NUR 265 Exam 3: Advanced MedSurg - Galen College of
Nursing Updated and Latest Questions and Correct
Answers with Rationale
1. A nurse is caring for a patient who sustained burns to the entire left arm and the anterior trunk. Using the
Rule of Nines, what is the estimated total body surface area (TBSA) affected?
A. 18%
B. 27%
C. 36%
D. 45%
Correct Answer: B
Rationale: The Rule of Nines assigns 9% to the entire left arm. The anterior trunk is assigned 18% of the
total body surface area. Adding these two values together results in a total of 27%. Accurate calculation is
essential for determining the appropriate volume of fluid resuscitation. This measurement helps
prioritize care based on the severity of the thermal injury.
2. The nurse is calculating the fluid resuscitation for a patient weighing 70 kg with a 50% TBSA burn using
the Parkland Formula (4mL/kg/%TBSA). How much fluid should be administered in the first 8 hours?
A. 3,500 mL
B. 14,000 mL
C. 7,000 mL
D. 10,500 mL
Correct Answer: C
,Rationale: The Parkland Formula calculates the total 24-hour fluid requirement as 4mL x 70kg x 50,
which equals 14,000 mL. According to protocol, half of this total volume must be given in the first 8
hours. Therefore, 7,000 mL should be infused during the initial eight-hour period. This fluid is typically
administered as Lactated Ringer’s to replace lost electrolytes and volume. Proper timing is measured
from the actual time of the injury, not hospital arrival.
3. Which clinical manifestation is most indicative of an inhalation injury in a patient who was rescued from a
house fire?
A. Tachycardia and hypertension
B. Generalized edema in the extremities
C. Singed nasal hairs and soot in the sputum
D. Decreased bowel sounds and abdominal distension
Correct Answer: C
Rationale: Inhalation injury is a major cause of morbidity and mortality in burn victims. Physical signs
like singed nasal hairs and carbonaceous sputum are primary indicators of airway thermal damage.
These patients require immediate assessment for respiratory distress and possible prophylactic
intubation. Stridor or hoarseness would also suggest that the upper airway is becoming obstructed by
edema. Monitoring oxygen saturation alone is insufficient as carbon monoxide may provide false high
readings.
4. A patient in the emergent phase of burn care has a serum potassium level of 6.2 mEq/L. What is the
physiological reason for this finding?
A. Excessive administration of potassium-rich IV fluids
B. Massive cell destruction releasing intracellular potassium
, C. Renal failure due to decreased cardiac output
D. Retention of potassium by the adrenal glands
Correct Answer: B
Rationale: During the emergent phase of a burn, massive cellular damage causes the release of
potassium into the extracellular space. This leads to a rapid increase in serum potassium levels, known as
hyperkalemia. The nurse must monitor the patient for cardiac dysrhythmias and EKG changes like
peaked T-waves. As fluid shifts stabilize and diuresis begins, potassium levels typically start to decline.
Careful monitoring of electrolytes is a high priority during the first 48 hours.
5. During the acute phase of burn management, what is the primary goal of care?
A. Successful completion of fluid resuscitation
B. Return of the patient to the highest level of function
C. Prevention of infection and wound closure
D. Assessment of the mechanism of injury
Correct Answer: C
Rationale: The acute phase begins when the patient is hemodynamically stable and capillary
permeability is restored. The focus shifts from life-saving resuscitation to the prevention of sepsis and
wound healing. Infection is the leading cause of death during this specific phase of burn recovery.
Interventions include debridement, dressing changes, and providing adequate nutritional support for
tissue repair. Constant vigilance for signs of systemic inflammatory response syndrome is required.
6. A patient with a full-thickness burn to the circumferential chest area is experiencing respiratory distress.
What is the most likely surgical intervention needed?
A. Thoracotomy
Nursing Updated and Latest Questions and Correct
Answers with Rationale
1. A nurse is caring for a patient who sustained burns to the entire left arm and the anterior trunk. Using the
Rule of Nines, what is the estimated total body surface area (TBSA) affected?
A. 18%
B. 27%
C. 36%
D. 45%
Correct Answer: B
Rationale: The Rule of Nines assigns 9% to the entire left arm. The anterior trunk is assigned 18% of the
total body surface area. Adding these two values together results in a total of 27%. Accurate calculation is
essential for determining the appropriate volume of fluid resuscitation. This measurement helps
prioritize care based on the severity of the thermal injury.
2. The nurse is calculating the fluid resuscitation for a patient weighing 70 kg with a 50% TBSA burn using
the Parkland Formula (4mL/kg/%TBSA). How much fluid should be administered in the first 8 hours?
A. 3,500 mL
B. 14,000 mL
C. 7,000 mL
D. 10,500 mL
Correct Answer: C
,Rationale: The Parkland Formula calculates the total 24-hour fluid requirement as 4mL x 70kg x 50,
which equals 14,000 mL. According to protocol, half of this total volume must be given in the first 8
hours. Therefore, 7,000 mL should be infused during the initial eight-hour period. This fluid is typically
administered as Lactated Ringer’s to replace lost electrolytes and volume. Proper timing is measured
from the actual time of the injury, not hospital arrival.
3. Which clinical manifestation is most indicative of an inhalation injury in a patient who was rescued from a
house fire?
A. Tachycardia and hypertension
B. Generalized edema in the extremities
C. Singed nasal hairs and soot in the sputum
D. Decreased bowel sounds and abdominal distension
Correct Answer: C
Rationale: Inhalation injury is a major cause of morbidity and mortality in burn victims. Physical signs
like singed nasal hairs and carbonaceous sputum are primary indicators of airway thermal damage.
These patients require immediate assessment for respiratory distress and possible prophylactic
intubation. Stridor or hoarseness would also suggest that the upper airway is becoming obstructed by
edema. Monitoring oxygen saturation alone is insufficient as carbon monoxide may provide false high
readings.
4. A patient in the emergent phase of burn care has a serum potassium level of 6.2 mEq/L. What is the
physiological reason for this finding?
A. Excessive administration of potassium-rich IV fluids
B. Massive cell destruction releasing intracellular potassium
, C. Renal failure due to decreased cardiac output
D. Retention of potassium by the adrenal glands
Correct Answer: B
Rationale: During the emergent phase of a burn, massive cellular damage causes the release of
potassium into the extracellular space. This leads to a rapid increase in serum potassium levels, known as
hyperkalemia. The nurse must monitor the patient for cardiac dysrhythmias and EKG changes like
peaked T-waves. As fluid shifts stabilize and diuresis begins, potassium levels typically start to decline.
Careful monitoring of electrolytes is a high priority during the first 48 hours.
5. During the acute phase of burn management, what is the primary goal of care?
A. Successful completion of fluid resuscitation
B. Return of the patient to the highest level of function
C. Prevention of infection and wound closure
D. Assessment of the mechanism of injury
Correct Answer: C
Rationale: The acute phase begins when the patient is hemodynamically stable and capillary
permeability is restored. The focus shifts from life-saving resuscitation to the prevention of sepsis and
wound healing. Infection is the leading cause of death during this specific phase of burn recovery.
Interventions include debridement, dressing changes, and providing adequate nutritional support for
tissue repair. Constant vigilance for signs of systemic inflammatory response syndrome is required.
6. A patient with a full-thickness burn to the circumferential chest area is experiencing respiratory distress.
What is the most likely surgical intervention needed?
A. Thoracotomy
