NUR 417 Care of Adult II EXAM with Questions and
Answers/Plus a Rationale Updated 2026 A+/Instant
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Table of Contents
1. Cardiovascular Disorders and Hemodynamics
2. Respiratory Failure and Mechanical Ventilation
3. Acute Kidney Injury and Renal Replacement Therapy
4. Endocrine Emergencies and Metabolic Regulation
5. Neurological Trauma and Increased Intracranial Pressure
6. Shock States and Multi-Organ Dysfunction Syndrome
7. Advanced Perioperative Nursing Care
1. A patient in the ICU with cardiogenic shock exhibits a narrowing pulse pressure, cool/clammy
extremities, and decreased urine output. Which hemodynamic finding is most consistent with this
assessment?
A. Decreased Systemic Vascular Resistance (SVR)
B. Increased Pulmonary Capillary Wedge Pressure (PCWP)
C. Increased Cardiac Index (CI)
D. Decreased Central Venous Pressure (CVP)
, CORRECT ANSWER : B
Rationale: Cardiogenic shock results in left ventricular failure, leading to fluid backup into the
pulmonary vasculature, which elevates PCWP. SVR is typically increased due to compensatory
vasoconstriction, CI is decreased, and CVP is often elevated, making B the only correct
physiological finding.
2. A patient recovering from a lung resection develops a sudden decrease in tidal volume on the
ventilator and high-pressure alarms. Assessment reveals absent breath sounds on the right side.
What is the priority nursing intervention?
A. Increase the high-pressure alarm limit.
B. Obtain an urgent arterial blood gas (ABG).
C. Prepare for immediate chest tube insertion.
D. Administer a nebulized bronchodilator.
CORRECT ANSWER : C
Rationale: The clinical signs strongly suggest a tension pneumothorax, a life-threatening
complication post-thoracic surgery. Chest tube insertion is required to re-expand the lung; the
other options do not address the acute physiological compromise.
3. A patient is admitted with Acute Kidney Injury (AKI). Laboratory values include potassium 6.2
mEq/L, bicarbonate 18 mEq/L, and BUN 80 mg/dL. The patient is currently asymptomatic.
What is the most appropriate initial management for the electrolyte imbalance?
A. Immediate hemodialysis
B. Administration of sodium polystyrene sulfonate
C. Intravenous calcium gluconate
D. Rapid infusion of normal saline
CORRECT ANSWER : B
Rationale: Sodium polystyrene sulfonate is indicated to reduce serum potassium levels in
asymptomatic patients with moderate hyperkalemia. Calcium gluconate is reserved for ECG
changes, dialysis is for refractory cases, and saline may worsen the patient's fluid status.
4. A patient with Diabetic Ketoacidosis (DKA) is receiving an insulin infusion. Blood glucose has
dropped from 450 mg/dL to 260 mg/dL within 2 hours. Which intervention is indicated at this
time?
, A. Stop the insulin infusion immediately.
B. Initiate Dextrose 5% in the intravenous fluids.
C. Decrease the insulin infusion rate by 50%.
D. Administer a bolus of rapid-acting insulin.
CORRECT ANSWER : B
Rationale: In DKA management, once blood glucose reaches approximately 250 mg/dL, dextrose
is added to prevent hypoglycemia and cerebral edema while continuing the insulin drip to
resolve the underlying ketoacidosis. Stopping insulin or bolusing glucose would be clinically
inappropriate.
5. A patient with a traumatic brain injury (TBI) has an ICP of 22 mmHg. Which nursing action is
contraindicated when managing this patient?
A. Maintaining the head of the bed at 30 degrees.
B. Clustering all nursing care activities to minimize disturbances.
C. Administering stool softeners to prevent straining.
D. Maintaining a neutral neck position to facilitate venous drainage.
CORRECT ANSWER : B
Rationale: Clustering care is contraindicated in patients with elevated ICP because frequent
stimulation and the physical exertion required for multiple tasks can cause transient spikes in
intracranial pressure. The other options are standard, evidence-based measures to protect
cerebral perfusion.
6. A patient is experiencing early signs of septic shock. Despite fluid resuscitation of 30 mL/kg, the
patient’s mean arterial pressure (MAP) remains 55 mmHg. What is the next pharmacological
intervention of choice?
A. Add a second isotonic fluid bolus.
B. Initiate a norepinephrine infusion.
C. Administer low-dose hydrocortisone.
D. Start an infusion of dopamine.
CORRECT ANSWER : B
, Rationale: According to Surviving Sepsis Guidelines, if fluid resuscitation fails to restore a MAP
≥ 65 mmHg, vasopressors are required, with norepinephrine being the first-line choice.
Dopamine is no longer recommended as first-line due to increased mortality, and steroids are
adjunctive, not primary.
7. A patient presents with signs of syndrome of inappropriate antidiuretic hormone (SIADH)
secondary to small cell lung cancer. Which laboratory finding is expected?
A. Serum sodium 150 mEq/L
B. Serum osmolality 260 mOsm/kg
C. Urine specific gravity 1.005
D. Serum potassium 5.5 mEq/L
CORRECT ANSWER : B
Rationale: SIADH is characterized by excessive ADH release, causing water retention and
dilutional hyponatremia, resulting in low serum osmolality. High sodium or low urine specific
gravity would indicate diabetes insipidus, and high potassium is not a primary diagnostic marker
for SIADH.
8. A patient is receiving mechanical ventilation with Pressure Support (PSV). The nurse notes the
patient is tachypneic, accessory muscles are in use, and the high-pressure alarm is sounding.
What is the most likely cause?
A. Disconnection of the ventilator circuit.
B. Excessive sedation.
C. Increased airway resistance or secretions.
D. The patient is fighting the ventilator (asynchrony).
CORRECT ANSWER : C
Rationale: High-pressure alarms in PSV are triggered by increased resistance, such as
secretions, coughing, or bronchospasm. Disconnection causes a low-pressure alarm, sedation
would cause a low respiratory rate/volume, and asynchrony usually presents with varying
pressures, but secretions are the most frequent mechanical trigger.
9. A patient is post-operative day 2 following an abdominal aortic aneurysm (AAA) repair. The
patient suddenly develops hematuria and an output of 15 mL/hour. What is the most critical
assessment?
Answers/Plus a Rationale Updated 2026 A+/Instant
Download PDF
Table of Contents
1. Cardiovascular Disorders and Hemodynamics
2. Respiratory Failure and Mechanical Ventilation
3. Acute Kidney Injury and Renal Replacement Therapy
4. Endocrine Emergencies and Metabolic Regulation
5. Neurological Trauma and Increased Intracranial Pressure
6. Shock States and Multi-Organ Dysfunction Syndrome
7. Advanced Perioperative Nursing Care
1. A patient in the ICU with cardiogenic shock exhibits a narrowing pulse pressure, cool/clammy
extremities, and decreased urine output. Which hemodynamic finding is most consistent with this
assessment?
A. Decreased Systemic Vascular Resistance (SVR)
B. Increased Pulmonary Capillary Wedge Pressure (PCWP)
C. Increased Cardiac Index (CI)
D. Decreased Central Venous Pressure (CVP)
, CORRECT ANSWER : B
Rationale: Cardiogenic shock results in left ventricular failure, leading to fluid backup into the
pulmonary vasculature, which elevates PCWP. SVR is typically increased due to compensatory
vasoconstriction, CI is decreased, and CVP is often elevated, making B the only correct
physiological finding.
2. A patient recovering from a lung resection develops a sudden decrease in tidal volume on the
ventilator and high-pressure alarms. Assessment reveals absent breath sounds on the right side.
What is the priority nursing intervention?
A. Increase the high-pressure alarm limit.
B. Obtain an urgent arterial blood gas (ABG).
C. Prepare for immediate chest tube insertion.
D. Administer a nebulized bronchodilator.
CORRECT ANSWER : C
Rationale: The clinical signs strongly suggest a tension pneumothorax, a life-threatening
complication post-thoracic surgery. Chest tube insertion is required to re-expand the lung; the
other options do not address the acute physiological compromise.
3. A patient is admitted with Acute Kidney Injury (AKI). Laboratory values include potassium 6.2
mEq/L, bicarbonate 18 mEq/L, and BUN 80 mg/dL. The patient is currently asymptomatic.
What is the most appropriate initial management for the electrolyte imbalance?
A. Immediate hemodialysis
B. Administration of sodium polystyrene sulfonate
C. Intravenous calcium gluconate
D. Rapid infusion of normal saline
CORRECT ANSWER : B
Rationale: Sodium polystyrene sulfonate is indicated to reduce serum potassium levels in
asymptomatic patients with moderate hyperkalemia. Calcium gluconate is reserved for ECG
changes, dialysis is for refractory cases, and saline may worsen the patient's fluid status.
4. A patient with Diabetic Ketoacidosis (DKA) is receiving an insulin infusion. Blood glucose has
dropped from 450 mg/dL to 260 mg/dL within 2 hours. Which intervention is indicated at this
time?
, A. Stop the insulin infusion immediately.
B. Initiate Dextrose 5% in the intravenous fluids.
C. Decrease the insulin infusion rate by 50%.
D. Administer a bolus of rapid-acting insulin.
CORRECT ANSWER : B
Rationale: In DKA management, once blood glucose reaches approximately 250 mg/dL, dextrose
is added to prevent hypoglycemia and cerebral edema while continuing the insulin drip to
resolve the underlying ketoacidosis. Stopping insulin or bolusing glucose would be clinically
inappropriate.
5. A patient with a traumatic brain injury (TBI) has an ICP of 22 mmHg. Which nursing action is
contraindicated when managing this patient?
A. Maintaining the head of the bed at 30 degrees.
B. Clustering all nursing care activities to minimize disturbances.
C. Administering stool softeners to prevent straining.
D. Maintaining a neutral neck position to facilitate venous drainage.
CORRECT ANSWER : B
Rationale: Clustering care is contraindicated in patients with elevated ICP because frequent
stimulation and the physical exertion required for multiple tasks can cause transient spikes in
intracranial pressure. The other options are standard, evidence-based measures to protect
cerebral perfusion.
6. A patient is experiencing early signs of septic shock. Despite fluid resuscitation of 30 mL/kg, the
patient’s mean arterial pressure (MAP) remains 55 mmHg. What is the next pharmacological
intervention of choice?
A. Add a second isotonic fluid bolus.
B. Initiate a norepinephrine infusion.
C. Administer low-dose hydrocortisone.
D. Start an infusion of dopamine.
CORRECT ANSWER : B
, Rationale: According to Surviving Sepsis Guidelines, if fluid resuscitation fails to restore a MAP
≥ 65 mmHg, vasopressors are required, with norepinephrine being the first-line choice.
Dopamine is no longer recommended as first-line due to increased mortality, and steroids are
adjunctive, not primary.
7. A patient presents with signs of syndrome of inappropriate antidiuretic hormone (SIADH)
secondary to small cell lung cancer. Which laboratory finding is expected?
A. Serum sodium 150 mEq/L
B. Serum osmolality 260 mOsm/kg
C. Urine specific gravity 1.005
D. Serum potassium 5.5 mEq/L
CORRECT ANSWER : B
Rationale: SIADH is characterized by excessive ADH release, causing water retention and
dilutional hyponatremia, resulting in low serum osmolality. High sodium or low urine specific
gravity would indicate diabetes insipidus, and high potassium is not a primary diagnostic marker
for SIADH.
8. A patient is receiving mechanical ventilation with Pressure Support (PSV). The nurse notes the
patient is tachypneic, accessory muscles are in use, and the high-pressure alarm is sounding.
What is the most likely cause?
A. Disconnection of the ventilator circuit.
B. Excessive sedation.
C. Increased airway resistance or secretions.
D. The patient is fighting the ventilator (asynchrony).
CORRECT ANSWER : C
Rationale: High-pressure alarms in PSV are triggered by increased resistance, such as
secretions, coughing, or bronchospasm. Disconnection causes a low-pressure alarm, sedation
would cause a low respiratory rate/volume, and asynchrony usually presents with varying
pressures, but secretions are the most frequent mechanical trigger.
9. A patient is post-operative day 2 following an abdominal aortic aneurysm (AAA) repair. The
patient suddenly develops hematuria and an output of 15 mL/hour. What is the most critical
assessment?
