NR341/NR 341 Final Exam V3 | Complex
Adult Health Q&A with Rationale |
Chamberlain University
1. A patient in the intensive care unit is exhibiting signs of neurogenic shock following a spinal
cord injury at T3. Which clinical finding should the nurse anticipate?
A. Tachycardia and hypertension
B. Tachypnea and cool, clammy skin
C. Bradycardia and hypotension
D. Bounding pulses and increased cardiac output
Correct Answer: C
Expert Explanation: Neurogenic shock results from the loss of sympathetic tone, leading
to massive vasodilation and bradycardia. Unlike other forms of shock, the heart rate does
not increase to compensate for low blood pressure because the sympathetic nervous
system is inhibited. The nurse must monitor for hypotension and bradycardia as primary
indicators of this condition.
2. The nurse is caring for a patient with Acute Respiratory Distress Syndrome (ARDS) who is
on mechanical ventilation. The provider adds Positive End-Expiratory Pressure (PEEP). What is
the primary purpose of PEEP?
A. To increase the fraction of inspired oxygen (FiO2)
,B. To decrease the work of breathing for the patient
C. To prevent alveoli from collapsing during expiration
D. To clear secretions from the lower airways
Correct Answer: C
Expert Explanation: PEEP is used in ARDS to keep the alveoli open at the end of
expiration, which improves gas exchange and increases functional residual capacity. This
intervention helps to correct the severe hypoxemia typically seen in patients with non-
compliant lungs. It allows for the use of lower FiO2 levels, thereby reducing the risk of
oxygen toxicity.
3. A patient with a history of heart failure presents with a Pulmonary Artery Wedge Pressure
(PAWP) of 22 mmHg. Which physical assessment finding is most consistent with this data?
A. Bilateral crackles and shortness of breath
B. Jugular venous distention and peripheral edema
C. Dry mucous membranes and poor skin turgor
D. Hyperactive bowel sounds and increased urine output
Correct Answer: A
Expert Explanation: An elevated PAWP, which normally ranges from 6-12 mmHg,
indicates increased left-sided heart pressures and fluid overload. This often manifests as
,pulmonary congestion, leading to symptoms such as crackles and dyspnea. The nurse
should recognize this as a sign of left ventricular failure requiring diuretic therapy.
4. While monitoring a patient’s ECG, the nurse notes a sawtooth pattern of P waves with a
ventricular rate of 80 bpm. Which rhythm is the patient experiencing?
A. Atrial Flutter
B. Atrial Fibrillation
C. Ventricular Tachycardia
D. Third-Degree Heart Block
Correct Answer: A
Expert Explanation: Atrial flutter is characterized by a distinctive ‘sawtooth’ pattern
caused by rapid atrial depolarization. The ventricular rate depends on the conduction ratio
through the AV node, which acts as a gatekeeper. Proper identification is crucial because
patients with this rhythm are at high risk for thromboembolism.
5. A patient in septic shock has a serum lactate level of 5 mmol/L. How should the nurse
interpret this finding?
A. The patient is experiencing cellular hypoxia and anaerobic metabolism.
B. The patient has adequate tissue perfusion.
C. The patient is experiencing normal aerobic metabolism.
D. The patient is in the compensatory stage of shock.
, Correct Answer: A
Expert Explanation: Elevated lactate levels (typically above 2 mmol/L) are a hallmark of
tissue hypoperfusion and anaerobic metabolism in sepsis. This finding indicates that the
cells are not receiving enough oxygen to function normally, leading to metabolic acidosis.
The nurse must prioritize fluid resuscitation and vasopressor support to improve oxygen
delivery.
6. The nurse is preparing to administer Mannitol to a patient with increased intracranial
pressure (ICP). What is the primary mechanism of action for this medication?
A. To decrease cerebral metabolic rate
B. To increase the production of cerebrospinal fluid
C. To create an osmotic gradient that pulls fluid from brain tissue
D. To promote vasodilation of cerebral arteries
Correct Answer: C
Expert Explanation: Mannitol is an osmotic diuretic that increases the osmolality of the
blood, causing fluid to shift from the intracellular space of the brain into the vascular
system. This reduces cerebral edema and lowers ICP in patients with head injuries or
stroke. It is essential for the nurse to monitor the patient’s intake and output as well as
serum osmolality during treatment.
Adult Health Q&A with Rationale |
Chamberlain University
1. A patient in the intensive care unit is exhibiting signs of neurogenic shock following a spinal
cord injury at T3. Which clinical finding should the nurse anticipate?
A. Tachycardia and hypertension
B. Tachypnea and cool, clammy skin
C. Bradycardia and hypotension
D. Bounding pulses and increased cardiac output
Correct Answer: C
Expert Explanation: Neurogenic shock results from the loss of sympathetic tone, leading
to massive vasodilation and bradycardia. Unlike other forms of shock, the heart rate does
not increase to compensate for low blood pressure because the sympathetic nervous
system is inhibited. The nurse must monitor for hypotension and bradycardia as primary
indicators of this condition.
2. The nurse is caring for a patient with Acute Respiratory Distress Syndrome (ARDS) who is
on mechanical ventilation. The provider adds Positive End-Expiratory Pressure (PEEP). What is
the primary purpose of PEEP?
A. To increase the fraction of inspired oxygen (FiO2)
,B. To decrease the work of breathing for the patient
C. To prevent alveoli from collapsing during expiration
D. To clear secretions from the lower airways
Correct Answer: C
Expert Explanation: PEEP is used in ARDS to keep the alveoli open at the end of
expiration, which improves gas exchange and increases functional residual capacity. This
intervention helps to correct the severe hypoxemia typically seen in patients with non-
compliant lungs. It allows for the use of lower FiO2 levels, thereby reducing the risk of
oxygen toxicity.
3. A patient with a history of heart failure presents with a Pulmonary Artery Wedge Pressure
(PAWP) of 22 mmHg. Which physical assessment finding is most consistent with this data?
A. Bilateral crackles and shortness of breath
B. Jugular venous distention and peripheral edema
C. Dry mucous membranes and poor skin turgor
D. Hyperactive bowel sounds and increased urine output
Correct Answer: A
Expert Explanation: An elevated PAWP, which normally ranges from 6-12 mmHg,
indicates increased left-sided heart pressures and fluid overload. This often manifests as
,pulmonary congestion, leading to symptoms such as crackles and dyspnea. The nurse
should recognize this as a sign of left ventricular failure requiring diuretic therapy.
4. While monitoring a patient’s ECG, the nurse notes a sawtooth pattern of P waves with a
ventricular rate of 80 bpm. Which rhythm is the patient experiencing?
A. Atrial Flutter
B. Atrial Fibrillation
C. Ventricular Tachycardia
D. Third-Degree Heart Block
Correct Answer: A
Expert Explanation: Atrial flutter is characterized by a distinctive ‘sawtooth’ pattern
caused by rapid atrial depolarization. The ventricular rate depends on the conduction ratio
through the AV node, which acts as a gatekeeper. Proper identification is crucial because
patients with this rhythm are at high risk for thromboembolism.
5. A patient in septic shock has a serum lactate level of 5 mmol/L. How should the nurse
interpret this finding?
A. The patient is experiencing cellular hypoxia and anaerobic metabolism.
B. The patient has adequate tissue perfusion.
C. The patient is experiencing normal aerobic metabolism.
D. The patient is in the compensatory stage of shock.
, Correct Answer: A
Expert Explanation: Elevated lactate levels (typically above 2 mmol/L) are a hallmark of
tissue hypoperfusion and anaerobic metabolism in sepsis. This finding indicates that the
cells are not receiving enough oxygen to function normally, leading to metabolic acidosis.
The nurse must prioritize fluid resuscitation and vasopressor support to improve oxygen
delivery.
6. The nurse is preparing to administer Mannitol to a patient with increased intracranial
pressure (ICP). What is the primary mechanism of action for this medication?
A. To decrease cerebral metabolic rate
B. To increase the production of cerebrospinal fluid
C. To create an osmotic gradient that pulls fluid from brain tissue
D. To promote vasodilation of cerebral arteries
Correct Answer: C
Expert Explanation: Mannitol is an osmotic diuretic that increases the osmolality of the
blood, causing fluid to shift from the intracellular space of the brain into the vascular
system. This reduces cerebral edema and lowers ICP in patients with head injuries or
stroke. It is essential for the nurse to monitor the patient’s intake and output as well as
serum osmolality during treatment.
