NSG 3800 Advanced Adult Health Nursing Prep: Master
Complex Multisystem Health Alterations Practice Questions
& Detailed Explanations
Subject / Subtopic: NSG 3800 Advanced Adult Health Nursing – Multisystem
Dysfunction, Shock, and Critical Care
Question 1: A patient in the ICU with severe sepsis is receiving a norepinephrine infusion. The
nurse notes the patient’s mean arterial pressure (MAP) has improved from 50 mmHg to 68
mmHg, but the patient’s extremities are becoming cool and mottled. What is the most
appropriate interpretation of these findings?
A) The norepinephrine dose is too low and should be titrated up immediately.
B) The patient is experiencing peripheral vasoconstriction as a compensatory mechanism for
shock, necessitating careful perfusion monitoring.
C) The norepinephrine has extravasated and requires the immediate administration of
phentolamine.
D) The patient has developed septic emboli, requiring an urgent CT scan.
Correct Answer: B) The patient is experiencing peripheral vasoconstriction as a
compensatory mechanism for shock, necessitating careful perfusion monitoring.
Explanation: Norepinephrine is a potent alpha-agonist that increases systemic vascular
resistance (SVR) to support MAP. Peripheral coolness and mottling are expected consequences
of peripheral vasoconstriction, which shunts blood to vital organs. While this is the intended
mechanism, the nurse must monitor for ischemia (e.g., in fingertips or toes). Increasing the dose
(A) would worsen the perfusion deficit, and there is no evidence of extravasation (C) or emboli
(D).
Question 2: A patient is admitted with blunt force chest trauma. Assessment reveals jugular
venous distention (JVD), hypotension, and muffled heart sounds. Which hemodynamic
intervention is the priority?
A) Rapid administration of 2L of isotonic crystalloid.
B) Preparation for emergent needle pericardiocentesis.
C) Initiation of positive end-expiratory pressure (PEEP) at 15 cmH2O.
D) Administration of a loop diuretic to reduce preload.
Correct Answer: B) Preparation for emergent needle pericardiocentesis.
, Explanation: The patient is exhibiting Beck’s Triad (JVD, hypotension, muffled heart sounds),
which is pathognomonic for cardiac tamponade. This is a life-threatening obstructive shock state
requiring immediate decompression. Fluid resuscitation (A) may provide a temporary bridge but
does not resolve the obstruction. PEEP (C) will increase intrathoracic pressure and potentially
decrease venous return, worsening the tamponade, and diuretics (D) will dangerously reduce
preload in an already obstructed heart.
Question 3: In managing a patient with Acute Respiratory Distress Syndrome (ARDS), the nurse
notes a peak inspiratory pressure (PIP) of 45 cmH2O and a plateau pressure of 40 cmH2O. What
is the most appropriate action based on these findings?
A) Increase the respiratory rate to improve oxygenation.
B) Increase the PEEP to 20 cmH2O to recruit more alveoli.
C) Assess for airway obstruction, such as a mucus plug, as PIP and plateau pressures are both
elevated.
D) Decrease the tidal volume to maintain plateau pressure below 30 cmH2O.
Correct Answer: D) Decrease the tidal volume to maintain plateau pressure below 30
cmH2O.
Explanation: The plateau pressure is the gold standard for measuring alveolar pressure. A
plateau pressure of 40 cmH2O indicates a high risk for barotrauma. Lung-protective ventilation
strategies in ARDS dictate keeping plateau pressures <30 cmH2O, primarily by reducing tidal
volumes. Because both PIP and plateau are elevated, this reflects decreased lung compliance
(stiffness) rather than an isolated airway obstruction (which would show a high PIP but normal
plateau).
Question 4: A patient with a subarachnoid hemorrhage (SAH) is at risk for cerebral vasospasm.
Which medication is the standard of care for prophylaxis against ischemic deficits associated
with vasospasm?
A) Mannitol
B) Nimodipine
C) Phenytoin
D) Dexamethasone
Correct Answer: B) Nimodipine
Explanation: Nimodipine, a calcium channel blocker, is specifically indicated in the management
of SAH to prevent or reduce the severity of secondary cerebral vasospasms. Mannitol (A) is used
Complex Multisystem Health Alterations Practice Questions
& Detailed Explanations
Subject / Subtopic: NSG 3800 Advanced Adult Health Nursing – Multisystem
Dysfunction, Shock, and Critical Care
Question 1: A patient in the ICU with severe sepsis is receiving a norepinephrine infusion. The
nurse notes the patient’s mean arterial pressure (MAP) has improved from 50 mmHg to 68
mmHg, but the patient’s extremities are becoming cool and mottled. What is the most
appropriate interpretation of these findings?
A) The norepinephrine dose is too low and should be titrated up immediately.
B) The patient is experiencing peripheral vasoconstriction as a compensatory mechanism for
shock, necessitating careful perfusion monitoring.
C) The norepinephrine has extravasated and requires the immediate administration of
phentolamine.
D) The patient has developed septic emboli, requiring an urgent CT scan.
Correct Answer: B) The patient is experiencing peripheral vasoconstriction as a
compensatory mechanism for shock, necessitating careful perfusion monitoring.
Explanation: Norepinephrine is a potent alpha-agonist that increases systemic vascular
resistance (SVR) to support MAP. Peripheral coolness and mottling are expected consequences
of peripheral vasoconstriction, which shunts blood to vital organs. While this is the intended
mechanism, the nurse must monitor for ischemia (e.g., in fingertips or toes). Increasing the dose
(A) would worsen the perfusion deficit, and there is no evidence of extravasation (C) or emboli
(D).
Question 2: A patient is admitted with blunt force chest trauma. Assessment reveals jugular
venous distention (JVD), hypotension, and muffled heart sounds. Which hemodynamic
intervention is the priority?
A) Rapid administration of 2L of isotonic crystalloid.
B) Preparation for emergent needle pericardiocentesis.
C) Initiation of positive end-expiratory pressure (PEEP) at 15 cmH2O.
D) Administration of a loop diuretic to reduce preload.
Correct Answer: B) Preparation for emergent needle pericardiocentesis.
, Explanation: The patient is exhibiting Beck’s Triad (JVD, hypotension, muffled heart sounds),
which is pathognomonic for cardiac tamponade. This is a life-threatening obstructive shock state
requiring immediate decompression. Fluid resuscitation (A) may provide a temporary bridge but
does not resolve the obstruction. PEEP (C) will increase intrathoracic pressure and potentially
decrease venous return, worsening the tamponade, and diuretics (D) will dangerously reduce
preload in an already obstructed heart.
Question 3: In managing a patient with Acute Respiratory Distress Syndrome (ARDS), the nurse
notes a peak inspiratory pressure (PIP) of 45 cmH2O and a plateau pressure of 40 cmH2O. What
is the most appropriate action based on these findings?
A) Increase the respiratory rate to improve oxygenation.
B) Increase the PEEP to 20 cmH2O to recruit more alveoli.
C) Assess for airway obstruction, such as a mucus plug, as PIP and plateau pressures are both
elevated.
D) Decrease the tidal volume to maintain plateau pressure below 30 cmH2O.
Correct Answer: D) Decrease the tidal volume to maintain plateau pressure below 30
cmH2O.
Explanation: The plateau pressure is the gold standard for measuring alveolar pressure. A
plateau pressure of 40 cmH2O indicates a high risk for barotrauma. Lung-protective ventilation
strategies in ARDS dictate keeping plateau pressures <30 cmH2O, primarily by reducing tidal
volumes. Because both PIP and plateau are elevated, this reflects decreased lung compliance
(stiffness) rather than an isolated airway obstruction (which would show a high PIP but normal
plateau).
Question 4: A patient with a subarachnoid hemorrhage (SAH) is at risk for cerebral vasospasm.
Which medication is the standard of care for prophylaxis against ischemic deficits associated
with vasospasm?
A) Mannitol
B) Nimodipine
C) Phenytoin
D) Dexamethasone
Correct Answer: B) Nimodipine
Explanation: Nimodipine, a calcium channel blocker, is specifically indicated in the management
of SAH to prevent or reduce the severity of secondary cerebral vasospasms. Mannitol (A) is used
