NR341/NR 341 Exam 2 V1 | Complex Adult
Health Q&A with Rationale | Chamberlain
University
1. A patient with a history of acute myocardial infarction is monitored on the telemetry unit
and shows a sudden onset of ventricular tachycardia (VT) on the monitor. The patient is
awake and talking but complains of dizziness. What is the priority nursing intervention?
A. Perform immediate unsynchronized defibrillation.
B. Initiate high-quality chest compressions.
C. Administer a 2L bolus of Normal Saline.
D. Prepare for synchronized cardioversion.
Correct Answer: D
Expert Explanation: In a stable patient with ventricular tachycardia who has a pulse,
synchronized cardioversion is the treatment of choice to disrupt the abnormal rhythm.
Defibrillation is reserved for pulseless VT or ventricular fibrillation where no cardiac
output is present. The nurse must ensure the ‘sync’ button is active to avoid delivery of a
shock during the vulnerable T-wave period.
,2. The nurse is caring for a patient on a mechanical ventilator with Positive End-Expiratory
Pressure (PEEP) set at 15 cm H2O. Which hemodynamic change should the nurse monitor for
most closely?
A. Decreased cardiac output.
B. Increased cardiac output.
C. Increased systemic vascular resistance (SVR).
D. Decreased pulmonary artery wedge pressure (PAWP).
Correct Answer: A
Expert Explanation: High levels of PEEP increase intrathoracic pressure, which can
compress the vena cava and decrease venous return to the heart. This reduction in preload
leads to a subsequent decrease in cardiac output and can cause hypotension. Monitoring
blood pressure and perfusion is essential when PEEP levels are titrated upward.
3. A patient is admitted with septic shock. The nurse notes a serum lactate level of 5.2
mmol/L and a mean arterial pressure (MAP) of 58 mmHg despite initial fluid resuscitation.
Which medication does the nurse anticipate administering next?
A. Nitroprusside
B. Furosemide
C. Norepinephrine
D. Atropine
,Correct Answer: C
Expert Explanation: Norepinephrine is the first-line vasopressor used in septic shock
when fluid resuscitation fails to maintain a MAP of at least 65 mmHg. It works primarily
through alpha-adrenergic stimulation to increase systemic vascular resistance and blood
pressure. The elevated lactate level indicates ongoing tissue hypoxia and the need for
improved perfusion pressure.
4. A patient in the ICU is being monitored with a pulmonary artery catheter. The nurse notes
a Central Venous Pressure (CVP) of 2 mmHg and a Pulmonary Artery Wedge Pressure (PAWP)
of 4 mmHg. Which condition do these values suggest?
A. Hypervolemia
B. Hypovolemia
C. Right-sided heart failure
D. Pulmonary hypertension
Correct Answer: B
Expert Explanation: CVP and PAWP are measures of preload for the right and left sides of
the heart, respectively, with normal CVP being 2-8 mmHg and PAWP being 6-12 mmHg.
Low values in both parameters typically indicate a state of hypovolemia or fluid volume
deficit. The nurse should anticipate orders for fluid boluses or blood products depending
on the underlying cause.
, 5. A patient presents to the emergency department with deep partial-thickness burns to the
chest and both arms. Using the Rule of Nines, what is the estimated Total Body Surface Area
(TBSA) affected?
A. 18%
B. 36%
C. 27%
D. 45%
Correct Answer: B
Expert Explanation: According to the Rule of Nines, the anterior chest accounts for 18% of
TBSA and each entire arm accounts for 9%. Therefore, 18% (chest) + 9% (right arm) + 9%
(left arm) equals 36%. Accurate TBSA calculation is critical for determining the volume of
fluid resuscitation needed via the Parkland formula.
6. During the emergent phase of burn management, which electrolyte imbalance is the nurse
most likely to observe?
A. Hypokalemia
B. Hypocalcemia
C. Hypernatremia
D. Hyperkalemia
Correct Answer: D
Health Q&A with Rationale | Chamberlain
University
1. A patient with a history of acute myocardial infarction is monitored on the telemetry unit
and shows a sudden onset of ventricular tachycardia (VT) on the monitor. The patient is
awake and talking but complains of dizziness. What is the priority nursing intervention?
A. Perform immediate unsynchronized defibrillation.
B. Initiate high-quality chest compressions.
C. Administer a 2L bolus of Normal Saline.
D. Prepare for synchronized cardioversion.
Correct Answer: D
Expert Explanation: In a stable patient with ventricular tachycardia who has a pulse,
synchronized cardioversion is the treatment of choice to disrupt the abnormal rhythm.
Defibrillation is reserved for pulseless VT or ventricular fibrillation where no cardiac
output is present. The nurse must ensure the ‘sync’ button is active to avoid delivery of a
shock during the vulnerable T-wave period.
,2. The nurse is caring for a patient on a mechanical ventilator with Positive End-Expiratory
Pressure (PEEP) set at 15 cm H2O. Which hemodynamic change should the nurse monitor for
most closely?
A. Decreased cardiac output.
B. Increased cardiac output.
C. Increased systemic vascular resistance (SVR).
D. Decreased pulmonary artery wedge pressure (PAWP).
Correct Answer: A
Expert Explanation: High levels of PEEP increase intrathoracic pressure, which can
compress the vena cava and decrease venous return to the heart. This reduction in preload
leads to a subsequent decrease in cardiac output and can cause hypotension. Monitoring
blood pressure and perfusion is essential when PEEP levels are titrated upward.
3. A patient is admitted with septic shock. The nurse notes a serum lactate level of 5.2
mmol/L and a mean arterial pressure (MAP) of 58 mmHg despite initial fluid resuscitation.
Which medication does the nurse anticipate administering next?
A. Nitroprusside
B. Furosemide
C. Norepinephrine
D. Atropine
,Correct Answer: C
Expert Explanation: Norepinephrine is the first-line vasopressor used in septic shock
when fluid resuscitation fails to maintain a MAP of at least 65 mmHg. It works primarily
through alpha-adrenergic stimulation to increase systemic vascular resistance and blood
pressure. The elevated lactate level indicates ongoing tissue hypoxia and the need for
improved perfusion pressure.
4. A patient in the ICU is being monitored with a pulmonary artery catheter. The nurse notes
a Central Venous Pressure (CVP) of 2 mmHg and a Pulmonary Artery Wedge Pressure (PAWP)
of 4 mmHg. Which condition do these values suggest?
A. Hypervolemia
B. Hypovolemia
C. Right-sided heart failure
D. Pulmonary hypertension
Correct Answer: B
Expert Explanation: CVP and PAWP are measures of preload for the right and left sides of
the heart, respectively, with normal CVP being 2-8 mmHg and PAWP being 6-12 mmHg.
Low values in both parameters typically indicate a state of hypovolemia or fluid volume
deficit. The nurse should anticipate orders for fluid boluses or blood products depending
on the underlying cause.
, 5. A patient presents to the emergency department with deep partial-thickness burns to the
chest and both arms. Using the Rule of Nines, what is the estimated Total Body Surface Area
(TBSA) affected?
A. 18%
B. 36%
C. 27%
D. 45%
Correct Answer: B
Expert Explanation: According to the Rule of Nines, the anterior chest accounts for 18% of
TBSA and each entire arm accounts for 9%. Therefore, 18% (chest) + 9% (right arm) + 9%
(left arm) equals 36%. Accurate TBSA calculation is critical for determining the volume of
fluid resuscitation needed via the Parkland formula.
6. During the emergent phase of burn management, which electrolyte imbalance is the nurse
most likely to observe?
A. Hypokalemia
B. Hypocalcemia
C. Hypernatremia
D. Hyperkalemia
Correct Answer: D
