GALEN COLLEGE NSG 3280 EXAM 4
QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT
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Core Domains
• Advanced Medical-Surgical Nursing
• Critical Care Nursing Principles
• Fluid, Electrolyte, and Acid-Base Balance
• Cardiovascular and Respiratory Disorders
• Neurological and Endocrine Emergencies
• Renal and Gastrointestinal Dysfunction
• Multisystem Organ Failure and Shock States
• Pharmacology and Nursing Interventions in Acute Care
• Ethical and Legal Considerations in Critical Care
• Disaster Preparedness and Triage
Introduction
This comprehensive assessment is designed to evaluate the advanced
nursing knowledge and clinical judgment required for success in NSG
3280. The examination focuses on the care of acutely and critically ill
patients across the lifespan, emphasizing evidence-based interventions,
hemodynamic monitoring, and rapid clinical decision-making. The
questions are structured to test both foundational pathophysiological
concepts and their application in complex, high-acuity scenarios. Students
will be expected to interpret clinical data, prioritize nursing actions, and
,evaluate the efficacy of treatments. This resource serves as a definitive tool
for exam preparation and self-assessment, ensuring readiness for the
rigors of Galen College's nursing curriculum and the NCLEX-RN
examination.
SECTION ONE: QUESTIONS 1 – 100
1. A patient with severe sepsis is exhibiting signs of inadequate
tissue perfusion. Which hemodynamic parameter is most indicative
of decreased cardiac output?
A. Increased central venous pressure (CVP)
B. Decreased pulmonary artery wedge pressure (PAWP)
C. Increased systemic vascular resistance (SVR)
D. Decreased mixed venous oxygen saturation (SvO2)
D. Decreased mixed venous oxygen saturation (SvO2)
RATIONALE: SvO2 reflects the balance between oxygen delivery
and consumption. A decrease indicates that tissues are extracting more
oxygen due to inadequate delivery from low cardiac output. CVP and
PAWP reflect filling pressures and can be elevated in failure, while SVR
is a measure of afterload.
2. A patient is receiving a continuous infusion of norepinephrine.
Which assessment finding indicates a desired therapeutic effect?
A. Heart rate decreases to 60 bpm.
B. Urine output increases to 40 mL/hr.
C. Systolic blood pressure increases to 100 mmHg.
D. Capillary refill time is 4 seconds.
C. Systolic blood pressure increases to 100 mmHg.
RATIONALE: Norepinephrine is a potent vasopressor that increases
systemic vascular resistance and blood pressure. The desired effect is
the restoration of adequate mean arterial pressure (MAP) to ensure
organ perfusion. A MAP target is often >65 mmHg.
,3. The nurse is caring for a patient with diabetic ketoacidosis
(DKA). Which laboratory value indicates the most critical risk for
cerebral edema during treatment?
A. Serum glucose of 400 mg/dL
B. Serum potassium of 3.0 mEq/L
C. Serum sodium of 155 mEq/L
D. Serum bicarbonate of 10 mEq/L
C. Serum sodium of 155 mEq/L
RATIONALE: Hypertonicity from severe hypernatremia, particularly
when corrected rapidly, creates a significant osmotic gradient that can
cause fluid to shift into the brain, leading to cerebral edema. While other
labs are abnormal, this is the most direct risk factor for this life-
threatening complication.
4. A patient in the ICU has a pulmonary artery (PA) catheter. The
nurse notes a sudden increase in the pulmonary artery wedge
pressure (PAWP) from 12 mmHg to 25 mmHg. Which condition is
the most likely cause?
A. Hypovolemia
B. Cardiac tamponade
C. Acute mitral regurgitation
D. Pulmonary embolism
C. Acute mitral regurgitation
RATIONALE: Acute mitral regurgitation causes a rapid rise in left
atrial pressure, which is reflected in the PAWP. Hypovolemia would
decrease PAWP, tamponade would cause equalization of pressures, and
a large pulmonary embolism would not acutely increase left-sided filling
pressures.
5. Which nursing intervention is most appropriate for a patient with
a suspected pulmonary embolism (PE) who is experiencing severe
dyspnea and chest pain?
A. Ambulate the patient to promote circulation.
, B. Administer a stool softener to prevent straining.
C. Apply warm compresses to the chest wall.
D. Instruct the patient to cough and deep breathe.
B. Administer a stool softener to prevent straining.
RATIONALE: In the acute phase of a PE, preventing complications is
key. Straining can increase intrathoracic pressure and worsen dyspnea
or precipitate cardiac arrhythmias. Ambulation is contraindicated until
stable, and interventions must be aimed at reducing oxygen demand
and preventing embolic recurrence.
6. A patient with acute respiratory distress syndrome (ARDS) is on a
mechanical ventilator. The nurse recognizes a plateau pressure of
35 cm H2O is a concern primarily because it indicates:
A. Increased airway resistance
B. Risk of volutrauma
C. Alveolar overdistension
D. Decreased lung compliance
C. Alveolar overdistension
RATIONALE: Plateau pressure reflects alveolar pressure at end-
inspiration. A pressure >30 cm H2O significantly increases the risk of
alveolar overdistension, which is a form of ventilator-induced lung injury
(VILI) known as volutrauma.
7. A patient in a hemorrhagic shock state is receiving massive fluid
resuscitation. Which clinical manifestation is the earliest indicator
of fluid overload?
A. Jugular venous distention
B. Peripheral edema
C. Dyspnea with crackles
D. Increased body weight
A. Jugular venous distention
RATIONALE: Jugular venous distention is an early clinical sign of
increased central venous pressure and right heart strain, often
QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT
DOWNLOAD PDF
Core Domains
• Advanced Medical-Surgical Nursing
• Critical Care Nursing Principles
• Fluid, Electrolyte, and Acid-Base Balance
• Cardiovascular and Respiratory Disorders
• Neurological and Endocrine Emergencies
• Renal and Gastrointestinal Dysfunction
• Multisystem Organ Failure and Shock States
• Pharmacology and Nursing Interventions in Acute Care
• Ethical and Legal Considerations in Critical Care
• Disaster Preparedness and Triage
Introduction
This comprehensive assessment is designed to evaluate the advanced
nursing knowledge and clinical judgment required for success in NSG
3280. The examination focuses on the care of acutely and critically ill
patients across the lifespan, emphasizing evidence-based interventions,
hemodynamic monitoring, and rapid clinical decision-making. The
questions are structured to test both foundational pathophysiological
concepts and their application in complex, high-acuity scenarios. Students
will be expected to interpret clinical data, prioritize nursing actions, and
,evaluate the efficacy of treatments. This resource serves as a definitive tool
for exam preparation and self-assessment, ensuring readiness for the
rigors of Galen College's nursing curriculum and the NCLEX-RN
examination.
SECTION ONE: QUESTIONS 1 – 100
1. A patient with severe sepsis is exhibiting signs of inadequate
tissue perfusion. Which hemodynamic parameter is most indicative
of decreased cardiac output?
A. Increased central venous pressure (CVP)
B. Decreased pulmonary artery wedge pressure (PAWP)
C. Increased systemic vascular resistance (SVR)
D. Decreased mixed venous oxygen saturation (SvO2)
D. Decreased mixed venous oxygen saturation (SvO2)
RATIONALE: SvO2 reflects the balance between oxygen delivery
and consumption. A decrease indicates that tissues are extracting more
oxygen due to inadequate delivery from low cardiac output. CVP and
PAWP reflect filling pressures and can be elevated in failure, while SVR
is a measure of afterload.
2. A patient is receiving a continuous infusion of norepinephrine.
Which assessment finding indicates a desired therapeutic effect?
A. Heart rate decreases to 60 bpm.
B. Urine output increases to 40 mL/hr.
C. Systolic blood pressure increases to 100 mmHg.
D. Capillary refill time is 4 seconds.
C. Systolic blood pressure increases to 100 mmHg.
RATIONALE: Norepinephrine is a potent vasopressor that increases
systemic vascular resistance and blood pressure. The desired effect is
the restoration of adequate mean arterial pressure (MAP) to ensure
organ perfusion. A MAP target is often >65 mmHg.
,3. The nurse is caring for a patient with diabetic ketoacidosis
(DKA). Which laboratory value indicates the most critical risk for
cerebral edema during treatment?
A. Serum glucose of 400 mg/dL
B. Serum potassium of 3.0 mEq/L
C. Serum sodium of 155 mEq/L
D. Serum bicarbonate of 10 mEq/L
C. Serum sodium of 155 mEq/L
RATIONALE: Hypertonicity from severe hypernatremia, particularly
when corrected rapidly, creates a significant osmotic gradient that can
cause fluid to shift into the brain, leading to cerebral edema. While other
labs are abnormal, this is the most direct risk factor for this life-
threatening complication.
4. A patient in the ICU has a pulmonary artery (PA) catheter. The
nurse notes a sudden increase in the pulmonary artery wedge
pressure (PAWP) from 12 mmHg to 25 mmHg. Which condition is
the most likely cause?
A. Hypovolemia
B. Cardiac tamponade
C. Acute mitral regurgitation
D. Pulmonary embolism
C. Acute mitral regurgitation
RATIONALE: Acute mitral regurgitation causes a rapid rise in left
atrial pressure, which is reflected in the PAWP. Hypovolemia would
decrease PAWP, tamponade would cause equalization of pressures, and
a large pulmonary embolism would not acutely increase left-sided filling
pressures.
5. Which nursing intervention is most appropriate for a patient with
a suspected pulmonary embolism (PE) who is experiencing severe
dyspnea and chest pain?
A. Ambulate the patient to promote circulation.
, B. Administer a stool softener to prevent straining.
C. Apply warm compresses to the chest wall.
D. Instruct the patient to cough and deep breathe.
B. Administer a stool softener to prevent straining.
RATIONALE: In the acute phase of a PE, preventing complications is
key. Straining can increase intrathoracic pressure and worsen dyspnea
or precipitate cardiac arrhythmias. Ambulation is contraindicated until
stable, and interventions must be aimed at reducing oxygen demand
and preventing embolic recurrence.
6. A patient with acute respiratory distress syndrome (ARDS) is on a
mechanical ventilator. The nurse recognizes a plateau pressure of
35 cm H2O is a concern primarily because it indicates:
A. Increased airway resistance
B. Risk of volutrauma
C. Alveolar overdistension
D. Decreased lung compliance
C. Alveolar overdistension
RATIONALE: Plateau pressure reflects alveolar pressure at end-
inspiration. A pressure >30 cm H2O significantly increases the risk of
alveolar overdistension, which is a form of ventilator-induced lung injury
(VILI) known as volutrauma.
7. A patient in a hemorrhagic shock state is receiving massive fluid
resuscitation. Which clinical manifestation is the earliest indicator
of fluid overload?
A. Jugular venous distention
B. Peripheral edema
C. Dyspnea with crackles
D. Increased body weight
A. Jugular venous distention
RATIONALE: Jugular venous distention is an early clinical sign of
increased central venous pressure and right heart strain, often
