2026 UPDATED QUESTIONS DOWNLOAD
NUR125 Exam 4 Master Study Guide | Verified Q&A | Parkland Formula &
Rule of 9s, Shock Stages & Hemodynamics, ARDS & Ventilator Alarms,
AKI/CRRT & Disaster Triage (MCI)
Crush your NUR125 Exam 4 with this question master set covering high-acuity nursing care
for Burns, Shock, Respiratory Failure, and Renal emergencies. Each question includes a
high-level italicized rationale designed to master the clinical reasoning behind Sepsis
bundles, MAP calculations, ABG interpretation, and MODS. This rewritten 2024–2026
guide is the ultimate resource for the most difficult exam in the curriculum, ensuring you reach
Level 3 proficiency on your first attempt.
1. A nurse is caring for a client who weighs 80 kg and has 30% TBSA burns. Using the
Parkland Formula, what is the total fluid volume required in the first 24 hours?
A. 4,800 mL
B. 9,600 mL
C. 12,000 mL
D. 2,400 mL
Answer: B
Rationale: Parkland Formula = 4mL x kg x %TBSA. (4 x 80 x 30 = 9,600 mL). The nurse would
administer 4,800 mL in the first 8 hours.
2. A nurse is assessing a client in the "Compensatory Stage" of shock. Which finding is
expected?
A. MAP of 50 mmHg
B. Heart rate of 115 bpm and cold, clammy skin
C. Lethargy and metabolic acidosis
D. Heart rate of 105 bpm and narrowed pulse pressure
Answer: D
Rationale: In the compensatory stage, the body maintains BP through vasoconstriction
(narrowed pulse pressure) and mild tachycardia. Cold/clammy skin and acidosis (B, C) occur
in the progressive stage.
3. A client on a mechanical ventilator has a "Low-Pressure" alarm sounding. Which
action should the nurse take first?
A. Suction the client’s endotracheal tube.
B. Check for a disconnection in the ventilator circuit.
C. Increase the PEEP setting.
D. Administer a sedative.
Answer: B
, 2026 UPDATED QUESTIONS DOWNLOAD
Rationale: Low-pressure alarms indicate a leak or total disconnection. High-pressure alarms
indicate an obstruction, which would require suctioning (A).
4. A nurse is triaging victims of a mass casualty incident. Which client should receive a
"Red Tag"?
A. A client with a sucking chest wound and labored breathing.
B. A client with a simple wrist fracture who is walking.
C. A client with a massive head injury and no pulse.
D. A client with a 2-inch laceration on the thigh.
Answer: A
Rationale: Red tags are for "Immediate" life-threatening injuries that are survivable with
treatment. Sucking chest wounds/tension pneumothorax are priorities.
5. A client in Septic Shock has a BP of 80/40 after receiving 3,000 mL of IV fluids. Which
medication is the priority?
A. Dobutamine
B. Nitroprusside
C. Norepinephrine
D. Furosemide
Answer: C
Rationale: Norepinephrine (Levophed) is the first-line vasopressor for septic shock that is
"fluid-refractory" to maintain a MAP > 65.
6. A nurse is caring for a client with 40% TBSA burns. Which laboratory result is
expected during the "Emergent Phase"?
A. Potassium 3.2 mEq/L
B. Hematocrit 55%
C. Sodium 150 mEq/L
D. Albumin 4.5 g/dL
Answer: B
Rationale: Hemoconcentration occurs in the emergent phase due to massive fluid loss from
the vascular space, causing the hematocrit to rise. Potassium would be high (hyperkalemia)
due to cell destruction.
7. A nurse is monitoring a client with ARDS. Which finding indicates "Refractory
Hypoxemia"?
A. PaO2 remains at 58 mmHg despite 100% FiO2.
B. PaCO2 is 48 mmHg.
C. SaO2 is 92% on room air.
D. pH is 7.35.
Answer: A
Rationale: Refractory hypoxemia is the hallmark of ARDS, where oxygen levels do not improve
even with maximum oxygen delivery.
, 2026 UPDATED QUESTIONS DOWNLOAD
8. Which hemodynamic value indicates "Left-Sided Heart Failure" in a client with
Cardiogenic Shock?
A. CVP of 2 mmHg
B. PAWP of 22 mmHg
C. SVR of 800 dynes
D. MAP of 75 mmHg
Answer: B
Rationale: Pulmonary Artery Wedge Pressure (PAWP) measures left-atrial pressure. Normal is
6–12; 22 indicates fluid backup from a failing left ventricle.
9. A client with an AV fistula for hemodialysis is being assessed. Which finding requires
immediate intervention?
A. Presence of a bruit upon auscultation.
B. Palpable thrill over the site.
C. Absence of a thrill and bruit.
D. Small amount of bruising at the needle site.
Answer: C
Rationale: Absence of a thrill/bruit indicates the fistula is clotted (thrombosed) and is no longer
patent for dialysis.
10. A nurse is caring for a client with a "Chest Tube" for a pneumothorax. The nurse
notes constant, vigorous bubbling in the water seal chamber. What does this indicate?
A. The lung has fully re-expanded.
B. There is an air leak in the system.
C. The suction is set correctly.
D. The client is breathing normally.
Answer: B
Rationale: Constant bubbling in the water seal chamber (not the suction chamber) indicates air
is leaking into the system from a hole in the tube or a loose connection.
11. A client with a burn injury is in the "Acute Phase." Which electrolyte imbalance is
the most common during this time?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypernatremia
Answer: B
Rationale: During the acute phase (diuresis), potassium moves back into the cells or is lost
through urine and wound drainage, leading to hypokalemia.
12. A client in "Anaphylactic Shock" is wheezing and has a BP of 70/30. Which
medication should be given first?
A. Diphenhydramine IV
, 2026 UPDATED QUESTIONS DOWNLOAD
B. Methylprednisolone IV
C. Epinephrine IM
D. Albuterol Nebulizer
Answer: C
Rationale: Epinephrine is the priority to cause rapid bronchodilation and increase systemic
vascular resistance (BP).
13. A nurse is assessing a client with a "Basilar Skull Fracture." Which finding is a
priority?
A. Headache
B. Periorbital ecchymosis (Raccoon Eyes)
C. Nausea
D. Increased thirst
Answer: B
Rationale: Raccoon eyes and Battle's sign are classic indicators of a basilar skull fracture,
which carries a high risk for CSF leakage and meningitis.
14. A client has a "MAP" of 55 mmHg. What is the nurse's priority action?
A. Document the finding.
B. Notify the healthcare provider.
C. Re-check the BP in 2 hours.
D. Place the client in a high-Fowler's position.
Answer: B
Rationale: A MAP < 65 indicates that vital organs (kidneys, brain) are not being adequately
perfused.
15. A client with "Acute Tubular Necrosis" (ATN) is in the Oliguric Phase. What is the
priority nursing diagnosis?
A. Fluid Volume Deficit
B. Excess Fluid Volume
C. Risk for Injury
D. Deficient Knowledge
Answer: B
Rationale: In the oliguric phase of AKI, the kidneys cannot excrete water, leading to edema,
hypertension, and risk for heart failure.
16. Which "Rule of 9s" percentage is assigned to the "Back of the Left Leg"?
A. 4.5%
B. 9%
C. 18%
D. 1%
Answer: B
Rationale: Each entire leg is 18%. The front is 9% and the back is 9%.
NUR125 Exam 4 Master Study Guide | Verified Q&A | Parkland Formula &
Rule of 9s, Shock Stages & Hemodynamics, ARDS & Ventilator Alarms,
AKI/CRRT & Disaster Triage (MCI)
Crush your NUR125 Exam 4 with this question master set covering high-acuity nursing care
for Burns, Shock, Respiratory Failure, and Renal emergencies. Each question includes a
high-level italicized rationale designed to master the clinical reasoning behind Sepsis
bundles, MAP calculations, ABG interpretation, and MODS. This rewritten 2024–2026
guide is the ultimate resource for the most difficult exam in the curriculum, ensuring you reach
Level 3 proficiency on your first attempt.
1. A nurse is caring for a client who weighs 80 kg and has 30% TBSA burns. Using the
Parkland Formula, what is the total fluid volume required in the first 24 hours?
A. 4,800 mL
B. 9,600 mL
C. 12,000 mL
D. 2,400 mL
Answer: B
Rationale: Parkland Formula = 4mL x kg x %TBSA. (4 x 80 x 30 = 9,600 mL). The nurse would
administer 4,800 mL in the first 8 hours.
2. A nurse is assessing a client in the "Compensatory Stage" of shock. Which finding is
expected?
A. MAP of 50 mmHg
B. Heart rate of 115 bpm and cold, clammy skin
C. Lethargy and metabolic acidosis
D. Heart rate of 105 bpm and narrowed pulse pressure
Answer: D
Rationale: In the compensatory stage, the body maintains BP through vasoconstriction
(narrowed pulse pressure) and mild tachycardia. Cold/clammy skin and acidosis (B, C) occur
in the progressive stage.
3. A client on a mechanical ventilator has a "Low-Pressure" alarm sounding. Which
action should the nurse take first?
A. Suction the client’s endotracheal tube.
B. Check for a disconnection in the ventilator circuit.
C. Increase the PEEP setting.
D. Administer a sedative.
Answer: B
, 2026 UPDATED QUESTIONS DOWNLOAD
Rationale: Low-pressure alarms indicate a leak or total disconnection. High-pressure alarms
indicate an obstruction, which would require suctioning (A).
4. A nurse is triaging victims of a mass casualty incident. Which client should receive a
"Red Tag"?
A. A client with a sucking chest wound and labored breathing.
B. A client with a simple wrist fracture who is walking.
C. A client with a massive head injury and no pulse.
D. A client with a 2-inch laceration on the thigh.
Answer: A
Rationale: Red tags are for "Immediate" life-threatening injuries that are survivable with
treatment. Sucking chest wounds/tension pneumothorax are priorities.
5. A client in Septic Shock has a BP of 80/40 after receiving 3,000 mL of IV fluids. Which
medication is the priority?
A. Dobutamine
B. Nitroprusside
C. Norepinephrine
D. Furosemide
Answer: C
Rationale: Norepinephrine (Levophed) is the first-line vasopressor for septic shock that is
"fluid-refractory" to maintain a MAP > 65.
6. A nurse is caring for a client with 40% TBSA burns. Which laboratory result is
expected during the "Emergent Phase"?
A. Potassium 3.2 mEq/L
B. Hematocrit 55%
C. Sodium 150 mEq/L
D. Albumin 4.5 g/dL
Answer: B
Rationale: Hemoconcentration occurs in the emergent phase due to massive fluid loss from
the vascular space, causing the hematocrit to rise. Potassium would be high (hyperkalemia)
due to cell destruction.
7. A nurse is monitoring a client with ARDS. Which finding indicates "Refractory
Hypoxemia"?
A. PaO2 remains at 58 mmHg despite 100% FiO2.
B. PaCO2 is 48 mmHg.
C. SaO2 is 92% on room air.
D. pH is 7.35.
Answer: A
Rationale: Refractory hypoxemia is the hallmark of ARDS, where oxygen levels do not improve
even with maximum oxygen delivery.
, 2026 UPDATED QUESTIONS DOWNLOAD
8. Which hemodynamic value indicates "Left-Sided Heart Failure" in a client with
Cardiogenic Shock?
A. CVP of 2 mmHg
B. PAWP of 22 mmHg
C. SVR of 800 dynes
D. MAP of 75 mmHg
Answer: B
Rationale: Pulmonary Artery Wedge Pressure (PAWP) measures left-atrial pressure. Normal is
6–12; 22 indicates fluid backup from a failing left ventricle.
9. A client with an AV fistula for hemodialysis is being assessed. Which finding requires
immediate intervention?
A. Presence of a bruit upon auscultation.
B. Palpable thrill over the site.
C. Absence of a thrill and bruit.
D. Small amount of bruising at the needle site.
Answer: C
Rationale: Absence of a thrill/bruit indicates the fistula is clotted (thrombosed) and is no longer
patent for dialysis.
10. A nurse is caring for a client with a "Chest Tube" for a pneumothorax. The nurse
notes constant, vigorous bubbling in the water seal chamber. What does this indicate?
A. The lung has fully re-expanded.
B. There is an air leak in the system.
C. The suction is set correctly.
D. The client is breathing normally.
Answer: B
Rationale: Constant bubbling in the water seal chamber (not the suction chamber) indicates air
is leaking into the system from a hole in the tube or a loose connection.
11. A client with a burn injury is in the "Acute Phase." Which electrolyte imbalance is
the most common during this time?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypernatremia
Answer: B
Rationale: During the acute phase (diuresis), potassium moves back into the cells or is lost
through urine and wound drainage, leading to hypokalemia.
12. A client in "Anaphylactic Shock" is wheezing and has a BP of 70/30. Which
medication should be given first?
A. Diphenhydramine IV
, 2026 UPDATED QUESTIONS DOWNLOAD
B. Methylprednisolone IV
C. Epinephrine IM
D. Albuterol Nebulizer
Answer: C
Rationale: Epinephrine is the priority to cause rapid bronchodilation and increase systemic
vascular resistance (BP).
13. A nurse is assessing a client with a "Basilar Skull Fracture." Which finding is a
priority?
A. Headache
B. Periorbital ecchymosis (Raccoon Eyes)
C. Nausea
D. Increased thirst
Answer: B
Rationale: Raccoon eyes and Battle's sign are classic indicators of a basilar skull fracture,
which carries a high risk for CSF leakage and meningitis.
14. A client has a "MAP" of 55 mmHg. What is the nurse's priority action?
A. Document the finding.
B. Notify the healthcare provider.
C. Re-check the BP in 2 hours.
D. Place the client in a high-Fowler's position.
Answer: B
Rationale: A MAP < 65 indicates that vital organs (kidneys, brain) are not being adequately
perfused.
15. A client with "Acute Tubular Necrosis" (ATN) is in the Oliguric Phase. What is the
priority nursing diagnosis?
A. Fluid Volume Deficit
B. Excess Fluid Volume
C. Risk for Injury
D. Deficient Knowledge
Answer: B
Rationale: In the oliguric phase of AKI, the kidneys cannot excrete water, leading to edema,
hypertension, and risk for heart failure.
16. Which "Rule of 9s" percentage is assigned to the "Back of the Left Leg"?
A. 4.5%
B. 9%
C. 18%
D. 1%
Answer: B
Rationale: Each entire leg is 18%. The front is 9% and the back is 9%.
