NSG 430 ADULT HEALTH NURSING II
FINAL EXAM QUESTIONS AND
ANSWERS
1. A client with septic shock has a mean arterial pressure (MAP) of 58 mmHg despite receiving
3 liters of 0.9% normal saline. Which prescription should the nurse implement first?
A. Administer 500 mL albumin 5%
B. Insert a peripherally inserted central catheter (PICC)
C. Draw a repeat serum lactate level
D. Initiate a norepinephrine infusion
Answer: D
Conceptual Explanation: Norepinephrine is the first-line vasopressor for septic shock
when fluid resuscitation fails to achieve a MAP of at least 65 mmHg.
2. A client is admitted with Acute Respiratory Distress Syndrome (ARDS). Which mechanical
ventilator setting is most effective in preventing ventilator-induced lung injury (VILI) in this
client?
A. Low tidal volumes (6 mL/kg)
,B. High tidal volumes (12 mL/kg)
C. Positive end-expiratory pressure (PEEP) of 0 cm H2O
D. Pressure support ventilation (PSV) of 20 cm H2O
Answer: A
Conceptual Explanation: Low tidal volume ventilation (6 mL/kg of predicted body
weight) is the gold standard for ARDS to prevent volutrauma and barotrauma.
3. The nurse is caring for a patient with a traumatic brain injury. The patient’s intracranial
pressure (ICP) is 24 mmHg and the MAP is 70 mmHg. What is the calculated Cerebral
Perfusion Pressure (CPP)?
A. 94 mmHg
B. 46 mmHg
C. 50 mmHg
D. 1.6 mmHg
Answer: B
Conceptual Explanation: CPP = MAP - ICP. 70 - 24 = 46 mmHg. A CPP below 50-60 mmHg
indicates inadequate cerebral perfusion.
4. Which assessment finding in a client with a C6 spinal cord injury would alert the nurse to
the development of autonomic dysreflexia?
A. Hypotension and tachycardia
, B. Hyperthermia and dry skin
C. Flaccid paralysis below the level of injury
D. Piloerection and severe headache
Answer: D
Conceptual Explanation: Autonomic dysreflexia is characterized by severe hypertension,
a pounding headache, and piloerection (goosebumps) above the level of injury.
5. A client with chronic kidney disease (CKD) is receiving hemodialysis. During the treatment,
the client complains of a headache, nausea, and becomes confused. What is the nurse’s
priority action?
A. Administer an antiemetic and continue treatment
B. Bolus the client with 500 mL of normal saline
C. Increase the blood flow rate to finish faster
D. Slow or stop the dialysis treatment
Answer: D
Conceptual Explanation: These symptoms suggest Dialysis Disequilibrium Syndrome
(DDS), caused by rapid solute removal. The priority is to slow or stop the procedure to
prevent cerebral edema.
FINAL EXAM QUESTIONS AND
ANSWERS
1. A client with septic shock has a mean arterial pressure (MAP) of 58 mmHg despite receiving
3 liters of 0.9% normal saline. Which prescription should the nurse implement first?
A. Administer 500 mL albumin 5%
B. Insert a peripherally inserted central catheter (PICC)
C. Draw a repeat serum lactate level
D. Initiate a norepinephrine infusion
Answer: D
Conceptual Explanation: Norepinephrine is the first-line vasopressor for septic shock
when fluid resuscitation fails to achieve a MAP of at least 65 mmHg.
2. A client is admitted with Acute Respiratory Distress Syndrome (ARDS). Which mechanical
ventilator setting is most effective in preventing ventilator-induced lung injury (VILI) in this
client?
A. Low tidal volumes (6 mL/kg)
,B. High tidal volumes (12 mL/kg)
C. Positive end-expiratory pressure (PEEP) of 0 cm H2O
D. Pressure support ventilation (PSV) of 20 cm H2O
Answer: A
Conceptual Explanation: Low tidal volume ventilation (6 mL/kg of predicted body
weight) is the gold standard for ARDS to prevent volutrauma and barotrauma.
3. The nurse is caring for a patient with a traumatic brain injury. The patient’s intracranial
pressure (ICP) is 24 mmHg and the MAP is 70 mmHg. What is the calculated Cerebral
Perfusion Pressure (CPP)?
A. 94 mmHg
B. 46 mmHg
C. 50 mmHg
D. 1.6 mmHg
Answer: B
Conceptual Explanation: CPP = MAP - ICP. 70 - 24 = 46 mmHg. A CPP below 50-60 mmHg
indicates inadequate cerebral perfusion.
4. Which assessment finding in a client with a C6 spinal cord injury would alert the nurse to
the development of autonomic dysreflexia?
A. Hypotension and tachycardia
, B. Hyperthermia and dry skin
C. Flaccid paralysis below the level of injury
D. Piloerection and severe headache
Answer: D
Conceptual Explanation: Autonomic dysreflexia is characterized by severe hypertension,
a pounding headache, and piloerection (goosebumps) above the level of injury.
5. A client with chronic kidney disease (CKD) is receiving hemodialysis. During the treatment,
the client complains of a headache, nausea, and becomes confused. What is the nurse’s
priority action?
A. Administer an antiemetic and continue treatment
B. Bolus the client with 500 mL of normal saline
C. Increase the blood flow rate to finish faster
D. Slow or stop the dialysis treatment
Answer: D
Conceptual Explanation: These symptoms suggest Dialysis Disequilibrium Syndrome
(DDS), caused by rapid solute removal. The priority is to slow or stop the procedure to
prevent cerebral edema.
