N261 Exam 2 Actual Exam V2 | N261 Nursing (N261 Exam 2) |
University of California, Los Angeles
1. A patient with chronic kidney disease (CKD) presents with a pH of 7.28, HCO3 of 18 mEq/L,
and PCO2 of 35 mmHg. Which acid-base imbalance is the patient experiencing?
A. Respiratory Acidosis
B. Metabolic Alkalosis
C. Respiratory Alkalosis
D. Metabolic Acidosis
Answer: D
Rationale: The pH is below 7.35, indicating acidosis, and the HCO3 is below 22 mEq/L,
indicating a metabolic origin. In CKD, the kidneys fail to excrete hydrogen ions and
regenerate bicarbonate, leading to this state. The PCO2 is within normal limits, suggesting
no significant respiratory compensation yet.
2. Which clinical manifestation should the nurse prioritize when assessing a patient suspected
of having Acute Respiratory Distress Syndrome (ARDS)?
A. Bradypnea and hypertension
B. Localized wheezing in the left lower lobe
C. Increased lung compliance
D. Refractory hypoxemia despite oxygen therapy
Answer: D
Rationale: Refractory hypoxemia, where the PaO2 does not improve with increased FiO2,
is a hallmark sign of ARDS. This occurs due to shunting and alveolar collapse which
prevents effective gas exchange. Assessing for this sign is critical for early diagnosis and
intervention in the ICU setting.
3. A patient is admitted with Heart Failure (HF) and exhibits crackles in the lung bases and an
S3 gallop. The nurse understands these findings indicate which type of failure?
A. Right-sided heart failure
B. Left-sided heart failure
C. Isolated tricuspid regurgitation
D. Cor pulmonale
Answer: B
,Rationale: Left-sided heart failure leads to pulmonary congestion because the left ventricle
cannot effectively pump blood into the systemic circulation. This results in backflow into
the pulmonary veins and capillaries, causing fluid to leak into the alveoli, manifested as
crackles. The S3 gallop is a classic sign of ventricular volume overload and poor
contractility.
4. A nurse is caring for a patient on a mechanical ventilator. The ‘High Pressure’ alarm begins
to sound. What is the most appropriate initial action?
A. Silencing the alarm and documenting the event
B. Check for a leak in the ventilator circuit
C. Assess the patient’s airway for secretions and need for suctioning
D. Increase the PEEP setting on the ventilator
Answer: C
Rationale: A high-pressure alarm indicates increased resistance in the system, often
caused by secretions, biting the tube, or kinking of the circuit. The nurse must first ensure
the patient’s airway is clear and the tube is patent before investigating mechanical issues.
Safe patient care requires physical assessment before troubleshooting machine settings.
5. A patient in Septic Shock has a lactate level of 6.2 mmol/L. How should the nurse interpret
this finding?
A. The patient is adequately perfusing tissues
B. This is a normal finding in the early stages of infection
C. The patient has developed metabolic alkalosis
D. The patient is experiencing significant tissue hypoxia and anaerobic metabolism
Answer: D
Rationale: Lactate levels rise above 2 mmol/L when tissues are not receiving enough
oxygen, forcing cells into anaerobic metabolism. A level of 6.2 mmol/L is dangerously high
and indicates severe hypoperfusion typical of septic shock. This diagnostic marker is used
to guide fluid resuscitation and monitor the severity of shock.
6. During the management of a patient with Myocardial Infarction (MI), which medication is
typically administered to reduce preload and afterload while relieving chest pain?
A. Atropine
B. Nitroglycerin
C. Epinephrine
D. Calcium Gluconate
, Answer: B
Rationale: Nitroglycerin is a vasodilator that reduces both preload (venous return) and
afterload (systemic resistance). By decreasing the workload of the heart, it lowers
myocardial oxygen demand and relieves ischemic chest pain. It is a cornerstone therapy in
the acute management of MI patients.
7. A patient presents with sudden onset of shortness of breath, pleuritic chest pain, and a
heart rate of 120 bpm after a long-haul flight. Which diagnostic test is the ‘gold standard’ for
confirming a Pulmonary Embolism (PE)?
A. Chest X-ray
B. 12-lead Electrocardiogram
C. CT Pulmonary Angiography (CTPA)
D. Serum D-dimer
Answer: C
Rationale: CT Pulmonary Angiography is currently the gold standard for visualizing clots
in the pulmonary vasculature. While D-dimer is sensitive for screening, it is not specific
enough for confirmation. Timely diagnosis is essential to start anticoagulation and prevent
sudden cardiac death.
8. A patient is diagnosed with Diabetes Insipidus (DI) following head trauma. Which clinical
manifestation should the nurse expect?
A. Oliguria and high urine specific gravity
B. Weight gain and peripheral edema
C. Polyuria and very low urine specific gravity
D. Hyperglycemia and metabolic acidosis
Answer: C
Rationale: Diabetes Insipidus results from a deficiency of Antidiuretic Hormone (ADH),
leading to the excretion of large volumes of dilute urine. The urine specific gravity is
typically below 1.005 because the kidneys cannot concentrate urine. This condition
requires careful monitoring of fluid balance and electrolyte levels, specifically sodium.
9. When assessing a patient with a chest tube, the nurse notes continuous bubbling in the
water-seal chamber. What does this finding indicate?
A. An air leak is present in the system or the pleural space
B. The lung has fully re-expanded
C. The suction pressure is set correctly
University of California, Los Angeles
1. A patient with chronic kidney disease (CKD) presents with a pH of 7.28, HCO3 of 18 mEq/L,
and PCO2 of 35 mmHg. Which acid-base imbalance is the patient experiencing?
A. Respiratory Acidosis
B. Metabolic Alkalosis
C. Respiratory Alkalosis
D. Metabolic Acidosis
Answer: D
Rationale: The pH is below 7.35, indicating acidosis, and the HCO3 is below 22 mEq/L,
indicating a metabolic origin. In CKD, the kidneys fail to excrete hydrogen ions and
regenerate bicarbonate, leading to this state. The PCO2 is within normal limits, suggesting
no significant respiratory compensation yet.
2. Which clinical manifestation should the nurse prioritize when assessing a patient suspected
of having Acute Respiratory Distress Syndrome (ARDS)?
A. Bradypnea and hypertension
B. Localized wheezing in the left lower lobe
C. Increased lung compliance
D. Refractory hypoxemia despite oxygen therapy
Answer: D
Rationale: Refractory hypoxemia, where the PaO2 does not improve with increased FiO2,
is a hallmark sign of ARDS. This occurs due to shunting and alveolar collapse which
prevents effective gas exchange. Assessing for this sign is critical for early diagnosis and
intervention in the ICU setting.
3. A patient is admitted with Heart Failure (HF) and exhibits crackles in the lung bases and an
S3 gallop. The nurse understands these findings indicate which type of failure?
A. Right-sided heart failure
B. Left-sided heart failure
C. Isolated tricuspid regurgitation
D. Cor pulmonale
Answer: B
,Rationale: Left-sided heart failure leads to pulmonary congestion because the left ventricle
cannot effectively pump blood into the systemic circulation. This results in backflow into
the pulmonary veins and capillaries, causing fluid to leak into the alveoli, manifested as
crackles. The S3 gallop is a classic sign of ventricular volume overload and poor
contractility.
4. A nurse is caring for a patient on a mechanical ventilator. The ‘High Pressure’ alarm begins
to sound. What is the most appropriate initial action?
A. Silencing the alarm and documenting the event
B. Check for a leak in the ventilator circuit
C. Assess the patient’s airway for secretions and need for suctioning
D. Increase the PEEP setting on the ventilator
Answer: C
Rationale: A high-pressure alarm indicates increased resistance in the system, often
caused by secretions, biting the tube, or kinking of the circuit. The nurse must first ensure
the patient’s airway is clear and the tube is patent before investigating mechanical issues.
Safe patient care requires physical assessment before troubleshooting machine settings.
5. A patient in Septic Shock has a lactate level of 6.2 mmol/L. How should the nurse interpret
this finding?
A. The patient is adequately perfusing tissues
B. This is a normal finding in the early stages of infection
C. The patient has developed metabolic alkalosis
D. The patient is experiencing significant tissue hypoxia and anaerobic metabolism
Answer: D
Rationale: Lactate levels rise above 2 mmol/L when tissues are not receiving enough
oxygen, forcing cells into anaerobic metabolism. A level of 6.2 mmol/L is dangerously high
and indicates severe hypoperfusion typical of septic shock. This diagnostic marker is used
to guide fluid resuscitation and monitor the severity of shock.
6. During the management of a patient with Myocardial Infarction (MI), which medication is
typically administered to reduce preload and afterload while relieving chest pain?
A. Atropine
B. Nitroglycerin
C. Epinephrine
D. Calcium Gluconate
, Answer: B
Rationale: Nitroglycerin is a vasodilator that reduces both preload (venous return) and
afterload (systemic resistance). By decreasing the workload of the heart, it lowers
myocardial oxygen demand and relieves ischemic chest pain. It is a cornerstone therapy in
the acute management of MI patients.
7. A patient presents with sudden onset of shortness of breath, pleuritic chest pain, and a
heart rate of 120 bpm after a long-haul flight. Which diagnostic test is the ‘gold standard’ for
confirming a Pulmonary Embolism (PE)?
A. Chest X-ray
B. 12-lead Electrocardiogram
C. CT Pulmonary Angiography (CTPA)
D. Serum D-dimer
Answer: C
Rationale: CT Pulmonary Angiography is currently the gold standard for visualizing clots
in the pulmonary vasculature. While D-dimer is sensitive for screening, it is not specific
enough for confirmation. Timely diagnosis is essential to start anticoagulation and prevent
sudden cardiac death.
8. A patient is diagnosed with Diabetes Insipidus (DI) following head trauma. Which clinical
manifestation should the nurse expect?
A. Oliguria and high urine specific gravity
B. Weight gain and peripheral edema
C. Polyuria and very low urine specific gravity
D. Hyperglycemia and metabolic acidosis
Answer: C
Rationale: Diabetes Insipidus results from a deficiency of Antidiuretic Hormone (ADH),
leading to the excretion of large volumes of dilute urine. The urine specific gravity is
typically below 1.005 because the kidneys cannot concentrate urine. This condition
requires careful monitoring of fluid balance and electrolyte levels, specifically sodium.
9. When assessing a patient with a chest tube, the nurse notes continuous bubbling in the
water-seal chamber. What does this finding indicate?
A. An air leak is present in the system or the pleural space
B. The lung has fully re-expanded
C. The suction pressure is set correctly
