NSG 430: ADULT HEALTH NURSING II -
ADVANCED CLINICAL CONCEPTS.
QUESTIONS AND ANSWERS
1. A patient in the ICU is being treated for ARDS and is on mechanical ventilation with high
PEEP settings. The nurse notes a sudden drop in blood pressure and decreased breath sounds
on the right side. Which complication should the nurse suspect first?
A. Pulmonary embolism
B. Myocardial infarction
C. Ventilator-associated pneumonia
D. Tension pneumothorax
Answer: D
Conceptual Explanation: High PEEP (Positive End-Expiratory Pressure) increases the risk
of barotrauma, which can lead to a tension pneumothorax. Clinical signs include sudden
hypotension and absent breath sounds on the affected side.
,2. Which ABG result is most consistent with a patient experiencing early-stage hypovolemic
shock?
A. pH 7.32, PaCO2 48, HCO3 24
B. pH 7.35, PaCO2 45, HCO3 26
C. pH 7.25, PaCO2 35, HCO3 18
D. pH 7.48, PaCO2 30, HCO3 22
Answer: D
Conceptual Explanation: In early shock, compensatory mechanisms like tachypnea lead to
respiratory alkalosis (high pH, low PaCO2) as the body attempts to blow off CO2.
3. A patient with a traumatic brain injury (TBI) has an ICP monitor. The nurse notes the ICP is
22 mmHg and the BP is 100/60 mmHg. What is the calculated Cerebral Perfusion Pressure
(CPP)?
A. 38 mmHg
B. 78 mmHg
C. 51 mmHg
D. 122 mmHg
Answer: C
Conceptual Explanation: MAP = [Systolic + 2(Diastolic)] / 3. MAP = [100 + 120] / 3 = 73.3.
CPP = MAP - ICP. 73.3 - 22 = 51.3 mmHg. A CPP below 60 is concerning for brain ischemia.
, 4. A patient is admitted with Acute Pancreatitis. Which assessment finding is most indicative
of a poor prognosis according to Ranson’s Criteria?
A. Serum amylase > 1000 U/L
B. White blood cell count > 16,000/mm3
C. Abdominal pain radiating to the back
D. Lipase levels 3x the normal limit
Answer: B
Conceptual Explanation: Ranson’s Criteria for assessing severity includes age, WBC count,
blood glucose, AST, and LDH on admission. A WBC > 16,000 is a specific indicator of
severity.
5. During a massive blood transfusion for a trauma patient, the nurse should monitor for
which electrolyte imbalance?
A. Hypercalcemia
B. Hypokalemia
C. Hypocalcemia
D. Hypernatremia
Answer: C
Conceptual Explanation: Citrate is used as an anticoagulant in stored blood; it binds to
calcium, leading to hypocalcemia during rapid, large-volume transfusions.
ADVANCED CLINICAL CONCEPTS.
QUESTIONS AND ANSWERS
1. A patient in the ICU is being treated for ARDS and is on mechanical ventilation with high
PEEP settings. The nurse notes a sudden drop in blood pressure and decreased breath sounds
on the right side. Which complication should the nurse suspect first?
A. Pulmonary embolism
B. Myocardial infarction
C. Ventilator-associated pneumonia
D. Tension pneumothorax
Answer: D
Conceptual Explanation: High PEEP (Positive End-Expiratory Pressure) increases the risk
of barotrauma, which can lead to a tension pneumothorax. Clinical signs include sudden
hypotension and absent breath sounds on the affected side.
,2. Which ABG result is most consistent with a patient experiencing early-stage hypovolemic
shock?
A. pH 7.32, PaCO2 48, HCO3 24
B. pH 7.35, PaCO2 45, HCO3 26
C. pH 7.25, PaCO2 35, HCO3 18
D. pH 7.48, PaCO2 30, HCO3 22
Answer: D
Conceptual Explanation: In early shock, compensatory mechanisms like tachypnea lead to
respiratory alkalosis (high pH, low PaCO2) as the body attempts to blow off CO2.
3. A patient with a traumatic brain injury (TBI) has an ICP monitor. The nurse notes the ICP is
22 mmHg and the BP is 100/60 mmHg. What is the calculated Cerebral Perfusion Pressure
(CPP)?
A. 38 mmHg
B. 78 mmHg
C. 51 mmHg
D. 122 mmHg
Answer: C
Conceptual Explanation: MAP = [Systolic + 2(Diastolic)] / 3. MAP = [100 + 120] / 3 = 73.3.
CPP = MAP - ICP. 73.3 - 22 = 51.3 mmHg. A CPP below 60 is concerning for brain ischemia.
, 4. A patient is admitted with Acute Pancreatitis. Which assessment finding is most indicative
of a poor prognosis according to Ranson’s Criteria?
A. Serum amylase > 1000 U/L
B. White blood cell count > 16,000/mm3
C. Abdominal pain radiating to the back
D. Lipase levels 3x the normal limit
Answer: B
Conceptual Explanation: Ranson’s Criteria for assessing severity includes age, WBC count,
blood glucose, AST, and LDH on admission. A WBC > 16,000 is a specific indicator of
severity.
5. During a massive blood transfusion for a trauma patient, the nurse should monitor for
which electrolyte imbalance?
A. Hypercalcemia
B. Hypokalemia
C. Hypocalcemia
D. Hypernatremia
Answer: C
Conceptual Explanation: Citrate is used as an anticoagulant in stored blood; it binds to
calcium, leading to hypocalcemia during rapid, large-volume transfusions.
