NURS 4581 NURSING OF ADULTS 2026
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
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 significant complication?
A. Increased cardiac output
B. Barotrauma and pneumothorax
C. Decreased intracranial pressure
D. Respiratory alkalosis
Answer: B
Conceptual Explanation: High PEEP levels can lead to barotrauma due to excessive
pressure in the alveoli, potentially causing a pneumothorax or tension pneumothorax. It
also tends to decrease cardiac output due to increased intrathoracic pressure.
,2. Which arterial blood gas (ABG) result is most indicative of a patient in the compensatory
stage of shock?
A. pH 7.32, PaCO2 48, HCO3 24
B. pH 7.48, PaCO2 40, HCO3 30
C. pH 7.25, PaCO2 50, HCO3 28
D. pH 7.42, PaCO2 32, HCO3 18
Answer: D
Conceptual Explanation: In the compensatory stage of shock, the body attempts to
counter metabolic acidosis by increasing respirations, leading to respiratory alkalosis
(lowered PaCO2) to bring the pH toward normal (compensated).
3. A nurse is caring for a patient with a Mean Arterial Pressure (MAP) of 55 mmHg. Which
physiological response should the nurse anticipate?
A. Improved renal perfusion
B. Vasodilation of peripheral vessels
C. Decrease in heart rate
D. Release of renin and activation of the RAAS
Answer: D
Conceptual Explanation: A MAP below 60-65 mmHg triggers the RAAS system to
conserve sodium and water and cause vasoconstriction to maintain organ perfusion.
, 4. A patient diagnosed with Pheochromocytoma is admitted. Which nursing intervention is
the highest priority?
A. Monitoring for hypoglycemia
B. Palpating the abdomen to check for masses
C. Administering alpha-adrenergic blockers as ordered
D. Encouraging vigorous physical activity
Answer: C
Conceptual Explanation: Alpha-adrenergic blockers are critical to control hypertension.
Abdominal palpation is contraindicated as it can trigger a sudden release of
catecholamines, causing a hypertensive crisis.
5. During the assessment of a patient with Chronic Kidney Disease (CKD), the nurse notes tall,
peaked T-waves on the ECG. Which medication should the nurse prepare to administer first
to protect the heart?
A. Sodium polystyrene sulfonate
B. Furosemide
C. Insulin and D50W
D. Calcium gluconate
Answer: D
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
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 significant complication?
A. Increased cardiac output
B. Barotrauma and pneumothorax
C. Decreased intracranial pressure
D. Respiratory alkalosis
Answer: B
Conceptual Explanation: High PEEP levels can lead to barotrauma due to excessive
pressure in the alveoli, potentially causing a pneumothorax or tension pneumothorax. It
also tends to decrease cardiac output due to increased intrathoracic pressure.
,2. Which arterial blood gas (ABG) result is most indicative of a patient in the compensatory
stage of shock?
A. pH 7.32, PaCO2 48, HCO3 24
B. pH 7.48, PaCO2 40, HCO3 30
C. pH 7.25, PaCO2 50, HCO3 28
D. pH 7.42, PaCO2 32, HCO3 18
Answer: D
Conceptual Explanation: In the compensatory stage of shock, the body attempts to
counter metabolic acidosis by increasing respirations, leading to respiratory alkalosis
(lowered PaCO2) to bring the pH toward normal (compensated).
3. A nurse is caring for a patient with a Mean Arterial Pressure (MAP) of 55 mmHg. Which
physiological response should the nurse anticipate?
A. Improved renal perfusion
B. Vasodilation of peripheral vessels
C. Decrease in heart rate
D. Release of renin and activation of the RAAS
Answer: D
Conceptual Explanation: A MAP below 60-65 mmHg triggers the RAAS system to
conserve sodium and water and cause vasoconstriction to maintain organ perfusion.
, 4. A patient diagnosed with Pheochromocytoma is admitted. Which nursing intervention is
the highest priority?
A. Monitoring for hypoglycemia
B. Palpating the abdomen to check for masses
C. Administering alpha-adrenergic blockers as ordered
D. Encouraging vigorous physical activity
Answer: C
Conceptual Explanation: Alpha-adrenergic blockers are critical to control hypertension.
Abdominal palpation is contraindicated as it can trigger a sudden release of
catecholamines, causing a hypertensive crisis.
5. During the assessment of a patient with Chronic Kidney Disease (CKD), the nurse notes tall,
peaked T-waves on the ECG. Which medication should the nurse prepare to administer first
to protect the heart?
A. Sodium polystyrene sulfonate
B. Furosemide
C. Insulin and D50W
D. Calcium gluconate
Answer: D
