NR341/NR 341 Exam 3 V3 | Complex Adult
Health Q&A with Rationale | Chamberlain
University
1. A patient is admitted with severe sepsis. The nurse notes a blood pressure of 82/46 mmHg
and a serum lactate level of 4.5 mmol/L. Which intervention should the nurse prioritize first?
A. Initiate norepinephrine infusion at 2 mcg/min.
B. Administer a 30 mL/kg isotonic crystalloid bolus.
C. Obtain two sets of blood cultures from different sites.
D. Administer broad-spectrum antibiotics within the hour.
Correct Answer: B
Expert Explanation: According to the Surviving Sepsis Campaign guidelines, initial
resuscitation begins with a 30 mL/kg crystalloid bolus for hypotension or lactate levels >=
4 mmol/L. While blood cultures and antibiotics are critical, restoring perfusion via fluid
resuscitation is the immediate physiological priority for a patient in septic shock.
Vasopressors like norepinephrine are only indicated if the patient remains hypotensive
after adequate fluid resuscitation.
2. A nurse is caring for a patient on a mechanical ventilator in Assist/Control (A/C) mode. The
high-pressure alarm sounds. Which action should the nurse take first?
A. Increase the oxygen concentration to 100%.
,B. Assess the patient’s breath sounds and check for secretions.
C. Disconnect the patient and manually ventilate with a bag-valve-mask.
D. Silence the alarm and monitor the patient for five minutes.
Correct Answer: B
Expert Explanation: A high-pressure alarm indicates that the ventilator is meeting
resistance to air delivery, often caused by secretions, kinking of the tube, or the patient
biting the tube. The nurse must first assess the patient to identify the cause, such as
checking for the need to suction or ensuring tube patency. If the patient is in immediate
respiratory distress and the cause cannot be found, manual ventilation would be the next
step, but assessment comes first.
3. A patient with ARDS is being considered for prone positioning. Which assessment finding
would the nurse recognize as a contraindication for this procedure?
A. FiO2 requirement of 80%.
B. PaO2/FiO2 ratio of 120.
C. Recent spinal surgery with instability.
D. High PEEP levels of 15 cm H2O.
Correct Answer: C
Expert Explanation: Prone positioning is used in ARDS to improve oxygenation by recruit
lung units in the posterior regions, but it is contraindicated in patients with spinal
, instability. Patients with high FiO2 needs or low P/F ratios are actually the target
population for this intervention to improve V/Q matching. Hemodynamic instability or
recent abdominal surgery are also potential contraindications the nurse must monitor for.
4. An 80-kg patient has sustained deep partial-thickness burns to 40% of their total body
surface area (TBSA). Using the Parkland formula, what is the total fluid volume required for
the first 24 hours?
A. 6,400 mL
B. 3,200 mL
C. 12,800 mL
D. 9,600 mL
Correct Answer: C
Expert Explanation: The Parkland formula is calculated as 4 mL x kg x % TBSA. For this
patient, the calculation is 4 mL x 80 kg x 40 = 12,800 mL. Half of this volume (6,400 mL)
must be administered in the first 8 hours from the time of the burn injury.
5. A patient in the ICU has a Central Venous Pressure (CVP) of 1 mmHg and a heart rate of 120
bpm. The nurse interprets these findings as which of the following?
A. Fluid volume excess.
B. Right-sided heart failure.
C. Pulmonary hypertension.
Health Q&A with Rationale | Chamberlain
University
1. A patient is admitted with severe sepsis. The nurse notes a blood pressure of 82/46 mmHg
and a serum lactate level of 4.5 mmol/L. Which intervention should the nurse prioritize first?
A. Initiate norepinephrine infusion at 2 mcg/min.
B. Administer a 30 mL/kg isotonic crystalloid bolus.
C. Obtain two sets of blood cultures from different sites.
D. Administer broad-spectrum antibiotics within the hour.
Correct Answer: B
Expert Explanation: According to the Surviving Sepsis Campaign guidelines, initial
resuscitation begins with a 30 mL/kg crystalloid bolus for hypotension or lactate levels >=
4 mmol/L. While blood cultures and antibiotics are critical, restoring perfusion via fluid
resuscitation is the immediate physiological priority for a patient in septic shock.
Vasopressors like norepinephrine are only indicated if the patient remains hypotensive
after adequate fluid resuscitation.
2. A nurse is caring for a patient on a mechanical ventilator in Assist/Control (A/C) mode. The
high-pressure alarm sounds. Which action should the nurse take first?
A. Increase the oxygen concentration to 100%.
,B. Assess the patient’s breath sounds and check for secretions.
C. Disconnect the patient and manually ventilate with a bag-valve-mask.
D. Silence the alarm and monitor the patient for five minutes.
Correct Answer: B
Expert Explanation: A high-pressure alarm indicates that the ventilator is meeting
resistance to air delivery, often caused by secretions, kinking of the tube, or the patient
biting the tube. The nurse must first assess the patient to identify the cause, such as
checking for the need to suction or ensuring tube patency. If the patient is in immediate
respiratory distress and the cause cannot be found, manual ventilation would be the next
step, but assessment comes first.
3. A patient with ARDS is being considered for prone positioning. Which assessment finding
would the nurse recognize as a contraindication for this procedure?
A. FiO2 requirement of 80%.
B. PaO2/FiO2 ratio of 120.
C. Recent spinal surgery with instability.
D. High PEEP levels of 15 cm H2O.
Correct Answer: C
Expert Explanation: Prone positioning is used in ARDS to improve oxygenation by recruit
lung units in the posterior regions, but it is contraindicated in patients with spinal
, instability. Patients with high FiO2 needs or low P/F ratios are actually the target
population for this intervention to improve V/Q matching. Hemodynamic instability or
recent abdominal surgery are also potential contraindications the nurse must monitor for.
4. An 80-kg patient has sustained deep partial-thickness burns to 40% of their total body
surface area (TBSA). Using the Parkland formula, what is the total fluid volume required for
the first 24 hours?
A. 6,400 mL
B. 3,200 mL
C. 12,800 mL
D. 9,600 mL
Correct Answer: C
Expert Explanation: The Parkland formula is calculated as 4 mL x kg x % TBSA. For this
patient, the calculation is 4 mL x 80 kg x 40 = 12,800 mL. Half of this volume (6,400 mL)
must be administered in the first 8 hours from the time of the burn injury.
5. A patient in the ICU has a Central Venous Pressure (CVP) of 1 mmHg and a heart rate of 120
bpm. The nurse interprets these findings as which of the following?
A. Fluid volume excess.
B. Right-sided heart failure.
C. Pulmonary hypertension.
