NSG 3850 Advanced Adult Health & Critical Care Nursing – Comprehensive Course Exam (100+ Questions with Detailed Rationales)

NSG 3850 Advanced Adult Health & Critical Care
Nursing – Comprehensive Course Exam (100+
Questions with Detailed Rationales)


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✅ Correct answers




SECTION 1: ADVANCED CARDIOVASCULAR CARE AND HEMODYNAMIC
MONITORING




Question 1



A patient in the cardiac intensive care unit is being monitored with a pulmonary artery
catheter. The nurse notes the following hemodynamic readings: Central Venous
Pressure of 12 mmHg, Pulmonary Artery Wedge Pressure of 18 mmHg, Cardiac Index
of 1.8 L/min/m2, and Systemic Vascular Resistance of 1600 dynes/sec/cm5. Based on
these readings, which condition is the patient most likely experiencing?



▫ Hypovolemic shock

✅ Cardiogenic shock

▫ Septic shock

▫ Neurogenic shock

,Rationale: Cardiogenic shock is characterized by a decrease in cardiac output and
cardiac index (less than 2.2 L/min/m2) due to pump failure. This failure leads to a
backup of blood, which increases filling pressures in the heart, manifested as elevated
Central Venous Pressure (normal 2 to 8 mmHg) and elevated Pulmonary Artery Wedge
Pressure (normal 6 to 12 mmHg). To compensate for the low cardiac output, the body
vasoconstricts, leading to an elevated Systemic Vascular Resistance (normal 800 to
1200 dynes/sec/cm5). In hypovolemic shock, all filling pressures are low. In septic
shock, the Systemic Vascular Resistance is profoundly low. In neurogenic shock, both
the heart rate and Systemic Vascular Resistance are low due to loss of sympathetic
tone.



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Question 2



The nurse is caring for a patient experiencing acute decompensated heart failure. The
physician prescribes an intravenous infusion of nitroprusside. What is the primary
nursing priority when administering this medication?



▫ Assessing for hyperkalemia and hyponatremia

▫ Monitoring for signs of constipation and urinary retention

✅ Continuous blood pressure monitoring and assessing for cyanide toxicity

▫ Monitoring for tendon rupture and visual disturbances



Rationale: Nitroprusside is a potent, fast-acting vasodilator used to reduce preload and
afterload in acute heart failure and hypertensive crises. Because it works rapidly,
continuous blood pressure monitoring is required to prevent profound hypotension.
Furthermore, nitroprusside is metabolized into thiocyanate and cyanide. Patients
receiving high doses or prolonged infusions, especially those with renal or hepatic
impairment, are at high risk for cyanide toxicity. Signs of toxicity include altered mental
status, metabolic acidosis, tachycardia, and a smell of almonds on the breath.

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Question 3



A patient arrives in the emergency department complaining of severe, crushing chest
pain that radiates to the left jaw and arm. The 12-lead electrocardiogram reveals ST-
segment elevation in leads V1, V2, V3, and V4. Which coronary artery is most likely
occluded?



✅ Left anterior descending artery

▫ Right coronary artery

▫ Circumflex artery

▫ Left main coronary artery



Rationale: ST-segment elevations in leads V1 through V4 indicate an anterior wall
myocardial infarction. The left anterior descending artery supplies blood to the anterior
wall of the left ventricle and the interventricular septum. Occlusion of the right coronary
artery typically results in an inferior wall myocardial infarction (elevations in leads II, III,
and aVF). Occlusion of the circumflex artery results in a lateral wall myocardial
infarction (elevations in I, aVL, V5, and V6). Left main coronary artery occlusion is a
catastrophic event often referred to as the widow maker, affecting massive portions of
the left ventricle.



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Question 4

, While assessing a patient with a history of infective endocarditis, the nurse notes small,
painless, red nodules on the pads of the patient’s fingers and toes. How should the
nurse document this finding?



✅ Janeway lesions

▫ Osler nodes

▫ Roth spots
▫ Splinter hemorrhages



Rationale: Janeway lesions are flat, painless, red to bluish spots seen on the palms and
soles in patients with infective endocarditis. They are caused by septic emboli. Osler
nodes are painful, tender, raised nodules found on the pads of fingers and toes. Roth
spots are retinal hemorrhages with white centers. Splinter hemorrhages are vertical
reddish-brown streaks under the nail beds.



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Question 5



A nurse is evaluating a patient rhythm strip and notes the following: PR interval is
constant at 0.16 seconds, QRS complex is 0.08 seconds, heart rate is 72 beats per
minute, and there are occasional premature beats where the P wave is hidden in the T
wave, followed by a wide, distorted QRS complex. What is the interpretation of this
rhythm?



▫ Sinus rhythm with premature atrial contractions

✅ Sinus rhythm with premature ventricular contractions