NR 341 Exam 1 – Complex Adult Health – (2026) –
Original Practice Questions
300 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 NR 341 Exam 1 – Complex Adult Health – (2026) – Original Practice Questions
,Q1
A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical ventilation.
Which ventilator strategy is most consistent with current evidence-based practice to reduce
mortality?
A) High tidal volume (12 mL/kg predicted body weight) with low PEEP
B) Low tidal volume (6 mL/kg predicted body weight) with adequate PEEP CORRECT
C) Pressure-controlled ventilation with tidal volume 10 mL/kg and minimal PEEP
D) High-frequency oscillatory ventilation as first-line therapy
Rationale
Low tidal volume ventilation (6 mL/kg PBW) with adequate PEEP is the cornerstone of ARDS
management, proven to reduce mortality by limiting ventilator-induced lung injury. High tidal volumes and
minimal PEEP increase barotrauma and atelectrauma. HFOV is not recommended as first-line.
Q2
A patient with sepsis has the following hemodynamic parameters: CVP 2 mm Hg, MAP 55 mm Hg,
cardiac index 1.8 L/min/m², and mixed venous oxygen saturation (SvO₂) 50%. Which intervention
is the priority?
A) Administer norepinephrine to increase systemic vascular resistance
B) Initiate dobutamine infusion to increase cardiac contractility
C) Administer a 30 mL/kg crystalloid fluid bolus CORRECT
D) Transfuse packed red blood cells to increase oxygen delivery
Rationale
The low CVP and cardiac index with low SvO₂ indicate hypovolemia and inadequate preload; fluid
resuscitation is the first step in sepsis management. Vasopressors are added if hypotension persists
after fluids. Inotropes and transfusions are considered later based on response.
Q3
A patient with increased intracranial pressure (ICP) from a traumatic brain injury has an ICP of 22
mm Hg and a MAP of 70 mm Hg. What is the cerebral perfusion pressure (CPP), and what is the
priority nursing action?
A) CPP 48 mm Hg; administer mannitol and hyperventilate to PaCO₂ 30 mm Hg
2
,B) CPP 92 mm Hg; maintain current therapy and monitor
C) CPP 48 mm Hg; elevate head of bed to 30 degrees and maintain normocapnia CORRECT
D) CPP 92 mm Hg; administer vasopressors to increase MAP
Rationale
CPP = MAP − ICP = 70 − 22 = 48 mm Hg, which is below the target of 60–70 mm Hg. The priority is to
reduce ICP by elevating the head of bed and maintaining normocapnia (PaCO₂ 35–40 mm Hg);
hyperventilation is only a temporary measure. Vasopressors may be used but not as the first action.
Q4
A patient with type 1 diabetes is admitted with diabetic ketoacidosis (DKA). The provider orders
an insulin infusion. Which laboratory value must be monitored most closely to prevent a
complication of therapy?
A) Serum sodium
B) Serum potassium CORRECT
C) Serum chloride
D) Serum magnesium
Rationale
Insulin therapy drives potassium into cells, risking severe hypokalemia and cardiac dysrhythmias.
Potassium must be monitored closely and replaced as needed, even if initial serum potassium is normal
or high. Sodium, chloride, and magnesium are less acutely affected.
Q5
A patient with acute kidney injury is receiving continuous renal replacement therapy (CRRT).
Which assessment finding requires immediate intervention?
A) Blood flow rate of 150 mL/min
B) Filter pressure drop of 20 mm Hg
C) Transmembrane pressure (TMP) of 250 mm Hg CORRECT
D) Effluent volume equal to 25% of dialysate flow
3
, Rationale
A TMP greater than 250 mm Hg indicates filter clotting and requires immediate intervention to prevent
circuit failure. Normal TMP is typically < 200 mm Hg. The other values are within expected parameters
for CRRT.
Q6
A patient receiving chemotherapy for leukemia develops a temperature of 38.3°C and
neutropenia. Which action should the nurse take first?
A) Administer acetaminophen and reassess in 1 hour
B) Obtain blood cultures and administer broad-spectrum antibiotics within 1 CORRECT
hour
C) Place the patient in a negative-pressure isolation room
D) Administer granulocyte colony-stimulating factor (G-CSF)
Rationale
Febrile neutropenia is an oncologic emergency; blood cultures and empiric broad-spectrum antibiotics
must be initiated within 1 hour to reduce mortality. Acetaminophen may mask fever. Isolation and G-CSF
are adjunctive but not the first priority.
Q7
The nurse is interviewing a patient in the community clinic and gathers the following information:
she is intermittently homeless, a single parent with two children who have developmental delays,
and is suffering from chronic asthma. She does not laugh or smile, does not volunteer any
information, and at times appears close to tears. She has no support system and does not work.
She is experiencing an allostatic load. As a result, which of the following would be present during
a complete patient assessment? (Select all that apply.)
A) Post-traumatic stress disorder
B) Rising hormone levels
C) Chronic illness CORRECT
D) Return of vital signs to normal
E) Depression
4
Original Practice Questions
300 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 NR 341 Exam 1 – Complex Adult Health – (2026) – Original Practice Questions
,Q1
A patient with acute respiratory distress syndrome (ARDS) is receiving mechanical ventilation.
Which ventilator strategy is most consistent with current evidence-based practice to reduce
mortality?
A) High tidal volume (12 mL/kg predicted body weight) with low PEEP
B) Low tidal volume (6 mL/kg predicted body weight) with adequate PEEP CORRECT
C) Pressure-controlled ventilation with tidal volume 10 mL/kg and minimal PEEP
D) High-frequency oscillatory ventilation as first-line therapy
Rationale
Low tidal volume ventilation (6 mL/kg PBW) with adequate PEEP is the cornerstone of ARDS
management, proven to reduce mortality by limiting ventilator-induced lung injury. High tidal volumes and
minimal PEEP increase barotrauma and atelectrauma. HFOV is not recommended as first-line.
Q2
A patient with sepsis has the following hemodynamic parameters: CVP 2 mm Hg, MAP 55 mm Hg,
cardiac index 1.8 L/min/m², and mixed venous oxygen saturation (SvO₂) 50%. Which intervention
is the priority?
A) Administer norepinephrine to increase systemic vascular resistance
B) Initiate dobutamine infusion to increase cardiac contractility
C) Administer a 30 mL/kg crystalloid fluid bolus CORRECT
D) Transfuse packed red blood cells to increase oxygen delivery
Rationale
The low CVP and cardiac index with low SvO₂ indicate hypovolemia and inadequate preload; fluid
resuscitation is the first step in sepsis management. Vasopressors are added if hypotension persists
after fluids. Inotropes and transfusions are considered later based on response.
Q3
A patient with increased intracranial pressure (ICP) from a traumatic brain injury has an ICP of 22
mm Hg and a MAP of 70 mm Hg. What is the cerebral perfusion pressure (CPP), and what is the
priority nursing action?
A) CPP 48 mm Hg; administer mannitol and hyperventilate to PaCO₂ 30 mm Hg
2
,B) CPP 92 mm Hg; maintain current therapy and monitor
C) CPP 48 mm Hg; elevate head of bed to 30 degrees and maintain normocapnia CORRECT
D) CPP 92 mm Hg; administer vasopressors to increase MAP
Rationale
CPP = MAP − ICP = 70 − 22 = 48 mm Hg, which is below the target of 60–70 mm Hg. The priority is to
reduce ICP by elevating the head of bed and maintaining normocapnia (PaCO₂ 35–40 mm Hg);
hyperventilation is only a temporary measure. Vasopressors may be used but not as the first action.
Q4
A patient with type 1 diabetes is admitted with diabetic ketoacidosis (DKA). The provider orders
an insulin infusion. Which laboratory value must be monitored most closely to prevent a
complication of therapy?
A) Serum sodium
B) Serum potassium CORRECT
C) Serum chloride
D) Serum magnesium
Rationale
Insulin therapy drives potassium into cells, risking severe hypokalemia and cardiac dysrhythmias.
Potassium must be monitored closely and replaced as needed, even if initial serum potassium is normal
or high. Sodium, chloride, and magnesium are less acutely affected.
Q5
A patient with acute kidney injury is receiving continuous renal replacement therapy (CRRT).
Which assessment finding requires immediate intervention?
A) Blood flow rate of 150 mL/min
B) Filter pressure drop of 20 mm Hg
C) Transmembrane pressure (TMP) of 250 mm Hg CORRECT
D) Effluent volume equal to 25% of dialysate flow
3
, Rationale
A TMP greater than 250 mm Hg indicates filter clotting and requires immediate intervention to prevent
circuit failure. Normal TMP is typically < 200 mm Hg. The other values are within expected parameters
for CRRT.
Q6
A patient receiving chemotherapy for leukemia develops a temperature of 38.3°C and
neutropenia. Which action should the nurse take first?
A) Administer acetaminophen and reassess in 1 hour
B) Obtain blood cultures and administer broad-spectrum antibiotics within 1 CORRECT
hour
C) Place the patient in a negative-pressure isolation room
D) Administer granulocyte colony-stimulating factor (G-CSF)
Rationale
Febrile neutropenia is an oncologic emergency; blood cultures and empiric broad-spectrum antibiotics
must be initiated within 1 hour to reduce mortality. Acetaminophen may mask fever. Isolation and G-CSF
are adjunctive but not the first priority.
Q7
The nurse is interviewing a patient in the community clinic and gathers the following information:
she is intermittently homeless, a single parent with two children who have developmental delays,
and is suffering from chronic asthma. She does not laugh or smile, does not volunteer any
information, and at times appears close to tears. She has no support system and does not work.
She is experiencing an allostatic load. As a result, which of the following would be present during
a complete patient assessment? (Select all that apply.)
A) Post-traumatic stress disorder
B) Rising hormone levels
C) Chronic illness CORRECT
D) Return of vital signs to normal
E) Depression
4
