
D. 1,280 mL/hr
Correct Answer: A
Explanation: Total fluid = 4mL x 80kg x 40% = 12,800 mL. Half of this (6,400 mL) must be
given in the first 8 hours from the time of injury. Since 2 hours have already passed, the
6,400 mL must be infused over the next 6 hours (6, = 1,066.67 mL/hr). Monitoring
hourly urine output is essential to ensure the adequacy of this resuscitation rate.
, 5. A patient in the ICU with Acute Respiratory Distress Syndrome (ARDS) is receiving
mechanical ventilation with a PEEP of 15 cm H2O. The nurse notices the patient’s blood
pressure drops from 120/80 to 90/60 mmHg. What is the most likely physiological cause?
A. Increased pulmonary vascular resistance.
B. Shift of the oxyhemoglobin dissociation curve to the left.
C. Development of a tension pneumothorax.
D. Decreased venous return to the heart.
Correct Answer: D
Explanation: High levels of Positive End-Expiratory Pressure (PEEP) increase
intrathoracic pressure, which compresses the vena cava and decreases venous return
(preload). This leads to a subsequent decrease in cardiac output and systemic blood
pressure. The nurse must monitor hemodynamics closely when PEEP levels are titrated
upward.
6. The nurse is caring for a patient who is in the refractory stage of shock. Which finding is
most consistent with this stage?
A. Hyperventilation and respiratory alkalosis.
B. Multi-organ dysfunction and profound acidemia.
C. Responsiveness to fluid resuscitation and vasopressors.
D. Map drop of 10 mmHg from baseline.
