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NR 341 COMPLEX ADULT HEALTH FINAL ACTUAL
EXAM PREP 2026 ALL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES ALREADY
A GRADED WITH EXPERT FEEDBACK |NEW AND
REVISED
Question 1
A nurse is caring for a client with septic shock. Which hemodynamic profile is
consistent with the early (hyperdynamic) phase of septic shock?
A) Increased cardiac output, decreased systemic vascular resistance (SVR)
B) Decreased cardiac output, increased SVR
C) Decreased cardiac output, decreased SVR
D) Increased cardiac output, increased SVR
Correct Answer: A – Increased cardiac output, decreased systemic vascular
resistance (SVR)
Rationale: Early septic shock (warm shock) is hyperdynamic: cardiac output is
normal or increased due to vasodilation and compensatory tachycardia, while
SVR is decreased. Late septic shock (cold shock) presents with decreased cardiac
output and increased SVR.
Question 2
A client with acute respiratory distress syndrome (ARDS) is on a mechanical
ventilator with a tidal volume of 6 mL/kg predicted body weight. The nurse
understands that this low tidal volume strategy is used to:
A) Increase mean airway pressure
B) Prevent volutrauma and barotrauma
C) Improve oxygenation by recruiting alveoli
D) Decrease the risk of ventilator-associated pneumonia
Correct Answer: B – Prevent volutrauma and barotrauma
*Rationale: Low tidal volume (6 mL/kg) is standard in ARDS to reduce alveolar
overdistention (volutrauma) and barotrauma, which decrease mortality. Prone
positioning and PEEP recruit alveoli; VAP prevention involves other measures.*
Question 3
A client with a traumatic brain injury has an intracranial pressure (ICP) of 32 mm
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Hg and a mean arterial pressure (MAP) of 70 mm Hg. The cerebral perfusion
pressure (CPP) is:
A) 38 mm Hg
B) 70 mm Hg
C) 102 mm Hg
D) 32 mm Hg
Correct Answer: A – 38 mm Hg
*Rationale: CPP = MAP – ICP = 70 – 32 = 38 mm Hg. Normal CPP is 60–100 mm
Hg; <60 indicates inadequate cerebral perfusion. This is a critical finding requiring
immediate intervention.*
Question 4
A client is receiving a continuous infusion of norepinephrine for septic shock.
Which assessment finding requires immediate action?
A) Blood pressure 100/60 mm Hg
B) Heart rate 110 beats per minute
C) Urine output 25 mL over 2 hours
D) Cool, mottled fingers on the hand without an IV
Correct Answer: C – Urine output 25 mL over 2 hours
*Rationale: Urine output <0.5 mL/kg/hour indicates inadequate renal perfusion
despite vasopressor support. This suggests insufficient cardiac output or continued
shock. The other findings are common in septic shock but not as immediately
concerning.*
Question 5
A nurse is caring for a client with acute respiratory distress syndrome (ARDS)
receiving pressure control ventilation. The plateau pressure is 32 cm H₂O. The
nurse should:
A) Increase the inspiratory pressure
B) Notify the provider because high plateau pressure increases barotrauma risk
C) Decrease the respiratory rate
D) Suction the endotracheal tube
Correct Answer: B – Notify the provider because high plateau pressure increases
barotrauma risk
Rationale: Plateau pressure should be maintained <30 cm H₂O to reduce
ventilator-induced lung injury. A plateau pressure of 32 is elevated and requires
provider notification for possible adjustments (e.g., decreasing tidal volume or
PEEP).
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Question 6
A client with cardiogenic shock has a pulmonary artery catheter in place. Which
finding indicates poor tissue perfusion?
A) Cardiac index 2.8 L/min/m²
B) Pulmonary artery wedge pressure (PAWP) 20 mm Hg
C) Mixed venous oxygen saturation (SvO₂) 55%
D) Systemic vascular resistance (SVR) 800 dynes/sec/cm⁻⁵
Correct Answer: C – Mixed venous oxygen saturation (SvO₂) 55%
Rationale: Normal SvO₂ is 60–80%; values below 60% indicate increased oxygen
extraction due to inadequate cardiac output or hypoxemia. Cardiac index of 2.8
is low normal; PAWP 20 indicates fluid overload; SVR 800 is normal to low.
Question 7
A client with a spinal cord injury at C5 is admitted to the ICU. Which assessment
finding requires immediate intervention?
A) Blood pressure 90/60 mm Hg, heart rate 50 beats per minute
B) Respiratory rate 24 breaths per minute, SpO₂ 94%
C) Paralysis of the lower extremities
D) Absent deep tendon reflexes in the legs
Correct Answer: A – Blood pressure 90/60 mm Hg, heart rate 50 beats per minute
Rationale: C5 injury causes loss of sympathetic tone, leading to neurogenic
shock: hypotension and bradycardia. This requires vasopressors and atropine.
Respiratory compromise (C3-5) may also occur, but the given respiratory values
are acceptable.
Question 8
A nurse is caring for a client following a cardiac arrest. The client is receiving
targeted temperature management (TTM). Which finding indicates a complication
of TTM?
A) Shivering
B) Heart rate 50 beats per minute
C) Serum potassium 4.0 mEq/L
D) Blood glucose 120 mg/dL
Correct Answer: A – Shivering
Rationale: Shivering increases metabolic rate and oxygen demand,
counteracting the benefits of TTM. It should be treated with sedation, paralytics,
or surface warming. Bradycardia and hypokalemia are expected; hyperglycemia
may occur but 120 is normal.
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Question 9
A client with acute kidney injury (AKI) secondary to sepsis has a serum potassium
of 6.2 mEq/L. The nurse should anticipate which intervention first?
A) Administer sodium polystyrene sulfonate
B) Start IV regular insulin and dextrose
C) Prepare for emergent hemodialysis
D) Restrict dietary potassium
Correct Answer: B – Start IV regular insulin and dextrose
*Rationale: Severe hyperkalemia (>6.0) with ECG changes requires immediate
shift of potassium into cells. Insulin+dextrose works in 30–60 minutes. Sodium
polystyrene works slowly; dialysis is definitive but not first.*
Question 10
A client with increased intracranial pressure (ICP) has an order for mannitol.
Which nursing action is most important before administering mannitol?
A) Assess serum osmolality
B) Insert a Foley catheter
C) Elevate the head of the bed to 30 degrees
D) Administer a sedative
Correct Answer: B – Insert a Foley catheter
Rationale: Mannitol is an osmotic diuretic that causes rapid diuresis. An
indwelling urinary catheter is needed to monitor output and prevent bladder
distention. Serum osmolality should be monitored but not required before each
dose.
Question 11
A client is being weaned from mechanical ventilation. Which finding indicates
readiness for extubation?
A) Rapid shallow breathing index (RSBI) of 105 breaths/min/L
B) PaO₂/FiO₂ ratio of 180
C) Negative inspiratory force (NIF) of –30 cm H₂O
D) Spontaneous tidal volume of 3 mL/kg
Correct Answer: C – Negative inspiratory force (NIF) of –30 cm H₂O
*Rationale: NIF less than –20 to –25 cm H₂O indicates adequate respiratory
muscle strength. RSBI <105 is weaning readiness; PaO₂/FiO₂ >200; tidal volume
>5 mL/kg. NIF –30 meets criteria.*
NR 341 COMPLEX ADULT HEALTH FINAL ACTUAL
EXAM PREP 2026 ALL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES ALREADY
A GRADED WITH EXPERT FEEDBACK |NEW AND
REVISED
Question 1
A nurse is caring for a client with septic shock. Which hemodynamic profile is
consistent with the early (hyperdynamic) phase of septic shock?
A) Increased cardiac output, decreased systemic vascular resistance (SVR)
B) Decreased cardiac output, increased SVR
C) Decreased cardiac output, decreased SVR
D) Increased cardiac output, increased SVR
Correct Answer: A – Increased cardiac output, decreased systemic vascular
resistance (SVR)
Rationale: Early septic shock (warm shock) is hyperdynamic: cardiac output is
normal or increased due to vasodilation and compensatory tachycardia, while
SVR is decreased. Late septic shock (cold shock) presents with decreased cardiac
output and increased SVR.
Question 2
A client with acute respiratory distress syndrome (ARDS) is on a mechanical
ventilator with a tidal volume of 6 mL/kg predicted body weight. The nurse
understands that this low tidal volume strategy is used to:
A) Increase mean airway pressure
B) Prevent volutrauma and barotrauma
C) Improve oxygenation by recruiting alveoli
D) Decrease the risk of ventilator-associated pneumonia
Correct Answer: B – Prevent volutrauma and barotrauma
*Rationale: Low tidal volume (6 mL/kg) is standard in ARDS to reduce alveolar
overdistention (volutrauma) and barotrauma, which decrease mortality. Prone
positioning and PEEP recruit alveoli; VAP prevention involves other measures.*
Question 3
A client with a traumatic brain injury has an intracranial pressure (ICP) of 32 mm
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Hg and a mean arterial pressure (MAP) of 70 mm Hg. The cerebral perfusion
pressure (CPP) is:
A) 38 mm Hg
B) 70 mm Hg
C) 102 mm Hg
D) 32 mm Hg
Correct Answer: A – 38 mm Hg
*Rationale: CPP = MAP – ICP = 70 – 32 = 38 mm Hg. Normal CPP is 60–100 mm
Hg; <60 indicates inadequate cerebral perfusion. This is a critical finding requiring
immediate intervention.*
Question 4
A client is receiving a continuous infusion of norepinephrine for septic shock.
Which assessment finding requires immediate action?
A) Blood pressure 100/60 mm Hg
B) Heart rate 110 beats per minute
C) Urine output 25 mL over 2 hours
D) Cool, mottled fingers on the hand without an IV
Correct Answer: C – Urine output 25 mL over 2 hours
*Rationale: Urine output <0.5 mL/kg/hour indicates inadequate renal perfusion
despite vasopressor support. This suggests insufficient cardiac output or continued
shock. The other findings are common in septic shock but not as immediately
concerning.*
Question 5
A nurse is caring for a client with acute respiratory distress syndrome (ARDS)
receiving pressure control ventilation. The plateau pressure is 32 cm H₂O. The
nurse should:
A) Increase the inspiratory pressure
B) Notify the provider because high plateau pressure increases barotrauma risk
C) Decrease the respiratory rate
D) Suction the endotracheal tube
Correct Answer: B – Notify the provider because high plateau pressure increases
barotrauma risk
Rationale: Plateau pressure should be maintained <30 cm H₂O to reduce
ventilator-induced lung injury. A plateau pressure of 32 is elevated and requires
provider notification for possible adjustments (e.g., decreasing tidal volume or
PEEP).
,Page 3 of 52
Question 6
A client with cardiogenic shock has a pulmonary artery catheter in place. Which
finding indicates poor tissue perfusion?
A) Cardiac index 2.8 L/min/m²
B) Pulmonary artery wedge pressure (PAWP) 20 mm Hg
C) Mixed venous oxygen saturation (SvO₂) 55%
D) Systemic vascular resistance (SVR) 800 dynes/sec/cm⁻⁵
Correct Answer: C – Mixed venous oxygen saturation (SvO₂) 55%
Rationale: Normal SvO₂ is 60–80%; values below 60% indicate increased oxygen
extraction due to inadequate cardiac output or hypoxemia. Cardiac index of 2.8
is low normal; PAWP 20 indicates fluid overload; SVR 800 is normal to low.
Question 7
A client with a spinal cord injury at C5 is admitted to the ICU. Which assessment
finding requires immediate intervention?
A) Blood pressure 90/60 mm Hg, heart rate 50 beats per minute
B) Respiratory rate 24 breaths per minute, SpO₂ 94%
C) Paralysis of the lower extremities
D) Absent deep tendon reflexes in the legs
Correct Answer: A – Blood pressure 90/60 mm Hg, heart rate 50 beats per minute
Rationale: C5 injury causes loss of sympathetic tone, leading to neurogenic
shock: hypotension and bradycardia. This requires vasopressors and atropine.
Respiratory compromise (C3-5) may also occur, but the given respiratory values
are acceptable.
Question 8
A nurse is caring for a client following a cardiac arrest. The client is receiving
targeted temperature management (TTM). Which finding indicates a complication
of TTM?
A) Shivering
B) Heart rate 50 beats per minute
C) Serum potassium 4.0 mEq/L
D) Blood glucose 120 mg/dL
Correct Answer: A – Shivering
Rationale: Shivering increases metabolic rate and oxygen demand,
counteracting the benefits of TTM. It should be treated with sedation, paralytics,
or surface warming. Bradycardia and hypokalemia are expected; hyperglycemia
may occur but 120 is normal.
, Page 4 of 52
Question 9
A client with acute kidney injury (AKI) secondary to sepsis has a serum potassium
of 6.2 mEq/L. The nurse should anticipate which intervention first?
A) Administer sodium polystyrene sulfonate
B) Start IV regular insulin and dextrose
C) Prepare for emergent hemodialysis
D) Restrict dietary potassium
Correct Answer: B – Start IV regular insulin and dextrose
*Rationale: Severe hyperkalemia (>6.0) with ECG changes requires immediate
shift of potassium into cells. Insulin+dextrose works in 30–60 minutes. Sodium
polystyrene works slowly; dialysis is definitive but not first.*
Question 10
A client with increased intracranial pressure (ICP) has an order for mannitol.
Which nursing action is most important before administering mannitol?
A) Assess serum osmolality
B) Insert a Foley catheter
C) Elevate the head of the bed to 30 degrees
D) Administer a sedative
Correct Answer: B – Insert a Foley catheter
Rationale: Mannitol is an osmotic diuretic that causes rapid diuresis. An
indwelling urinary catheter is needed to monitor output and prevent bladder
distention. Serum osmolality should be monitored but not required before each
dose.
Question 11
A client is being weaned from mechanical ventilation. Which finding indicates
readiness for extubation?
A) Rapid shallow breathing index (RSBI) of 105 breaths/min/L
B) PaO₂/FiO₂ ratio of 180
C) Negative inspiratory force (NIF) of –30 cm H₂O
D) Spontaneous tidal volume of 3 mL/kg
Correct Answer: C – Negative inspiratory force (NIF) of –30 cm H₂O
*Rationale: NIF less than –20 to –25 cm H₂O indicates adequate respiratory
muscle strength. RSBI <105 is weaning readiness; PaO₂/FiO₂ >200; tidal volume
>5 mL/kg. NIF –30 meets criteria.*
