NUR2790/NUR 2790 Exam 1 V1 |
Professional Nursing III / PN3 Q&A
with Rationale | Rasmussen
University
1. A patient in the early stage of ARDS is experiencing hypoxemia despite receiving 60%
oxygen via mask. Which pathophysiological mechanism explains this?
A. Decreased surfactant production causing massive airway obstruction
B. Increased pulmonary compliance allowing for over-expansion
C. Alveolar capillary membrane damage leading to shunting
D. Excessive mucus production blocking the bronchioles
Correct Answer: C
Expert Explanation: In Acute Respiratory Distress Syndrome (ARDS), the alveolar
capillary membrane becomes damaged and more permeable. This allows fluid to leak into
the alveoli, which prevents gas exchange and leads to a right-to-left shunt. Because the
blood is passing by non-ventilated alveoli, increasing oxygen concentration often fails to
significantly improve PaO2.
2. When caring for a patient with a Mean Arterial Pressure (MAP) of 55 mmHg, what is the
nurse’s priority action?
A. Document the finding as normal for a resting patient
,B. Increase the rate of IV fluids and notify the physician
C. Re-check the blood pressure in 30 minutes
D. Encourage the patient to perform deep breathing exercises
Correct Answer: B
Expert Explanation: A MAP of at least 60-65 mmHg is generally required to maintain
adequate perfusion to vital organs like the brain and kidneys. A MAP of 55 mmHg indicates
inadequate tissue perfusion and potentially impending shock. The nurse must intervene
immediately by initiating fluid resuscitation or vasopressors as ordered to prevent organ
damage.
3. A patient is admitted with suspected Septic Shock. Which clinical finding is most indicative
of the ‘hyperdynamic’ or ‘warm’ phase?
A. High cardiac output and decreased systemic vascular resistance
B. Cool, clammy skin and bradycardia
C. Severe oliguria and metabolic alkalosis
D. Hypoventilation and respiratory acidosis
Correct Answer: A
Expert Explanation: The early or hyperdynamic phase of septic shock is characterized by
vasodilation and a compensatory increase in heart rate and stroke volume. This results in a
, high cardiac output despite a drop in systemic vascular resistance. Patients typically
present with warm, flushed skin and a bounding pulse during this stage.
4. Which laboratory value is the most sensitive indicator of Acute Kidney Injury (AKI) in a
critically ill patient?
A. Blood Urea Nitrogen (BUN)
B. Serum Albumin
C. Urine Specific Gravity
D. Serum Creatinine
Correct Answer: D
Expert Explanation: Serum creatinine is more specific to kidney function than BUN
because it is not significantly affected by diet or hydration status. As the glomerular
filtration rate (GFR) drops, creatinine levels rise, reflecting the kidneys’ inability to filter
waste. However, even creatinine can lag behind the actual insult, requiring careful
monitoring of trended values.
5. The nurse is monitoring a patient for Autonomic Dysreflexia. Which vital sign change is
most characteristic of this condition?
A. Tachycardia and hypotension
B. Irregular respirations and narrowed pulse pressure
C. Tachypnea and hyperthermia
Professional Nursing III / PN3 Q&A
with Rationale | Rasmussen
University
1. A patient in the early stage of ARDS is experiencing hypoxemia despite receiving 60%
oxygen via mask. Which pathophysiological mechanism explains this?
A. Decreased surfactant production causing massive airway obstruction
B. Increased pulmonary compliance allowing for over-expansion
C. Alveolar capillary membrane damage leading to shunting
D. Excessive mucus production blocking the bronchioles
Correct Answer: C
Expert Explanation: In Acute Respiratory Distress Syndrome (ARDS), the alveolar
capillary membrane becomes damaged and more permeable. This allows fluid to leak into
the alveoli, which prevents gas exchange and leads to a right-to-left shunt. Because the
blood is passing by non-ventilated alveoli, increasing oxygen concentration often fails to
significantly improve PaO2.
2. When caring for a patient with a Mean Arterial Pressure (MAP) of 55 mmHg, what is the
nurse’s priority action?
A. Document the finding as normal for a resting patient
,B. Increase the rate of IV fluids and notify the physician
C. Re-check the blood pressure in 30 minutes
D. Encourage the patient to perform deep breathing exercises
Correct Answer: B
Expert Explanation: A MAP of at least 60-65 mmHg is generally required to maintain
adequate perfusion to vital organs like the brain and kidneys. A MAP of 55 mmHg indicates
inadequate tissue perfusion and potentially impending shock. The nurse must intervene
immediately by initiating fluid resuscitation or vasopressors as ordered to prevent organ
damage.
3. A patient is admitted with suspected Septic Shock. Which clinical finding is most indicative
of the ‘hyperdynamic’ or ‘warm’ phase?
A. High cardiac output and decreased systemic vascular resistance
B. Cool, clammy skin and bradycardia
C. Severe oliguria and metabolic alkalosis
D. Hypoventilation and respiratory acidosis
Correct Answer: A
Expert Explanation: The early or hyperdynamic phase of septic shock is characterized by
vasodilation and a compensatory increase in heart rate and stroke volume. This results in a
, high cardiac output despite a drop in systemic vascular resistance. Patients typically
present with warm, flushed skin and a bounding pulse during this stage.
4. Which laboratory value is the most sensitive indicator of Acute Kidney Injury (AKI) in a
critically ill patient?
A. Blood Urea Nitrogen (BUN)
B. Serum Albumin
C. Urine Specific Gravity
D. Serum Creatinine
Correct Answer: D
Expert Explanation: Serum creatinine is more specific to kidney function than BUN
because it is not significantly affected by diet or hydration status. As the glomerular
filtration rate (GFR) drops, creatinine levels rise, reflecting the kidneys’ inability to filter
waste. However, even creatinine can lag behind the actual insult, requiring careful
monitoring of trended values.
5. The nurse is monitoring a patient for Autonomic Dysreflexia. Which vital sign change is
most characteristic of this condition?
A. Tachycardia and hypotension
B. Irregular respirations and narrowed pulse pressure
C. Tachypnea and hyperthermia
