NUR283 COMPREHENSIVE
EXAMINATION - ADVANCED NURSING
CONCEPTS
1. A patient with a pulmonary artery catheter has a Pulmonary Artery Wedge Pressure
(PAWP) of 22 mmHg. Which clinical manifestation should the nurse anticipate?
A. Decreased skin turgor and dry mucous membranes
B. Bilateral crackles in the lung bases
C. Flattened jugular veins when supine
D. Hyperactive bowel sounds and diarrhea
Answer: B
Conceptual Explanation: Normal PAWP is 6–12 mmHg. A level of 22 mmHg indicates left-
sided heart failure or fluid volume overload, leading to pulmonary congestion and crackles.
2. A client is admitted with Diabetic Ketoacidosis (DKA). The nurse notes a pH of 7.28, PaCO2
of 30 mmHg, and HCO3 of 14 mEq/L. How should the nurse interpret this acid-base
imbalance?
A. Compensated Respiratory Alkalosis
,B. Partially Compensated Metabolic Acidosis
C. Uncompensated Metabolic Acidosis
D. Partially Compensated Respiratory Acidosis
Answer: B
Conceptual Explanation: The pH is acidic (<7.35), the HCO3 is low (acidic), and the PaCO2
is low (alkalotic). Since both pH and HCO3 are abnormal in the same direction and the
PaCO2 is attempting to compensate, it is partially compensated metabolic acidosis.
3. Which assessment finding in a patient with a T4 spinal cord injury should lead the nurse to
suspect Autonomic Dysreflexia?
A. Tachycardia and hypotension
B. Severe pounding headache and profuse sweating above the injury
C. Flaccid paralysis below the level of injury
D. Low body temperature and shivering
Answer: B
Conceptual Explanation: Autonomic dysreflexia is characterized by sudden high blood
pressure, a pounding headache, and diaphoresis above the level of the spinal cord lesion,
often triggered by a full bladder or bowel.
, 4. A patient is receiving a continuous Heparin infusion for a pulmonary embolism. The aPTT is
110 seconds (Control: 25-35 seconds). What is the priority nursing action?
A. Continue the infusion at the current rate
B. Increase the infusion rate by 10%
C. Stop the infusion and notify the healthcare provider
D. Administer Vitamin K intramuscularly
Answer: C
Conceptual Explanation: The therapeutic aPTT for Heparin is usually 1.5 to 2.5 times the
control (approx 40-85 seconds). A value of 110 is critically high, increasing the risk of
hemorrhage. The infusion must be stopped.
5. During the emergent phase of a 40% Total Body Surface Area (TBSA) burn, which
electrolyte abnormality is the nurse most likely to observe?
A. Hyperkalemia
B. Hypercalcemia
C. Hypernatremia
D. Hypokalemia
Answer: A
EXAMINATION - ADVANCED NURSING
CONCEPTS
1. A patient with a pulmonary artery catheter has a Pulmonary Artery Wedge Pressure
(PAWP) of 22 mmHg. Which clinical manifestation should the nurse anticipate?
A. Decreased skin turgor and dry mucous membranes
B. Bilateral crackles in the lung bases
C. Flattened jugular veins when supine
D. Hyperactive bowel sounds and diarrhea
Answer: B
Conceptual Explanation: Normal PAWP is 6–12 mmHg. A level of 22 mmHg indicates left-
sided heart failure or fluid volume overload, leading to pulmonary congestion and crackles.
2. A client is admitted with Diabetic Ketoacidosis (DKA). The nurse notes a pH of 7.28, PaCO2
of 30 mmHg, and HCO3 of 14 mEq/L. How should the nurse interpret this acid-base
imbalance?
A. Compensated Respiratory Alkalosis
,B. Partially Compensated Metabolic Acidosis
C. Uncompensated Metabolic Acidosis
D. Partially Compensated Respiratory Acidosis
Answer: B
Conceptual Explanation: The pH is acidic (<7.35), the HCO3 is low (acidic), and the PaCO2
is low (alkalotic). Since both pH and HCO3 are abnormal in the same direction and the
PaCO2 is attempting to compensate, it is partially compensated metabolic acidosis.
3. Which assessment finding in a patient with a T4 spinal cord injury should lead the nurse to
suspect Autonomic Dysreflexia?
A. Tachycardia and hypotension
B. Severe pounding headache and profuse sweating above the injury
C. Flaccid paralysis below the level of injury
D. Low body temperature and shivering
Answer: B
Conceptual Explanation: Autonomic dysreflexia is characterized by sudden high blood
pressure, a pounding headache, and diaphoresis above the level of the spinal cord lesion,
often triggered by a full bladder or bowel.
, 4. A patient is receiving a continuous Heparin infusion for a pulmonary embolism. The aPTT is
110 seconds (Control: 25-35 seconds). What is the priority nursing action?
A. Continue the infusion at the current rate
B. Increase the infusion rate by 10%
C. Stop the infusion and notify the healthcare provider
D. Administer Vitamin K intramuscularly
Answer: C
Conceptual Explanation: The therapeutic aPTT for Heparin is usually 1.5 to 2.5 times the
control (approx 40-85 seconds). A value of 110 is critically high, increasing the risk of
hemorrhage. The infusion must be stopped.
5. During the emergent phase of a 40% Total Body Surface Area (TBSA) burn, which
electrolyte abnormality is the nurse most likely to observe?
A. Hyperkalemia
B. Hypercalcemia
C. Hypernatremia
D. Hypokalemia
Answer: A
