NR 341 Complex Adult Health Exam (2026/2027) |
QUESTIONS AND ANSWERS | A+ GRADE
NR 341: Complex Adult Health Nursing Comprehensive Examination | Core
Domains: Advanced Pathophysiology of Complex Multi-System Disorders, Critical Care &
Hemodynamic Monitoring, Advanced Cardiac & Respiratory Management, Neurological &
Neurosurgical Emergencies, Renal Failure & Electrolyte Imbalances, Shock States &
Resuscitation, Advanced Pharmacology & High-Alert Infusions, End-of-Life & Ethical
Decision-Making in Critical Care, and Interprofessional Collaboration in High-Acuity Settings
Exam Structure
The NR 341 Complex Adult Health Exam for the 2026/2027 academic cycle is a 120-question,
multiple-choice question (MCQ) examination.
Full Exam: 120 Multiple-Choice Questions (MCQs)
with Answers & Rationales
1.
A patient in the ICU has a pulmonary artery catheter. Current values: CVP 4 mmHg, PAWP 6
mmHg, CO 3.2 L/min, SVR 900 dynes·sec/cm⁵, MAP 58 mmHg. The patient is tachycardic and
cool peripherally. Which type of shock is most likely?
A. Cardiogenic
B. Hypovolemic
C. Distributive (septic)
D. Obstructive
C. Distributive (septic)
Low SVR (<1200) with low filling pressures (CVP and PAWP) and hypotension despite
near-normal CO is classic for septic (distributive) shock. Vasodilation causes relative
hypovolemia and decreased SVR, leading to warm or cold extremities depending on stage.
Cardiogenic shock would show high PAWP and low CO; hypovolemic would have low
,CVP/PAWP but also low CO and high SVR; obstructive (e.g., PE, tamponade) typically
presents with high CVP but low PAWP and CO.
2.
A nurse is caring for a patient with acute respiratory distress syndrome (ARDS). Which
ventilator setting adjustment is most appropriate to reduce ventilator-induced lung injury?
A. Increase tidal volume to 10 mL/kg
B. Maintain PEEP at 5 cm H₂O
C. Use low tidal volume (6 mL/kg predicted body weight)
D. Set FiO₂ to 100% continuously
C. Use low tidal volume (6 mL/kg predicted body weight)
The ARDSNet protocol recommends low tidal volume ventilation (4–6 mL/kg predicted body
weight) to minimize volutrauma and barotrauma. High tidal volumes (>8 mL/kg) increase
mortality. PEEP is often increased (not kept at 5) to prevent alveolar collapse. FiO₂ should be
titrated to maintain SpO₂ ≥88–95%, not kept at 100% due to oxygen toxicity risk.
3.
A patient with traumatic brain injury has an intracranial pressure (ICP) of 28 mmHg and CPP of
52 mmHg. Mean arterial pressure (MAP) is 80 mmHg. What is the priority nursing
intervention?
A. Administer mannitol 25 g IV
B. Elevate head of bed to 30 degrees
C. Increase MAP with vasopressors to improve CPP
D. Sedate with propofol to reduce metabolic demand
,C. Increase MAP with vasopressors to improve CPP
Cerebral perfusion pressure (CPP) = MAP – ICP. Target CPP is >60–70 mmHg in TBI. Here,
CPP = 80 – 28 = 52 mmHg, which is inadequate and risks cerebral ischemia. While mannitol
and head elevation help lower ICP, the immediate threat is low CPP. Vasopressors (e.g.,
norepinephrine) are used to raise MAP and restore CPP, per Brain Trauma Foundation
guidelines.
4.
A patient with chronic kidney disease (CKD Stage 4) develops ECG changes: peaked T waves,
widened QRS complex, and prolonged PR interval. Serum potassium is 6.8 mEq/L. What is the
first-line emergency treatment?
A. Oral sodium polystyrene sulfonate
B. IV furosemide
C. IV calcium gluconate
D. IV insulin + dextrose
C. IV calcium gluconate
Hyperkalemia with ECG changes is a medical emergency. Calcium gluconate (or calcium
chloride) stabilizes the myocardial membrane within minutes, protecting against arrhythmias.
It does not lower serum K⁺ but is given first for cardiac protection. Insulin + dextrose shifts K⁺
intracellularly and is given next. Kayexalate and diuretics lower total body K⁺ but act slowly
and are not for acute stabilization.
5.
A patient receiving a norepinephrine infusion at 10 mcg/min has a blood pressure of 180/100
mmHg and complains of severe headache. The nurse notes new-onset atrial fibrillation with
rapid ventricular response. What should the nurse do first?
, A. Administer metoprolol 5 mg IV
B. Reduce the norepinephrine infusion rate
C. Notify the provider for possible labetalol order
D. Assess neurological status for signs of hypertensive emergency
D. Assess neurological status for signs of hypertensive emergency
Severe hypertension with headache in a patient on high-dose vasopressors raises concern for
hypertensive emergency (e.g., encephalopathy, stroke). Neurological assessment (e.g., vision
changes, confusion, focal deficits) must occur before interventions. While reducing
norepinephrine may be needed, abrupt withdrawal can cause hypotension. Beta-blockers like
metoprolol are contraindicated initially in unopposed alpha-stimulation (can cause
paradoxical hypertension). Labetalol is appropriate later if no contraindications.
6.
A patient with septic shock is receiving vasopressin at 0.03 units/min and norepinephrine at 15
mcg/min. Urine output has dropped to 10 mL/hr over the past 2 hours. What is the most
appropriate action?
A. Increase vasopressin to 0.06 units/min
B. Administer a 500 mL fluid bolus
C. Start a dopamine drip at 2 mcg/kg/min
D. Assess for abdominal compartment syndrome
D. Assess for abdominal compartment syndrome
In refractory shock with sudden oliguria despite adequate resuscitation and high vasopressor
doses, abdominal compartment syndrome (ACS) must be ruled out. ACS causes renal vein
compression and reduced perfusion. Bladder pressure measurement is diagnostic. Increasing
QUESTIONS AND ANSWERS | A+ GRADE
NR 341: Complex Adult Health Nursing Comprehensive Examination | Core
Domains: Advanced Pathophysiology of Complex Multi-System Disorders, Critical Care &
Hemodynamic Monitoring, Advanced Cardiac & Respiratory Management, Neurological &
Neurosurgical Emergencies, Renal Failure & Electrolyte Imbalances, Shock States &
Resuscitation, Advanced Pharmacology & High-Alert Infusions, End-of-Life & Ethical
Decision-Making in Critical Care, and Interprofessional Collaboration in High-Acuity Settings
Exam Structure
The NR 341 Complex Adult Health Exam for the 2026/2027 academic cycle is a 120-question,
multiple-choice question (MCQ) examination.
Full Exam: 120 Multiple-Choice Questions (MCQs)
with Answers & Rationales
1.
A patient in the ICU has a pulmonary artery catheter. Current values: CVP 4 mmHg, PAWP 6
mmHg, CO 3.2 L/min, SVR 900 dynes·sec/cm⁵, MAP 58 mmHg. The patient is tachycardic and
cool peripherally. Which type of shock is most likely?
A. Cardiogenic
B. Hypovolemic
C. Distributive (septic)
D. Obstructive
C. Distributive (septic)
Low SVR (<1200) with low filling pressures (CVP and PAWP) and hypotension despite
near-normal CO is classic for septic (distributive) shock. Vasodilation causes relative
hypovolemia and decreased SVR, leading to warm or cold extremities depending on stage.
Cardiogenic shock would show high PAWP and low CO; hypovolemic would have low
,CVP/PAWP but also low CO and high SVR; obstructive (e.g., PE, tamponade) typically
presents with high CVP but low PAWP and CO.
2.
A nurse is caring for a patient with acute respiratory distress syndrome (ARDS). Which
ventilator setting adjustment is most appropriate to reduce ventilator-induced lung injury?
A. Increase tidal volume to 10 mL/kg
B. Maintain PEEP at 5 cm H₂O
C. Use low tidal volume (6 mL/kg predicted body weight)
D. Set FiO₂ to 100% continuously
C. Use low tidal volume (6 mL/kg predicted body weight)
The ARDSNet protocol recommends low tidal volume ventilation (4–6 mL/kg predicted body
weight) to minimize volutrauma and barotrauma. High tidal volumes (>8 mL/kg) increase
mortality. PEEP is often increased (not kept at 5) to prevent alveolar collapse. FiO₂ should be
titrated to maintain SpO₂ ≥88–95%, not kept at 100% due to oxygen toxicity risk.
3.
A patient with traumatic brain injury has an intracranial pressure (ICP) of 28 mmHg and CPP of
52 mmHg. Mean arterial pressure (MAP) is 80 mmHg. What is the priority nursing
intervention?
A. Administer mannitol 25 g IV
B. Elevate head of bed to 30 degrees
C. Increase MAP with vasopressors to improve CPP
D. Sedate with propofol to reduce metabolic demand
,C. Increase MAP with vasopressors to improve CPP
Cerebral perfusion pressure (CPP) = MAP – ICP. Target CPP is >60–70 mmHg in TBI. Here,
CPP = 80 – 28 = 52 mmHg, which is inadequate and risks cerebral ischemia. While mannitol
and head elevation help lower ICP, the immediate threat is low CPP. Vasopressors (e.g.,
norepinephrine) are used to raise MAP and restore CPP, per Brain Trauma Foundation
guidelines.
4.
A patient with chronic kidney disease (CKD Stage 4) develops ECG changes: peaked T waves,
widened QRS complex, and prolonged PR interval. Serum potassium is 6.8 mEq/L. What is the
first-line emergency treatment?
A. Oral sodium polystyrene sulfonate
B. IV furosemide
C. IV calcium gluconate
D. IV insulin + dextrose
C. IV calcium gluconate
Hyperkalemia with ECG changes is a medical emergency. Calcium gluconate (or calcium
chloride) stabilizes the myocardial membrane within minutes, protecting against arrhythmias.
It does not lower serum K⁺ but is given first for cardiac protection. Insulin + dextrose shifts K⁺
intracellularly and is given next. Kayexalate and diuretics lower total body K⁺ but act slowly
and are not for acute stabilization.
5.
A patient receiving a norepinephrine infusion at 10 mcg/min has a blood pressure of 180/100
mmHg and complains of severe headache. The nurse notes new-onset atrial fibrillation with
rapid ventricular response. What should the nurse do first?
, A. Administer metoprolol 5 mg IV
B. Reduce the norepinephrine infusion rate
C. Notify the provider for possible labetalol order
D. Assess neurological status for signs of hypertensive emergency
D. Assess neurological status for signs of hypertensive emergency
Severe hypertension with headache in a patient on high-dose vasopressors raises concern for
hypertensive emergency (e.g., encephalopathy, stroke). Neurological assessment (e.g., vision
changes, confusion, focal deficits) must occur before interventions. While reducing
norepinephrine may be needed, abrupt withdrawal can cause hypotension. Beta-blockers like
metoprolol are contraindicated initially in unopposed alpha-stimulation (can cause
paradoxical hypertension). Labetalol is appropriate later if no contraindications.
6.
A patient with septic shock is receiving vasopressin at 0.03 units/min and norepinephrine at 15
mcg/min. Urine output has dropped to 10 mL/hr over the past 2 hours. What is the most
appropriate action?
A. Increase vasopressin to 0.06 units/min
B. Administer a 500 mL fluid bolus
C. Start a dopamine drip at 2 mcg/kg/min
D. Assess for abdominal compartment syndrome
D. Assess for abdominal compartment syndrome
In refractory shock with sudden oliguria despite adequate resuscitation and high vasopressor
doses, abdominal compartment syndrome (ACS) must be ruled out. ACS causes renal vein
compression and reduced perfusion. Bladder pressure measurement is diagnostic. Increasing
