BSN 346 | BSN346 Exam 2: Concepts of Nursing III -
Nightingale College Updated and Latest Questions
and Correct Answers with Rationale
1. A patient with ARDS is on a ventilator with a high PEEP setting. Which assessment finding
most indicates a complication of high PEEP?
A. Increased oxygen saturation from 88% to 94%
B. Decreased cardiac output and hypotension
C. Bilateral breath sounds with fine crackles
D. Respiratory rate of 18 breaths per minute
Correct Answer: B
Expert Explanation: High levels of PEEP can cause increased intrathoracic pressure which
leads to decreased venous return and subsequent hypotension. Option B is a desired
therapeutic effect of PEEP rather than a complication. Option C suggests the underlying
lung condition but not necessarily a PEEP-specific complication like barotrauma. Option D
reflects a stable respiratory status which is not indicative of an adverse event. The nurse
must monitor hemodynamics closely whenever PEEP levels are adjusted significantly.
2. A patient with chronic kidney disease (CKD) has a serum potassium level of 6.8 mEq/L.
Which intervention should the nurse prioritize first?
A. Administer sodium polystyrene sulfonate orally
B. Initiate a low-potassium diet
C. Obtain an immediate 12-lead ECG
D. Prepare the patient for scheduled hemodialysis
Correct Answer: C
Expert Explanation: The primary concern with severe hyperkalemia is the risk of lethal
cardiac dysrhythmias, necessitating an immediate ECG. Option A is used for potassium
removal but takes longer to work than acute cardiac stabilization. Option C is a long-term
management strategy and is not appropriate for an acute emergency. Option D is necessary
for CKD patients but the immediate safety of the heart must be assessed first. Monitoring
for peaked T-waves or widened QRS complexes is vital in this clinical scenario.
3. A patient in the ICU is being treated for DKA. The current blood glucose is 240 mg/dL. What
is the nurse’s most appropriate next action?
A. Discontinue the intravenous insulin infusion
B. Increase the rate of the normal saline infusion
,C. Administer a bolus of regular insulin
D. Switch the IV fluid to 5% dextrose in 0.45% saline
Correct Answer: D
Expert Explanation: When blood glucose levels reach approximately 250 mg/dL in DKA,
dextrose is added to prevent hypoglycemia and cerebral edema during continued insulin
therapy. Option A is incorrect because insulin must continue until the anion gap closes and
acidosis is resolved. Option C is wrong because bolusing at this stage could cause the
glucose to drop too rapidly. Option D does not address the need to maintain glucose levels
while the insulin drip continues. The goal is a gradual reduction of glucose to ensure
metabolic stability.
4. A patient with liver cirrhosis presents with increased confusion and asterixis. Which lab
result is the nurse most likely to find?
A. Decreased serum creatinine level
B. Elevated serum ammonia level
C. Elevated serum albumin level
D. Decreased prothrombin time (PT)
Correct Answer: B
Expert Explanation: Hepatic encephalopathy is characterized by confusion and a flapping
hand tremor called asterixis, often caused by high ammonia levels. Option B is incorrect
because liver failure often leads to hepatorenal syndrome and increased creatinine. Option
C is wrong as liver failure typically results in hypoalbuminemia due to impaired protein
synthesis. Option D is incorrect because liver damage results in an increased PT due to
fewer clotting factors. Management often involves administering lactulose to reduce
ammonia absorption in the gut.
5. A patient with a head injury has a BP of 180/60, HR 50, and irregular respirations. Which
condition does the nurse suspect?
A. Increased intracranial pressure
B. Septic shock
C. Hypovolemic shock
D. Pulmonary embolism
Correct Answer: A
Expert Explanation: Cushing’s triad, consisting of hypertension with a wide pulse
pressure, bradycardia, and irregular respirations, indicates increased intracranial pressure.
Option A and B are incorrect because shock usually presents with tachycardia and
hypotension. Option D is wrong because PE typically presents with tachycardia and
, tachypnea rather than bradycardia. These findings indicate that the brain is beginning to
herniate and require immediate neurosurgical intervention. The nurse should maintain the
head of the bed at 30 degrees to help lower pressure.
6. A 70kg patient has 40% TBSA burns. Using the Parkland formula (4mL/kg/%TBSA), how
many mL of fluid should be given in the first 8 hours?
A. 11,200 mL
B. 2,800 mL
C. 5,600 mL
D. 1,400 mL
Correct Answer: C
Expert Explanation: The Parkland formula calculates total 24-hour fluid as 4mL x 70kg x
40% = 11,200 mL. Half of this total volume, which is 5,600 mL, must be administered
within the first 8 hours from the time of injury. Option A represents the total 24-hour
volume, not the first 8-hour portion. Option C and D are incorrect calculations based on the
provided formula. Fluid resuscitation is critical in burn management to prevent
hypovolemic shock and maintain organ perfusion.
7. A patient with acute pancreatitis reports severe abdominal pain. Which position should the
nurse encourage to improve comfort?
A. Supine with legs extended
B. Side-lying with knees flexed
C. High-Fowler’s position
D. Trendelenburg position
Correct Answer: B
Expert Explanation: A fetal or side-lying position with knees drawn up to the chest helps
relieve pressure on the inflamed pancreas. Option A increases tension on the abdominal
muscles and typically worsens the pain of pancreatitis. Option B may be helpful for
breathing but is less effective for the specific pain of this condition. Option D is used for
shock and would not benefit a patient with pancreatitis pain. Pain management in these
patients often requires IV opioids along with NPO status to rest the organ.
8. A patient is admitted with a suspected pulmonary embolism. Which diagnostic test is
considered the gold standard for confirmation?
A. Chest X-ray
B. CT pulmonary angiography
C. D-dimer assay
Nightingale College Updated and Latest Questions
and Correct Answers with Rationale
1. A patient with ARDS is on a ventilator with a high PEEP setting. Which assessment finding
most indicates a complication of high PEEP?
A. Increased oxygen saturation from 88% to 94%
B. Decreased cardiac output and hypotension
C. Bilateral breath sounds with fine crackles
D. Respiratory rate of 18 breaths per minute
Correct Answer: B
Expert Explanation: High levels of PEEP can cause increased intrathoracic pressure which
leads to decreased venous return and subsequent hypotension. Option B is a desired
therapeutic effect of PEEP rather than a complication. Option C suggests the underlying
lung condition but not necessarily a PEEP-specific complication like barotrauma. Option D
reflects a stable respiratory status which is not indicative of an adverse event. The nurse
must monitor hemodynamics closely whenever PEEP levels are adjusted significantly.
2. A patient with chronic kidney disease (CKD) has a serum potassium level of 6.8 mEq/L.
Which intervention should the nurse prioritize first?
A. Administer sodium polystyrene sulfonate orally
B. Initiate a low-potassium diet
C. Obtain an immediate 12-lead ECG
D. Prepare the patient for scheduled hemodialysis
Correct Answer: C
Expert Explanation: The primary concern with severe hyperkalemia is the risk of lethal
cardiac dysrhythmias, necessitating an immediate ECG. Option A is used for potassium
removal but takes longer to work than acute cardiac stabilization. Option C is a long-term
management strategy and is not appropriate for an acute emergency. Option D is necessary
for CKD patients but the immediate safety of the heart must be assessed first. Monitoring
for peaked T-waves or widened QRS complexes is vital in this clinical scenario.
3. A patient in the ICU is being treated for DKA. The current blood glucose is 240 mg/dL. What
is the nurse’s most appropriate next action?
A. Discontinue the intravenous insulin infusion
B. Increase the rate of the normal saline infusion
,C. Administer a bolus of regular insulin
D. Switch the IV fluid to 5% dextrose in 0.45% saline
Correct Answer: D
Expert Explanation: When blood glucose levels reach approximately 250 mg/dL in DKA,
dextrose is added to prevent hypoglycemia and cerebral edema during continued insulin
therapy. Option A is incorrect because insulin must continue until the anion gap closes and
acidosis is resolved. Option C is wrong because bolusing at this stage could cause the
glucose to drop too rapidly. Option D does not address the need to maintain glucose levels
while the insulin drip continues. The goal is a gradual reduction of glucose to ensure
metabolic stability.
4. A patient with liver cirrhosis presents with increased confusion and asterixis. Which lab
result is the nurse most likely to find?
A. Decreased serum creatinine level
B. Elevated serum ammonia level
C. Elevated serum albumin level
D. Decreased prothrombin time (PT)
Correct Answer: B
Expert Explanation: Hepatic encephalopathy is characterized by confusion and a flapping
hand tremor called asterixis, often caused by high ammonia levels. Option B is incorrect
because liver failure often leads to hepatorenal syndrome and increased creatinine. Option
C is wrong as liver failure typically results in hypoalbuminemia due to impaired protein
synthesis. Option D is incorrect because liver damage results in an increased PT due to
fewer clotting factors. Management often involves administering lactulose to reduce
ammonia absorption in the gut.
5. A patient with a head injury has a BP of 180/60, HR 50, and irregular respirations. Which
condition does the nurse suspect?
A. Increased intracranial pressure
B. Septic shock
C. Hypovolemic shock
D. Pulmonary embolism
Correct Answer: A
Expert Explanation: Cushing’s triad, consisting of hypertension with a wide pulse
pressure, bradycardia, and irregular respirations, indicates increased intracranial pressure.
Option A and B are incorrect because shock usually presents with tachycardia and
hypotension. Option D is wrong because PE typically presents with tachycardia and
, tachypnea rather than bradycardia. These findings indicate that the brain is beginning to
herniate and require immediate neurosurgical intervention. The nurse should maintain the
head of the bed at 30 degrees to help lower pressure.
6. A 70kg patient has 40% TBSA burns. Using the Parkland formula (4mL/kg/%TBSA), how
many mL of fluid should be given in the first 8 hours?
A. 11,200 mL
B. 2,800 mL
C. 5,600 mL
D. 1,400 mL
Correct Answer: C
Expert Explanation: The Parkland formula calculates total 24-hour fluid as 4mL x 70kg x
40% = 11,200 mL. Half of this total volume, which is 5,600 mL, must be administered
within the first 8 hours from the time of injury. Option A represents the total 24-hour
volume, not the first 8-hour portion. Option C and D are incorrect calculations based on the
provided formula. Fluid resuscitation is critical in burn management to prevent
hypovolemic shock and maintain organ perfusion.
7. A patient with acute pancreatitis reports severe abdominal pain. Which position should the
nurse encourage to improve comfort?
A. Supine with legs extended
B. Side-lying with knees flexed
C. High-Fowler’s position
D. Trendelenburg position
Correct Answer: B
Expert Explanation: A fetal or side-lying position with knees drawn up to the chest helps
relieve pressure on the inflamed pancreas. Option A increases tension on the abdominal
muscles and typically worsens the pain of pancreatitis. Option B may be helpful for
breathing but is less effective for the specific pain of this condition. Option D is used for
shock and would not benefit a patient with pancreatitis pain. Pain management in these
patients often requires IV opioids along with NPO status to rest the organ.
8. A patient is admitted with a suspected pulmonary embolism. Which diagnostic test is
considered the gold standard for confirmation?
A. Chest X-ray
B. CT pulmonary angiography
C. D-dimer assay
