NSG 3160 ADVANCED ADULT HEALTH
NURSING FINAL EXAM QUESTIONS
AND ANSWERS AND EXPLANATIONS
1. A patient is admitted with suspected Acute Respiratory Distress Syndrome (ARDS). Which
clinical finding is the most sensitive indicator of the early stage of ARDS?
A. Diffuse crackles on auscultation
B. Increased pulmonary capillary wedge pressure (PCWP)
C. Decreased lung compliance on ventilator settings
D. Refractory hypoxemia despite oxygen therapy
Answer: D
Conceptual Explanation: Refractory hypoxemia, where the PaO2 does not improve
significantly with supplemental oxygen, is a hallmark diagnostic feature of ARDS. PCWP in
ARDS is typically low or normal (under 18 mmHg), unlike cardiogenic pulmonary edema.
2. A patient with Chronic Obstructive Pulmonary Disease (COPD) is experiencing respiratory
failure. Which ABG result best represents compensated respiratory acidosis?
A. pH 7.45, PaCO2 35, HCO3 22
B. pH 7.28, PaCO2 60, HCO3 24
,C. pH 7.35, PaCO2 55, HCO3 30
D. pH 7.32, PaCO2 48, HCO3 25
Answer: C
Conceptual Explanation: Compensated respiratory acidosis is characterized by a pH in
the normal range (7.35-7.45) but leaning acidic, an elevated PaCO2, and a high HCO3
indicating renal compensation.
3. A patient with a traumatic brain injury has a Glasglow Coma Scale (GCS) score of 7. Which
intervention is the absolute priority?
A. Preparing for immediate endotracheal intubation
B. Administering IV Mannitol as prescribed
C. Monitoring intracranial pressure (ICP) via bolt
D. Performing a STAT non-contrast CT scan
Answer: A
Conceptual Explanation: A GCS score of 8 or less indicates a severe head injury and
inability to protect the airway; ‘Less than 8, intubate’ is the gold standard for airway
management.
4. Which electrolyte imbalance is most likely to cause a prolonged QTc interval and Torsades
de Pointes?
A. Hyperkalemia
, B. Hypercalcemia
C. Hypomagnesemia
D. Hyponatremia
Answer: C
Conceptual Explanation: Hypomagnesemia is a classic trigger for prolonged QT intervals
which can deteriorate into the life-threatening ventricular arrhythmia Torsades de Pointes.
5. In a patient with Acute Pancreatitis, which laboratory value is the most specific indicator of
pancreatic cell necrosis?
A. Serum Amylase
B. Serum Lipase
C. C-Reactive Protein
D. Blood Glucose
Answer: B
Conceptual Explanation: Lipase is more specific to the pancreas than amylase and stays
elevated longer, making it the preferred marker for diagnosing and monitoring
pancreatitis.
6. A patient is in the compensatory stage of shock. Which physiological response would the
nurse expect to observe?
A. Increased urinary output and bradycardia
NURSING FINAL EXAM QUESTIONS
AND ANSWERS AND EXPLANATIONS
1. A patient is admitted with suspected Acute Respiratory Distress Syndrome (ARDS). Which
clinical finding is the most sensitive indicator of the early stage of ARDS?
A. Diffuse crackles on auscultation
B. Increased pulmonary capillary wedge pressure (PCWP)
C. Decreased lung compliance on ventilator settings
D. Refractory hypoxemia despite oxygen therapy
Answer: D
Conceptual Explanation: Refractory hypoxemia, where the PaO2 does not improve
significantly with supplemental oxygen, is a hallmark diagnostic feature of ARDS. PCWP in
ARDS is typically low or normal (under 18 mmHg), unlike cardiogenic pulmonary edema.
2. A patient with Chronic Obstructive Pulmonary Disease (COPD) is experiencing respiratory
failure. Which ABG result best represents compensated respiratory acidosis?
A. pH 7.45, PaCO2 35, HCO3 22
B. pH 7.28, PaCO2 60, HCO3 24
,C. pH 7.35, PaCO2 55, HCO3 30
D. pH 7.32, PaCO2 48, HCO3 25
Answer: C
Conceptual Explanation: Compensated respiratory acidosis is characterized by a pH in
the normal range (7.35-7.45) but leaning acidic, an elevated PaCO2, and a high HCO3
indicating renal compensation.
3. A patient with a traumatic brain injury has a Glasglow Coma Scale (GCS) score of 7. Which
intervention is the absolute priority?
A. Preparing for immediate endotracheal intubation
B. Administering IV Mannitol as prescribed
C. Monitoring intracranial pressure (ICP) via bolt
D. Performing a STAT non-contrast CT scan
Answer: A
Conceptual Explanation: A GCS score of 8 or less indicates a severe head injury and
inability to protect the airway; ‘Less than 8, intubate’ is the gold standard for airway
management.
4. Which electrolyte imbalance is most likely to cause a prolonged QTc interval and Torsades
de Pointes?
A. Hyperkalemia
, B. Hypercalcemia
C. Hypomagnesemia
D. Hyponatremia
Answer: C
Conceptual Explanation: Hypomagnesemia is a classic trigger for prolonged QT intervals
which can deteriorate into the life-threatening ventricular arrhythmia Torsades de Pointes.
5. In a patient with Acute Pancreatitis, which laboratory value is the most specific indicator of
pancreatic cell necrosis?
A. Serum Amylase
B. Serum Lipase
C. C-Reactive Protein
D. Blood Glucose
Answer: B
Conceptual Explanation: Lipase is more specific to the pancreas than amylase and stays
elevated longer, making it the preferred marker for diagnosing and monitoring
pancreatitis.
6. A patient is in the compensatory stage of shock. Which physiological response would the
nurse expect to observe?
A. Increased urinary output and bradycardia
