NUR 376 COMPREHENSIVE EXAM
MASTERY (EXAMS 1-4) QUESTIONS
AND ANSWERS
1. A patient in the ICU with ARDS is placed on high-level PEEP. The nurse notes a sudden drop
in cardiac output and blood pressure. What is the most likely physiological cause?
A. Increased left ventricular preload due to thoracic expansion
B. Systemic vasodilation triggered by alveolar recruitment
C. Decreased pulmonary vascular resistance
D. Decreased venous return caused by increased intrathoracic pressure
Answer: D
Conceptual Explanation: High PEEP increases intrathoracic pressure, which compresses
the vena cava and decreases venous return (preload) to the right heart, subsequently
decreasing cardiac output and BP.
2. When interpreting a Swan-Ganz catheter reading, the nurse notes a Pulmonary Artery
Occlusion Pressure (PAOP) of 22 mmHg. Which condition does this most likely indicate?
A. Left-sided heart failure or fluid overload
B. Right ventricular failure
,C. Hypovolemic shock
D. Pulmonary embolism
Answer: A
Conceptual Explanation: Normal PAOP is 8-12 mmHg. An elevation to 22 mmHg suggests
increased pressure in the left atrium, commonly seen in left-sided heart failure or
hypervolemia.
3. A patient presents with the following ABG results: pH 7.28, PaCO2 55, HCO3 28. How
should the nurse interpret this acid-base imbalance?
A. Compensated Metabolic Acidosis
B. Fully Compensated Respiratory Acidosis
C. Uncompensated Metabolic Alkalosis
D. Partially Compensated Respiratory Acidosis
Answer: D
Conceptual Explanation: The pH is low (acidosis), the PaCO2 is high (respiratory cause),
and the HCO3 is high (attempting to compensate), but the pH has not returned to normal,
making it partially compensated.
4. Which assessment finding is a hallmark sign of the ‘Late’ or ‘Cold’ stage of Septic Shock?
A. Increased Cardiac Output and bounding pulses
B. Hypodynamic state with cool, clammy skin and decreased CO
, C. Warm, flushed skin with rapid capillary refill
D. Respiratory alkalosis due to tachypnea
Answer: B
Conceptual Explanation: In late septic shock, the body can no longer compensate; cardiac
output drops, and vasoconstriction occurs to maintain core perfusion, leading to cool,
clammy skin.
5. A patient with a traumatic brain injury (TBI) has an ICP of 22 mmHg. Which of the following
is the priority nursing intervention?
A. Cluster nursing care to promote rest
B. Maintain head of bed at 30 degrees and head in neutral midline position
C. Perform vigorous suctioning every hour to maintain airway
D. Provide Trendelenburg positioning to improve cerebral perfusion
Answer: B
Conceptual Explanation: Neutral head alignment and HOB elevation promote venous
drainage from the brain, helping to lower intracranial pressure. Clustering care and
suctioning can increase ICP.
6. A nurse is caring for a patient with a T4 spinal cord injury. The patient reports a sudden
pounding headache and the BP is 210/110. What is the first action the nurse should take?
A. Elevate the head of the bed to 45-90 degrees
MASTERY (EXAMS 1-4) QUESTIONS
AND ANSWERS
1. A patient in the ICU with ARDS is placed on high-level PEEP. The nurse notes a sudden drop
in cardiac output and blood pressure. What is the most likely physiological cause?
A. Increased left ventricular preload due to thoracic expansion
B. Systemic vasodilation triggered by alveolar recruitment
C. Decreased pulmonary vascular resistance
D. Decreased venous return caused by increased intrathoracic pressure
Answer: D
Conceptual Explanation: High PEEP increases intrathoracic pressure, which compresses
the vena cava and decreases venous return (preload) to the right heart, subsequently
decreasing cardiac output and BP.
2. When interpreting a Swan-Ganz catheter reading, the nurse notes a Pulmonary Artery
Occlusion Pressure (PAOP) of 22 mmHg. Which condition does this most likely indicate?
A. Left-sided heart failure or fluid overload
B. Right ventricular failure
,C. Hypovolemic shock
D. Pulmonary embolism
Answer: A
Conceptual Explanation: Normal PAOP is 8-12 mmHg. An elevation to 22 mmHg suggests
increased pressure in the left atrium, commonly seen in left-sided heart failure or
hypervolemia.
3. A patient presents with the following ABG results: pH 7.28, PaCO2 55, HCO3 28. How
should the nurse interpret this acid-base imbalance?
A. Compensated Metabolic Acidosis
B. Fully Compensated Respiratory Acidosis
C. Uncompensated Metabolic Alkalosis
D. Partially Compensated Respiratory Acidosis
Answer: D
Conceptual Explanation: The pH is low (acidosis), the PaCO2 is high (respiratory cause),
and the HCO3 is high (attempting to compensate), but the pH has not returned to normal,
making it partially compensated.
4. Which assessment finding is a hallmark sign of the ‘Late’ or ‘Cold’ stage of Septic Shock?
A. Increased Cardiac Output and bounding pulses
B. Hypodynamic state with cool, clammy skin and decreased CO
, C. Warm, flushed skin with rapid capillary refill
D. Respiratory alkalosis due to tachypnea
Answer: B
Conceptual Explanation: In late septic shock, the body can no longer compensate; cardiac
output drops, and vasoconstriction occurs to maintain core perfusion, leading to cool,
clammy skin.
5. A patient with a traumatic brain injury (TBI) has an ICP of 22 mmHg. Which of the following
is the priority nursing intervention?
A. Cluster nursing care to promote rest
B. Maintain head of bed at 30 degrees and head in neutral midline position
C. Perform vigorous suctioning every hour to maintain airway
D. Provide Trendelenburg positioning to improve cerebral perfusion
Answer: B
Conceptual Explanation: Neutral head alignment and HOB elevation promote venous
drainage from the brain, helping to lower intracranial pressure. Clustering care and
suctioning can increase ICP.
6. A nurse is caring for a patient with a T4 spinal cord injury. The patient reports a sudden
pounding headache and the BP is 210/110. What is the first action the nurse should take?
A. Elevate the head of the bed to 45-90 degrees
