NUR 265 Advanced Medical-Surgical Nursing Exam 4 Study Guide 2026
|Galen College
1. A patient arrives in the ER with severe burns. Using the Parkland formula, the
nurse calculates the total fluid requirement for the first 24 hours. How much of
this fluid should be administered in the first 8 hours?
A. One-half of the total volume
B. One-fourth of the total volume
C. One-third of the total volume
D. The entire calculated volume
Answer: A
Rationale: According to the Parkland formula, half of the total calculated 24-hour fluid
volume is administered in the first 8 hours from the time of the burn injury.
2. Which clinical manifestation is a hallmark sign of the exudative phase of
Acute Respiratory Distress Syndrome (ARDS)?
A. Bradycardia
B. Respiratory acidosis
C. Increased lung compliance
D. Refractory hypoxemia
Answer: D
Rationale: Refractory hypoxemia, where oxygen levels stay low despite increasing the
fraction of inspired oxygen (FiO2), is a classic sign of ARDS due to shunting and alveolar
collapse.
,3. A nurse is caring for a patient in septic shock. Which of the following
laboratory values most accurately reflects the transition from aerobic to
anaerobic metabolism?
A. Decreased White Blood Cell count
B. Elevated Serum Lactate
C. Increased Serum Glucose
D. Decreased Hemoglobin
Answer: B
Rationale: Lactic acid is a byproduct of anaerobic metabolism. Elevated lactate levels in
sepsis indicate tissue hypoperfusion and cellular hypoxia.
4. In neurogenic shock, which physiological response differentiates it from other
forms of shock?
A. Tachycardia
B. Hypertension
C. Cool, clammy skin
D. Bradycardia
Answer: D
Rationale: Neurogenic shock is characterized by bradycardia and hypotension due to the
loss of sympathetic nervous system tone, whereas most other shocks feature compensatory
tachycardia.
, 5. A patient has suffered a full-thickness burn to the entire left arm and the
anterior trunk. Using the Rule of Nines, what is the Total Body Surface Area
(TBSA) percentage burned?
A. 18%
B. 27%
C. 36%
D. 45%
Answer: B
Rationale: The arm is 9% and the anterior trunk is 18%. 9% + 18% = 27%.
6. Which of the following is the priority intervention for a patient experiencing
anaphylactic shock?
A. Administration of IV fluids
B. Applying high-flow oxygen
C. Starting a corticosteroid infusion
D. Administration of Epinephrine
Answer: D
Rationale: Epinephrine is the first-line treatment for anaphylaxis to cause vasoconstriction
and bronchodilation to maintain the airway and blood pressure.
7. What is the primary goal of applying Positive End-Expiratory Pressure (PEEP)
in a patient with ARDS?
A. To decrease the risk of barotrauma
B. To increase the respiratory rate
C. To prevent alveolar collapse and improve oxygenation
D. To remove excess carbon dioxide
Answer: C
Rationale: PEEP keeps the alveoli open at the end of expiration, increasing the surface area
for gas exchange and preventing atelectasis.
|Galen College
1. A patient arrives in the ER with severe burns. Using the Parkland formula, the
nurse calculates the total fluid requirement for the first 24 hours. How much of
this fluid should be administered in the first 8 hours?
A. One-half of the total volume
B. One-fourth of the total volume
C. One-third of the total volume
D. The entire calculated volume
Answer: A
Rationale: According to the Parkland formula, half of the total calculated 24-hour fluid
volume is administered in the first 8 hours from the time of the burn injury.
2. Which clinical manifestation is a hallmark sign of the exudative phase of
Acute Respiratory Distress Syndrome (ARDS)?
A. Bradycardia
B. Respiratory acidosis
C. Increased lung compliance
D. Refractory hypoxemia
Answer: D
Rationale: Refractory hypoxemia, where oxygen levels stay low despite increasing the
fraction of inspired oxygen (FiO2), is a classic sign of ARDS due to shunting and alveolar
collapse.
,3. A nurse is caring for a patient in septic shock. Which of the following
laboratory values most accurately reflects the transition from aerobic to
anaerobic metabolism?
A. Decreased White Blood Cell count
B. Elevated Serum Lactate
C. Increased Serum Glucose
D. Decreased Hemoglobin
Answer: B
Rationale: Lactic acid is a byproduct of anaerobic metabolism. Elevated lactate levels in
sepsis indicate tissue hypoperfusion and cellular hypoxia.
4. In neurogenic shock, which physiological response differentiates it from other
forms of shock?
A. Tachycardia
B. Hypertension
C. Cool, clammy skin
D. Bradycardia
Answer: D
Rationale: Neurogenic shock is characterized by bradycardia and hypotension due to the
loss of sympathetic nervous system tone, whereas most other shocks feature compensatory
tachycardia.
, 5. A patient has suffered a full-thickness burn to the entire left arm and the
anterior trunk. Using the Rule of Nines, what is the Total Body Surface Area
(TBSA) percentage burned?
A. 18%
B. 27%
C. 36%
D. 45%
Answer: B
Rationale: The arm is 9% and the anterior trunk is 18%. 9% + 18% = 27%.
6. Which of the following is the priority intervention for a patient experiencing
anaphylactic shock?
A. Administration of IV fluids
B. Applying high-flow oxygen
C. Starting a corticosteroid infusion
D. Administration of Epinephrine
Answer: D
Rationale: Epinephrine is the first-line treatment for anaphylaxis to cause vasoconstriction
and bronchodilation to maintain the airway and blood pressure.
7. What is the primary goal of applying Positive End-Expiratory Pressure (PEEP)
in a patient with ARDS?
A. To decrease the risk of barotrauma
B. To increase the respiratory rate
C. To prevent alveolar collapse and improve oxygenation
D. To remove excess carbon dioxide
Answer: C
Rationale: PEEP keeps the alveoli open at the end of expiration, increasing the surface area
for gas exchange and preventing atelectasis.
