NUR 265 Advanced Medical-Surgical Nursing Exam 3 2026 |Galen
College
1. A patient has sustained deep partial-thickness burns to the front of both legs
and the entire perineum. Using the Rule of Nines, what is the estimated Total
Body Surface Area (TBSA) burned?
A. 18%
B. 36%
C. 19%
D. 10%
Answer: C
Rationale: According to the Rule of Nines, each leg (front and back) is 18%. The front of
one leg is 9%. Front of both legs is 18%. The perineum is 1%. 18% + 1% = 19%.
2. Which electrolyte imbalance is a hallmark sign of the emergent phase of a
major burn injury?
A. Hypokalemia
B. Hypernatremia
C. Hyperkalemia
D. Hypocalcemia
Answer: C
Rationale: During the emergent phase, cell destruction releases potassium into the
extracellular fluid, resulting in hyperkalemia.
,3. A 70kg patient has 40% TBSA burns. Using the Parkland formula
(4mL/kg/%TBSA), calculate the total fluid volume required in the first 24 hours.
A. 5,600 mL
B. 8,400 mL
C. 11,200 mL
D. 2,800 mL
Answer: C
Rationale: 4mL x 70kg x 40 = 11,200 mL.
4. The nurse is caring for a patient in the resuscitation phase of burn injury.
What is the best indicator of adequate fluid resuscitation?
A. Heart rate below 120 bpm
B. Mean Arterial Pressure (MAP) of 50 mmHg
C. Weight gain of 2 lbs
D. Urine output of 0.5 to 1 mL/kg/hr
Answer: D
Rationale: Urine output is the most reliable indicator for fluid resuscitation adequacy in
burn patients, specifically 0.5 to 1 mL/kg/hr (or at least 30-50 mL/hr).
5. A patient arrives with singed nasal hairs, soot in the sputum, and a hoarse
voice. Which action should the nurse take first?
A. Start a large-bore IV
B. Prepare for immediate endotracheal intubation
C. Calculate the Rule of Nines
D. Administer pain medication
Answer: B
Rationale: These are classic signs of upper airway thermal injury and impending airway
obstruction. Airway management is the priority.
, 6. During the acute phase of burn care, which dietary intervention is most
appropriate?
A. Low-calorie, high-protein
B. NPO status for 72 hours
C. Fluid restriction
D. High-calorie, high-protein
Answer: D
Rationale: Burn patients are in a hypermetabolic state and require high calories and high
protein to facilitate wound healing.
7. Which type of shock is characterized by a high Cardiac Output but very low
Systemic Vascular Resistance (SVR)?
A. Hypovolemic Shock
B. Early (Warm) Septic Shock
C. Cardiogenic Shock
D. Neurogenic Shock
Answer: B
Rationale: Early septic shock is hyperdynamic; the body compensates for vasodilation by
increasing cardiac output initially.
8. A patient with a spinal cord injury at T3 presents with a BP of 82/40 and a
Heart Rate of 48. What type of shock is suspected?
A. Neurogenic Shock
B. Hypovolemic Shock
C. Anaphylactic Shock
D. Septic Shock
Answer: A
Rationale: Neurogenic shock is unique because it presents with hypotension and
bradycardia due to the loss of sympathetic tone.
College
1. A patient has sustained deep partial-thickness burns to the front of both legs
and the entire perineum. Using the Rule of Nines, what is the estimated Total
Body Surface Area (TBSA) burned?
A. 18%
B. 36%
C. 19%
D. 10%
Answer: C
Rationale: According to the Rule of Nines, each leg (front and back) is 18%. The front of
one leg is 9%. Front of both legs is 18%. The perineum is 1%. 18% + 1% = 19%.
2. Which electrolyte imbalance is a hallmark sign of the emergent phase of a
major burn injury?
A. Hypokalemia
B. Hypernatremia
C. Hyperkalemia
D. Hypocalcemia
Answer: C
Rationale: During the emergent phase, cell destruction releases potassium into the
extracellular fluid, resulting in hyperkalemia.
,3. A 70kg patient has 40% TBSA burns. Using the Parkland formula
(4mL/kg/%TBSA), calculate the total fluid volume required in the first 24 hours.
A. 5,600 mL
B. 8,400 mL
C. 11,200 mL
D. 2,800 mL
Answer: C
Rationale: 4mL x 70kg x 40 = 11,200 mL.
4. The nurse is caring for a patient in the resuscitation phase of burn injury.
What is the best indicator of adequate fluid resuscitation?
A. Heart rate below 120 bpm
B. Mean Arterial Pressure (MAP) of 50 mmHg
C. Weight gain of 2 lbs
D. Urine output of 0.5 to 1 mL/kg/hr
Answer: D
Rationale: Urine output is the most reliable indicator for fluid resuscitation adequacy in
burn patients, specifically 0.5 to 1 mL/kg/hr (or at least 30-50 mL/hr).
5. A patient arrives with singed nasal hairs, soot in the sputum, and a hoarse
voice. Which action should the nurse take first?
A. Start a large-bore IV
B. Prepare for immediate endotracheal intubation
C. Calculate the Rule of Nines
D. Administer pain medication
Answer: B
Rationale: These are classic signs of upper airway thermal injury and impending airway
obstruction. Airway management is the priority.
, 6. During the acute phase of burn care, which dietary intervention is most
appropriate?
A. Low-calorie, high-protein
B. NPO status for 72 hours
C. Fluid restriction
D. High-calorie, high-protein
Answer: D
Rationale: Burn patients are in a hypermetabolic state and require high calories and high
protein to facilitate wound healing.
7. Which type of shock is characterized by a high Cardiac Output but very low
Systemic Vascular Resistance (SVR)?
A. Hypovolemic Shock
B. Early (Warm) Septic Shock
C. Cardiogenic Shock
D. Neurogenic Shock
Answer: B
Rationale: Early septic shock is hyperdynamic; the body compensates for vasodilation by
increasing cardiac output initially.
8. A patient with a spinal cord injury at T3 presents with a BP of 82/40 and a
Heart Rate of 48. What type of shock is suspected?
A. Neurogenic Shock
B. Hypovolemic Shock
C. Anaphylactic Shock
D. Septic Shock
Answer: A
Rationale: Neurogenic shock is unique because it presents with hypotension and
bradycardia due to the loss of sympathetic tone.
