1
NR 341 COMPLEX ADULT HEALTH EXAM 1
Actual Exam 2026/2027 Complete Questions and
Verified Answers Brand New Version Pass
Guaranteed - A+ Graded
SECTION 1: RESPIRATORY EMERGENCIES (Questions 1-20)
Q1: A patient with ARDS is on mechanical ventilation with low tidal volume (6 mL/kg predicted
body weight) and PEEP of 15 cm H2O. The nurse notes a sudden drop in oxygen saturation from
94% to 82% and absent breath sounds on the left side. What should the nurse do FIRST?
A. Increase FiO2 to 100%
B. Notify the healthcare provider
C. Assess for and prepare for needle decompression of tension pneumothorax. [CORRECT]
D. Suction the endotracheal tube
Correct Answer: C
Rationale: Sudden desaturation with absent breath sounds on one side in a ventilated patient
suggests tension pneumothorax, a life-threatening emergency requiring immediate needle
decompression (C). Increasing FiO2 (A) is secondary. Notifying provider (B) should occur after
immediate intervention. Suctioning (D) is not indicated without signs of airway obstruction.
Q2: A 68-year-old patient with severe community-acquired pneumonia develops acute
respiratory failure with PaO2 58 mmHg on 60% FiO2 via face mask. Which finding indicates the
patient has progressed to ARDS?
A. Bilateral infiltrates on chest x-ray consistent with pulmonary edema
B. PaO2/FiO2 ratio of 120 mmHg [CORRECT]
C. Elevated brain natriuretic peptide (BNP)
D. Unilateral pleural effusion
Correct Answer: B
Rationale: ARDS is defined by a PaO2/FiO2 ratio ≤300 mmHg (mild), ≤200 (moderate), or
≤100 (severe). A ratio of 120 indicates severe ARDS (B). Bilateral infiltrates (A) occur in ARDS
but also cardiogenic edema; BNP (C) suggests cardiac cause; unilateral effusion (D) is not
characteristic of ARDS.
,2
Q3: A patient with a massive pulmonary embolism presents with systolic BP 78/42 mmHg, heart
rate 128 bpm, and altered mental status. Which intervention is the HIGHEST priority?
A. Administer heparin infusion
B. Prepare for systemic thrombolytics [CORRECT]
C. Obtain CT pulmonary angiography
D. Start dobutamine for inotropic support
Correct Answer: B
Rationale: Massive PE with hemodynamic instability requires immediate systemic
thrombolytics to dissolve the clot and restore perfusion (B). Heparin (A) is indicated but
secondary to thrombolytics in massive PE. CT angiography (C) delays critical treatment.
Dobutamine (D) may worsen right ventricular ischemia by increasing oxygen demand.
Q4: A trauma patient with flail chest (ribs 4-7 fractured in two places) exhibits paradoxical chest
wall movement and respiratory distress. Which assessment finding indicates the need for
immediate intubation?
A. Paradoxical movement visible during inspiration
B. Respiratory rate 28 breaths/minute
C. PaCO2 58 mmHg with increasing fatigue [CORRECT]
D. Pain score 8/10
Correct Answer: C
Rationale: Hypercapnia (PaCO2 >45 mmHg) with fatigue indicates impending respiratory
failure requiring mechanical ventilation (C). Paradoxical movement (A) is expected in flail chest.
Tachypnea (B) and pain (D) require intervention but not immediate intubation.
Q5: A ventilated patient triggers a high-pressure alarm. The nurse assesses the patient and finds
decreased breath sounds on the right, tracheal deviation to the left, and neck vein distension.
Which action is MOST appropriate?
A. Increase the tidal volume setting
B. Perform immediate needle decompression at the 2nd intercostal space, midclavicular line on
the right [CORRECT]
C. Administer a bronchodilator via MDI adapter
D. Decrease the PEEP level
Correct Answer: B
Rationale: Tracheal deviation away from the affected side with JVD indicates tension
, 3
pneumothorax, requiring immediate needle decompression (B). Increasing tidal volume (A)
worsens barotrauma. Bronchodilators (C) treat bronchospasm, not pneumothorax. Decreasing
PEEP (D) is inappropriate during a life-threatening emergency.
Q6: A patient with ARDS is receiving prone positioning. Which nursing intervention is
ESSENTIAL during this procedure?
A. Maintain the head of bed at 30 degrees
B. Ensure endotracheal tube is secure and document tube depth before, during, and after turning
[CORRECT]
C. Administer prophylactic antibiotics
D. Place the patient in reverse Trendelenburg position
Correct Answer: B
Rationale: Prone positioning risks accidental extubation and tube displacement; securing and
documenting ET tube depth is critical for airway management (B). Head elevation (A) is not
maintained in prone. Prophylactic antibiotics (C) are not indicated. Reverse Trendelenburg (D) is
not used during proning.
Q7: A patient with severe pneumonia develops septic shock and requires mechanical ventilation.
The nurse notes ventilator-associated pneumonia (VAP) prevention bundle components. Which
intervention has the STRONGEST evidence for VAP prevention?
A. Routine changing of ventilator circuits every 24 hours
B. Elevating head of bed 30-45 degrees and daily sedation interruption [CORRECT]
C. Prophylactic systemic antibiotics
D. Scheduled oropharyngeal suctioning every 2 hours
Correct Answer: B
Rationale: Head elevation prevents aspiration, and daily sedation interruption allows assessment
for extubation readiness, both evidence-based VAP prevention strategies (B). Routine circuit
changes (A) do not prevent VAP and increase costs. Prophylactic antibiotics (C) promote
resistance. Scheduled suctioning (D) lacks evidence for VAP prevention.
Q8: A patient with chest trauma has a chest tube placed for hemothorax. The nurse notes 400 mL
of bright red blood in the collection chamber in the first hour. Which action is the PRIORITY?
A. Strip the chest tube to maintain patency
B. Prepare the patient for emergency thoracotomy [CORRECT]
NR 341 COMPLEX ADULT HEALTH EXAM 1
Actual Exam 2026/2027 Complete Questions and
Verified Answers Brand New Version Pass
Guaranteed - A+ Graded
SECTION 1: RESPIRATORY EMERGENCIES (Questions 1-20)
Q1: A patient with ARDS is on mechanical ventilation with low tidal volume (6 mL/kg predicted
body weight) and PEEP of 15 cm H2O. The nurse notes a sudden drop in oxygen saturation from
94% to 82% and absent breath sounds on the left side. What should the nurse do FIRST?
A. Increase FiO2 to 100%
B. Notify the healthcare provider
C. Assess for and prepare for needle decompression of tension pneumothorax. [CORRECT]
D. Suction the endotracheal tube
Correct Answer: C
Rationale: Sudden desaturation with absent breath sounds on one side in a ventilated patient
suggests tension pneumothorax, a life-threatening emergency requiring immediate needle
decompression (C). Increasing FiO2 (A) is secondary. Notifying provider (B) should occur after
immediate intervention. Suctioning (D) is not indicated without signs of airway obstruction.
Q2: A 68-year-old patient with severe community-acquired pneumonia develops acute
respiratory failure with PaO2 58 mmHg on 60% FiO2 via face mask. Which finding indicates the
patient has progressed to ARDS?
A. Bilateral infiltrates on chest x-ray consistent with pulmonary edema
B. PaO2/FiO2 ratio of 120 mmHg [CORRECT]
C. Elevated brain natriuretic peptide (BNP)
D. Unilateral pleural effusion
Correct Answer: B
Rationale: ARDS is defined by a PaO2/FiO2 ratio ≤300 mmHg (mild), ≤200 (moderate), or
≤100 (severe). A ratio of 120 indicates severe ARDS (B). Bilateral infiltrates (A) occur in ARDS
but also cardiogenic edema; BNP (C) suggests cardiac cause; unilateral effusion (D) is not
characteristic of ARDS.
,2
Q3: A patient with a massive pulmonary embolism presents with systolic BP 78/42 mmHg, heart
rate 128 bpm, and altered mental status. Which intervention is the HIGHEST priority?
A. Administer heparin infusion
B. Prepare for systemic thrombolytics [CORRECT]
C. Obtain CT pulmonary angiography
D. Start dobutamine for inotropic support
Correct Answer: B
Rationale: Massive PE with hemodynamic instability requires immediate systemic
thrombolytics to dissolve the clot and restore perfusion (B). Heparin (A) is indicated but
secondary to thrombolytics in massive PE. CT angiography (C) delays critical treatment.
Dobutamine (D) may worsen right ventricular ischemia by increasing oxygen demand.
Q4: A trauma patient with flail chest (ribs 4-7 fractured in two places) exhibits paradoxical chest
wall movement and respiratory distress. Which assessment finding indicates the need for
immediate intubation?
A. Paradoxical movement visible during inspiration
B. Respiratory rate 28 breaths/minute
C. PaCO2 58 mmHg with increasing fatigue [CORRECT]
D. Pain score 8/10
Correct Answer: C
Rationale: Hypercapnia (PaCO2 >45 mmHg) with fatigue indicates impending respiratory
failure requiring mechanical ventilation (C). Paradoxical movement (A) is expected in flail chest.
Tachypnea (B) and pain (D) require intervention but not immediate intubation.
Q5: A ventilated patient triggers a high-pressure alarm. The nurse assesses the patient and finds
decreased breath sounds on the right, tracheal deviation to the left, and neck vein distension.
Which action is MOST appropriate?
A. Increase the tidal volume setting
B. Perform immediate needle decompression at the 2nd intercostal space, midclavicular line on
the right [CORRECT]
C. Administer a bronchodilator via MDI adapter
D. Decrease the PEEP level
Correct Answer: B
Rationale: Tracheal deviation away from the affected side with JVD indicates tension
, 3
pneumothorax, requiring immediate needle decompression (B). Increasing tidal volume (A)
worsens barotrauma. Bronchodilators (C) treat bronchospasm, not pneumothorax. Decreasing
PEEP (D) is inappropriate during a life-threatening emergency.
Q6: A patient with ARDS is receiving prone positioning. Which nursing intervention is
ESSENTIAL during this procedure?
A. Maintain the head of bed at 30 degrees
B. Ensure endotracheal tube is secure and document tube depth before, during, and after turning
[CORRECT]
C. Administer prophylactic antibiotics
D. Place the patient in reverse Trendelenburg position
Correct Answer: B
Rationale: Prone positioning risks accidental extubation and tube displacement; securing and
documenting ET tube depth is critical for airway management (B). Head elevation (A) is not
maintained in prone. Prophylactic antibiotics (C) are not indicated. Reverse Trendelenburg (D) is
not used during proning.
Q7: A patient with severe pneumonia develops septic shock and requires mechanical ventilation.
The nurse notes ventilator-associated pneumonia (VAP) prevention bundle components. Which
intervention has the STRONGEST evidence for VAP prevention?
A. Routine changing of ventilator circuits every 24 hours
B. Elevating head of bed 30-45 degrees and daily sedation interruption [CORRECT]
C. Prophylactic systemic antibiotics
D. Scheduled oropharyngeal suctioning every 2 hours
Correct Answer: B
Rationale: Head elevation prevents aspiration, and daily sedation interruption allows assessment
for extubation readiness, both evidence-based VAP prevention strategies (B). Routine circuit
changes (A) do not prevent VAP and increase costs. Prophylactic antibiotics (C) promote
resistance. Scheduled suctioning (D) lacks evidence for VAP prevention.
Q8: A patient with chest trauma has a chest tube placed for hemothorax. The nurse notes 400 mL
of bright red blood in the collection chamber in the first hour. Which action is the PRIORITY?
A. Strip the chest tube to maintain patency
B. Prepare the patient for emergency thoracotomy [CORRECT]
