NR 330 Final Exam: Adult Health II - Chamberlain
University Updated and Latest Questions and Correct
Answers with Rationale
1. A patient in the intensive care unit is diagnosed with ARDS and is being mechanically ventilated. The
nurse notes the PEEP is set at 15 cm H2O. Which assessment finding is most concerning regarding high PEEP
levels?
A. Improved oxygen saturation from 88% to 94%
B. A drop in blood pressure and cardiac output
C. Decreased work of breathing for the patient
D. Normal sinus rhythm on the cardiac monitor
Correct Answer: B
Rationale: High levels of Positive End-Expiratory Pressure (PEEP) are used to improve oxygenation in
ARDS patients. However, excessive PEEP increases intrathoracic pressure, which can impede venous
return to the heart. This reduction in venous return leads to a decrease in cardiac output and systemic
blood pressure. The nurse must monitor hemodynamic status closely when PEEP levels are titrated
upward. Preventing barotrauma and maintaining perfusion are primary goals during high PEEP
ventilation.
2. The nurse is caring for a patient with acute pancreatitis. Which laboratory result would most specifically
indicate the severity of the inflammatory process?
A. Serum amylase 450 U/L
B. Serum lipase 1200 U/L
C. Serum calcium 7.2 mg/dL
,D. White blood cell count 12,000/mm3
Correct Answer: C
Rationale: Hypocalcemia is a significant indicator of severe acute pancreatitis and carries a poor
prognosis. Calcium binds with fatty acids during the process of fat necrosis, a phenomenon known as
saponification. Serum amylase and lipase levels elevate quickly but do not always correlate with the
severity of the disease. A calcium level below 8 mg/dL suggests that the inflammatory process is
extensive and systemic. Nurses must monitor for Trousseau’s or Chvostek’s signs in these patients.
3. A patient with a history of liver cirrhosis is admitted with suspected hepatic encephalopathy. Which
medication should the nurse anticipate administering to reduce ammonia levels?
A. Lactulose
B. Spironolactone
C. Furosemide
D. Propranolol
Correct Answer: A
Rationale: Lactulose is the primary pharmacological treatment for reducing serum ammonia levels in
hepatic encephalopathy. It works by creating an acidic environment in the bowel, which converts
ammonia into ammonium for excretion. The medication also has an osmotic laxative effect, further
promoting the removal of toxins. Patients should typically have two to three soft stools per day to achieve
the therapeutic effect. The nurse must monitor for electrolyte imbalances caused by frequent bowel
movements.
4. Which priority intervention should the nurse implement for a patient experiencing an Addisonian crisis?
A. Administering insulin and dextrose IV
,B. Initiating a fluid restriction of 1000 mL/day
C. Rapid infusion of 0.9% normal saline and hydrocortisone
D. Giving oral potassium supplements immediately
Correct Answer: C
Rationale: Addisonian crisis is a life-threatening emergency characterized by severe hypotension and
electrolyte imbalances. Immediate management requires aggressive fluid resuscitation with normal
saline to restore blood volume. Intravenous hydrocortisone is essential to replace the missing cortisol
and stabilize the patient’s vascular tone. Without these interventions, the patient may progress to
irreversible shock and death. Monitoring for hyperkalemia and hyponatremia is also a critical nursing
responsibility during the crisis.
5. A patient is admitted with Diabetic Ketoacidosis (DKA). The nurse knows that the initial priority of
treatment is which of the following?
A. Administering a bolus of rapid-acting insulin
B. Checking the patient’s potassium level
C. Fluid resuscitation with isotonic saline
D. Setting up a sodium bicarbonate drip
Correct Answer: C
Rationale: The initial priority in DKA management is fluid resuscitation to address profound
dehydration and restore renal perfusion. Isotonic saline is usually administered first to stabilize the
patient’s hemodynamic status. Once fluid levels are being addressed, insulin therapy can be initiated to
correct the hyperglycemia and acidosis. Starting insulin without adequate fluid replacement can lead to
, vascular collapse as water shifts into cells. Potassium monitoring is also vital, but fluid volume
restoration takes precedence in the first hour.
6. The nurse assesses a patient who is post-operative day 1 following a thyroidectomy. The patient reports
tingling in the fingers and around the mouth. Which action is most appropriate?
A. Apply a warm compress to the neck incision
B. Administer a dose of morphine for pain
C. Encourage the patient to cough and deep breathe
D. Assess for a positive Chvostek’s sign
Correct Answer: D
Rationale: Tingling around the mouth and extremities after a thyroidectomy suggests accidental removal
or damage to the parathyroid glands. This leads to hypocalcemia, which causes increased neuromuscular
irritability. Assessing for Chvostek’s sign involves tapping the facial nerve to look for a twitch. If
hypocalcemia is confirmed, the patient will require intravenous calcium gluconate. Prompt identification
is necessary to prevent seizures or laryngospasm in the post-operative period.
7. In the management of a patient with Septic Shock, which clinical finding indicates that the patient is
responding effectively to fluid resuscitation?
A. Central Venous Pressure (CVP) of 2 mmHg
B. Mean Arterial Pressure (MAP) of 55 mmHg
C. Urine output of 0.5 mL/kg/hr or greater
D. Decrease in the heart rate to 110 beats/min
Correct Answer: C
University Updated and Latest Questions and Correct
Answers with Rationale
1. A patient in the intensive care unit is diagnosed with ARDS and is being mechanically ventilated. The
nurse notes the PEEP is set at 15 cm H2O. Which assessment finding is most concerning regarding high PEEP
levels?
A. Improved oxygen saturation from 88% to 94%
B. A drop in blood pressure and cardiac output
C. Decreased work of breathing for the patient
D. Normal sinus rhythm on the cardiac monitor
Correct Answer: B
Rationale: High levels of Positive End-Expiratory Pressure (PEEP) are used to improve oxygenation in
ARDS patients. However, excessive PEEP increases intrathoracic pressure, which can impede venous
return to the heart. This reduction in venous return leads to a decrease in cardiac output and systemic
blood pressure. The nurse must monitor hemodynamic status closely when PEEP levels are titrated
upward. Preventing barotrauma and maintaining perfusion are primary goals during high PEEP
ventilation.
2. The nurse is caring for a patient with acute pancreatitis. Which laboratory result would most specifically
indicate the severity of the inflammatory process?
A. Serum amylase 450 U/L
B. Serum lipase 1200 U/L
C. Serum calcium 7.2 mg/dL
,D. White blood cell count 12,000/mm3
Correct Answer: C
Rationale: Hypocalcemia is a significant indicator of severe acute pancreatitis and carries a poor
prognosis. Calcium binds with fatty acids during the process of fat necrosis, a phenomenon known as
saponification. Serum amylase and lipase levels elevate quickly but do not always correlate with the
severity of the disease. A calcium level below 8 mg/dL suggests that the inflammatory process is
extensive and systemic. Nurses must monitor for Trousseau’s or Chvostek’s signs in these patients.
3. A patient with a history of liver cirrhosis is admitted with suspected hepatic encephalopathy. Which
medication should the nurse anticipate administering to reduce ammonia levels?
A. Lactulose
B. Spironolactone
C. Furosemide
D. Propranolol
Correct Answer: A
Rationale: Lactulose is the primary pharmacological treatment for reducing serum ammonia levels in
hepatic encephalopathy. It works by creating an acidic environment in the bowel, which converts
ammonia into ammonium for excretion. The medication also has an osmotic laxative effect, further
promoting the removal of toxins. Patients should typically have two to three soft stools per day to achieve
the therapeutic effect. The nurse must monitor for electrolyte imbalances caused by frequent bowel
movements.
4. Which priority intervention should the nurse implement for a patient experiencing an Addisonian crisis?
A. Administering insulin and dextrose IV
,B. Initiating a fluid restriction of 1000 mL/day
C. Rapid infusion of 0.9% normal saline and hydrocortisone
D. Giving oral potassium supplements immediately
Correct Answer: C
Rationale: Addisonian crisis is a life-threatening emergency characterized by severe hypotension and
electrolyte imbalances. Immediate management requires aggressive fluid resuscitation with normal
saline to restore blood volume. Intravenous hydrocortisone is essential to replace the missing cortisol
and stabilize the patient’s vascular tone. Without these interventions, the patient may progress to
irreversible shock and death. Monitoring for hyperkalemia and hyponatremia is also a critical nursing
responsibility during the crisis.
5. A patient is admitted with Diabetic Ketoacidosis (DKA). The nurse knows that the initial priority of
treatment is which of the following?
A. Administering a bolus of rapid-acting insulin
B. Checking the patient’s potassium level
C. Fluid resuscitation with isotonic saline
D. Setting up a sodium bicarbonate drip
Correct Answer: C
Rationale: The initial priority in DKA management is fluid resuscitation to address profound
dehydration and restore renal perfusion. Isotonic saline is usually administered first to stabilize the
patient’s hemodynamic status. Once fluid levels are being addressed, insulin therapy can be initiated to
correct the hyperglycemia and acidosis. Starting insulin without adequate fluid replacement can lead to
, vascular collapse as water shifts into cells. Potassium monitoring is also vital, but fluid volume
restoration takes precedence in the first hour.
6. The nurse assesses a patient who is post-operative day 1 following a thyroidectomy. The patient reports
tingling in the fingers and around the mouth. Which action is most appropriate?
A. Apply a warm compress to the neck incision
B. Administer a dose of morphine for pain
C. Encourage the patient to cough and deep breathe
D. Assess for a positive Chvostek’s sign
Correct Answer: D
Rationale: Tingling around the mouth and extremities after a thyroidectomy suggests accidental removal
or damage to the parathyroid glands. This leads to hypocalcemia, which causes increased neuromuscular
irritability. Assessing for Chvostek’s sign involves tapping the facial nerve to look for a twitch. If
hypocalcemia is confirmed, the patient will require intravenous calcium gluconate. Prompt identification
is necessary to prevent seizures or laryngospasm in the post-operative period.
7. In the management of a patient with Septic Shock, which clinical finding indicates that the patient is
responding effectively to fluid resuscitation?
A. Central Venous Pressure (CVP) of 2 mmHg
B. Mean Arterial Pressure (MAP) of 55 mmHg
C. Urine output of 0.5 mL/kg/hr or greater
D. Decrease in the heart rate to 110 beats/min
Correct Answer: C
