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Exam 4 Final NSG 3800 Med Surg II Exam Questions and
Answers Practice Questions with Solutions Newest |
Already Graded A+
NSG 3800 Medical Surgical II Final Examination Practice Exam
This 180-question examination assesses your mastery of advanced medical-surgical nursing concepts.
Content areas include hemodynamic monitoring, mechanical ventilation, shock states, complex cardiac
and neurological conditions, multisystem organ dysfunction, and advanced pharmacology. Use this
exam to identify knowledge gaps and strengthen your clinical reasoning.
SECTION 1: Hemodynamic Monitoring and Critical Care Foundations
1. A nurse is caring for a client with a pulmonary artery catheter. The nurse notes the following
hemodynamic values: CVP 2 mmHg (normal 2-8), PAP 18/8 mmHg (normal 15-28/5-16), PAWP 4
mmHg (normal 6-12), CO 3.8 L/min (normal 4-8), CI 1.9 L/min/m² (normal 2.5-4.0). Which condition do
these findings most likely indicate?
A. Cardiogenic shock
B. Hypovolemic shock
C. Septic shock (early)
D. Pulmonary hypertension
Answer: B. Hypovolemic shock
Rationale: The hallmark of hypovolemic shock is decreased preload. This is reflected by low filling
pressures: CVP (2 mmHg, normal 2-8), PAWP (4 mmHg, normal 6-12). Cardiac output and cardiac index
are also decreased due to inadequate circulating volume. In contrast, cardiogenic shock presents with
elevated filling pressures (CVP, PAWP) and low CO. Early septic shock presents with low filling pressures
but high or normal CO due to vasodilation.
2. A nurse is caring for a client who is receiving mechanical ventilation. The high-pressure alarm
sounds. The nurse assesses the client and finds they are restless, with decreased breath sounds on the
right side and tracheal deviation to the left. What is the priority nursing action?
A. Suction the endotracheal tube.
B. Notify the healthcare provider immediately.
C. Prepare for needle decompression of the right chest.
D. Increase the FiO₂ to 100%.
,2
Answer: B. Notify the healthcare provider immediately.
Rationale: The client's assessment findings (decreased breath sounds on the right, tracheal deviation to
the left, high-pressure alarm) are classic for a tension pneumothorax, a life-threatening emergency. The
nurse should immediately notify the provider while preparing for emergency needle decompression.
Although the nurse may anticipate the need for decompression, this is a provider-performed procedure
(unless the nurse is credentialed in an advanced role). Suctioning will not resolve a pneumothorax and
may worsen hypoxia.
3. A client with septic shock has the following hemodynamic parameters after fluid resuscitation: CVP
8 mmHg, PAWP 12 mmHg, CO 7.5 L/min, SVR 450 dynes/sec/cm⁻⁵ (normal 800-1200). The nurse
anticipates the provider will order which medication?
A. Dobutamine
B. Nitroprusside
C. Norepinephrine
D. Furosemide
Answer: C. Norepinephrine
Rationale: Septic shock is characterized by distributive shock with profound vasodilation, reflected by a
low systemic vascular resistance (SVR). The client's SVR is 450 (normal 800-1200), indicating
vasodilation. Despite adequate fluid resuscitation (normal filling pressures), hypotension persists due to
low vascular tone. Norepinephrine, a potent vasopressor, is the first-line agent to increase SVR and
blood pressure. Dobutamine is an inotrope used to increase contractility in cardiogenic shock.
4. A nurse is monitoring a client's central venous pressure (CVP) reading. The nurse notes the CVP has
increased from 8 mmHg to 18 mmHg over the past 2 hours. Which of the following assessment
findings would the nurse expect?
A. Flat neck veins and hypotension
B. Jugular vein distention and crackles in the lungs
C. Warm, flushed skin and bounding pulses
D. Decreased urine output and poor skin turgor
Answer: B. Jugular vein distention and crackles in the lungs
Rationale: CVP reflects right ventricular preload. An elevated CVP (normal 2-8 mmHg) indicates
increased right-sided filling pressures, which can be caused by fluid volume overload, right ventricular
failure, or pulmonary hypertension. Clinical manifestations of elevated CVP include jugular vein
distention, peripheral edema, and if the fluid overload is significant, pulmonary congestion (crackles).
Flat neck veins and hypotension would be seen with low CVP.
,3
5. A client with cardiogenic shock has the following hemodynamic parameters: CVP 18 mmHg, PAWP
22 mmHg, CO 3.2 L/min, CI 1.6 L/min/m², SVR 1600 dynes/sec/cm⁻⁵. Which medication order should
the nurse question?
A. Dobutamine 5 mcg/kg/min
B. Norepinephrine 2 mcg/min
C. Furosemide 40 mg IV push
D. Milrinone loading dose followed by infusion
Answer: B. Norepinephrine 2 mcg/min
Rationale: In cardiogenic shock, the primary problem is pump failure, not loss of vascular tone. The
client has an elevated SVR (1600) as a compensatory mechanism. Adding a potent vasoconstrictor like
norepinephrine would further increase afterload, making it even harder for the failing ventricle to eject
blood. This could worsen cardiac output. The appropriate interventions include inotropes (dobutamine,
milrinone) to improve contractility and diuretics (furosemide) to reduce preload and pulmonary
congestion.
6. A nurse is caring for a client with an arterial line in the right radial artery. The nurse notes the
waveform is dampened and the systolic pressure reading is 20 mmHg lower than the previous
reading. What is the priority nursing action?
A. Re-zero the transducer.
B. Assess the tubing for kinks, air bubbles, or clots.
C. Notify the healthcare provider.
D. Remove the arterial line.
Answer: B. Assess the tubing for kinks, air bubbles, or clots.
Rationale: A dampened arterial waveform (loss of the dicrotic notch, flattened appearance) with a
falsely low systolic reading is most commonly caused by a problem with the monitoring system, such as
kinked tubing, air bubbles, a clot at the catheter tip, or a loose connection. The nurse's first action is to
assess and troubleshoot the system. Re-zeroing may be necessary after troubleshooting, but it will not
fix a mechanical obstruction.
7. A nurse is caring for a client who is receiving positive pressure mechanical ventilation. Which of the
following physiological effects should the nurse anticipate?
A. Increased venous return and increased cardiac output
B. Decreased venous return and decreased cardiac output
C. Increased afterload and increased stroke volume
D. Decreased intrathoracic pressure and increased preload
Answer: B. Decreased venous return and decreased cardiac output
, 4
Rationale: Positive pressure ventilation increases intrathoracic pressure throughout the respiratory
cycle. This elevated pressure compresses the vena cava and right atrium, impeding venous return to the
heart. Decreased venous return leads to decreased preload, which can reduce cardiac output, especially
in clients who are hypovolemic. This is why clients on mechanical ventilation may require fluid
resuscitation or vasopressor support.
8. A client with acute respiratory distress syndrome (ARDS) is being mechanically ventilated. The
provider orders an increase in positive end-expiratory pressure (PEEP) from 5 cm H₂O to 15 cm H₂O.
Which of the following is the priority nursing assessment after this change?
A. Oxygen saturation and breath sounds
B. Blood pressure and heart rate
C. Urine output
D. Level of consciousness
Answer: B. Blood pressure and heart rate
Rationale: Increasing PEEP improves oxygenation by recruiting collapsed alveoli, but it also increases
intrathoracic pressure, which can significantly decrease venous return and cardiac output. Hypotension
is a common and potentially serious adverse effect of high PEEP. The nurse's priority is to monitor the
client's hemodynamic status (blood pressure, heart rate) after any increase in PEEP.
9. A nurse is monitoring a client's mixed venous oxygen saturation (SvO₂) via a pulmonary artery
catheter. The nurse notes the SvO₂ has decreased from 70% to 52%. Which of the following
interpretations is correct?
A. Oxygen delivery is exceeding oxygen consumption.
B. Oxygen consumption is exceeding oxygen delivery.
C. The client is hypervolemic.
D. The client is vasodilated.
Answer: B. Oxygen consumption is exceeding oxygen delivery.
Rationale: SvO₂ reflects the balance between oxygen delivery (DO₂) and oxygen consumption (VO₂).
Normal SvO₂ is 60-80%. A decrease in SvO₂ indicates that tissues are extracting more oxygen from the
blood, which occurs when oxygen delivery is decreased (e.g., low cardiac output, anemia, hypoxemia) or
when oxygen consumption is increased (e.g., fever, pain, agitation, shivering). A value of 52% indicates
significant imbalance and requires immediate investigation.
10. A client with a pulmonary artery catheter has the following hemodynamic profile: CVP 14 mmHg,
PAP 42/24 mmHg, PAWP 10 mmHg, CO 4.2 L/min. Which condition is most consistent with these
findings?
Exam 4 Final NSG 3800 Med Surg II Exam Questions and
Answers Practice Questions with Solutions Newest |
Already Graded A+
NSG 3800 Medical Surgical II Final Examination Practice Exam
This 180-question examination assesses your mastery of advanced medical-surgical nursing concepts.
Content areas include hemodynamic monitoring, mechanical ventilation, shock states, complex cardiac
and neurological conditions, multisystem organ dysfunction, and advanced pharmacology. Use this
exam to identify knowledge gaps and strengthen your clinical reasoning.
SECTION 1: Hemodynamic Monitoring and Critical Care Foundations
1. A nurse is caring for a client with a pulmonary artery catheter. The nurse notes the following
hemodynamic values: CVP 2 mmHg (normal 2-8), PAP 18/8 mmHg (normal 15-28/5-16), PAWP 4
mmHg (normal 6-12), CO 3.8 L/min (normal 4-8), CI 1.9 L/min/m² (normal 2.5-4.0). Which condition do
these findings most likely indicate?
A. Cardiogenic shock
B. Hypovolemic shock
C. Septic shock (early)
D. Pulmonary hypertension
Answer: B. Hypovolemic shock
Rationale: The hallmark of hypovolemic shock is decreased preload. This is reflected by low filling
pressures: CVP (2 mmHg, normal 2-8), PAWP (4 mmHg, normal 6-12). Cardiac output and cardiac index
are also decreased due to inadequate circulating volume. In contrast, cardiogenic shock presents with
elevated filling pressures (CVP, PAWP) and low CO. Early septic shock presents with low filling pressures
but high or normal CO due to vasodilation.
2. A nurse is caring for a client who is receiving mechanical ventilation. The high-pressure alarm
sounds. The nurse assesses the client and finds they are restless, with decreased breath sounds on the
right side and tracheal deviation to the left. What is the priority nursing action?
A. Suction the endotracheal tube.
B. Notify the healthcare provider immediately.
C. Prepare for needle decompression of the right chest.
D. Increase the FiO₂ to 100%.
,2
Answer: B. Notify the healthcare provider immediately.
Rationale: The client's assessment findings (decreased breath sounds on the right, tracheal deviation to
the left, high-pressure alarm) are classic for a tension pneumothorax, a life-threatening emergency. The
nurse should immediately notify the provider while preparing for emergency needle decompression.
Although the nurse may anticipate the need for decompression, this is a provider-performed procedure
(unless the nurse is credentialed in an advanced role). Suctioning will not resolve a pneumothorax and
may worsen hypoxia.
3. A client with septic shock has the following hemodynamic parameters after fluid resuscitation: CVP
8 mmHg, PAWP 12 mmHg, CO 7.5 L/min, SVR 450 dynes/sec/cm⁻⁵ (normal 800-1200). The nurse
anticipates the provider will order which medication?
A. Dobutamine
B. Nitroprusside
C. Norepinephrine
D. Furosemide
Answer: C. Norepinephrine
Rationale: Septic shock is characterized by distributive shock with profound vasodilation, reflected by a
low systemic vascular resistance (SVR). The client's SVR is 450 (normal 800-1200), indicating
vasodilation. Despite adequate fluid resuscitation (normal filling pressures), hypotension persists due to
low vascular tone. Norepinephrine, a potent vasopressor, is the first-line agent to increase SVR and
blood pressure. Dobutamine is an inotrope used to increase contractility in cardiogenic shock.
4. A nurse is monitoring a client's central venous pressure (CVP) reading. The nurse notes the CVP has
increased from 8 mmHg to 18 mmHg over the past 2 hours. Which of the following assessment
findings would the nurse expect?
A. Flat neck veins and hypotension
B. Jugular vein distention and crackles in the lungs
C. Warm, flushed skin and bounding pulses
D. Decreased urine output and poor skin turgor
Answer: B. Jugular vein distention and crackles in the lungs
Rationale: CVP reflects right ventricular preload. An elevated CVP (normal 2-8 mmHg) indicates
increased right-sided filling pressures, which can be caused by fluid volume overload, right ventricular
failure, or pulmonary hypertension. Clinical manifestations of elevated CVP include jugular vein
distention, peripheral edema, and if the fluid overload is significant, pulmonary congestion (crackles).
Flat neck veins and hypotension would be seen with low CVP.
,3
5. A client with cardiogenic shock has the following hemodynamic parameters: CVP 18 mmHg, PAWP
22 mmHg, CO 3.2 L/min, CI 1.6 L/min/m², SVR 1600 dynes/sec/cm⁻⁵. Which medication order should
the nurse question?
A. Dobutamine 5 mcg/kg/min
B. Norepinephrine 2 mcg/min
C. Furosemide 40 mg IV push
D. Milrinone loading dose followed by infusion
Answer: B. Norepinephrine 2 mcg/min
Rationale: In cardiogenic shock, the primary problem is pump failure, not loss of vascular tone. The
client has an elevated SVR (1600) as a compensatory mechanism. Adding a potent vasoconstrictor like
norepinephrine would further increase afterload, making it even harder for the failing ventricle to eject
blood. This could worsen cardiac output. The appropriate interventions include inotropes (dobutamine,
milrinone) to improve contractility and diuretics (furosemide) to reduce preload and pulmonary
congestion.
6. A nurse is caring for a client with an arterial line in the right radial artery. The nurse notes the
waveform is dampened and the systolic pressure reading is 20 mmHg lower than the previous
reading. What is the priority nursing action?
A. Re-zero the transducer.
B. Assess the tubing for kinks, air bubbles, or clots.
C. Notify the healthcare provider.
D. Remove the arterial line.
Answer: B. Assess the tubing for kinks, air bubbles, or clots.
Rationale: A dampened arterial waveform (loss of the dicrotic notch, flattened appearance) with a
falsely low systolic reading is most commonly caused by a problem with the monitoring system, such as
kinked tubing, air bubbles, a clot at the catheter tip, or a loose connection. The nurse's first action is to
assess and troubleshoot the system. Re-zeroing may be necessary after troubleshooting, but it will not
fix a mechanical obstruction.
7. A nurse is caring for a client who is receiving positive pressure mechanical ventilation. Which of the
following physiological effects should the nurse anticipate?
A. Increased venous return and increased cardiac output
B. Decreased venous return and decreased cardiac output
C. Increased afterload and increased stroke volume
D. Decreased intrathoracic pressure and increased preload
Answer: B. Decreased venous return and decreased cardiac output
, 4
Rationale: Positive pressure ventilation increases intrathoracic pressure throughout the respiratory
cycle. This elevated pressure compresses the vena cava and right atrium, impeding venous return to the
heart. Decreased venous return leads to decreased preload, which can reduce cardiac output, especially
in clients who are hypovolemic. This is why clients on mechanical ventilation may require fluid
resuscitation or vasopressor support.
8. A client with acute respiratory distress syndrome (ARDS) is being mechanically ventilated. The
provider orders an increase in positive end-expiratory pressure (PEEP) from 5 cm H₂O to 15 cm H₂O.
Which of the following is the priority nursing assessment after this change?
A. Oxygen saturation and breath sounds
B. Blood pressure and heart rate
C. Urine output
D. Level of consciousness
Answer: B. Blood pressure and heart rate
Rationale: Increasing PEEP improves oxygenation by recruiting collapsed alveoli, but it also increases
intrathoracic pressure, which can significantly decrease venous return and cardiac output. Hypotension
is a common and potentially serious adverse effect of high PEEP. The nurse's priority is to monitor the
client's hemodynamic status (blood pressure, heart rate) after any increase in PEEP.
9. A nurse is monitoring a client's mixed venous oxygen saturation (SvO₂) via a pulmonary artery
catheter. The nurse notes the SvO₂ has decreased from 70% to 52%. Which of the following
interpretations is correct?
A. Oxygen delivery is exceeding oxygen consumption.
B. Oxygen consumption is exceeding oxygen delivery.
C. The client is hypervolemic.
D. The client is vasodilated.
Answer: B. Oxygen consumption is exceeding oxygen delivery.
Rationale: SvO₂ reflects the balance between oxygen delivery (DO₂) and oxygen consumption (VO₂).
Normal SvO₂ is 60-80%. A decrease in SvO₂ indicates that tissues are extracting more oxygen from the
blood, which occurs when oxygen delivery is decreased (e.g., low cardiac output, anemia, hypoxemia) or
when oxygen consumption is increased (e.g., fever, pain, agitation, shivering). A value of 52% indicates
significant imbalance and requires immediate investigation.
10. A client with a pulmonary artery catheter has the following hemodynamic profile: CVP 14 mmHg,
PAP 42/24 mmHg, PAWP 10 mmHg, CO 4.2 L/min. Which condition is most consistent with these
findings?
