NR 341 EXAM 1 – COMPLEX ADULT HEALTH 2026 |
Chamberlain College of Nursing | Complete Exam
Questions with VERIFIED Correct Answers & WELL
DETAILED Rationales | Adult Health Nursing Exam
Review | Latest Updated 2026 | A+ Graded
Question 1 A nurse is caring for a patient diagnosed with acute respiratory distress
syndrome (ARDS). The patient's PaO2/FiO2 ratio is 180 mmHg. According to the
Berlin Definition, how should the nurse classify this patient's ARDS?
A. Mild ARDS (PaO2/FiO2 200–300) B. Moderate ARDS (PaO2/FiO2 100–
200) C. Severe ARDS (PaO2/FiO2 <100) D. Early ARDS (PaO2/FiO2 >300) E.
Refractory ARDS
RATIONALE: According to the Berlin Definition, ARDS is classified as mild
(200–300), moderate (100–200), or severe (<100). A ratio of 180 mmHg falls
within the moderate category, indicating significant impairment of gas exchange.
Question 2 A patient with ARDS is being mechanically ventilated. Which tidal
volume setting aligns with the lung-protective ventilation strategy?
A. 4 mL/kg IBW B. 6 mL/kg IBW C. 8 mL/kg IBW D. 10 mL/kg IBW E. 12
mL/kg IBW
RATIONALE: Lung-protective ventilation using low tidal volumes of 6 mL/kg
IBW reduces ventilator-induced lung injury (VILI) and improves survival in
ARDS, as established by the ARDSNet trial. Plateau pressures should be
maintained below 30 cmH2O.
Question 3 The high-pressure alarm on a mechanically ventilated patient's
ventilator activates. Which nursing action should be performed FIRST?
A. Increase the FiO2 setting to 100% B. Notify the respiratory therapist
immediately C. Assess the patient and inspect the ventilator circuit for
obstruction D. Administer a bronchodilator via nebulizer E. Obtain a stat portable
chest X-ray
,RATIONALE: The nurse must first assess the patient for acute distress and
identify causes such as kinked tubing, secretion buildup, the patient biting the ET
tube, or bronchospasm. Patient assessment and circuit inspection always precede
other interventions.
Question 4 A patient receiving mechanical ventilation with PEEP of 14 cmH2O
suddenly develops hypotension with a blood pressure of 80/50 mmHg. What is the
most likely cause?
A. Increased cardiac output from improved oxygenation B. Decreased preload
due to elevated intrathoracic pressure from high PEEP C. Acute pulmonary
embolism D. Myocardial infarction triggered by hypoxemia E. Vasodilation from
high oxygen concentration
RATIONALE: High PEEP increases intrathoracic pressure, which compresses the
inferior vena cava and right atrium, decreasing venous return and preload. This
reduces cardiac output and causes hypotension — a well-recognized complication
of high PEEP therapy.
Question 5 A patient with COPD presents with acute exacerbation. ABG results:
pH 7.30, PaCO2 58 mmHg, PaO2 55 mmHg, HCO3 28 mEq/L. How should the
nurse interpret these results?
A. Respiratory alkalosis with metabolic compensation B. Metabolic acidosis with
respiratory compensation C. Respiratory acidosis with partial metabolic
compensation D. Fully compensated metabolic alkalosis E. Mixed respiratory and
metabolic acidosis
RATIONALE: pH 7.30 indicates acidosis. Elevated PaCO2 (58 mmHg) identifies
the respiratory cause. Elevated HCO3 (28 mEq/L) above normal indicates the
kidneys are retaining bicarbonate as a compensatory mechanism. The pH is not yet
normal, making this partial compensation — typical of a COPD exacerbation.
,Question 6 A nurse is caring for a patient with suspected pulmonary embolism
(PE). Which constellation of findings is MOST consistent with this diagnosis?
A. Bradycardia, hypotension, and bilateral crackles B. Sudden onset dyspnea,
pleuritic chest pain, and tachycardia C. Gradual onset productive cough with
fever and night sweats D. Bilateral crackles, peripheral edema, and elevated BNP
E. Decreased respiratory rate, confusion, and diaphoresis
RATIONALE: The classic triad of PE includes sudden onset dyspnea, pleuritic
chest pain (worsened by inspiration), and tachycardia. A thrombus obstructs
pulmonary blood flow causing V/Q mismatch and hypoxemia, triggering
compensatory tachycardia.
Question 7 A nurse assesses a mechanically ventilated patient and finds breath
sounds absent on the left side. The patient's SpO2 is 90% and declining. What is
the FIRST action?
A. Order a stat chest X-ray B. Call the physician immediately C. Gently
withdraw the endotracheal tube 1–2 cm and reassess breath sounds D.
Increase FiO2 to 100% E. Perform bilateral chest physiotherapy
RATIONALE: Absent unilateral breath sounds in an intubated patient most likely
indicates right mainstem bronchus intubation, ventilating only the right lung. The
immediate action is to gently withdraw the ET tube and reassess bilaterally.
Confirmation via chest X-ray follows stabilization.
Question 8 A patient hospitalized with pneumonia develops an SpO2 of 86%
despite receiving 6 L/min O2 via nasal cannula. Which complication should the
nurse suspect?
A. Expected progression of community-acquired pneumonia B. Development
of acute respiratory distress syndrome (ARDS) C. Mild hypoxemia requiring
repositioning only D. Oxygen toxicity from prolonged supplemental oxygen E.
Anxiety-related hyperventilation
, RATIONALE: Persistent hypoxemia (SpO2 86%) despite supplemental oxygen in
a pneumonia patient suggests progression to ARDS — a life-threatening
complication caused by the systemic inflammatory response causing diffuse
alveolar damage and refractory hypoxemia.
Question 9 A patient with a chest tube inserted for hemothorax has 280 mL of
drainage in the first hour. What is the nurse's priority action?
A. Document the finding and reassess in 30 minutes B. Clamp the chest tube to
slow drainage C. Notify the physician immediately about excessive
hemorrhage D. Reposition the patient to promote drainage and reduce output E.
Increase the suction level on the drainage system
RATIONALE: Chest tube drainage exceeding 200 mL/hour from a hemothorax
indicates significant ongoing hemorrhage requiring immediate physician
notification. The patient may require emergent surgical intervention. Clamping the
chest tube is contraindicated as it can cause tension hemothorax.
Question 10 A nurse is titrating oxygen for a COPD patient in acute exacerbation.
Which oxygen delivery device and target SpO2 is MOST appropriate?
A. Non-rebreather mask at 15 L/min; target SpO2 >98% B. Simple face mask at 8
L/min; target SpO2 >95% C. Venturi mask at 24–28% FiO2; target SpO2
88–92% D. Nasal cannula at 6 L/min; target SpO2 95–100% E. High-flow nasal
cannula at 40 L/min; target SpO2 100%
RATIONALE: Patients with COPD who are chronic CO2 retainers may depend
on hypoxic drive. A Venturi mask provides precise, controlled FiO2 of 24–28%.
Target SpO2 is 88–92% to treat hypoxemia while avoiding over-oxygenation,
which can suppress respiratory drive and worsen hypercapnia.
Question 11 A patient with severe asthma exacerbation presents with minimal
audible wheezing and markedly diminished breath sounds bilaterally. How should
the nurse interpret this finding?
Chamberlain College of Nursing | Complete Exam
Questions with VERIFIED Correct Answers & WELL
DETAILED Rationales | Adult Health Nursing Exam
Review | Latest Updated 2026 | A+ Graded
Question 1 A nurse is caring for a patient diagnosed with acute respiratory distress
syndrome (ARDS). The patient's PaO2/FiO2 ratio is 180 mmHg. According to the
Berlin Definition, how should the nurse classify this patient's ARDS?
A. Mild ARDS (PaO2/FiO2 200–300) B. Moderate ARDS (PaO2/FiO2 100–
200) C. Severe ARDS (PaO2/FiO2 <100) D. Early ARDS (PaO2/FiO2 >300) E.
Refractory ARDS
RATIONALE: According to the Berlin Definition, ARDS is classified as mild
(200–300), moderate (100–200), or severe (<100). A ratio of 180 mmHg falls
within the moderate category, indicating significant impairment of gas exchange.
Question 2 A patient with ARDS is being mechanically ventilated. Which tidal
volume setting aligns with the lung-protective ventilation strategy?
A. 4 mL/kg IBW B. 6 mL/kg IBW C. 8 mL/kg IBW D. 10 mL/kg IBW E. 12
mL/kg IBW
RATIONALE: Lung-protective ventilation using low tidal volumes of 6 mL/kg
IBW reduces ventilator-induced lung injury (VILI) and improves survival in
ARDS, as established by the ARDSNet trial. Plateau pressures should be
maintained below 30 cmH2O.
Question 3 The high-pressure alarm on a mechanically ventilated patient's
ventilator activates. Which nursing action should be performed FIRST?
A. Increase the FiO2 setting to 100% B. Notify the respiratory therapist
immediately C. Assess the patient and inspect the ventilator circuit for
obstruction D. Administer a bronchodilator via nebulizer E. Obtain a stat portable
chest X-ray
,RATIONALE: The nurse must first assess the patient for acute distress and
identify causes such as kinked tubing, secretion buildup, the patient biting the ET
tube, or bronchospasm. Patient assessment and circuit inspection always precede
other interventions.
Question 4 A patient receiving mechanical ventilation with PEEP of 14 cmH2O
suddenly develops hypotension with a blood pressure of 80/50 mmHg. What is the
most likely cause?
A. Increased cardiac output from improved oxygenation B. Decreased preload
due to elevated intrathoracic pressure from high PEEP C. Acute pulmonary
embolism D. Myocardial infarction triggered by hypoxemia E. Vasodilation from
high oxygen concentration
RATIONALE: High PEEP increases intrathoracic pressure, which compresses the
inferior vena cava and right atrium, decreasing venous return and preload. This
reduces cardiac output and causes hypotension — a well-recognized complication
of high PEEP therapy.
Question 5 A patient with COPD presents with acute exacerbation. ABG results:
pH 7.30, PaCO2 58 mmHg, PaO2 55 mmHg, HCO3 28 mEq/L. How should the
nurse interpret these results?
A. Respiratory alkalosis with metabolic compensation B. Metabolic acidosis with
respiratory compensation C. Respiratory acidosis with partial metabolic
compensation D. Fully compensated metabolic alkalosis E. Mixed respiratory and
metabolic acidosis
RATIONALE: pH 7.30 indicates acidosis. Elevated PaCO2 (58 mmHg) identifies
the respiratory cause. Elevated HCO3 (28 mEq/L) above normal indicates the
kidneys are retaining bicarbonate as a compensatory mechanism. The pH is not yet
normal, making this partial compensation — typical of a COPD exacerbation.
,Question 6 A nurse is caring for a patient with suspected pulmonary embolism
(PE). Which constellation of findings is MOST consistent with this diagnosis?
A. Bradycardia, hypotension, and bilateral crackles B. Sudden onset dyspnea,
pleuritic chest pain, and tachycardia C. Gradual onset productive cough with
fever and night sweats D. Bilateral crackles, peripheral edema, and elevated BNP
E. Decreased respiratory rate, confusion, and diaphoresis
RATIONALE: The classic triad of PE includes sudden onset dyspnea, pleuritic
chest pain (worsened by inspiration), and tachycardia. A thrombus obstructs
pulmonary blood flow causing V/Q mismatch and hypoxemia, triggering
compensatory tachycardia.
Question 7 A nurse assesses a mechanically ventilated patient and finds breath
sounds absent on the left side. The patient's SpO2 is 90% and declining. What is
the FIRST action?
A. Order a stat chest X-ray B. Call the physician immediately C. Gently
withdraw the endotracheal tube 1–2 cm and reassess breath sounds D.
Increase FiO2 to 100% E. Perform bilateral chest physiotherapy
RATIONALE: Absent unilateral breath sounds in an intubated patient most likely
indicates right mainstem bronchus intubation, ventilating only the right lung. The
immediate action is to gently withdraw the ET tube and reassess bilaterally.
Confirmation via chest X-ray follows stabilization.
Question 8 A patient hospitalized with pneumonia develops an SpO2 of 86%
despite receiving 6 L/min O2 via nasal cannula. Which complication should the
nurse suspect?
A. Expected progression of community-acquired pneumonia B. Development
of acute respiratory distress syndrome (ARDS) C. Mild hypoxemia requiring
repositioning only D. Oxygen toxicity from prolonged supplemental oxygen E.
Anxiety-related hyperventilation
, RATIONALE: Persistent hypoxemia (SpO2 86%) despite supplemental oxygen in
a pneumonia patient suggests progression to ARDS — a life-threatening
complication caused by the systemic inflammatory response causing diffuse
alveolar damage and refractory hypoxemia.
Question 9 A patient with a chest tube inserted for hemothorax has 280 mL of
drainage in the first hour. What is the nurse's priority action?
A. Document the finding and reassess in 30 minutes B. Clamp the chest tube to
slow drainage C. Notify the physician immediately about excessive
hemorrhage D. Reposition the patient to promote drainage and reduce output E.
Increase the suction level on the drainage system
RATIONALE: Chest tube drainage exceeding 200 mL/hour from a hemothorax
indicates significant ongoing hemorrhage requiring immediate physician
notification. The patient may require emergent surgical intervention. Clamping the
chest tube is contraindicated as it can cause tension hemothorax.
Question 10 A nurse is titrating oxygen for a COPD patient in acute exacerbation.
Which oxygen delivery device and target SpO2 is MOST appropriate?
A. Non-rebreather mask at 15 L/min; target SpO2 >98% B. Simple face mask at 8
L/min; target SpO2 >95% C. Venturi mask at 24–28% FiO2; target SpO2
88–92% D. Nasal cannula at 6 L/min; target SpO2 95–100% E. High-flow nasal
cannula at 40 L/min; target SpO2 100%
RATIONALE: Patients with COPD who are chronic CO2 retainers may depend
on hypoxic drive. A Venturi mask provides precise, controlled FiO2 of 24–28%.
Target SpO2 is 88–92% to treat hypoxemia while avoiding over-oxygenation,
which can suppress respiratory drive and worsen hypercapnia.
Question 11 A patient with severe asthma exacerbation presents with minimal
audible wheezing and markedly diminished breath sounds bilaterally. How should
the nurse interpret this finding?
