2026 UPDATED QUESTIONS DOWNLOAD
NUR125 Exam 4 Master Study Guide | 300 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 300 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 in the compensatory stage of shock. Which finding
should the nurse expect?
A. Metabolic acidosis
B. Tachycardia and narrowed pulse pressure
C. Cold, mottled skin
D. Decreased level of consciousness
Answer: B
Rationale: In the compensatory stage, the SNS triggers tachycardia and vasoconstriction to
maintain CO. Metabolic acidosis and mottled skin occur in later stages.
2. A client has deep partial-thickness burns to the anterior trunk and both anterior arms.
Using the Rule of Nines, what is the %TBSA?
A. 18%
B. 27%
C. 36%
D. 45%
Answer: B
Rationale: Anterior trunk (18%) + Anterior right arm (4.5%) + Anterior left arm (4.5%) = 27%.
3. Which is the priority assessment for a client with circumferential chest burns?
A. Pain level
B. Urine output
C. Airway and chest excursion
D. Peripheral pulses
Answer: C
, 2026 UPDATED QUESTIONS DOWNLOAD
Rationale: Circumferential burns can cause "restriction" of the chest wall, leading to immediate
respiratory failure.
4. A ventilator high-pressure alarm sounds. Which action should the nurse take first?
A. Check for a leak in the cuff.
B. Suction the client's airway.
C. Call the respiratory therapist.
D. Check for a disconnected tube.
Answer: B
Rationale: High-pressure alarms are caused by resistance, such as biting the tube, kinks, or
secretions (suctioning).
5. A client in septic shock has a BP of 82/46 after a 3L fluid bolus. Which medication is
anticipated next?
A. Nitroprusside
B. Furosemide
C. Norepinephrine
D. Atropine
Answer: C
Rationale: Norepinephrine is the first-line vasopressor for septic shock when fluid resuscitation
fails to maintain a MAP > 65.
6. Which lab value indicates effective treatment in a client with MODS?
A. Increased Lactic Acid
B. Decreased Serum Creatinine
C. Decreased Platelets
D. Increased WBCs
Answer: B
Rationale: Decreasing creatinine indicates improving renal perfusion and reversing organ
dysfunction.
7. A client with AKI is in the oliguric phase. Which electrolyte imbalance is most likely?
A. Hypokalemia
B. Hypernatremia
C. Hyperkalemia
D. Hypomagnesemia
Answer: C
Rationale: In the oliguric phase, the kidneys fail to excrete potassium, leading to dangerous
hyperkalemia.
8. A nurse monitors a client for "Refeeding Syndrome." Which lab is the priority?
A. Sodium
B. Phosphorus
C. Hemoglobin
, 2026 UPDATED QUESTIONS DOWNLOAD
D. BUN
Answer: B
Rationale: Hypophosphatemia is the hallmark sign of refeeding syndrome and can lead to fatal
cardiac arrhythmias.
9. A client with 40% TBSA burns receives fluid resuscitation. Which finding indicates
effectiveness?
A. CVP of 2 mmHg
B. Heart rate of 120 bpm
C. Urine output of 0.5 mL/kg/hr
D. Weight gain of 2 lbs
Answer: C
Rationale: Urine output (0.5–1 mL/kg/hr) is the gold standard for measuring adequate organ
perfusion during burn resuscitation.
10. A nurse is caring for a client in the "Refractory Stage" of shock. What is the
prognosis?
A. Excellent with antibiotics.
B. Condition is irreversible; MODS is occurring.
C. High with aggressive fluid boluses.
D. Stable for discharge.
Answer: B
Rationale: The refractory stage is the final stage where cell death and organ failure are too
severe for survival.
11. A client with ARDS is placed in the prone position. What is the primary goal?
A. To decrease the work of breathing.
B. To improve oxygenation by recruiting alveoli.
C. To prevent pressure ulcers.
D. To facilitate easier suctioning.
Answer: B
Rationale: Prone positioning shifts perfusion to under-ventilated lung areas, improving V/Q
matching in ARDS.
12. A nurse is caring for a client with an AV fistula. Which action is appropriate?
A. Take blood pressure in the arm with the fistula.
B. Draw blood samples from the fistula.
C. Palpate for a thrill and auscultate for a bruit.
D. Wrap the arm tightly with a compression sleeve.
Answer: C
Rationale: A palpable thrill and audible bruit indicate the fistula is patent. Never use the fistula
arm for BP or blood draws.
, 2026 UPDATED QUESTIONS DOWNLOAD
13. A client is in anaphylactic shock. What is the first-line medication?
A. Diphenhydramine
B. Albuterol
C. Epinephrine
D. Methylprednisolone
Answer: C
Rationale: Epinephrine IM is the priority to cause bronchodilation and vasoconstriction during
anaphylaxis.
14. A nurse is assessing a client with a suspected inhalation injury. Which finding is the
priority?
A. Generalized edema
B. Singed nasal hairs and soot in the sputum
C. Pain at the burn site
D. Hypotension
Answer: B
Rationale: Singed nasal hairs and soot are "red flags" for upper airway burns that can cause
rapid swelling and obstruction.
15. A client's ABG results: pH 7.28, PaCO2 50, HCO3 24. What is the interpretation?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Respiratory Acidosis
D. Metabolic Alkalosis
Answer: C
Rationale: Low pH (<7.35) and high CO2 (>45) indicate respiratory acidosis.
16. A client in the emergent phase of a burn injury is most at risk for which electrolyte
imbalance?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypernatremia
Answer: B
Rationale: Massive cell destruction releases intracellular potassium into the bloodstream
during the first 24–48 hours.
17. What is the "Sepsis Bundle" priority within the first hour?
A. Intubation
B. CT scan
C. Obtain blood cultures then start broad-spectrum antibiotics
D. Perform a wound debridement
Answer: C
NUR125 Exam 4 Master Study Guide | 300 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 300 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 in the compensatory stage of shock. Which finding
should the nurse expect?
A. Metabolic acidosis
B. Tachycardia and narrowed pulse pressure
C. Cold, mottled skin
D. Decreased level of consciousness
Answer: B
Rationale: In the compensatory stage, the SNS triggers tachycardia and vasoconstriction to
maintain CO. Metabolic acidosis and mottled skin occur in later stages.
2. A client has deep partial-thickness burns to the anterior trunk and both anterior arms.
Using the Rule of Nines, what is the %TBSA?
A. 18%
B. 27%
C. 36%
D. 45%
Answer: B
Rationale: Anterior trunk (18%) + Anterior right arm (4.5%) + Anterior left arm (4.5%) = 27%.
3. Which is the priority assessment for a client with circumferential chest burns?
A. Pain level
B. Urine output
C. Airway and chest excursion
D. Peripheral pulses
Answer: C
, 2026 UPDATED QUESTIONS DOWNLOAD
Rationale: Circumferential burns can cause "restriction" of the chest wall, leading to immediate
respiratory failure.
4. A ventilator high-pressure alarm sounds. Which action should the nurse take first?
A. Check for a leak in the cuff.
B. Suction the client's airway.
C. Call the respiratory therapist.
D. Check for a disconnected tube.
Answer: B
Rationale: High-pressure alarms are caused by resistance, such as biting the tube, kinks, or
secretions (suctioning).
5. A client in septic shock has a BP of 82/46 after a 3L fluid bolus. Which medication is
anticipated next?
A. Nitroprusside
B. Furosemide
C. Norepinephrine
D. Atropine
Answer: C
Rationale: Norepinephrine is the first-line vasopressor for septic shock when fluid resuscitation
fails to maintain a MAP > 65.
6. Which lab value indicates effective treatment in a client with MODS?
A. Increased Lactic Acid
B. Decreased Serum Creatinine
C. Decreased Platelets
D. Increased WBCs
Answer: B
Rationale: Decreasing creatinine indicates improving renal perfusion and reversing organ
dysfunction.
7. A client with AKI is in the oliguric phase. Which electrolyte imbalance is most likely?
A. Hypokalemia
B. Hypernatremia
C. Hyperkalemia
D. Hypomagnesemia
Answer: C
Rationale: In the oliguric phase, the kidneys fail to excrete potassium, leading to dangerous
hyperkalemia.
8. A nurse monitors a client for "Refeeding Syndrome." Which lab is the priority?
A. Sodium
B. Phosphorus
C. Hemoglobin
, 2026 UPDATED QUESTIONS DOWNLOAD
D. BUN
Answer: B
Rationale: Hypophosphatemia is the hallmark sign of refeeding syndrome and can lead to fatal
cardiac arrhythmias.
9. A client with 40% TBSA burns receives fluid resuscitation. Which finding indicates
effectiveness?
A. CVP of 2 mmHg
B. Heart rate of 120 bpm
C. Urine output of 0.5 mL/kg/hr
D. Weight gain of 2 lbs
Answer: C
Rationale: Urine output (0.5–1 mL/kg/hr) is the gold standard for measuring adequate organ
perfusion during burn resuscitation.
10. A nurse is caring for a client in the "Refractory Stage" of shock. What is the
prognosis?
A. Excellent with antibiotics.
B. Condition is irreversible; MODS is occurring.
C. High with aggressive fluid boluses.
D. Stable for discharge.
Answer: B
Rationale: The refractory stage is the final stage where cell death and organ failure are too
severe for survival.
11. A client with ARDS is placed in the prone position. What is the primary goal?
A. To decrease the work of breathing.
B. To improve oxygenation by recruiting alveoli.
C. To prevent pressure ulcers.
D. To facilitate easier suctioning.
Answer: B
Rationale: Prone positioning shifts perfusion to under-ventilated lung areas, improving V/Q
matching in ARDS.
12. A nurse is caring for a client with an AV fistula. Which action is appropriate?
A. Take blood pressure in the arm with the fistula.
B. Draw blood samples from the fistula.
C. Palpate for a thrill and auscultate for a bruit.
D. Wrap the arm tightly with a compression sleeve.
Answer: C
Rationale: A palpable thrill and audible bruit indicate the fistula is patent. Never use the fistula
arm for BP or blood draws.
, 2026 UPDATED QUESTIONS DOWNLOAD
13. A client is in anaphylactic shock. What is the first-line medication?
A. Diphenhydramine
B. Albuterol
C. Epinephrine
D. Methylprednisolone
Answer: C
Rationale: Epinephrine IM is the priority to cause bronchodilation and vasoconstriction during
anaphylaxis.
14. A nurse is assessing a client with a suspected inhalation injury. Which finding is the
priority?
A. Generalized edema
B. Singed nasal hairs and soot in the sputum
C. Pain at the burn site
D. Hypotension
Answer: B
Rationale: Singed nasal hairs and soot are "red flags" for upper airway burns that can cause
rapid swelling and obstruction.
15. A client's ABG results: pH 7.28, PaCO2 50, HCO3 24. What is the interpretation?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Respiratory Acidosis
D. Metabolic Alkalosis
Answer: C
Rationale: Low pH (<7.35) and high CO2 (>45) indicate respiratory acidosis.
16. A client in the emergent phase of a burn injury is most at risk for which electrolyte
imbalance?
A. Hypokalemia
B. Hyperkalemia
C. Hypocalcemia
D. Hypernatremia
Answer: B
Rationale: Massive cell destruction releases intracellular potassium into the bloodstream
during the first 24–48 hours.
17. What is the "Sepsis Bundle" priority within the first hour?
A. Intubation
B. CT scan
C. Obtain blood cultures then start broad-spectrum antibiotics
D. Perform a wound debridement
Answer: C
