NUR 2502 MULTIDIMENSIONAL CARE
III COMPREHENSIVE EXAM
QUESTIONS AND ANSWERS
1. A patient with a suspected tension pneumothorax is experiencing severe respiratory
distress. Which of the following clinical findings most specifically indicates a tension
pneumothorax rather than a simple pneumothorax?
A. Sudden onset of chest pain
B. Absence of breath sounds on the affected side
C. Tracheal deviation to the unaffected side
D. Tachypnea and tachycardia
Answer: C
Conceptual Explanation: Tracheal deviation is a late and specific sign of tension
pneumothorax caused by significant mediastinal shift due to trapped air. The other signs
are common to both simple and tension pneumothorax.
,2. In a patient with Acute Respiratory Distress Syndrome (ARDS), the nurse notes a decrease
in cardiac output after PEEP is increased to 15 cm H2O. What is the most likely physiological
cause?
A. Increased pulmonary vascular resistance
B. Decreased venous return due to increased intrathoracic pressure
C. Decreased systemic vascular resistance
D. Right ventricular failure due to hypercapnia
Answer: B
Conceptual Explanation: High levels of Positive End-Expiratory Pressure (PEEP) increase
intrathoracic pressure, which compresses the vena cava and decreases venous return
(preload) to the right heart, subsequently lowering cardiac output.
3. A patient in the ICU is being treated for Septic Shock. The hemodynamic profile shows a
CVP of 2 mmHg, a PAWP of 4 mmHg, and a Systemic Vascular Resistance (SVR) of 500
dynes/sec/cm^-5. Which intervention is the highest priority?
A. Administration of Norepinephrine
B. Initiation of broad-spectrum antibiotics
C. Administration of Dobutamine
D. Aggressive fluid resuscitation with crystalloids
Answer: D
, Conceptual Explanation: The low CVP and PAWP indicate hypovolemia. In septic shock,
the initial priority is fluid resuscitation to restore volume before initiating vasopressors
like Norepinephrine.
4. Which of the following EKG changes is most characteristic of hypokalemia?
A. Presence of U waves
B. ST-segment elevation
C. Peaked T waves
D. Widened QRS complex
Answer: A
Conceptual Explanation: Hypokalemia typically presents with flat or inverted T waves
and the presence of U waves. Peaked T waves are associated with hyperkalemia.
5. A patient with a traumatic brain injury is showing signs of Cushing’s Triad. Which set of
vital signs represents this condition?
A. BP 90/60, Pulse 120, Rapid shallow respirations
B. BP 180/60, Pulse 50, irregular respirations
C. BP 120/80, Pulse 70, Eupnea
D. BP 150/100, Pulse 110, Cheyne-Stokes respirations
Answer: B
III COMPREHENSIVE EXAM
QUESTIONS AND ANSWERS
1. A patient with a suspected tension pneumothorax is experiencing severe respiratory
distress. Which of the following clinical findings most specifically indicates a tension
pneumothorax rather than a simple pneumothorax?
A. Sudden onset of chest pain
B. Absence of breath sounds on the affected side
C. Tracheal deviation to the unaffected side
D. Tachypnea and tachycardia
Answer: C
Conceptual Explanation: Tracheal deviation is a late and specific sign of tension
pneumothorax caused by significant mediastinal shift due to trapped air. The other signs
are common to both simple and tension pneumothorax.
,2. In a patient with Acute Respiratory Distress Syndrome (ARDS), the nurse notes a decrease
in cardiac output after PEEP is increased to 15 cm H2O. What is the most likely physiological
cause?
A. Increased pulmonary vascular resistance
B. Decreased venous return due to increased intrathoracic pressure
C. Decreased systemic vascular resistance
D. Right ventricular failure due to hypercapnia
Answer: B
Conceptual Explanation: High levels of Positive End-Expiratory Pressure (PEEP) increase
intrathoracic pressure, which compresses the vena cava and decreases venous return
(preload) to the right heart, subsequently lowering cardiac output.
3. A patient in the ICU is being treated for Septic Shock. The hemodynamic profile shows a
CVP of 2 mmHg, a PAWP of 4 mmHg, and a Systemic Vascular Resistance (SVR) of 500
dynes/sec/cm^-5. Which intervention is the highest priority?
A. Administration of Norepinephrine
B. Initiation of broad-spectrum antibiotics
C. Administration of Dobutamine
D. Aggressive fluid resuscitation with crystalloids
Answer: D
, Conceptual Explanation: The low CVP and PAWP indicate hypovolemia. In septic shock,
the initial priority is fluid resuscitation to restore volume before initiating vasopressors
like Norepinephrine.
4. Which of the following EKG changes is most characteristic of hypokalemia?
A. Presence of U waves
B. ST-segment elevation
C. Peaked T waves
D. Widened QRS complex
Answer: A
Conceptual Explanation: Hypokalemia typically presents with flat or inverted T waves
and the presence of U waves. Peaked T waves are associated with hyperkalemia.
5. A patient with a traumatic brain injury is showing signs of Cushing’s Triad. Which set of
vital signs represents this condition?
A. BP 90/60, Pulse 120, Rapid shallow respirations
B. BP 180/60, Pulse 50, irregular respirations
C. BP 120/80, Pulse 70, Eupnea
D. BP 150/100, Pulse 110, Cheyne-Stokes respirations
Answer: B
