NUR 417 Final Exam V2 | NUR 417 Nursing Care of
the Adult II | Actual Q&A with Rationale (NUR417
Final Exam) | Concordia
1. A patient with acute respiratory distress syndrome (ARDS) is being mechanically ventilated
with high levels of positive end-expiratory pressure (PEEP). Which assessment finding most
indicates a complication of high PEEP?
A. Blood pressure decrease from 120/80 to 90/60 mmHg
B. SpO2 increase from 88% to 94%
C. Decreased respiratory rate from 24 to 18 breaths/min
D. Improved lung compliance on the ventilator display
Correct Answer: A
Explanation: High PEEP levels can increase intrathoracic pressure, which decreases
venous return to the heart and subsequently lowers cardiac output and blood pressure.
This hemodynamic instability is a common complication that requires immediate
monitoring. The nurse must assess the patient for signs of barotrauma or decreased tissue
perfusion while PEEP is being titrated.
2. The nurse is caring for a patient in the hyperdynamic (early) phase of septic shock. Which
hemodynamic finding should the nurse expect?
A. Increased cardiac output (CO)
B. Increased systemic vascular resistance (SVR)
,C. Bradycardia
D. Decreased pulse pressure
Correct Answer: A
Explanation: In the early or warm phase of septic shock, massive vasodilation leads to
decreased SVR, which the body compensates for by increasing cardiac output and heart
rate. This results in warm, flushed skin and a bounding pulse despite low blood pressure.
As the shock progresses to the hypodynamic phase, the cardiac output will eventually drop
as the heart fails to keep up with the metabolic demands.
3. A patient is admitted with a suspected spinal cord injury at the T3 level. Which finding
would indicate that the patient is experiencing neurogenic shock?
A. Bradycardia and hypotension
B. Tachycardia and hypertension
C. Hyperthermia and shivering
D. Increased systemic vascular resistance
Correct Answer: A
Explanation: Neurogenic shock is characterized by the loss of sympathetic nervous system
tone, leading to massive vasodilation and the inability of the heart rate to increase. This
manifests clinically as the triad of hypotension, bradycardia, and poikilothermia (inability
to regulate body temperature). It is most commonly seen in injuries occurring at or above
the T6 level of the spinal cord.
,4. Which of the following interventions is the priority for a patient diagnosed with Diabetic
Ketoacidosis (DKA)?
A. Initiating a continuous IV insulin infusion
B. Rapid fluid resuscitation with 0.9% Normal Saline
C. Administering intravenous sodium bicarbonate
D. Correction of hypokalemia via oral supplements
Correct Answer: B
Explanation: The initial priority in DKA management is fluid resuscitation to restore
circulatory volume and improve renal perfusion, which helps clear glucose and ketones.
While insulin is necessary to stop ketosis, it should follow initial volume expansion to
prevent a rapid fluid shift that could lead to cerebral edema. Serum potassium must also be
monitored closely, but fluid replacement takes precedence in the emergent phase.
5. A patient with a history of cirrhosis is admitted with hematemesis and a diagnosis of
esophageal varices. Which medication should the nurse anticipate administering to reduce
portal pressure?
A. Lactulose
B. Spironolactone
C. Octreotide
D. Vitamin K
, Correct Answer: C
Explanation: Octreotide is a synthetic somatostatin analog used in acute GI bleeding to
decrease portal venous pressure through splanchnic vasoconstriction. Lactulose is used to
reduce ammonia levels, not to stop bleeding directly. Spironolactone is a diuretic used for
long-term management of ascites but is not indicated for acute variceal hemorrhage.
6. A nurse is monitoring a patient following a kidney transplant. Which clinical manifestation
suggests hyperacute rejection?
A. Gradual increase in BUN and Creatinine after 2 weeks
B. Sudden increase in body temperature and pain at the site within 48 hours
C. Weight gain of 2 lbs over a week
D. Development of hypertension months after surgery
Correct Answer: B
Explanation: Hyperacute rejection occurs within minutes to 48 hours after transplantation
and is caused by pre-formed antibodies against the donor organ. It causes immediate
thrombosis and graft necrosis, requiring the surgical removal of the kidney. Acute rejection
typically occurs within weeks to months, while chronic rejection happens over years.
7. The nurse is managing a patient on a mechanical ventilator who is fighting the ventilator
(bucking). The high-pressure alarm is sounding. What is the nurse’s first action?
A. Suction the patient’s airway
B. Assess the patient’s oxygenation and lung sounds
the Adult II | Actual Q&A with Rationale (NUR417
Final Exam) | Concordia
1. A patient with acute respiratory distress syndrome (ARDS) is being mechanically ventilated
with high levels of positive end-expiratory pressure (PEEP). Which assessment finding most
indicates a complication of high PEEP?
A. Blood pressure decrease from 120/80 to 90/60 mmHg
B. SpO2 increase from 88% to 94%
C. Decreased respiratory rate from 24 to 18 breaths/min
D. Improved lung compliance on the ventilator display
Correct Answer: A
Explanation: High PEEP levels can increase intrathoracic pressure, which decreases
venous return to the heart and subsequently lowers cardiac output and blood pressure.
This hemodynamic instability is a common complication that requires immediate
monitoring. The nurse must assess the patient for signs of barotrauma or decreased tissue
perfusion while PEEP is being titrated.
2. The nurse is caring for a patient in the hyperdynamic (early) phase of septic shock. Which
hemodynamic finding should the nurse expect?
A. Increased cardiac output (CO)
B. Increased systemic vascular resistance (SVR)
,C. Bradycardia
D. Decreased pulse pressure
Correct Answer: A
Explanation: In the early or warm phase of septic shock, massive vasodilation leads to
decreased SVR, which the body compensates for by increasing cardiac output and heart
rate. This results in warm, flushed skin and a bounding pulse despite low blood pressure.
As the shock progresses to the hypodynamic phase, the cardiac output will eventually drop
as the heart fails to keep up with the metabolic demands.
3. A patient is admitted with a suspected spinal cord injury at the T3 level. Which finding
would indicate that the patient is experiencing neurogenic shock?
A. Bradycardia and hypotension
B. Tachycardia and hypertension
C. Hyperthermia and shivering
D. Increased systemic vascular resistance
Correct Answer: A
Explanation: Neurogenic shock is characterized by the loss of sympathetic nervous system
tone, leading to massive vasodilation and the inability of the heart rate to increase. This
manifests clinically as the triad of hypotension, bradycardia, and poikilothermia (inability
to regulate body temperature). It is most commonly seen in injuries occurring at or above
the T6 level of the spinal cord.
,4. Which of the following interventions is the priority for a patient diagnosed with Diabetic
Ketoacidosis (DKA)?
A. Initiating a continuous IV insulin infusion
B. Rapid fluid resuscitation with 0.9% Normal Saline
C. Administering intravenous sodium bicarbonate
D. Correction of hypokalemia via oral supplements
Correct Answer: B
Explanation: The initial priority in DKA management is fluid resuscitation to restore
circulatory volume and improve renal perfusion, which helps clear glucose and ketones.
While insulin is necessary to stop ketosis, it should follow initial volume expansion to
prevent a rapid fluid shift that could lead to cerebral edema. Serum potassium must also be
monitored closely, but fluid replacement takes precedence in the emergent phase.
5. A patient with a history of cirrhosis is admitted with hematemesis and a diagnosis of
esophageal varices. Which medication should the nurse anticipate administering to reduce
portal pressure?
A. Lactulose
B. Spironolactone
C. Octreotide
D. Vitamin K
, Correct Answer: C
Explanation: Octreotide is a synthetic somatostatin analog used in acute GI bleeding to
decrease portal venous pressure through splanchnic vasoconstriction. Lactulose is used to
reduce ammonia levels, not to stop bleeding directly. Spironolactone is a diuretic used for
long-term management of ascites but is not indicated for acute variceal hemorrhage.
6. A nurse is monitoring a patient following a kidney transplant. Which clinical manifestation
suggests hyperacute rejection?
A. Gradual increase in BUN and Creatinine after 2 weeks
B. Sudden increase in body temperature and pain at the site within 48 hours
C. Weight gain of 2 lbs over a week
D. Development of hypertension months after surgery
Correct Answer: B
Explanation: Hyperacute rejection occurs within minutes to 48 hours after transplantation
and is caused by pre-formed antibodies against the donor organ. It causes immediate
thrombosis and graft necrosis, requiring the surgical removal of the kidney. Acute rejection
typically occurs within weeks to months, while chronic rejection happens over years.
7. The nurse is managing a patient on a mechanical ventilator who is fighting the ventilator
(bucking). The high-pressure alarm is sounding. What is the nurse’s first action?
A. Suction the patient’s airway
B. Assess the patient’s oxygenation and lung sounds
