NSG 430 FINAL EXAM: ADULT HEALTH
NURSING II COMPREHENSIVE REVIEW
1. A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical
ventilation with high levels of positive end-expiratory pressure (PEEP). The nurse should
monitor for which adverse hemodynamic effect?
A. Decreased cardiac output
B. Increased systemic vascular resistance
C. Decreased intracranial pressure
D. Increased left ventricular end-diastolic volume
Answer: A
Conceptual Explanation: High levels of PEEP increase intrathoracic pressure, which can
compress the heart and great vessels, leading to decreased venous return and subsequent
decreased cardiac output.
2. A patient arrives in the ED with suspected septic shock. Which clinical finding should the
nurse prioritize as an indicator of early (hyperdynamic) septic shock?
A. Hypothermia and bradycardia
,B. Warm, flushed skin and high cardiac output
C. Cold, clammy skin and oliguria
D. Low central venous pressure (CVP) and cyanosis
Answer: B
Conceptual Explanation: Early septic shock is characterized by a hyperdynamic state
where vasodilation leads to warm, flushed skin and a compensatory increase in cardiac
output before the patient enters the hypodynamic, cold phase.
3. The nurse is monitoring a patient with a traumatic brain injury. Which clinical
manifestation is most indicative of increasing intracranial pressure (ICP)?
A. Increased heart rate and hypotension
B. Narrowing pulse pressure and tachypnea
C. Widening pulse pressure and bradycardia
D. Hyperactive deep tendon reflexes
Answer: C
Conceptual Explanation: Cushing’s triad, a late sign of increased ICP, includes systolic
hypertension (widening pulse pressure), bradycardia, and irregular respirations.
4. Which lab value is the most specific indicator of acute kidney injury (AKI) in a critically ill
patient?
A. Blood urea nitrogen (BUN)
, B. Serum Creatinine
C. Urine Specific Gravity
D. Serum Potassium
Answer: B
Conceptual Explanation: Creatinine is a more specific indicator of renal function than
BUN because it is not significantly affected by diet or hydration status, though GFR is the
overall best measure.
5. A patient with cirrhosis and esophageal varices is prescribed lactulose. What is the primary
therapeutic goal of this medication?
A. To reduce portal vein pressure
B. To decrease gastric acidity
C. To promote the excretion of ammonia through the stool
D. To prevent gastrointestinal bleeding
Answer: C
Conceptual Explanation: Lactulose is an osmotic laxative used in hepatic encephalopathy
to convert ammonia in the colon to ammonium, which is then excreted, reducing
neurotoxicity.
NURSING II COMPREHENSIVE REVIEW
1. A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical
ventilation with high levels of positive end-expiratory pressure (PEEP). The nurse should
monitor for which adverse hemodynamic effect?
A. Decreased cardiac output
B. Increased systemic vascular resistance
C. Decreased intracranial pressure
D. Increased left ventricular end-diastolic volume
Answer: A
Conceptual Explanation: High levels of PEEP increase intrathoracic pressure, which can
compress the heart and great vessels, leading to decreased venous return and subsequent
decreased cardiac output.
2. A patient arrives in the ED with suspected septic shock. Which clinical finding should the
nurse prioritize as an indicator of early (hyperdynamic) septic shock?
A. Hypothermia and bradycardia
,B. Warm, flushed skin and high cardiac output
C. Cold, clammy skin and oliguria
D. Low central venous pressure (CVP) and cyanosis
Answer: B
Conceptual Explanation: Early septic shock is characterized by a hyperdynamic state
where vasodilation leads to warm, flushed skin and a compensatory increase in cardiac
output before the patient enters the hypodynamic, cold phase.
3. The nurse is monitoring a patient with a traumatic brain injury. Which clinical
manifestation is most indicative of increasing intracranial pressure (ICP)?
A. Increased heart rate and hypotension
B. Narrowing pulse pressure and tachypnea
C. Widening pulse pressure and bradycardia
D. Hyperactive deep tendon reflexes
Answer: C
Conceptual Explanation: Cushing’s triad, a late sign of increased ICP, includes systolic
hypertension (widening pulse pressure), bradycardia, and irregular respirations.
4. Which lab value is the most specific indicator of acute kidney injury (AKI) in a critically ill
patient?
A. Blood urea nitrogen (BUN)
, B. Serum Creatinine
C. Urine Specific Gravity
D. Serum Potassium
Answer: B
Conceptual Explanation: Creatinine is a more specific indicator of renal function than
BUN because it is not significantly affected by diet or hydration status, though GFR is the
overall best measure.
5. A patient with cirrhosis and esophageal varices is prescribed lactulose. What is the primary
therapeutic goal of this medication?
A. To reduce portal vein pressure
B. To decrease gastric acidity
C. To promote the excretion of ammonia through the stool
D. To prevent gastrointestinal bleeding
Answer: C
Conceptual Explanation: Lactulose is an osmotic laxative used in hepatic encephalopathy
to convert ammonia in the colon to ammonium, which is then excreted, reducing
neurotoxicity.
