NSG4100 Nursing Practice - Adult Health III Exam
2 Version 1 Questions with Correct Answers and
Expert Explanation for Each Question
1. A patient’s ABG results are pH 7.28, PaCO2 52 mmHg, and HCO3 24 mEq/L. Which
acid-base imbalance is present?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Correct Answer: D
Expert Explanation: The pH is below the normal range of 7.35, which signifies an
acidic state. The PaCO2 is elevated above 45 mmHg, indicating that the lungs are
retaining too much carbon dioxide. Since the bicarbonate is normal, this is
uncompensated respiratory acidosis.
2. A nurse hears the high-pressure alarm on a patient’s mechanical ventilator. Which
action should the nurse take first?
A. Assess the patient’s need for suctioning
B. Check for a leak in the ventilator circuit
C. Call the respiratory therapist to adjust settings
,D. Check if the patient has become disconnected
Correct Answer: A
Expert Explanation: High-pressure alarms are often triggered by obstructions such
as secretions, kinking of the tube, or the patient biting the tube. The nurse should
immediately assess the patient’s airway and breath sounds to determine if
suctioning is necessary. This ensures patient safety before troubleshooting the
mechanical equipment.
3. Using the Parkland Formula, calculate the total fluid volume needed in the first 24
hours for a 70 kg patient with a 40% total body surface area (TBSA) burn.
A. 14,000 mL
B. 5,600 mL
C. 2,800 mL
D. 11,200 mL
Correct Answer: D
Expert Explanation: The Parkland Formula is 4 mL x kg x % TBSA. For this patient,
the calculation is 4 mL x 70 kg x 40, which equals 11,200 mL. Half of this volume is
administered in the first 8 hours, and the remaining half over the next 16 hours.
,4. Which hemodynamic finding is most characteristic of early septic shock?
A. Increased systemic vascular resistance (SVR)
B. Decreased cardiac output
C. Decreased systemic vascular resistance (SVR)
D. Increased central venous pressure (CVP)
Correct Answer: C
Expert Explanation: Early or ‘warm’ septic shock is characterized by massive
vasodilation caused by inflammatory mediators. This vasodilation leads to a
significant drop in systemic vascular resistance (SVR). Despite the low SVR, cardiac
output is often high at this stage as a compensatory mechanism.
5. A patient with ARDS is placed in the prone position. What is the primary
physiological benefit of this intervention?
A. It improves oxygenation by recruiting dorsal lung segments
B. It increases the patient’s comfort level during ventilation
C. It prevents the development of pressure ulcers on the back
D. It reduces the need for high levels of PEEP
Correct Answer: A
, Expert Explanation: Prone positioning helps to redistribute pulmonary blood flow
and improve ventilation to dorsal lung regions that are often collapsed in ARDS. By
shifting the heart’s weight off the lungs, it promotes better gas exchange and
improves the V/Q ratio. This technique is often used when traditional supine
ventilation fails to resolve refractory hypoxemia.
6. Which laboratory value is most indicative of Disseminated Intravascular Coagulation
(DIC)?
A. Elevated D-dimer levels
B. Increased fibrinogen levels
C. Decreased D-dimer levels
D. Increased platelet count
Correct Answer: A
Expert Explanation: DIC is characterized by the simultaneous formation of clots
and the depletion of clotting factors. An elevated D-dimer is a specific marker that
indicates the breakdown of fibrin and active clot lysis within the body. In DIC,
platelets and fibrinogen are typically consumed and will therefore be decreased.
7. A patient is diagnosed with neurogenic shock. Which clinical manifestation should
the nurse anticipate?
A. Tachycardia and hypertension
2 Version 1 Questions with Correct Answers and
Expert Explanation for Each Question
1. A patient’s ABG results are pH 7.28, PaCO2 52 mmHg, and HCO3 24 mEq/L. Which
acid-base imbalance is present?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Correct Answer: D
Expert Explanation: The pH is below the normal range of 7.35, which signifies an
acidic state. The PaCO2 is elevated above 45 mmHg, indicating that the lungs are
retaining too much carbon dioxide. Since the bicarbonate is normal, this is
uncompensated respiratory acidosis.
2. A nurse hears the high-pressure alarm on a patient’s mechanical ventilator. Which
action should the nurse take first?
A. Assess the patient’s need for suctioning
B. Check for a leak in the ventilator circuit
C. Call the respiratory therapist to adjust settings
,D. Check if the patient has become disconnected
Correct Answer: A
Expert Explanation: High-pressure alarms are often triggered by obstructions such
as secretions, kinking of the tube, or the patient biting the tube. The nurse should
immediately assess the patient’s airway and breath sounds to determine if
suctioning is necessary. This ensures patient safety before troubleshooting the
mechanical equipment.
3. Using the Parkland Formula, calculate the total fluid volume needed in the first 24
hours for a 70 kg patient with a 40% total body surface area (TBSA) burn.
A. 14,000 mL
B. 5,600 mL
C. 2,800 mL
D. 11,200 mL
Correct Answer: D
Expert Explanation: The Parkland Formula is 4 mL x kg x % TBSA. For this patient,
the calculation is 4 mL x 70 kg x 40, which equals 11,200 mL. Half of this volume is
administered in the first 8 hours, and the remaining half over the next 16 hours.
,4. Which hemodynamic finding is most characteristic of early septic shock?
A. Increased systemic vascular resistance (SVR)
B. Decreased cardiac output
C. Decreased systemic vascular resistance (SVR)
D. Increased central venous pressure (CVP)
Correct Answer: C
Expert Explanation: Early or ‘warm’ septic shock is characterized by massive
vasodilation caused by inflammatory mediators. This vasodilation leads to a
significant drop in systemic vascular resistance (SVR). Despite the low SVR, cardiac
output is often high at this stage as a compensatory mechanism.
5. A patient with ARDS is placed in the prone position. What is the primary
physiological benefit of this intervention?
A. It improves oxygenation by recruiting dorsal lung segments
B. It increases the patient’s comfort level during ventilation
C. It prevents the development of pressure ulcers on the back
D. It reduces the need for high levels of PEEP
Correct Answer: A
, Expert Explanation: Prone positioning helps to redistribute pulmonary blood flow
and improve ventilation to dorsal lung regions that are often collapsed in ARDS. By
shifting the heart’s weight off the lungs, it promotes better gas exchange and
improves the V/Q ratio. This technique is often used when traditional supine
ventilation fails to resolve refractory hypoxemia.
6. Which laboratory value is most indicative of Disseminated Intravascular Coagulation
(DIC)?
A. Elevated D-dimer levels
B. Increased fibrinogen levels
C. Decreased D-dimer levels
D. Increased platelet count
Correct Answer: A
Expert Explanation: DIC is characterized by the simultaneous formation of clots
and the depletion of clotting factors. An elevated D-dimer is a specific marker that
indicates the breakdown of fibrin and active clot lysis within the body. In DIC,
platelets and fibrinogen are typically consumed and will therefore be decreased.
7. A patient is diagnosed with neurogenic shock. Which clinical manifestation should
the nurse anticipate?
A. Tachycardia and hypertension
