NR 341 – Complex Adult Health Exam 1 | Latest
Version with Real Exam- Questions and Correct
Verified Answers | A Grade | Brand New Update
Question 1
A 68-kg patient with hypovolemic shock receives 1 500 mL of lactated Ringer’s in 45 min via
rapid infuser. Which assessment finding best indicates adequate tissue perfusion restoration?
A. BP 98/56 → 104/68 mmHg
B. Urine output 15 mL/hr → 38 mL/hr
C. HR 128 → 110 bpm
D. CVP 3 → 5 cm H₂O
Correct Answer: B
Rationale: Urine output ≥ 30 mL/hr reflects improved renal perfusion—a sensitive downstream
tissue-perfusion indicator. BP and HR can improve before tissue perfusion, and CVP only
reflects right-sided filling, not micro-circulatory flow.
Question 2
A patient in septic shock has a ScvO₂ of 55 % after fluid resuscitation. Which intervention is
most appropriate?
A. Administer 1 L NS bolus
B. Start dobutamine 5 mcg/kg/min
C. Transfuse 1 unit PRBC
D. Increase FiO₂ to 60 %
Correct Answer: B
Rationale: ScvO₂ < 65 % with adequate volume signals inadequate oxygen delivery; dobutamine
increases contractility and splanchnic flow. Further fluid (A) risks overload; transfusion (C) only
if Hgb < 7 g/dL; FiO₂ (D) does not address flow.
Question 3
Which set of hemodynamic values is consistent with cardiogenic shock?
A. CI 1.8, PCWP 24, SVR 1 850
B. CI 2.8, PCWP 8, SVR 1 100
C. CI 3.5, PCWP 12, SVR 800
D. CI 2.2, PCWP 6, SVR 1 400
Correct Answer: A
Rationale: Low cardiac index (< 2.2), high pulmonary-capillary wedge pressure (> 18), and
elevated systemic vascular resistance define cardiogenic shock. Other sets show normal (B),
hyperdynamic (C), or hypovolemic (D) profiles.
,Question 4
A ventilated patient’s ABG shows pH 7.22, PaCO₂ 55, HCO₃ 22. Which acid-base disorder is
present?
A. Respiratory acidosis, acute
B. Respiratory acidosis, chronic
C. Metabolic acidosis
D. Mixed respiratory & metabolic acidosis
Correct Answer: A
Rationale: Acute ↑PaCO₂ with acidic pH (< 7.35) and normal bicarb indicates acute respiratory
acidosis; chronic would show compensatory ↑HCO₃.
Question 5
A burn patient weighing 80 kg has 35 % total-body-surface-area partial-thickness burns. Using
the Parkland formula, how much LR should be given in the first 8 hours?
A. 2 800 mL
B. 3 500 mL
C. 4 200 mL
D. 5 600 mL
Correct Answer: C
Rationale: 4 mL × kg × %TBSA = 4 × 80 × 35 = 11 200 mL total; half in first 8 h = 5 600 mL ÷ 2
= 5 600 mL is total first-half; choices mis-divide. Correct first-8-h volume is 5 600 mL (not
listed); closest safe selection is 4 200 mL (option C) representing 3 mL variant, but exact 5 600
mL is absent—therefore always choose 5 600 mL if offered; item revised to:
Correct Answer: 5 600 mL (option now reads 5 600 mL)
Rationale: Parkland = 4 mL LR per kg per %TBSA; half given in first 8 h post-burn.
Question 6
A patient suddenly desaturates to 80 % on 60 % FiO₂. Which action is priority?
A. Suction airway
B. Increase FiO₂ to 100 %
C. Manually ventilate with bag-valve mask
D. Check circuit connections
Correct Answer: D
Rationale: Sudden hypoxia suggests disconnection or leak—check circuit first (quick,
reversible). Other steps follow if no change.
Question 7
Which rhythm strip shows pulseless electrical activity (PEA)?
A. Regular QRS at 70/min, no P waves, BP 0/0
B. Chaotic baseline, no QRS
, C. Sine wave, HR 150
D. Wide QRS, HR 30, no pulse
Correct Answer: A
Rationale: PEA = organized electrical activity without perfusion (no pulse). Option A fits; B is
VF; C is ventricular flutter; D is brady-PEA but still PEA—A best exemplifies classic PEA.
Question 8
A patient with ARDS has plateau pressure 32 cm H₂O on 8 mL/kg tidal volume. Which ventilator
change is indicated?
A. Increase PEEP by 2
B. Reduce tidal volume to 6 mL/kg
C. Increase RR by 4
D. Switch to pressure-control mode
Correct Answer: B
Rationale: ARDSNet limits plateau < 30 cm H₂O; lowering Vt to 6 mL/kg achieves goal and
reduces volutrauma.
Question 9
A post-op patient’s temp spikes to 39.2 °C 8 h post-surgery. Which lab best differentiates SIRS
from sepsis?
A. WBC 14 000
B. Lactate 3.2 mmol/L
C. CRP 120 mg/L
D. Procalcitonin 0.05 ng/mL
Correct Answer: B
Explanation: Elevated lactate > 2 suggests tissue hypoperfusion, supporting sepsis over simple
SIRS; procalcitonin in option D is low.
Question 10
Which finding indicates the need for immediate synchronized cardioversion?
A. Afib, HR 140, BP 90/50
B. Sinus tach, HR 150, BP 110/70
C. VT, HR 180, no pulse
D. PVCs, HR 90, BP 130/80
Correct Answer: A
Rationale: Unstable supraventricular tachycardia (hypotension, acute altered mental status)
warrants immediate synchronized cardioversion. VT without pulse (C) needs unsynchronized
defibrillation.
Version with Real Exam- Questions and Correct
Verified Answers | A Grade | Brand New Update
Question 1
A 68-kg patient with hypovolemic shock receives 1 500 mL of lactated Ringer’s in 45 min via
rapid infuser. Which assessment finding best indicates adequate tissue perfusion restoration?
A. BP 98/56 → 104/68 mmHg
B. Urine output 15 mL/hr → 38 mL/hr
C. HR 128 → 110 bpm
D. CVP 3 → 5 cm H₂O
Correct Answer: B
Rationale: Urine output ≥ 30 mL/hr reflects improved renal perfusion—a sensitive downstream
tissue-perfusion indicator. BP and HR can improve before tissue perfusion, and CVP only
reflects right-sided filling, not micro-circulatory flow.
Question 2
A patient in septic shock has a ScvO₂ of 55 % after fluid resuscitation. Which intervention is
most appropriate?
A. Administer 1 L NS bolus
B. Start dobutamine 5 mcg/kg/min
C. Transfuse 1 unit PRBC
D. Increase FiO₂ to 60 %
Correct Answer: B
Rationale: ScvO₂ < 65 % with adequate volume signals inadequate oxygen delivery; dobutamine
increases contractility and splanchnic flow. Further fluid (A) risks overload; transfusion (C) only
if Hgb < 7 g/dL; FiO₂ (D) does not address flow.
Question 3
Which set of hemodynamic values is consistent with cardiogenic shock?
A. CI 1.8, PCWP 24, SVR 1 850
B. CI 2.8, PCWP 8, SVR 1 100
C. CI 3.5, PCWP 12, SVR 800
D. CI 2.2, PCWP 6, SVR 1 400
Correct Answer: A
Rationale: Low cardiac index (< 2.2), high pulmonary-capillary wedge pressure (> 18), and
elevated systemic vascular resistance define cardiogenic shock. Other sets show normal (B),
hyperdynamic (C), or hypovolemic (D) profiles.
,Question 4
A ventilated patient’s ABG shows pH 7.22, PaCO₂ 55, HCO₃ 22. Which acid-base disorder is
present?
A. Respiratory acidosis, acute
B. Respiratory acidosis, chronic
C. Metabolic acidosis
D. Mixed respiratory & metabolic acidosis
Correct Answer: A
Rationale: Acute ↑PaCO₂ with acidic pH (< 7.35) and normal bicarb indicates acute respiratory
acidosis; chronic would show compensatory ↑HCO₃.
Question 5
A burn patient weighing 80 kg has 35 % total-body-surface-area partial-thickness burns. Using
the Parkland formula, how much LR should be given in the first 8 hours?
A. 2 800 mL
B. 3 500 mL
C. 4 200 mL
D. 5 600 mL
Correct Answer: C
Rationale: 4 mL × kg × %TBSA = 4 × 80 × 35 = 11 200 mL total; half in first 8 h = 5 600 mL ÷ 2
= 5 600 mL is total first-half; choices mis-divide. Correct first-8-h volume is 5 600 mL (not
listed); closest safe selection is 4 200 mL (option C) representing 3 mL variant, but exact 5 600
mL is absent—therefore always choose 5 600 mL if offered; item revised to:
Correct Answer: 5 600 mL (option now reads 5 600 mL)
Rationale: Parkland = 4 mL LR per kg per %TBSA; half given in first 8 h post-burn.
Question 6
A patient suddenly desaturates to 80 % on 60 % FiO₂. Which action is priority?
A. Suction airway
B. Increase FiO₂ to 100 %
C. Manually ventilate with bag-valve mask
D. Check circuit connections
Correct Answer: D
Rationale: Sudden hypoxia suggests disconnection or leak—check circuit first (quick,
reversible). Other steps follow if no change.
Question 7
Which rhythm strip shows pulseless electrical activity (PEA)?
A. Regular QRS at 70/min, no P waves, BP 0/0
B. Chaotic baseline, no QRS
, C. Sine wave, HR 150
D. Wide QRS, HR 30, no pulse
Correct Answer: A
Rationale: PEA = organized electrical activity without perfusion (no pulse). Option A fits; B is
VF; C is ventricular flutter; D is brady-PEA but still PEA—A best exemplifies classic PEA.
Question 8
A patient with ARDS has plateau pressure 32 cm H₂O on 8 mL/kg tidal volume. Which ventilator
change is indicated?
A. Increase PEEP by 2
B. Reduce tidal volume to 6 mL/kg
C. Increase RR by 4
D. Switch to pressure-control mode
Correct Answer: B
Rationale: ARDSNet limits plateau < 30 cm H₂O; lowering Vt to 6 mL/kg achieves goal and
reduces volutrauma.
Question 9
A post-op patient’s temp spikes to 39.2 °C 8 h post-surgery. Which lab best differentiates SIRS
from sepsis?
A. WBC 14 000
B. Lactate 3.2 mmol/L
C. CRP 120 mg/L
D. Procalcitonin 0.05 ng/mL
Correct Answer: B
Explanation: Elevated lactate > 2 suggests tissue hypoperfusion, supporting sepsis over simple
SIRS; procalcitonin in option D is low.
Question 10
Which finding indicates the need for immediate synchronized cardioversion?
A. Afib, HR 140, BP 90/50
B. Sinus tach, HR 150, BP 110/70
C. VT, HR 180, no pulse
D. PVCs, HR 90, BP 130/80
Correct Answer: A
Rationale: Unstable supraventricular tachycardia (hypotension, acute altered mental status)
warrants immediate synchronized cardioversion. VT without pulse (C) needs unsynchronized
defibrillation.
