NR 341 Complex Adult Health ACTUAL EXAM
2026/2027: 100% Verified Questions & Correct
Answers
Question 1:
A 64-year-old with septic shock is on norepinephrine 20 mcg/min. MAP is 58 mmHg, CI 1.9
L/min/m², SVR 680 dynes·s/cm⁵. Which vasoactive agent should be added?
A. Dobutamine
B. Vasopressin 0.03 units/min
C. Epinephrine 50 mcg/min
D. Nitroglycerin 20 mcg/min
Correct Answer: B
Rationale: Vasopressin recruits V1 receptors without β1 stimulation, raising MAP via
complementary pathway and sparing catecholamine dose per Surviving Sepsis 2025 update.
Question 2:
,An ARDS patient on VV-ECMO has PF ratio 65 mmHg, plateau pressure 32 cmH₂O, driving
pressure 18 cmH₂O. Which ventilator change is indicated?
A. Increase PEEP to 20 cmH₂O
B. Reduce tidal volume to 4 mL/kg PBW to achieve driving pressure ≤ 15 cmH₂O
C. Increase RR to 40/min
D. Switch to PC-CMV with ΔP 25 cmH₂O
Correct Answer: B
Rationale: Driving pressure < 15 cmH₂O is the lung-protective target that reduces mortality in
ARDS; lowering VT achieves this while ECMO clears CO₂.
Question 3:
A patient with AKI on CRRT has sudden filter pressure drop and blood leak alarm. Which action is
priority?
A. Increase anticoagulant dose
B. Clamp lines, stop pump, and assess circuit integrity for rupture
C. Flush filter with saline
D. Reduce blood-flow rate
,Correct Answer: B
Rationale: Blood-leak alarm signals membrane rupture; immediate line clamping prevents
exsanguination and infection risk.
Question 4:
PAWP 18 mmHg, CVP 14 mmHg, CI 1.8, SvO₂ 55 %. Which problem is most likely?
A. Hypovolemia
B. Cardiogenic shock
C. Distributive shock
D. Obstructive shock
Correct Answer: B
Rationale: Elevated filling pressures with low CI and SvO₂ indicate left-ventricular failure and
inadequate oxygen delivery consistent with cardiogenic shock.
Question 5:
A patient with TBI (GCS 6) has ICP 28 mmHg, MAP 80 mmHg, PaCO₂ 32 mmHg. Which intervention
is first-line?
, A. Mannitol 1 g/kg
B. Elevate head of bed 30°, maintain neck midline, target PaCO₂ 35 mmHg
C. Pentobarbital coma
D. Hypothermia 34 °C
Correct Answer: B
Rationale: Basic cerebral venous drainage optimization and mild hyperventilation (PaCO₂ 35) lower
ICP rapidly without systemic side effects.
Question 6:
A patient in DKA receives an insulin drip at 0.1 units/kg/hr. Which electrolyte must be repleted once
levels fall below 3.3 mEq/L despite adequate urine output?
A. Phosphate
B. Potassium
C. Magnesium
D. Calcium
Correct Answer: B
2026/2027: 100% Verified Questions & Correct
Answers
Question 1:
A 64-year-old with septic shock is on norepinephrine 20 mcg/min. MAP is 58 mmHg, CI 1.9
L/min/m², SVR 680 dynes·s/cm⁵. Which vasoactive agent should be added?
A. Dobutamine
B. Vasopressin 0.03 units/min
C. Epinephrine 50 mcg/min
D. Nitroglycerin 20 mcg/min
Correct Answer: B
Rationale: Vasopressin recruits V1 receptors without β1 stimulation, raising MAP via
complementary pathway and sparing catecholamine dose per Surviving Sepsis 2025 update.
Question 2:
,An ARDS patient on VV-ECMO has PF ratio 65 mmHg, plateau pressure 32 cmH₂O, driving
pressure 18 cmH₂O. Which ventilator change is indicated?
A. Increase PEEP to 20 cmH₂O
B. Reduce tidal volume to 4 mL/kg PBW to achieve driving pressure ≤ 15 cmH₂O
C. Increase RR to 40/min
D. Switch to PC-CMV with ΔP 25 cmH₂O
Correct Answer: B
Rationale: Driving pressure < 15 cmH₂O is the lung-protective target that reduces mortality in
ARDS; lowering VT achieves this while ECMO clears CO₂.
Question 3:
A patient with AKI on CRRT has sudden filter pressure drop and blood leak alarm. Which action is
priority?
A. Increase anticoagulant dose
B. Clamp lines, stop pump, and assess circuit integrity for rupture
C. Flush filter with saline
D. Reduce blood-flow rate
,Correct Answer: B
Rationale: Blood-leak alarm signals membrane rupture; immediate line clamping prevents
exsanguination and infection risk.
Question 4:
PAWP 18 mmHg, CVP 14 mmHg, CI 1.8, SvO₂ 55 %. Which problem is most likely?
A. Hypovolemia
B. Cardiogenic shock
C. Distributive shock
D. Obstructive shock
Correct Answer: B
Rationale: Elevated filling pressures with low CI and SvO₂ indicate left-ventricular failure and
inadequate oxygen delivery consistent with cardiogenic shock.
Question 5:
A patient with TBI (GCS 6) has ICP 28 mmHg, MAP 80 mmHg, PaCO₂ 32 mmHg. Which intervention
is first-line?
, A. Mannitol 1 g/kg
B. Elevate head of bed 30°, maintain neck midline, target PaCO₂ 35 mmHg
C. Pentobarbital coma
D. Hypothermia 34 °C
Correct Answer: B
Rationale: Basic cerebral venous drainage optimization and mild hyperventilation (PaCO₂ 35) lower
ICP rapidly without systemic side effects.
Question 6:
A patient in DKA receives an insulin drip at 0.1 units/kg/hr. Which electrolyte must be repleted once
levels fall below 3.3 mEq/L despite adequate urine output?
A. Phosphate
B. Potassium
C. Magnesium
D. Calcium
Correct Answer: B
