NURS 354 QUIZ 1: ADVANCED
CLINICAL MANAGEMENT AND
PATHOPHYSIOLOGY. EXAM
QUESTIONS AND ANSWERS
1. A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical
ventilation with high PEEP. Which assessment finding most indicates a complication of high
PEEP settings?
A. Reduced work of breathing
B. Increased arterial oxygen saturation
C. Decreased cardiac output and hypotension
D. Decreased plateau pressure
Answer: C
Conceptual Explanation: High PEEP can increase intrathoracic pressure, leading to
decreased venous return to the heart, which reduces cardiac output and causes
hypotension.
2. In the management of a patient with Diabetic Ketoacidosis (DKA), which lab value should
be monitored most closely before initiating an insulin drip?
A. Serum potassium
,B. Serum sodium
C. Bicarbonate level
D. Hemoglobin A1c
Answer: A
Conceptual Explanation: Insulin causes potassium to shift into the cells; if the patient is
already hypokalemic, starting insulin can cause a fatal drop in serum potassium.
3. A patient presents with Beck’s Triad. Which procedure should the nurse anticipate
immediately?
A. Thoracentesis
B. Chest tube insertion
C. Emergent pericardiocentesis
D. Endotracheal intubation
Answer: C
Conceptual Explanation: Beck’s Triad (muffled heart sounds, JVD, and hypotension)
indicates cardiac tamponade, requiring urgent drainage of fluid from the pericardial sac.
4. Which arterial blood gas (ABG) result reflects fully compensated respiratory acidosis?
A. pH 7.45, PaCO2 30, HCO3 20
B. pH 7.30, PaCO2 55, HCO3 26
, C. pH 7.35, PaCO2 50, HCO3 30
D. pH 7.40, PaCO2 40, HCO3 24
Answer: C
Conceptual Explanation: A pH of 7.35 is on the low end of normal (compensated), PaCO2
is high (acidosis), and HCO3 is high (compensatory base).
5. A patient with a spinal cord injury at T4 reports a sudden, severe headache and is found to
have a BP of 190/110. What is the priority nursing action?
A. Administer PRN antihypertensives
B. Call the physician immediately
C. Place the patient in a supine position
D. Assess for bladder distention
Answer: D
Conceptual Explanation: These are signs of autonomic dysreflexia. The priority is to
remove the triggering stimulus, most commonly a distended bladder or impacted bowel.
6. When assessing a patient with a suspected pheochromocytoma, which action is
contraindicated?
A. Collecting a 24-hour urine sample
B. Monitoring heart rate
C. Palpating the abdomen
CLINICAL MANAGEMENT AND
PATHOPHYSIOLOGY. EXAM
QUESTIONS AND ANSWERS
1. A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical
ventilation with high PEEP. Which assessment finding most indicates a complication of high
PEEP settings?
A. Reduced work of breathing
B. Increased arterial oxygen saturation
C. Decreased cardiac output and hypotension
D. Decreased plateau pressure
Answer: C
Conceptual Explanation: High PEEP can increase intrathoracic pressure, leading to
decreased venous return to the heart, which reduces cardiac output and causes
hypotension.
2. In the management of a patient with Diabetic Ketoacidosis (DKA), which lab value should
be monitored most closely before initiating an insulin drip?
A. Serum potassium
,B. Serum sodium
C. Bicarbonate level
D. Hemoglobin A1c
Answer: A
Conceptual Explanation: Insulin causes potassium to shift into the cells; if the patient is
already hypokalemic, starting insulin can cause a fatal drop in serum potassium.
3. A patient presents with Beck’s Triad. Which procedure should the nurse anticipate
immediately?
A. Thoracentesis
B. Chest tube insertion
C. Emergent pericardiocentesis
D. Endotracheal intubation
Answer: C
Conceptual Explanation: Beck’s Triad (muffled heart sounds, JVD, and hypotension)
indicates cardiac tamponade, requiring urgent drainage of fluid from the pericardial sac.
4. Which arterial blood gas (ABG) result reflects fully compensated respiratory acidosis?
A. pH 7.45, PaCO2 30, HCO3 20
B. pH 7.30, PaCO2 55, HCO3 26
, C. pH 7.35, PaCO2 50, HCO3 30
D. pH 7.40, PaCO2 40, HCO3 24
Answer: C
Conceptual Explanation: A pH of 7.35 is on the low end of normal (compensated), PaCO2
is high (acidosis), and HCO3 is high (compensatory base).
5. A patient with a spinal cord injury at T4 reports a sudden, severe headache and is found to
have a BP of 190/110. What is the priority nursing action?
A. Administer PRN antihypertensives
B. Call the physician immediately
C. Place the patient in a supine position
D. Assess for bladder distention
Answer: D
Conceptual Explanation: These are signs of autonomic dysreflexia. The priority is to
remove the triggering stimulus, most commonly a distended bladder or impacted bowel.
6. When assessing a patient with a suspected pheochromocytoma, which action is
contraindicated?
A. Collecting a 24-hour urine sample
B. Monitoring heart rate
C. Palpating the abdomen
