NUR 265 Advanced Medical-Surgical Nursing - Week 7: Burns and
Shock |Galen College
1. A patient arrives in the ED with facial burns and singed nasal hairs after a
house fire. Which assessment finding is the highest priority?
A. Heart rate of 110 beats per minute
B. Pain level of 8 out of 10
C. Full-thickness burns on the hands
D. Brassy cough and wheezing
Answer: D
Rationale: A brassy cough, wheezing, and singed nasal hairs indicate a potential inhalation
injury and impending airway obstruction, which is the priority in burn care.
2. Using the Parkland formula, calculate the total fluid volume needed in the
first 24 hours for a 70 kg patient with 40% TBSA burns.
A. 11,200 mL
B. 5,600 mL
C. 2,800 mL
D. 8,400 mL
Answer: A
Rationale: Parkland formula: 4 mL x kg x %TBSA. 4 x 70 x 40 = 11,200 mL.
,3. During the emergent phase of burn care, which electrolyte imbalance is most
commonly expected?
A. Hypokalemia and Hyponatremia
B. Hypercalcemia and Hypernatremia
C. Hyperkalemia and Hyponatremia
D. Hypokalemia and Hypernatremia
Answer: C
Rationale: Potassium is released from damaged cells (Hyperkalemia), and Sodium follows
water into the interstitial space (Hyponatremia).
4. Which type of shock is characterized by a low heart rate despite a low blood
pressure?
A. Hypovolemic Shock
B. Septic Shock
C. Anaphylactic Shock
D. Neurogenic Shock
Answer: D
Rationale: Neurogenic shock causes loss of sympathetic tone, leading to bradycardia and
vasodilation, unlike other shocks where the heart rate increases to compensate.
5. A patient in the progressive stage of shock has a Mean Arterial Pressure
(MAP) of 55 mmHg. What is the nurse’s primary concern?
A. Respiratory alkalosis
B. Excessive fluid volume
C. Increased cardiac output
D. Inadequate organ perfusion
Answer: D
Rationale: A MAP below 60-65 mmHg indicates that vital organs are not receiving
adequate oxygen and nutrients.
, 6. Which medication is typically considered the first-line vasopressor for septic
shock that is unresponsive to fluid resuscitation?
A. Epinephrine
B. Dopamine
C. Norepinephrine
D. Atropine
Answer: C
Rationale: Norepinephrine (Levophed) is the gold standard vasopressor for maintaining
MAP in septic shock after fluid volume is restored.
7. A patient has full-thickness burns on the entire left arm and the entire left
leg. What is the estimated TBSA percentage using the Rule of Nines?
A. 18%
B. 45%
C. 36%
D. 27%
Answer: D
Rationale: Left arm = 9%, Left leg = 18%. Total = 27%.
8. What is the primary goal of an escharotomy in a patient with circumferential
chest burns?
A. To prevent wound infection
B. To improve cardiac output
C. To reduce the need for skin grafting
D. To facilitate chest expansion and ventilation
Answer: D
Rationale: Eschar is non-elastic; a circumferential burn on the chest can restrict breathing,
making an escharotomy necessary to relieve pressure.
Shock |Galen College
1. A patient arrives in the ED with facial burns and singed nasal hairs after a
house fire. Which assessment finding is the highest priority?
A. Heart rate of 110 beats per minute
B. Pain level of 8 out of 10
C. Full-thickness burns on the hands
D. Brassy cough and wheezing
Answer: D
Rationale: A brassy cough, wheezing, and singed nasal hairs indicate a potential inhalation
injury and impending airway obstruction, which is the priority in burn care.
2. Using the Parkland formula, calculate the total fluid volume needed in the
first 24 hours for a 70 kg patient with 40% TBSA burns.
A. 11,200 mL
B. 5,600 mL
C. 2,800 mL
D. 8,400 mL
Answer: A
Rationale: Parkland formula: 4 mL x kg x %TBSA. 4 x 70 x 40 = 11,200 mL.
,3. During the emergent phase of burn care, which electrolyte imbalance is most
commonly expected?
A. Hypokalemia and Hyponatremia
B. Hypercalcemia and Hypernatremia
C. Hyperkalemia and Hyponatremia
D. Hypokalemia and Hypernatremia
Answer: C
Rationale: Potassium is released from damaged cells (Hyperkalemia), and Sodium follows
water into the interstitial space (Hyponatremia).
4. Which type of shock is characterized by a low heart rate despite a low blood
pressure?
A. Hypovolemic Shock
B. Septic Shock
C. Anaphylactic Shock
D. Neurogenic Shock
Answer: D
Rationale: Neurogenic shock causes loss of sympathetic tone, leading to bradycardia and
vasodilation, unlike other shocks where the heart rate increases to compensate.
5. A patient in the progressive stage of shock has a Mean Arterial Pressure
(MAP) of 55 mmHg. What is the nurse’s primary concern?
A. Respiratory alkalosis
B. Excessive fluid volume
C. Increased cardiac output
D. Inadequate organ perfusion
Answer: D
Rationale: A MAP below 60-65 mmHg indicates that vital organs are not receiving
adequate oxygen and nutrients.
, 6. Which medication is typically considered the first-line vasopressor for septic
shock that is unresponsive to fluid resuscitation?
A. Epinephrine
B. Dopamine
C. Norepinephrine
D. Atropine
Answer: C
Rationale: Norepinephrine (Levophed) is the gold standard vasopressor for maintaining
MAP in septic shock after fluid volume is restored.
7. A patient has full-thickness burns on the entire left arm and the entire left
leg. What is the estimated TBSA percentage using the Rule of Nines?
A. 18%
B. 45%
C. 36%
D. 27%
Answer: D
Rationale: Left arm = 9%, Left leg = 18%. Total = 27%.
8. What is the primary goal of an escharotomy in a patient with circumferential
chest burns?
A. To prevent wound infection
B. To improve cardiac output
C. To reduce the need for skin grafting
D. To facilitate chest expansion and ventilation
Answer: D
Rationale: Eschar is non-elastic; a circumferential burn on the chest can restrict breathing,
making an escharotomy necessary to relieve pressure.
