Adult Health II Final Exam
ADULT HEALTH II FINAL EXAM NEWEST 2025/2026 WITH
COMPLETE QUESTIONS AND CORRECT ANSWERS |ALREADY
GRADED A+||BRAND NEW VERSION!
1. Which of these findings is the best indicator that the fluid resuscitation for a
patient with hypovolemic shock has been successful?
A. Hemoglobin is WNL
B. Urine output is 60 ml over the last hour
C. Pulmonary artery wedge pressure (PAWP) is normal
D. Mean arterial pressure (MAP) is 65 mm Hg - ANSWER-A
Assessment of end organ perfusion, such as an adequate urine output, is the best
indicator that fluid resuscitation has been successful. The hemoglobin level, PAWP,
and MAP are useful in determining the effects of fluid administration, but they are
not as useful as data indicating good organ perfusion.
1. Which intervention will the nurse include in the plan of care for a patient who
has cardiogenic shock?
A. Avoid elevating the HOB
B. Check temperature every 2 hours
C. Monitor breath sounds frequently
D. Assess skin for flushing and itching - ANSWER-C
Since pulmonary congestion and dyspnea are characteristics of cardiogenic shock,
the nurse should assess the breath sounds frequently. The head of the bed is
usually elevated to decrease dyspnea. Elevated temperature and flushing or
itching of the skin are not typical of cardiogenic shock.
1|Page
, Adult Health II Final Exam
1. When the nurse is assessing a patient who is receiving nitroprusside (Nipride)
infusion to treat cardiogenic shock, which finding indicates that the medication is
effective?
A. No heart murmur is audible
B. Skin is warm, pink, and dry
C. Troponin level is decreased
D. Blood pressure is 90/40 mm Hg - ANSWER-B
Warm, pink, and dry skin indicates that perfusion to tissues is improved. Since
nitroprusside is a vasodilator, the blood pressure may be low even if the
medication is effective. Absence of a heart murmur and a decrease in troponin
level are not indicators of improvement in shock.
1. Which assessment information is most important for the nurse to make in order
to evaluate whether treatment for the patient with anaphylactic shock has been
effective?
A. Pulse rate
B. Orientation
C. Blood pressure
D. Oxygen saturation - ANSWER-D
Because the airway edema that is associated with anaphylaxis can affect airway
and breathing, the oxygen saturation is the most critical assessment.
Improvements in the other assessments also will be expected with effective
treatment of anaphylactic shock.
1. Which information obtained by the nurse when caring for a patient who has
cardiogenic shock is an indication that the patient may be developing multiple
organ dysfunction syndrome (MODS)?
2|Page
, Adult Health II Final Exam
A. The patient's serum creatinine level is elevated
B. The patient complains of intermittent chest pain
C. The patient has crackles throughout both lung fields
D. The patient's extremities are cool and pulses are weak - ANSWER-A
The elevated serum creatinine level indicates that the patient has renal failure as
well as heart failure. The crackles, chest pressure, and cool extremities are all
consistent with the patient's diagnosis of cardiogenic shock.
1. A patient with septic shock has a BP of 70/46 mm Hg, pulse 136, respirations
32, and blood glucose of 246. Which of these prescribed interventions will the
nurse implement first?
A. Give normal saline IV @ 500 ml / hr
B. Infuse drotrocogin alpha (Xigris) 24 mcg / kg
C. Start insulin drip to maintain blood glucose between 110 and 130 mg / dL
D. Titrate norepinephrine (Levophed) to keep MAP @ 70 mm Hg - ANSWER-A
Because of the low systemic vascular resistance (SVR) associated with septic
shock, fluid resuscitation is the initial therapy. The other actions also are
appropriate and should be initiated quickly as well.
1. When caring for a patient who has septic shock, which assessment finding is
most important for the nurse to report to the health care provider?
A. BP 92/56 mm Hg
B. Skin cool & clammy
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, Adult Health II Final Exam
C. Apical pulse 118 beats / min
D. Arterial oxygen saturation 91% - ANSWER-B
Since patients in the early stage of septic shock have warm and dry skin, the
patient's cool and clammy skin indicates that shock is progressing. The other
information also will be reported, but does not indicate deterioration of the
patient's status.
1. A patient who has been involved in a motor vehicle crash is admitted to the
emergency room with cool, clammy skin, tachycardia, and hypotension. Which of
the following interventions should the nurse implement first?
A. Place the patient on continuous cardiac monitor
B. Draw blood to type and crossmatch for transfusions
C. Insert two 14-guage IV catheters
D. Administer oxygen @ 100% per non-rebreather mask - ANSWER-D
The first priority in the initial management of shock is maintenance of the airway
and ventilation. Cardiac monitoring, insertion of IV catheters, and obtaining blood
for transfusions also should be rapidly accomplished, but only after actions to
maximize oxygen delivery have been implemented.
1. A patient with shock of unknown etiology whose hemodynamic monitoring
reveals BP 92/54, pulse 64, and an elevated pulmonary artery wedge pressure
(PAWP) has the following collaborative interventions prescribed. Which
intervention will the nurse question?
4|Page
ADULT HEALTH II FINAL EXAM NEWEST 2025/2026 WITH
COMPLETE QUESTIONS AND CORRECT ANSWERS |ALREADY
GRADED A+||BRAND NEW VERSION!
1. Which of these findings is the best indicator that the fluid resuscitation for a
patient with hypovolemic shock has been successful?
A. Hemoglobin is WNL
B. Urine output is 60 ml over the last hour
C. Pulmonary artery wedge pressure (PAWP) is normal
D. Mean arterial pressure (MAP) is 65 mm Hg - ANSWER-A
Assessment of end organ perfusion, such as an adequate urine output, is the best
indicator that fluid resuscitation has been successful. The hemoglobin level, PAWP,
and MAP are useful in determining the effects of fluid administration, but they are
not as useful as data indicating good organ perfusion.
1. Which intervention will the nurse include in the plan of care for a patient who
has cardiogenic shock?
A. Avoid elevating the HOB
B. Check temperature every 2 hours
C. Monitor breath sounds frequently
D. Assess skin for flushing and itching - ANSWER-C
Since pulmonary congestion and dyspnea are characteristics of cardiogenic shock,
the nurse should assess the breath sounds frequently. The head of the bed is
usually elevated to decrease dyspnea. Elevated temperature and flushing or
itching of the skin are not typical of cardiogenic shock.
1|Page
, Adult Health II Final Exam
1. When the nurse is assessing a patient who is receiving nitroprusside (Nipride)
infusion to treat cardiogenic shock, which finding indicates that the medication is
effective?
A. No heart murmur is audible
B. Skin is warm, pink, and dry
C. Troponin level is decreased
D. Blood pressure is 90/40 mm Hg - ANSWER-B
Warm, pink, and dry skin indicates that perfusion to tissues is improved. Since
nitroprusside is a vasodilator, the blood pressure may be low even if the
medication is effective. Absence of a heart murmur and a decrease in troponin
level are not indicators of improvement in shock.
1. Which assessment information is most important for the nurse to make in order
to evaluate whether treatment for the patient with anaphylactic shock has been
effective?
A. Pulse rate
B. Orientation
C. Blood pressure
D. Oxygen saturation - ANSWER-D
Because the airway edema that is associated with anaphylaxis can affect airway
and breathing, the oxygen saturation is the most critical assessment.
Improvements in the other assessments also will be expected with effective
treatment of anaphylactic shock.
1. Which information obtained by the nurse when caring for a patient who has
cardiogenic shock is an indication that the patient may be developing multiple
organ dysfunction syndrome (MODS)?
2|Page
, Adult Health II Final Exam
A. The patient's serum creatinine level is elevated
B. The patient complains of intermittent chest pain
C. The patient has crackles throughout both lung fields
D. The patient's extremities are cool and pulses are weak - ANSWER-A
The elevated serum creatinine level indicates that the patient has renal failure as
well as heart failure. The crackles, chest pressure, and cool extremities are all
consistent with the patient's diagnosis of cardiogenic shock.
1. A patient with septic shock has a BP of 70/46 mm Hg, pulse 136, respirations
32, and blood glucose of 246. Which of these prescribed interventions will the
nurse implement first?
A. Give normal saline IV @ 500 ml / hr
B. Infuse drotrocogin alpha (Xigris) 24 mcg / kg
C. Start insulin drip to maintain blood glucose between 110 and 130 mg / dL
D. Titrate norepinephrine (Levophed) to keep MAP @ 70 mm Hg - ANSWER-A
Because of the low systemic vascular resistance (SVR) associated with septic
shock, fluid resuscitation is the initial therapy. The other actions also are
appropriate and should be initiated quickly as well.
1. When caring for a patient who has septic shock, which assessment finding is
most important for the nurse to report to the health care provider?
A. BP 92/56 mm Hg
B. Skin cool & clammy
3|Page
, Adult Health II Final Exam
C. Apical pulse 118 beats / min
D. Arterial oxygen saturation 91% - ANSWER-B
Since patients in the early stage of septic shock have warm and dry skin, the
patient's cool and clammy skin indicates that shock is progressing. The other
information also will be reported, but does not indicate deterioration of the
patient's status.
1. A patient who has been involved in a motor vehicle crash is admitted to the
emergency room with cool, clammy skin, tachycardia, and hypotension. Which of
the following interventions should the nurse implement first?
A. Place the patient on continuous cardiac monitor
B. Draw blood to type and crossmatch for transfusions
C. Insert two 14-guage IV catheters
D. Administer oxygen @ 100% per non-rebreather mask - ANSWER-D
The first priority in the initial management of shock is maintenance of the airway
and ventilation. Cardiac monitoring, insertion of IV catheters, and obtaining blood
for transfusions also should be rapidly accomplished, but only after actions to
maximize oxygen delivery have been implemented.
1. A patient with shock of unknown etiology whose hemodynamic monitoring
reveals BP 92/54, pulse 64, and an elevated pulmonary artery wedge pressure
(PAWP) has the following collaborative interventions prescribed. Which
intervention will the nurse question?
4|Page
