NUR 265 Final Exam: Advanced MedSurg - Galen College of
Nursing Updated and Latest Questions and Correct
Answers with Rationale
1. A patient arrives in the ER with 40% TBSA burns and weighs 70kg. Using the Parkland formula
(4mL/kg/%TBSA), what is the total fluid requirement for the first 24 hours?
A. 5,600 mL
B. 11,200 mL
C. 2,800 mL
D. 8,400 mL
Ans: B
Rationale: The Parkland formula calculates total fluid volume as 4mL multiplied by weight in kilograms
and the percentage of TBSA burned. For this patient, the calculation is 4 times 70 times 40, which equals
11,200 mL. Half of this total amount must be infused within the first eight hours of the injury. The
remaining half is administered over the subsequent sixteen hours. This aggressive fluid resuscitation is
critical to prevent hypovolemic shock in major burn patients.
2. Which hemodynamic parameter is the most sensitive indicator of left ventricular function and fluid
overload in a patient with heart failure?
A. Central Venous Pressure (CVP)
B. Pulmonary Artery Wedge Pressure (PAWP)
C. Mean Arterial Pressure (MAP)
D. Systemic Vascular Resistance (SVR)
Ans: B
,Rationale: Pulmonary Artery Wedge Pressure reflects the pressure in the left atrium and left ventricle at
the end of diastole. This measurement is considered the gold standard for assessing left-sided heart
function. An elevated PAWP typically indicates fluid volume overload or left ventricular failure. Unlike
CVP, which measures right-sided pressures, PAWP specifically targets the left side of the cardiac system.
Nurses use this data to titrate diuretics and inotropic medications effectively.
3. A patient with ARDS is placed on mechanical ventilation with High PEEP settings. What is the primary
physiological purpose of using PEEP in this condition?
A. To increase the fraction of inspired oxygen (FiO2)
B. To prevent alveolar collapse and improve oxygenation
C. To decrease the work of breathing for the patient
D. To increase the tidal volume of each breath
Ans: B
Rationale: Positive End-Expiratory Pressure works by maintaining a set pressure in the lungs at the end
of expiration. This pressure keeps the alveoli open, preventing the collapse known as atelectasis. By
recruiting more functional alveoli, PEEP significantly improves the surface area available for gas
exchange. It allows the clinician to lower the FiO2 to safer levels to avoid oxygen toxicity. However,
nurses must monitor for complications such as barotrauma or decreased cardiac output.
4. A nurse is caring for a patient in the early stage of Septic Shock. Which clinical finding is most
characteristic of this ‘warm’ phase?
A. Cool, clammy skin
B. Bradycardia
C. Hyperdynamic cardiac output and vasodilation
, D. Increased Systemic Vascular Resistance (SVR)
Ans: C
Rationale: Early septic shock is characterized by a hyperdynamic state where the heart compensates for
vasodilation. During this phase, the patient often exhibits high cardiac output and low systemic vascular
resistance. The skin may feel warm and flushed due to the massive peripheral vasodilation caused by
inflammatory mediators. As the shock progresses to the ‘cold’ phase, the cardiac output will drop and the
skin becomes cool. Recognizing these early signs is vital for initiating the sepsis bundle and improving
survival rates.
5. Which electrolyte imbalance is most commonly associated with the oliguric phase of Acute Kidney Injury
(AKI)?
A. Hypokalemia
B. Hypernatremia
C. Hypophosphatemia
D. Hyperkalemia
Ans: D
Rationale: During the oliguric phase of AKI, the kidneys lose the ability to excrete potassium effectively.
This leads to a dangerous accumulation of potassium in the bloodstream known as hyperkalemia.
Hyperkalemia can cause life-threatening cardiac arrhythmias and must be treated urgently. Nurses
should monitor the EKG for peaked T waves and widened QRS complexes. Dietary restrictions and
medications like Kayexalate or insulin/dextrose are often utilized to manage these levels.
Nursing Updated and Latest Questions and Correct
Answers with Rationale
1. A patient arrives in the ER with 40% TBSA burns and weighs 70kg. Using the Parkland formula
(4mL/kg/%TBSA), what is the total fluid requirement for the first 24 hours?
A. 5,600 mL
B. 11,200 mL
C. 2,800 mL
D. 8,400 mL
Ans: B
Rationale: The Parkland formula calculates total fluid volume as 4mL multiplied by weight in kilograms
and the percentage of TBSA burned. For this patient, the calculation is 4 times 70 times 40, which equals
11,200 mL. Half of this total amount must be infused within the first eight hours of the injury. The
remaining half is administered over the subsequent sixteen hours. This aggressive fluid resuscitation is
critical to prevent hypovolemic shock in major burn patients.
2. Which hemodynamic parameter is the most sensitive indicator of left ventricular function and fluid
overload in a patient with heart failure?
A. Central Venous Pressure (CVP)
B. Pulmonary Artery Wedge Pressure (PAWP)
C. Mean Arterial Pressure (MAP)
D. Systemic Vascular Resistance (SVR)
Ans: B
,Rationale: Pulmonary Artery Wedge Pressure reflects the pressure in the left atrium and left ventricle at
the end of diastole. This measurement is considered the gold standard for assessing left-sided heart
function. An elevated PAWP typically indicates fluid volume overload or left ventricular failure. Unlike
CVP, which measures right-sided pressures, PAWP specifically targets the left side of the cardiac system.
Nurses use this data to titrate diuretics and inotropic medications effectively.
3. A patient with ARDS is placed on mechanical ventilation with High PEEP settings. What is the primary
physiological purpose of using PEEP in this condition?
A. To increase the fraction of inspired oxygen (FiO2)
B. To prevent alveolar collapse and improve oxygenation
C. To decrease the work of breathing for the patient
D. To increase the tidal volume of each breath
Ans: B
Rationale: Positive End-Expiratory Pressure works by maintaining a set pressure in the lungs at the end
of expiration. This pressure keeps the alveoli open, preventing the collapse known as atelectasis. By
recruiting more functional alveoli, PEEP significantly improves the surface area available for gas
exchange. It allows the clinician to lower the FiO2 to safer levels to avoid oxygen toxicity. However,
nurses must monitor for complications such as barotrauma or decreased cardiac output.
4. A nurse is caring for a patient in the early stage of Septic Shock. Which clinical finding is most
characteristic of this ‘warm’ phase?
A. Cool, clammy skin
B. Bradycardia
C. Hyperdynamic cardiac output and vasodilation
, D. Increased Systemic Vascular Resistance (SVR)
Ans: C
Rationale: Early septic shock is characterized by a hyperdynamic state where the heart compensates for
vasodilation. During this phase, the patient often exhibits high cardiac output and low systemic vascular
resistance. The skin may feel warm and flushed due to the massive peripheral vasodilation caused by
inflammatory mediators. As the shock progresses to the ‘cold’ phase, the cardiac output will drop and the
skin becomes cool. Recognizing these early signs is vital for initiating the sepsis bundle and improving
survival rates.
5. Which electrolyte imbalance is most commonly associated with the oliguric phase of Acute Kidney Injury
(AKI)?
A. Hypokalemia
B. Hypernatremia
C. Hypophosphatemia
D. Hyperkalemia
Ans: D
Rationale: During the oliguric phase of AKI, the kidneys lose the ability to excrete potassium effectively.
This leads to a dangerous accumulation of potassium in the bloodstream known as hyperkalemia.
Hyperkalemia can cause life-threatening cardiac arrhythmias and must be treated urgently. Nurses
should monitor the EKG for peaked T waves and widened QRS complexes. Dietary restrictions and
medications like Kayexalate or insulin/dextrose are often utilized to manage these levels.
