NR 341 EXAM 1 MASTER PREP 2026 200
COMPREHENSIVE Q and A WITH
RATIONALES CRITICAL CARE
HEMODYNAMICS AND ACLS
NR 341: Complex Adult Health Exam 1
1. A patient in the ICU has a Pulmonary Artery Wedge Pressure
(PAWP) of 22 mmHg and a Cardiac Output (CO) of 3.0 L/min.
Which condition does the nurse suspect?
A. Hypovolemic shock.
B. Left-sided heart failure.
C. Right-sided heart failure.
D. Septic shock.
B. Left-sided heart failure.
Rationale: Normal PAWP is 6–12 mmHg. An elevated PAWP
(>18–20 mmHg) indicates fluid backup from the left ventricle,
and a low CO indicates poor systemic perfusion.
2. A nurse is caring for a patient on a mechanical ventilator. The
high-pressure alarm sounds. Which action should the nurse take
first?
A. Check the patient for a disconnected circuit.
B. Assess the patient for a need for suctioning.
C. Call the respiratory therapist to recalibrate the machine.
D. Administer a sedative to prevent "fighting" the vent.
B. Assess the patient for a need for suctioning.
Rationale: High-pressure alarms are triggered by increased
resistance, such as secretions, biting the tube, or kinked tubing.
Low-pressure alarms are triggered by disconnections.
3. Which acid-base imbalance is most likely in a patient with an
initial diagnosis of Acute Respiratory Distress Syndrome (ARDS)?
A. Metabolic Alkalosis.
B. Respiratory Acidosis.
C. Respiratory Alkalosis.
D. Metabolic Acidosis.
C. Respiratory Alkalosis.
Rationale: In early ARDS, the patient hyperventilates due to
, hypoxia, blowing off CO2 and causing respiratory alkalosis. As
the disease progresses and the patient tires, they transition into
respiratory acidosis.
4. A patient’s arterial blood gas (ABG) results are: pH 7.30, PaCO2
55, HCO3 24. How does the nurse interpret this?
A. Fully compensated respiratory acidosis.
B. Uncompensated respiratory acidosis.
C. Partially compensated metabolic acidosis.
D. Uncompensated metabolic acidosis.
B. Uncompensated respiratory acidosis.
Rationale: The pH is low (acidic), the PaCO2 is high (respiratory
cause), and the HCO3 is normal, meaning the kidneys have not
yet begun to compensate.
5. The nurse is titrating Norepinephrine (Levophed) for a patient in
septic shock. What is the primary goal of this medication?
A. To decrease heart rate.
B. To increase systemic vascular resistance (SVR).
C. To sedate the patient.
D. To increase the force of contraction only.
B. To increase systemic vascular resistance (SVR).
Rationale: Norepinephrine is a potent vasoconstrictor (Alpha-1
agonist) used to increase blood pressure by increasing SVR in
distributive shock.
6. What is the priority nursing intervention during the "Exudative
Phase" of ARDS?
A. Administering broad-spectrum antibiotics.
B. Maintaining the patient in a prone position.
C. Encouraging vigorous coughing and deep breathing.
D. Restricting all fluid intake.
B. Maintaining the patient in a prone position.
Rationale: Prone positioning is a gold-standard intervention in
ARDS to improve oxygenation by recruiting collapsed alveoli in
the posterior lung fields.
7. A patient with a head injury has a Mean Arterial Pressure (MAP) of
80 mmHg and an Intracranial Pressure (ICP) of 15 mmHg. What is
the Cerebral Perfusion Pressure (CPP)?
A. 95 mmHg.
B. 65 mmHg.
, C. 1.2 mmHg.
D. 55 mmHg.
B. 65 mmHg.
Rationale: CPP = MAP - ICP. In this case, 80 - 15 = 65. A normal
CPP is 60–100 mmHg.
8. Which hemodynamic parameter would the nurse expect to see in a
patient with "Hypovolemic Shock"?
A. High CVP, High SVR.
B. Low CVP, Low SVR.
C. Low CVP, High SVR.
D. High CVP, Low SVR.
C. Low CVP, High SVR.
Rationale: In hypovolemia, Central Venous Pressure (CVP) is low
due to lack of volume, and SVR is high as the body tries to
compensate via vasoconstriction.
9. A patient is in Ventricular Fibrillation (V-Fib). What is the first
action the nurse should take?
A. Administer Amiodarone IV.
B. Synchronized cardioversion.
C. Start CPR and prepare for defibrillation.
D. Check the patient's carotid pulse for 10 seconds.
C. Start CPR and prepare for defibrillation.
Rationale: V-fib is a pulseless, lethal rhythm. The priority is
immediate unsynchronized defibrillation.
10. A patient on PEEP (Positive End-Expiratory Pressure) of 15
cm H2O is at high risk for which complication?
A. Pulmonary embolism.
B. Pneumothorax (Barotrauma).
C. Metabolic alkalosis.
D. Fluid volume deficit.
B. Pneumothorax (Barotrauma).
Rationale: High levels of PEEP can over-distend alveoli, leading
to rupture (barotrauma) and air leaking into the pleural space.
11. Which cardiac rhythm is characterized by a "sawtooth" P-wave
pattern?
A. Atrial Fibrillation.
B. Atrial Flutter.
C. Ventricular Tachycardia.
, D. Junctional Rhythm.
B. Atrial Flutter.
Rationale: Atrial flutter is distinct for its regular, sawtooth-
shaped waves.
12.A patient with a CVP of 1 mmHg and a BP of 88/50 mmHg
requires which intervention first?
A. Administration of Dopamine.
B. Infusion of a 0.9% Normal Saline bolus.
C. Placing the patient in Trendelenburg position.
D. Administration of Furosemide.
B. Infusion of a 0.9% Normal Saline bolus.
Rationale: Normal CVP is 2–8 mmHg. A value of 1 indicates
significant fluid volume deficit; volume replacement is the
priority over vasopressors.
13.What is the classic triad of symptoms for "Cardiac Tamponade"?
A. Hypertension, Bradycardia, Irregular respirations.
B. Muffled heart sounds, JVD, Hypotension.
C. Tachycardia, Flat neck veins, Clear lung sounds.
D. Fever, Chills, Chest pain.
B. Muffled heart sounds, JVD, Hypotension.
Rationale: These symptoms (Beck’s Triad) result from fluid in the
pericardial sac compressing the heart.
14.The nurse observes "bubbling" in the water-seal chamber of a chest
tube drainage system. What does this suggest?
A. The system is working perfectly.
B. There is an air leak in the system or the patient's lung.
C. The suction is turned up too high.
D. The chest tube is clogged.
B. There is an air leak in the system or the patient's lung.
Rationale: Continuous bubbling in the water-seal chamber
indicates an air leak. Intermittent tidaling (moving with breath)
is normal.
15. In "Neurogenic Shock," what unique finding does the nurse
expect?
A. Tachycardia and Hypertension.
B. Bradycardia and Hypotension.
C. Tachycardia and Hypotension.
D. Bradycardia and Hypertension.
COMPREHENSIVE Q and A WITH
RATIONALES CRITICAL CARE
HEMODYNAMICS AND ACLS
NR 341: Complex Adult Health Exam 1
1. A patient in the ICU has a Pulmonary Artery Wedge Pressure
(PAWP) of 22 mmHg and a Cardiac Output (CO) of 3.0 L/min.
Which condition does the nurse suspect?
A. Hypovolemic shock.
B. Left-sided heart failure.
C. Right-sided heart failure.
D. Septic shock.
B. Left-sided heart failure.
Rationale: Normal PAWP is 6–12 mmHg. An elevated PAWP
(>18–20 mmHg) indicates fluid backup from the left ventricle,
and a low CO indicates poor systemic perfusion.
2. A nurse is caring for a patient on a mechanical ventilator. The
high-pressure alarm sounds. Which action should the nurse take
first?
A. Check the patient for a disconnected circuit.
B. Assess the patient for a need for suctioning.
C. Call the respiratory therapist to recalibrate the machine.
D. Administer a sedative to prevent "fighting" the vent.
B. Assess the patient for a need for suctioning.
Rationale: High-pressure alarms are triggered by increased
resistance, such as secretions, biting the tube, or kinked tubing.
Low-pressure alarms are triggered by disconnections.
3. Which acid-base imbalance is most likely in a patient with an
initial diagnosis of Acute Respiratory Distress Syndrome (ARDS)?
A. Metabolic Alkalosis.
B. Respiratory Acidosis.
C. Respiratory Alkalosis.
D. Metabolic Acidosis.
C. Respiratory Alkalosis.
Rationale: In early ARDS, the patient hyperventilates due to
, hypoxia, blowing off CO2 and causing respiratory alkalosis. As
the disease progresses and the patient tires, they transition into
respiratory acidosis.
4. A patient’s arterial blood gas (ABG) results are: pH 7.30, PaCO2
55, HCO3 24. How does the nurse interpret this?
A. Fully compensated respiratory acidosis.
B. Uncompensated respiratory acidosis.
C. Partially compensated metabolic acidosis.
D. Uncompensated metabolic acidosis.
B. Uncompensated respiratory acidosis.
Rationale: The pH is low (acidic), the PaCO2 is high (respiratory
cause), and the HCO3 is normal, meaning the kidneys have not
yet begun to compensate.
5. The nurse is titrating Norepinephrine (Levophed) for a patient in
septic shock. What is the primary goal of this medication?
A. To decrease heart rate.
B. To increase systemic vascular resistance (SVR).
C. To sedate the patient.
D. To increase the force of contraction only.
B. To increase systemic vascular resistance (SVR).
Rationale: Norepinephrine is a potent vasoconstrictor (Alpha-1
agonist) used to increase blood pressure by increasing SVR in
distributive shock.
6. What is the priority nursing intervention during the "Exudative
Phase" of ARDS?
A. Administering broad-spectrum antibiotics.
B. Maintaining the patient in a prone position.
C. Encouraging vigorous coughing and deep breathing.
D. Restricting all fluid intake.
B. Maintaining the patient in a prone position.
Rationale: Prone positioning is a gold-standard intervention in
ARDS to improve oxygenation by recruiting collapsed alveoli in
the posterior lung fields.
7. A patient with a head injury has a Mean Arterial Pressure (MAP) of
80 mmHg and an Intracranial Pressure (ICP) of 15 mmHg. What is
the Cerebral Perfusion Pressure (CPP)?
A. 95 mmHg.
B. 65 mmHg.
, C. 1.2 mmHg.
D. 55 mmHg.
B. 65 mmHg.
Rationale: CPP = MAP - ICP. In this case, 80 - 15 = 65. A normal
CPP is 60–100 mmHg.
8. Which hemodynamic parameter would the nurse expect to see in a
patient with "Hypovolemic Shock"?
A. High CVP, High SVR.
B. Low CVP, Low SVR.
C. Low CVP, High SVR.
D. High CVP, Low SVR.
C. Low CVP, High SVR.
Rationale: In hypovolemia, Central Venous Pressure (CVP) is low
due to lack of volume, and SVR is high as the body tries to
compensate via vasoconstriction.
9. A patient is in Ventricular Fibrillation (V-Fib). What is the first
action the nurse should take?
A. Administer Amiodarone IV.
B. Synchronized cardioversion.
C. Start CPR and prepare for defibrillation.
D. Check the patient's carotid pulse for 10 seconds.
C. Start CPR and prepare for defibrillation.
Rationale: V-fib is a pulseless, lethal rhythm. The priority is
immediate unsynchronized defibrillation.
10. A patient on PEEP (Positive End-Expiratory Pressure) of 15
cm H2O is at high risk for which complication?
A. Pulmonary embolism.
B. Pneumothorax (Barotrauma).
C. Metabolic alkalosis.
D. Fluid volume deficit.
B. Pneumothorax (Barotrauma).
Rationale: High levels of PEEP can over-distend alveoli, leading
to rupture (barotrauma) and air leaking into the pleural space.
11. Which cardiac rhythm is characterized by a "sawtooth" P-wave
pattern?
A. Atrial Fibrillation.
B. Atrial Flutter.
C. Ventricular Tachycardia.
, D. Junctional Rhythm.
B. Atrial Flutter.
Rationale: Atrial flutter is distinct for its regular, sawtooth-
shaped waves.
12.A patient with a CVP of 1 mmHg and a BP of 88/50 mmHg
requires which intervention first?
A. Administration of Dopamine.
B. Infusion of a 0.9% Normal Saline bolus.
C. Placing the patient in Trendelenburg position.
D. Administration of Furosemide.
B. Infusion of a 0.9% Normal Saline bolus.
Rationale: Normal CVP is 2–8 mmHg. A value of 1 indicates
significant fluid volume deficit; volume replacement is the
priority over vasopressors.
13.What is the classic triad of symptoms for "Cardiac Tamponade"?
A. Hypertension, Bradycardia, Irregular respirations.
B. Muffled heart sounds, JVD, Hypotension.
C. Tachycardia, Flat neck veins, Clear lung sounds.
D. Fever, Chills, Chest pain.
B. Muffled heart sounds, JVD, Hypotension.
Rationale: These symptoms (Beck’s Triad) result from fluid in the
pericardial sac compressing the heart.
14.The nurse observes "bubbling" in the water-seal chamber of a chest
tube drainage system. What does this suggest?
A. The system is working perfectly.
B. There is an air leak in the system or the patient's lung.
C. The suction is turned up too high.
D. The chest tube is clogged.
B. There is an air leak in the system or the patient's lung.
Rationale: Continuous bubbling in the water-seal chamber
indicates an air leak. Intermittent tidaling (moving with breath)
is normal.
15. In "Neurogenic Shock," what unique finding does the nurse
expect?
A. Tachycardia and Hypertension.
B. Bradycardia and Hypotension.
C. Tachycardia and Hypotension.
D. Bradycardia and Hypertension.
