NUR 265 Exam 2: Advanced MedSurg - Galen College of
Nursing Updated and Latest Questions and Correct
Answers with Rationale
1. A nurse is caring for a patient in the early stages of septic shock. Which clinical manifestation should the
nurse expect to find?
A. Hypotension and bradycardia
B. Cool, clammy skin and oliguria
C. Tachycardia and warm, flushed skin
D. Severe metabolic acidosis and lethargy
Correct Answer: C
Rationale: In the early stage of septic shock, also known as the hyperdynamic phase, the patient typically
exhibits a high cardiac output. This results in tachycardia and vasodilation, which presents as warm and
flushed skin. The body is attempting to compensate for the infection and maintain tissue perfusion
initially. As the shock progresses, these compensatory mechanisms will fail and lead to cooler skin and
lower blood pressure. Recognizing these early signs is crucial for prompt medical intervention and
improved patient outcomes.
2. A patient with severe burns on the chest and arms is at risk for inhalation injury. Which assessment
finding is the most immediate priority?
A. Singed nasal hairs and soot in the sputum
B. Oozing serosanguinous drainage from the chest
C. Hoarseness and a brassy cough
D. Decreased peripheral pulses in the arms
,Correct Answer: C
Rationale: Hoarseness and a brassy cough are critical indicators of impending airway obstruction due to
edema in the upper respiratory tract. While singed nasal hairs suggest exposure, changes in voice and
cough characteristics indicate that the airway is actively being compromised. Immediate assessment of
airway patency and potential intubation is necessary to prevent complete obstruction. The nurse must
prioritize respiratory status over skin drainage or peripheral circulation in this context. Early recognition
of these signs can be life-saving for a patient with inhalation injuries.
3. The nurse is calculating the fluid resuscitation requirements for a patient using the Parkland Formula. The
patient weighs 75 kg and has sustained 40% total body surface area (TBSA) burns. What is the total volume
for the first 24 hours?
A. 12,000 mL
B. 9,000 mL
C. 6,000 mL
D. 15,000 mL
Correct Answer: A
Rationale: The Parkland Formula calculates total fluid needs as 4 mL x weight in kg x % TBSA burned.
For this patient, the calculation is 4 mL x 75 kg x 40, which equals 12,000 mL. Half of this total volume
must be administered within the first 8 hours post-injury. The remaining half is then distributed over the
subsequent 16 hours of the day. Accurate calculation is essential to prevent both hypovolemic shock and
fluid overload complications.
4. A client with Acute Kidney Injury (AKI) is in the diuretic phase. Which electrolyte abnormality should the
nurse monitor for most closely?
A. Hyperkalemia
, B. Hypermagnesemia
C. Hypokalemia
D. Hypernatremia
Correct Answer: C
Rationale: During the diuretic phase of AKI, the kidneys begin to recover their ability to excrete waste
but cannot yet concentrate urine. Large volumes of urine are produced, which often leads to the
significant loss of electrolytes such as potassium. Hypokalemia becomes a major risk as potassium is
flushed out with the high urine output. The nurse must monitor serum levels and watch for cardiac
arrhythmias or muscle weakness. Replacing lost fluids and electrolytes is the primary focus of care
during this recovery stage.
5. A patient is admitted with hepatic encephalopathy. Which medication should the nurse anticipate
administering to reduce serum ammonia levels?
A. Spironolactone
B. Lactulose
C. Furosemide
D. Rifaximin
Correct Answer: B
Rationale: Lactulose is the standard treatment for hepatic encephalopathy because it promotes the
excretion of ammonia through the stool. It works by creating an acidic environment in the bowel that
converts ammonia into ammonium, which is not easily reabsorbed. The patient will likely experience
multiple soft bowel movements as a result of this medication. Monitoring the frequency of stools and
Nursing Updated and Latest Questions and Correct
Answers with Rationale
1. A nurse is caring for a patient in the early stages of septic shock. Which clinical manifestation should the
nurse expect to find?
A. Hypotension and bradycardia
B. Cool, clammy skin and oliguria
C. Tachycardia and warm, flushed skin
D. Severe metabolic acidosis and lethargy
Correct Answer: C
Rationale: In the early stage of septic shock, also known as the hyperdynamic phase, the patient typically
exhibits a high cardiac output. This results in tachycardia and vasodilation, which presents as warm and
flushed skin. The body is attempting to compensate for the infection and maintain tissue perfusion
initially. As the shock progresses, these compensatory mechanisms will fail and lead to cooler skin and
lower blood pressure. Recognizing these early signs is crucial for prompt medical intervention and
improved patient outcomes.
2. A patient with severe burns on the chest and arms is at risk for inhalation injury. Which assessment
finding is the most immediate priority?
A. Singed nasal hairs and soot in the sputum
B. Oozing serosanguinous drainage from the chest
C. Hoarseness and a brassy cough
D. Decreased peripheral pulses in the arms
,Correct Answer: C
Rationale: Hoarseness and a brassy cough are critical indicators of impending airway obstruction due to
edema in the upper respiratory tract. While singed nasal hairs suggest exposure, changes in voice and
cough characteristics indicate that the airway is actively being compromised. Immediate assessment of
airway patency and potential intubation is necessary to prevent complete obstruction. The nurse must
prioritize respiratory status over skin drainage or peripheral circulation in this context. Early recognition
of these signs can be life-saving for a patient with inhalation injuries.
3. The nurse is calculating the fluid resuscitation requirements for a patient using the Parkland Formula. The
patient weighs 75 kg and has sustained 40% total body surface area (TBSA) burns. What is the total volume
for the first 24 hours?
A. 12,000 mL
B. 9,000 mL
C. 6,000 mL
D. 15,000 mL
Correct Answer: A
Rationale: The Parkland Formula calculates total fluid needs as 4 mL x weight in kg x % TBSA burned.
For this patient, the calculation is 4 mL x 75 kg x 40, which equals 12,000 mL. Half of this total volume
must be administered within the first 8 hours post-injury. The remaining half is then distributed over the
subsequent 16 hours of the day. Accurate calculation is essential to prevent both hypovolemic shock and
fluid overload complications.
4. A client with Acute Kidney Injury (AKI) is in the diuretic phase. Which electrolyte abnormality should the
nurse monitor for most closely?
A. Hyperkalemia
, B. Hypermagnesemia
C. Hypokalemia
D. Hypernatremia
Correct Answer: C
Rationale: During the diuretic phase of AKI, the kidneys begin to recover their ability to excrete waste
but cannot yet concentrate urine. Large volumes of urine are produced, which often leads to the
significant loss of electrolytes such as potassium. Hypokalemia becomes a major risk as potassium is
flushed out with the high urine output. The nurse must monitor serum levels and watch for cardiac
arrhythmias or muscle weakness. Replacing lost fluids and electrolytes is the primary focus of care
during this recovery stage.
5. A patient is admitted with hepatic encephalopathy. Which medication should the nurse anticipate
administering to reduce serum ammonia levels?
A. Spironolactone
B. Lactulose
C. Furosemide
D. Rifaximin
Correct Answer: B
Rationale: Lactulose is the standard treatment for hepatic encephalopathy because it promotes the
excretion of ammonia through the stool. It works by creating an acidic environment in the bowel that
converts ammonia into ammonium, which is not easily reabsorbed. The patient will likely experience
multiple soft bowel movements as a result of this medication. Monitoring the frequency of stools and
