NR 324 Adult Health II - Exam 1 Study Guide 2026 |Chamberlain
1. A nurse is caring for a patient with a pH of 7.25, PaCO2 of 55, and HCO3 of 24.
Which acid-base imbalance is the patient experiencing?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: The low pH (<7.35) indicates acidosis, and the high PaCO2 (>45) indicates a
respiratory cause, while the HCO3 is normal, confirming uncompensated respiratory
acidosis.
2. Which assessment finding is the most sensitive indicator of altered
neurological status in a critically ill patient?
A. Pupillary reaction to light
B. Motor response to pain
C. Vital sign fluctuations
D. Change in level of consciousness
Answer: D
Rationale: A change in the level of consciousness (LOC) is often the earliest and most
sensitive sign of neurological deterioration.
,3. A patient’s ventilator alarm sounds for ‘High Pressure.’ Which action should
the nurse take first?
A. Assess for kinks in the ventilator tubing
B. Check for a disconnected circuit
C. Manually bag the patient with 100% oxygen
D. Increase the pressure limit setting
Answer: A
Rationale: High-pressure alarms are triggered by increased resistance, such as kinked
tubing, secretions, or the patient biting the tube. Checking for kinks is a quick and non-
invasive first step.
4. In the early (warm) stage of septic shock, which clinical manifestation would
the nurse expect to find?
A. Cool, clammy skin
B. Bradycardia
C. Decreased cardiac output
D. Hyperdynamic state with warm, flushed skin
Answer: D
Rationale: Early septic shock is characterized by a hyperdynamic state, which includes
warm, flushed skin and high cardiac output due to systemic vasodilation.
5. A patient with a chest tube has continuous bubbling in the water-seal
chamber. What does this suggest?
A. There is an air leak in the system
B. The chest tube is functioning normally
C. The lung has fully re-expanded
D. Suction pressure is too high
Answer: A
, Rationale: Intermittent bubbling in the water-seal chamber is normal during expiration or
coughing, but continuous bubbling indicates a leak in the chest tube system.
6. Which medication is the treatment of choice for a patient in Ventricular
Fibrillation?
A. Atropine
B. Epinephrine
C. Adenosine
D. Digoxin
Answer: B
Rationale: During ACLS for VF/pulseless VT, Epinephrine is administered to improve
coronary and cerebral perfusion; Defibrillation is also a primary intervention.
7. A patient is diagnosed with ARDS. Which position is most beneficial for
improving oxygenation?
A. Prone
B. Supine
C. High-Fowler’s
D. Trendelenburg
Answer: A
Rationale: Prone positioning helps redistribute blood flow and air to the dorsal areas of
the lungs, which are better ventilated in ARDS, improving V/Q matching.
8. What is the primary goal of PEEP (Positive End-Expiratory Pressure) in
mechanical ventilation?
A. Decrease the work of breathing
B. Decrease the risk of barotrauma
C. Increase the tidal volume
D. Prevent alveolar collapse at the end of expiration
Answer: D
1. A nurse is caring for a patient with a pH of 7.25, PaCO2 of 55, and HCO3 of 24.
Which acid-base imbalance is the patient experiencing?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Metabolic Alkalosis
D. Respiratory Acidosis
Answer: D
Rationale: The low pH (<7.35) indicates acidosis, and the high PaCO2 (>45) indicates a
respiratory cause, while the HCO3 is normal, confirming uncompensated respiratory
acidosis.
2. Which assessment finding is the most sensitive indicator of altered
neurological status in a critically ill patient?
A. Pupillary reaction to light
B. Motor response to pain
C. Vital sign fluctuations
D. Change in level of consciousness
Answer: D
Rationale: A change in the level of consciousness (LOC) is often the earliest and most
sensitive sign of neurological deterioration.
,3. A patient’s ventilator alarm sounds for ‘High Pressure.’ Which action should
the nurse take first?
A. Assess for kinks in the ventilator tubing
B. Check for a disconnected circuit
C. Manually bag the patient with 100% oxygen
D. Increase the pressure limit setting
Answer: A
Rationale: High-pressure alarms are triggered by increased resistance, such as kinked
tubing, secretions, or the patient biting the tube. Checking for kinks is a quick and non-
invasive first step.
4. In the early (warm) stage of septic shock, which clinical manifestation would
the nurse expect to find?
A. Cool, clammy skin
B. Bradycardia
C. Decreased cardiac output
D. Hyperdynamic state with warm, flushed skin
Answer: D
Rationale: Early septic shock is characterized by a hyperdynamic state, which includes
warm, flushed skin and high cardiac output due to systemic vasodilation.
5. A patient with a chest tube has continuous bubbling in the water-seal
chamber. What does this suggest?
A. There is an air leak in the system
B. The chest tube is functioning normally
C. The lung has fully re-expanded
D. Suction pressure is too high
Answer: A
, Rationale: Intermittent bubbling in the water-seal chamber is normal during expiration or
coughing, but continuous bubbling indicates a leak in the chest tube system.
6. Which medication is the treatment of choice for a patient in Ventricular
Fibrillation?
A. Atropine
B. Epinephrine
C. Adenosine
D. Digoxin
Answer: B
Rationale: During ACLS for VF/pulseless VT, Epinephrine is administered to improve
coronary and cerebral perfusion; Defibrillation is also a primary intervention.
7. A patient is diagnosed with ARDS. Which position is most beneficial for
improving oxygenation?
A. Prone
B. Supine
C. High-Fowler’s
D. Trendelenburg
Answer: A
Rationale: Prone positioning helps redistribute blood flow and air to the dorsal areas of
the lungs, which are better ventilated in ARDS, improving V/Q matching.
8. What is the primary goal of PEEP (Positive End-Expiratory Pressure) in
mechanical ventilation?
A. Decrease the work of breathing
B. Decrease the risk of barotrauma
C. Increase the tidal volume
D. Prevent alveolar collapse at the end of expiration
Answer: D
