NR-341 – Complex Adult Health Advanced nursing course addressing critically ill adults, multisystem disorders, intensive interventions, and complex clinical decision-making.

NR-341 – Complex Adult Health Advanced
nursing course addressing critically ill adults,
multisystem disorders, intensive interventions,
and complex clinical decision-making.


Question 1
A patient in the intensive care unit (ICU) with septic shock has a mean arterial
pressure (MAP) of 55 mm Hg despite fluid resuscitation. The nurse anticipates
which initial vasopressor?
A) Dobutamine
B) Norepinephrine
C) Phenylephrine
D) Epinephrine
Answer: B – *Rationale: Norepinephrine is first-line vasopressor in septic shock
(increases MAP via alpha-1 vasoconstriction, with beta-1 inotropic support).
Dobutamine is for cardiogenic shock.*


Question 2
A patient with acute respiratory distress syndrome (ARDS) is on mechanical
ventilation with a tidal volume of 6 mL/kg predicted body weight. This strategy is
used to:
A) Increase oxygen delivery
B) Prevent ventilator-induced lung injury (volutrauma)
C) Decrease intracranial pressure
D) Improve carbon dioxide elimination
Answer: B – *Rationale: Low tidal volume (6 mL/kg PBW) in ARDS reduces
alveolar overdistention and volutrauma, improving mortality (ARMA trial).*


Question 3

,A patient post-cardiac arrest has a Glasgow Coma Scale score of 5 and is not
following commands. Targeted temperature management (TTM) is initiated.
Which temperature range is recommended?
A) 37.5°C to 38.5°C
B) 32°C to 36°C
C) 28°C to 30°C
D) 36°C to 37.5°C
Answer: B – *Rationale: Current guidelines recommend TTM between 32-36°C
for comatose post-arrest patients to reduce neuronal injury. Avoid hyperthermia.*


Question 4
A patient with acute kidney injury (AKI) in the ICU has a serum potassium of 6.8
mEq/L, ECG with peaked T waves, and wide QRS. Which intervention should the
nurse administer FIRST?
A) Sodium polystyrene sulfonate (Kayexalate) orally
B) Calcium gluconate IV
C) Insulin with dextrose IV
D) Furosemide IV
Answer: B – Rationale: Calcium gluconate stabilizes cardiac membranes
immediately in hyperkalemia. Insulin/glucose shifts K+ into cells; Kayexalate
removes K+ slowly.


Question 5
In a patient with increased intracranial pressure (ICP), which nursing intervention
is most important to maintain cerebral perfusion pressure (CPP)?
A) Keep head of bed flat
B) Maintain MAP ≥90 mm Hg and ICP ≤20 mm Hg
C) Hyperventilate to PaCO2 25 mm Hg
D) Administer hypotonic IV fluids
Answer: B – *Rationale: CPP = MAP – ICP. Target CPP >60 mm Hg. Maintain
MAP (fluids/vasopressors) and reduce ICP. HOB 30° reduces ICP.
Hyperventilation is temporary.*

,Question 6
A patient with severe traumatic brain injury has an ICP of 28 mm Hg and a blood
pressure of 100/60 mm Hg. What is the cerebral perfusion pressure (CPP)?
A) 72 mm Hg
B) 60 mm Hg
C) 48 mm Hg
D) 85 mm Hg
Answer: C – *Rationale: CPP = MAP – ICP. MAP = diastolic + 1/3 pulse pressure
(60 + 40/3 = 73.3). 73.3 – 28 = 45.3 (approx). Given options: 48 is closest. Normal
CPP 60-80.*


Question 7
A patient on mechanical ventilation has a plateau pressure of 35 cm H2O. The
nurse recognizes this as a risk for:
A) Hypotension from decreased preload
B) Barotrauma and alveolar overdistention
C) Auto-PEEP
D) Hypocapnia
Answer: B – *Rationale: Plateau pressure reflects alveolar pressure. Goal <30 cm
H2O to prevent barotrauma/volutrauma. High pressure indicates poor lung
compliance.*


Question 8
A patient with massive pulmonary embolism develops hypotension and right
ventricular dilation on echocardiogram. Which intervention is most appropriate?
A) Heparin infusion alone
B) Systemic thrombolysis (tPA)
C) Placement of inferior vena cava filter
D) Oral anticoagulation

, Answer: B – Rationale: Massive PE with hypotension and RV dysfunction =
indication for thrombolytics (tPA) to reduce mortality. Heparin alone for
submassive PE.


Question 9
A patient with acute decompensated heart failure has an ejection fraction of 25%
and is receiving dobutamine. The nurse monitors for which adverse effect?
A) Hypertension
B) Tachyarrhythmias and increased myocardial oxygen demand
C) Bradycardia
D) Hyperkalemia
Answer: B – *Rationale: Dobutamine (beta-1 agonist) increases contractility and
heart rate → can cause tachycardia, arrhythmias, increased O2 demand, and
ischemia.*


Question 10
A patient in the ICU develops new-onset atrial fibrillation with a ventricular rate of
150 beats per minute, hypotension (BP 85/50), and chest pain. The priority
intervention is:
A) Amiodarone IV bolus
B) Synchronized cardioversion
C) Digoxin IV
D) Beta-blocker IV
Answer: B – Rationale: Unstable atrial fibrillation (hypotension, chest pain, heart
failure) requires immediate synchronized cardioversion. Drugs are for stable
patients.


Question 11
A patient with severe acute pancreatitis develops hypocalcemia. The nurse
understands this is most likely due to:
A) Malabsorption of calcium
B) Saponification of calcium with necrotic fat