Medical-Surgical Nursing II Exam Questions And
Answers with Detailed Rationales
Course Name: Medical-Surgical Nursing II
Topic: Advanced Burn Care Management and Fluid Resuscitation
Academic Year: 2026/2027
,Question 1
When assessing a patient who spilled hot oil on the right leg and foot, the nurse
notes that the skin is dry, pale, and hard. The patient states that the burn is not
painful. What term would the nurse use to document the burn depth?
A. First-degree skin destruction
B. Full-thickness skin destruction
C. Deep partial-thickness skin destruction
D. Superficial partial-thickness skin destruction
CORRECT ANSWER: B
RATIONALE: Full-thickness skin destruction involves the destruction of all
epidermal and dermal layers, extending into subcutaneous fat, muscle, or bone.
The appearance is characteristically pale, white, dry, or leathery, and the area is
completely painless because the thermal energy has destroyed the specialized
nerve endings. Distractor A is incorrect because first-degree burns involve only the
epidermis, presenting with erythema, blanching, and acute pain. Distractor C and D
are incorrect because partial-thickness injuries leave some dermal elements intact
and present with pain and fluid-filled blisters rather than an anesthetic, hard, pale
surface.
Question 2
On admission to the burn unit, a patient with an approximate 25% total body
surface area (TBSA) burn has the following initial laboratory results: Hct 58%,
Hgb 18.2 mg/dL (172 g/L), serum K+ 4.9 mEq/L (4.8 mmol/L), and serum Na+
135 mEq/L (135 mmol/L). Which action will the nurse anticipate taking now?
A. Monitor urine output every 4 hours.
B. Continue to monitor the laboratory results.
C. Increase the rate of the ordered IV solution.
D. Type and crossmatch for a blood transfusion.
CORRECT ANSWER: C
RATIONALE: The laboratory data demonstrate hemoconcentration, as
evidenced by elevated hematocrit (58%) and hemoglobin (18.2 mg/dL), resulting
from massive capillary leaking and plasma loss into interstitial spaces. Increasing
the IV fluid infusion rate is critical to restore intravascular volume, protect
,microvascular perfusion, and prevent hypovolemic burn shock. Distractor A is
incorrect because urine output must be monitored hourly, not every 4 hours, during
the emergent resuscitation phase. Distractor B is passive and insufficient given the
active hypovolemia. Distractor D is incorrect because the elevated values reflect
fluid deficit, not a loss of red blood cells; infusing blood components at this stage
would dangerously increase blood viscosity.
Question 3
A patient is admitted to the burn unit with burns to the head, face, and hands.
Initially, wheezes are heard, but an hour later, the lung sounds are decreased and
no wheezes are audible. What is the best action for the nurse to take?
A. Encourage the patient to cough and auscultate the lungs again.
B. Notify the health care provider and prepare for endotracheal intubation.
C. Document the results and continue to monitor the patient's respiratory rate.
D. Reposition the patient in high-Fowler's position and reassess breath sounds.
CORRECT ANSWER: B
RATIONALE: The sudden disappearance of wheezing accompanied by silent
or significantly decreased breath sounds indicates rapid, complete closure of the
patient's airway due to severe, progressive thermal edema. This is an immediate,
life-threatening respiratory emergency that requires notifying the healthcare
provider and preparing for rapid sequence endotracheal intubation. Distractor
A and D are incorrect because coughing or changing the patient's physical position
cannot reverse or bypass anatomical airway occlusion caused by severe mucosal
edema. Distractor C is incorrect because delayed action and passive monitoring
will lead to complete respiratory arrest.
Question 4
A patient with severe burns has crystalloid fluid replacement ordered using the
Parkland formula. The initial volume of fluid to be administered in the first 24
hours is 30,000 mL. The initial rate of administration is 1875 mL/hr. After the first
8 hours, what rate should the nurse infuse the IV fluids?
A. 350 mL/hour
B. 523 mL/hour
, C. 938 mL/hour
D. 1250 mL/hour
CORRECT ANSWER: C
RATIONALE: According to the Parkland formula, half of the total calculated
24-hour fluid volume must be delivered within the first 8 hours following the burn
injury, and the remaining 50% must be infused evenly over the subsequent 16
hours. Since 15,000 mL (half of 30,000 mL) is left for the next 16 hours, the
mathematical calculation is: 15,000 mL / 16 hours = 937.5 mL/hr, which rounds
directly to 938 mL/hour. This is exactly half of the initial 8-hour rate (1875 mL/hr
/ 2 = 937.5 mL/hr). Distractors A, B, and D reflect arithmetic errors that would
cause dangerous under-resuscitation or over-resuscitation.
Question 5
During the emergent phase of burn care, which assessment will be most useful in
determining whether the patient is receiving adequate fluid infusion?
A. Check skin turgor.
B. Monitor daily weight.
C. Assess mucous membranes.
D. Measure hourly urine output.
CORRECT ANSWER: D
RATIONALE: Hourly urine output measurements serve as the gold standard
and most reliable operational proxy for vital organ and tissue perfusion during the
emergent resuscitation phase. Fluid administration is titrated to maintain a target
urine output of 0.5 to 1.0 mL/kg/hour in adults. Distractor B is incorrect because
acute changes in daily weight are heavily distorted by massive tissue edema, fluid
shifts ("third-spacing"), and evaporative fluid losses, making it unreliable for
tracking intravascular volume. Distractors A and C are incorrect because
generalized tissue injury and local fluid accumulation render skin turgor and
mucous membrane assessments highly inaccurate in burn patients.
Question 6
A patient has just been admitted with a 40% total body surface area (TBSA) burn
injury. To maintain adequate nutrition, the nurse should plan to take which
Answers with Detailed Rationales
Course Name: Medical-Surgical Nursing II
Topic: Advanced Burn Care Management and Fluid Resuscitation
Academic Year: 2026/2027
,Question 1
When assessing a patient who spilled hot oil on the right leg and foot, the nurse
notes that the skin is dry, pale, and hard. The patient states that the burn is not
painful. What term would the nurse use to document the burn depth?
A. First-degree skin destruction
B. Full-thickness skin destruction
C. Deep partial-thickness skin destruction
D. Superficial partial-thickness skin destruction
CORRECT ANSWER: B
RATIONALE: Full-thickness skin destruction involves the destruction of all
epidermal and dermal layers, extending into subcutaneous fat, muscle, or bone.
The appearance is characteristically pale, white, dry, or leathery, and the area is
completely painless because the thermal energy has destroyed the specialized
nerve endings. Distractor A is incorrect because first-degree burns involve only the
epidermis, presenting with erythema, blanching, and acute pain. Distractor C and D
are incorrect because partial-thickness injuries leave some dermal elements intact
and present with pain and fluid-filled blisters rather than an anesthetic, hard, pale
surface.
Question 2
On admission to the burn unit, a patient with an approximate 25% total body
surface area (TBSA) burn has the following initial laboratory results: Hct 58%,
Hgb 18.2 mg/dL (172 g/L), serum K+ 4.9 mEq/L (4.8 mmol/L), and serum Na+
135 mEq/L (135 mmol/L). Which action will the nurse anticipate taking now?
A. Monitor urine output every 4 hours.
B. Continue to monitor the laboratory results.
C. Increase the rate of the ordered IV solution.
D. Type and crossmatch for a blood transfusion.
CORRECT ANSWER: C
RATIONALE: The laboratory data demonstrate hemoconcentration, as
evidenced by elevated hematocrit (58%) and hemoglobin (18.2 mg/dL), resulting
from massive capillary leaking and plasma loss into interstitial spaces. Increasing
the IV fluid infusion rate is critical to restore intravascular volume, protect
,microvascular perfusion, and prevent hypovolemic burn shock. Distractor A is
incorrect because urine output must be monitored hourly, not every 4 hours, during
the emergent resuscitation phase. Distractor B is passive and insufficient given the
active hypovolemia. Distractor D is incorrect because the elevated values reflect
fluid deficit, not a loss of red blood cells; infusing blood components at this stage
would dangerously increase blood viscosity.
Question 3
A patient is admitted to the burn unit with burns to the head, face, and hands.
Initially, wheezes are heard, but an hour later, the lung sounds are decreased and
no wheezes are audible. What is the best action for the nurse to take?
A. Encourage the patient to cough and auscultate the lungs again.
B. Notify the health care provider and prepare for endotracheal intubation.
C. Document the results and continue to monitor the patient's respiratory rate.
D. Reposition the patient in high-Fowler's position and reassess breath sounds.
CORRECT ANSWER: B
RATIONALE: The sudden disappearance of wheezing accompanied by silent
or significantly decreased breath sounds indicates rapid, complete closure of the
patient's airway due to severe, progressive thermal edema. This is an immediate,
life-threatening respiratory emergency that requires notifying the healthcare
provider and preparing for rapid sequence endotracheal intubation. Distractor
A and D are incorrect because coughing or changing the patient's physical position
cannot reverse or bypass anatomical airway occlusion caused by severe mucosal
edema. Distractor C is incorrect because delayed action and passive monitoring
will lead to complete respiratory arrest.
Question 4
A patient with severe burns has crystalloid fluid replacement ordered using the
Parkland formula. The initial volume of fluid to be administered in the first 24
hours is 30,000 mL. The initial rate of administration is 1875 mL/hr. After the first
8 hours, what rate should the nurse infuse the IV fluids?
A. 350 mL/hour
B. 523 mL/hour
, C. 938 mL/hour
D. 1250 mL/hour
CORRECT ANSWER: C
RATIONALE: According to the Parkland formula, half of the total calculated
24-hour fluid volume must be delivered within the first 8 hours following the burn
injury, and the remaining 50% must be infused evenly over the subsequent 16
hours. Since 15,000 mL (half of 30,000 mL) is left for the next 16 hours, the
mathematical calculation is: 15,000 mL / 16 hours = 937.5 mL/hr, which rounds
directly to 938 mL/hour. This is exactly half of the initial 8-hour rate (1875 mL/hr
/ 2 = 937.5 mL/hr). Distractors A, B, and D reflect arithmetic errors that would
cause dangerous under-resuscitation or over-resuscitation.
Question 5
During the emergent phase of burn care, which assessment will be most useful in
determining whether the patient is receiving adequate fluid infusion?
A. Check skin turgor.
B. Monitor daily weight.
C. Assess mucous membranes.
D. Measure hourly urine output.
CORRECT ANSWER: D
RATIONALE: Hourly urine output measurements serve as the gold standard
and most reliable operational proxy for vital organ and tissue perfusion during the
emergent resuscitation phase. Fluid administration is titrated to maintain a target
urine output of 0.5 to 1.0 mL/kg/hour in adults. Distractor B is incorrect because
acute changes in daily weight are heavily distorted by massive tissue edema, fluid
shifts ("third-spacing"), and evaporative fluid losses, making it unreliable for
tracking intravascular volume. Distractors A and C are incorrect because
generalized tissue injury and local fluid accumulation render skin turgor and
mucous membrane assessments highly inaccurate in burn patients.
Question 6
A patient has just been admitted with a 40% total body surface area (TBSA) burn
injury. To maintain adequate nutrition, the nurse should plan to take which
