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NR 341 COMPLEX ADULT HEALTH – COMPREHENSIVE
PRACTICE EXAMINATION 2026/2027 COMPLETE (150)
CURRENT TESTING QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES.
NR
Prepare effectively for the NR 341 Exam with this focused study resource. It supports
review of key nursing concepts, patient assessment, clinical reasoning, nursing
interventions, safety, and evidence-based practice relevant to the course. Use the
material to reinforce your knowledge, review high-yield topics, and identify areas that
may require additional study. This resource is suited for nursing students, NR 341
learners, and candidates preparing for the NR 341 examination.
MULTIPLE CHOICE.
SECTION 1: HEMODYNAMICS & SHOCK STATES (Questions 1–25)
1. A patient in the ICU has a pulmonary artery catheter in place. The nurse
notes a cardiac output (CO) of 3.2 L/min, systemic vascular resistance
(SVR) of 1,800 dynes/sec/cm⁻⁵, and a pulmonary artery wedge pressure
(PAWP) of 4 mmHg. Which of the following conditions is MOST consistent
with these findings?
(A) Cardiogenic shock
(B) Hypovolemic shock
(C) Septic shock (early)
(D) Neurogenic shock
Answer: (B) Hypovolemic shock
Rationale: A low PAWP (normal 6–12 mmHg) indicates decreased left
ventricular preload, consistent with hypovolemia. The low cardiac output with
elevated SVR reflects compensatory vasoconstriction, which is characteristic
of hypovolemic shock. Cardiogenic shock would show high PAWP, septic
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shock (early) would show low SVR, and neurogenic shock would show low
SVR with normal CO.
2. The nurse is caring for a patient in septic shock who is receiving
norepinephrine. Which of the following assessment findings indicates the
medication is having the desired effect?
(A) Heart rate decreases from 110 to 90 bpm
(B) Mean arterial pressure (MAP) increases from 55 to 70 mmHg
(C) Central venous pressure (CVP) decreases from 12 to 8 mmHg
(D) Cardiac output decreases from 6.0 to 4.5 L/min
Answer: (B) Mean arterial pressure (MAP) increases from 55 to 70 mmHg
Rationale: Norepinephrine is a vasopressor used to increase systemic
vascular resistance and blood pressure in septic shock. The desired effect is
an increase in MAP to ≥65 mmHg. A MAP of 70 mmHg indicates adequate
perfusion pressure to vital organs.
3. A patient with a history of heart failure is admitted with cardiogenic
shock. Which hemodynamic parameter is MOST consistent with this
diagnosis?
(A) Elevated PAWP and low cardiac output
(B) Low PAWP and low cardiac output
(C) Elevated PAWP and high cardiac output
(D) Low PAWP and high cardiac output
Answer: (A) Elevated PAWP and low cardiac output
Rationale: Cardiogenic shock is characterized by pump failure, resulting in
elevated left ventricular filling pressures (PAWP >18 mmHg) and decreased
cardiac output (CI <2.2 L/min/m²). This distinguishes it from hypovolemic
shock (low PAWP) and distributive shock (low SVR, normal or high CO).
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4. The nurse is caring for a patient with a pulmonary artery catheter.
Which of the following waveforms indicates the catheter is correctly
positioned in the pulmonary artery?
(A) Tall P waves with a deep Q wave
(B) A waveform with a diastolic pressure higher than the pulmonary artery
wedge pressure
(C) A waveform with a dicrotic notch and systolic and diastolic pressures
(D) A waveform with a large "a" wave
Answer: (C) A waveform with a dicrotic notch and systolic and diastolic
pressures
Rationale: When the pulmonary artery catheter is correctly positioned in the
pulmonary artery, the waveform shows a systolic peak, a dicrotic notch
(indicating pulmonic valve closure), and a diastolic pressure. The pulmonary
artery wedge pressure (PAWP) waveform is seen when the balloon is inflated
and the catheter is wedged.
5. A patient in septic shock has a central venous pressure (CVP) of 2
mmHg, heart rate of 120 bpm, and blood pressure of 88/52 mmHg. Which
of the following is the priority nursing intervention?
(A) Administer norepinephrine
(B) Administer a 500 mL fluid bolus of normal saline
(C) Administer dobutamine
(D) Prepare for intubation
Answer: (B) Administer a 500 mL fluid bolus of normal saline
Rationale: In septic shock, the Surviving Sepsis Campaign recommends
initial fluid resuscitation with 30 mL/kg of crystalloid for hypotension or
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lactate ≥4 mmol/L. A low CVP indicates hypovolemia, and fluid resuscitation
is the priority before vasopressors are initiated.
6. The nurse is caring for a patient with neurogenic shock following a C5
spinal cord injury. Which of the following findings is MOST consistent with
this condition?
(A) Hypertension and bradycardia
(B) Hypotension and bradycardia
(C) Hypertension and tachycardia
(D) Hypotension and tachycardia
Answer: (B) Hypotension and bradycardia
Rationale: Neurogenic shock results from loss of sympathetic tone, leading
to vasodilation (hypotension) and unopposed vagal tone (bradycardia). This is
a classic presentation of spinal shock above T6. Hypertension and
bradycardia would suggest autonomic dysreflexia, which occurs in spinal cord
injury above T6 but is a later complication.
7. The nurse is calculating a patient's mean arterial pressure (MAP). The
blood pressure is 110/70 mmHg. What is the MAP?
(A) 73 mmHg
(B) 83 mmHg
(C) 90 mmHg
(D) 95 mmHg
Answer: (B) 83 mmHg
Rationale: MAP = [(2 × diastolic) + systolic] / 3 = [(2 × 70) + 110] / 3 = (140 +
110) / 3 = = 83.3 mmHg. A MAP of ≥65 mmHg is needed for adequate
organ perfusion.
NR 341 COMPLEX ADULT HEALTH – COMPREHENSIVE
PRACTICE EXAMINATION 2026/2027 COMPLETE (150)
CURRENT TESTING QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES.
NR
Prepare effectively for the NR 341 Exam with this focused study resource. It supports
review of key nursing concepts, patient assessment, clinical reasoning, nursing
interventions, safety, and evidence-based practice relevant to the course. Use the
material to reinforce your knowledge, review high-yield topics, and identify areas that
may require additional study. This resource is suited for nursing students, NR 341
learners, and candidates preparing for the NR 341 examination.
MULTIPLE CHOICE.
SECTION 1: HEMODYNAMICS & SHOCK STATES (Questions 1–25)
1. A patient in the ICU has a pulmonary artery catheter in place. The nurse
notes a cardiac output (CO) of 3.2 L/min, systemic vascular resistance
(SVR) of 1,800 dynes/sec/cm⁻⁵, and a pulmonary artery wedge pressure
(PAWP) of 4 mmHg. Which of the following conditions is MOST consistent
with these findings?
(A) Cardiogenic shock
(B) Hypovolemic shock
(C) Septic shock (early)
(D) Neurogenic shock
Answer: (B) Hypovolemic shock
Rationale: A low PAWP (normal 6–12 mmHg) indicates decreased left
ventricular preload, consistent with hypovolemia. The low cardiac output with
elevated SVR reflects compensatory vasoconstriction, which is characteristic
of hypovolemic shock. Cardiogenic shock would show high PAWP, septic
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shock (early) would show low SVR, and neurogenic shock would show low
SVR with normal CO.
2. The nurse is caring for a patient in septic shock who is receiving
norepinephrine. Which of the following assessment findings indicates the
medication is having the desired effect?
(A) Heart rate decreases from 110 to 90 bpm
(B) Mean arterial pressure (MAP) increases from 55 to 70 mmHg
(C) Central venous pressure (CVP) decreases from 12 to 8 mmHg
(D) Cardiac output decreases from 6.0 to 4.5 L/min
Answer: (B) Mean arterial pressure (MAP) increases from 55 to 70 mmHg
Rationale: Norepinephrine is a vasopressor used to increase systemic
vascular resistance and blood pressure in septic shock. The desired effect is
an increase in MAP to ≥65 mmHg. A MAP of 70 mmHg indicates adequate
perfusion pressure to vital organs.
3. A patient with a history of heart failure is admitted with cardiogenic
shock. Which hemodynamic parameter is MOST consistent with this
diagnosis?
(A) Elevated PAWP and low cardiac output
(B) Low PAWP and low cardiac output
(C) Elevated PAWP and high cardiac output
(D) Low PAWP and high cardiac output
Answer: (A) Elevated PAWP and low cardiac output
Rationale: Cardiogenic shock is characterized by pump failure, resulting in
elevated left ventricular filling pressures (PAWP >18 mmHg) and decreased
cardiac output (CI <2.2 L/min/m²). This distinguishes it from hypovolemic
shock (low PAWP) and distributive shock (low SVR, normal or high CO).
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4. The nurse is caring for a patient with a pulmonary artery catheter.
Which of the following waveforms indicates the catheter is correctly
positioned in the pulmonary artery?
(A) Tall P waves with a deep Q wave
(B) A waveform with a diastolic pressure higher than the pulmonary artery
wedge pressure
(C) A waveform with a dicrotic notch and systolic and diastolic pressures
(D) A waveform with a large "a" wave
Answer: (C) A waveform with a dicrotic notch and systolic and diastolic
pressures
Rationale: When the pulmonary artery catheter is correctly positioned in the
pulmonary artery, the waveform shows a systolic peak, a dicrotic notch
(indicating pulmonic valve closure), and a diastolic pressure. The pulmonary
artery wedge pressure (PAWP) waveform is seen when the balloon is inflated
and the catheter is wedged.
5. A patient in septic shock has a central venous pressure (CVP) of 2
mmHg, heart rate of 120 bpm, and blood pressure of 88/52 mmHg. Which
of the following is the priority nursing intervention?
(A) Administer norepinephrine
(B) Administer a 500 mL fluid bolus of normal saline
(C) Administer dobutamine
(D) Prepare for intubation
Answer: (B) Administer a 500 mL fluid bolus of normal saline
Rationale: In septic shock, the Surviving Sepsis Campaign recommends
initial fluid resuscitation with 30 mL/kg of crystalloid for hypotension or
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lactate ≥4 mmol/L. A low CVP indicates hypovolemia, and fluid resuscitation
is the priority before vasopressors are initiated.
6. The nurse is caring for a patient with neurogenic shock following a C5
spinal cord injury. Which of the following findings is MOST consistent with
this condition?
(A) Hypertension and bradycardia
(B) Hypotension and bradycardia
(C) Hypertension and tachycardia
(D) Hypotension and tachycardia
Answer: (B) Hypotension and bradycardia
Rationale: Neurogenic shock results from loss of sympathetic tone, leading
to vasodilation (hypotension) and unopposed vagal tone (bradycardia). This is
a classic presentation of spinal shock above T6. Hypertension and
bradycardia would suggest autonomic dysreflexia, which occurs in spinal cord
injury above T6 but is a later complication.
7. The nurse is calculating a patient's mean arterial pressure (MAP). The
blood pressure is 110/70 mmHg. What is the MAP?
(A) 73 mmHg
(B) 83 mmHg
(C) 90 mmHg
(D) 95 mmHg
Answer: (B) 83 mmHg
Rationale: MAP = [(2 × diastolic) + systolic] / 3 = [(2 × 70) + 110] / 3 = (140 +
110) / 3 = = 83.3 mmHg. A MAP of ≥65 mmHg is needed for adequate
organ perfusion.
