NUR 265 Advanced Medical-Surgical Nursing Exam 4 Practice 2026
|Galen College
1. A patient is admitted with neurogenic shock after a spinal cord injury. Which
clinical manifestation should the nurse expect?
A. Tachycardia and hypertension
B. Increased systemic vascular resistance
C. Cool, clammy skin
D. Bradycardia and hypotension
Answer: D
Rationale: Neurogenic shock results in the loss of sympathetic tone, leading to vasodilation
(hypotension) and the inability to increase the heart rate (bradycardia).
2. During the emergent phase of a burn injury, which electrolyte imbalance is
the nurse most likely to observe?
A. Hyperkalemia
B. Hypernatremia
C. Hypokalemia
D. Hypocalcemia
Answer: A
Rationale: In the emergent phase, potassium is released from damaged cells into the
extracellular fluid, leading to hyperkalemia.
,3. Using the Parkland formula, calculate the total fluid resuscitation needed in
the first 24 hours for a 70 kg patient with 50% TBSA burns.
A. 7,000 mL
B. 10,500 mL
C. 14,000 mL
D. 28,000 mL
Answer: C
Rationale: Parkland formula: 4 mL x weight (kg) x %TBSA. 4 x 70 x 50 = 14,000 mL.
4. Which of the following is a hallmark clinical sign of the progressive stage of
shock?
A. Decreased capillary refill and cold extremities
B. Mean Arterial Pressure (MAP) within normal limits
C. Respiratory alkalosis
D. Normal urine output
Answer: A
Rationale: In the progressive stage of shock, compensatory mechanisms fail, leading to
decreased peripheral perfusion, cold extremities, and organ dysfunction.
5. A patient in septic shock has a MAP of 55 mmHg despite fluid resuscitation.
Which medication should the nurse anticipate administering first?
A. Nitroprusside
B. Norepinephrine
C. Furosemide
D. Atropine
Answer: B
Rationale: Norepinephrine is the first-line vasopressor used in septic shock to maintain
MAP above 65 mmHg when fluid resuscitation is insufficient.
, 6. A patient is diagnosed with Acute Respiratory Distress Syndrome (ARDS).
Which oxygenation finding is characteristic of this condition?
A. Hyperoxemia with low FiO2
B. Increased pulmonary compliance
C. Rapid response to low-flow oxygen therapy
D. Refractory hypoxemia
Answer: D
Rationale: Refractory hypoxemia, where arterial oxygen levels remain low despite high
concentrations of supplemental oxygen, is a hallmark of ARDS.
7. What is the primary goal of prone positioning in a patient with ARDS?
A. To decrease intracranial pressure
B. To increase gastric emptying
C. To improve recruitment of posterior alveolar units
D. To make it easier for the nurse to perform skin care
Answer: C
Rationale: Prone positioning helps redistribute pulmonary edema and recruits collapsed
alveoli in the posterior segments of the lungs, improving oxygenation.
8. In a patient with Acute Kidney Injury (AKI), which phase is characterized by a
daily urine output of less than 400 mL?
A. Diuretic phase
B. Recovery phase
C. Oliguric phase
D. Initiation phase
Answer: C
Rationale: The oliguric phase is defined by a significant decrease in urine output, typically
less than 400 mL per day.
|Galen College
1. A patient is admitted with neurogenic shock after a spinal cord injury. Which
clinical manifestation should the nurse expect?
A. Tachycardia and hypertension
B. Increased systemic vascular resistance
C. Cool, clammy skin
D. Bradycardia and hypotension
Answer: D
Rationale: Neurogenic shock results in the loss of sympathetic tone, leading to vasodilation
(hypotension) and the inability to increase the heart rate (bradycardia).
2. During the emergent phase of a burn injury, which electrolyte imbalance is
the nurse most likely to observe?
A. Hyperkalemia
B. Hypernatremia
C. Hypokalemia
D. Hypocalcemia
Answer: A
Rationale: In the emergent phase, potassium is released from damaged cells into the
extracellular fluid, leading to hyperkalemia.
,3. Using the Parkland formula, calculate the total fluid resuscitation needed in
the first 24 hours for a 70 kg patient with 50% TBSA burns.
A. 7,000 mL
B. 10,500 mL
C. 14,000 mL
D. 28,000 mL
Answer: C
Rationale: Parkland formula: 4 mL x weight (kg) x %TBSA. 4 x 70 x 50 = 14,000 mL.
4. Which of the following is a hallmark clinical sign of the progressive stage of
shock?
A. Decreased capillary refill and cold extremities
B. Mean Arterial Pressure (MAP) within normal limits
C. Respiratory alkalosis
D. Normal urine output
Answer: A
Rationale: In the progressive stage of shock, compensatory mechanisms fail, leading to
decreased peripheral perfusion, cold extremities, and organ dysfunction.
5. A patient in septic shock has a MAP of 55 mmHg despite fluid resuscitation.
Which medication should the nurse anticipate administering first?
A. Nitroprusside
B. Norepinephrine
C. Furosemide
D. Atropine
Answer: B
Rationale: Norepinephrine is the first-line vasopressor used in septic shock to maintain
MAP above 65 mmHg when fluid resuscitation is insufficient.
, 6. A patient is diagnosed with Acute Respiratory Distress Syndrome (ARDS).
Which oxygenation finding is characteristic of this condition?
A. Hyperoxemia with low FiO2
B. Increased pulmonary compliance
C. Rapid response to low-flow oxygen therapy
D. Refractory hypoxemia
Answer: D
Rationale: Refractory hypoxemia, where arterial oxygen levels remain low despite high
concentrations of supplemental oxygen, is a hallmark of ARDS.
7. What is the primary goal of prone positioning in a patient with ARDS?
A. To decrease intracranial pressure
B. To increase gastric emptying
C. To improve recruitment of posterior alveolar units
D. To make it easier for the nurse to perform skin care
Answer: C
Rationale: Prone positioning helps redistribute pulmonary edema and recruits collapsed
alveoli in the posterior segments of the lungs, improving oxygenation.
8. In a patient with Acute Kidney Injury (AKI), which phase is characterized by a
daily urine output of less than 400 mL?
A. Diuretic phase
B. Recovery phase
C. Oliguric phase
D. Initiation phase
Answer: C
Rationale: The oliguric phase is defined by a significant decrease in urine output, typically
less than 400 mL per day.
