NUR 265 EXAM 4 ACTUAL EXAM 2026/2027 | Galen College |
Questions and Answers | 100% Correct Answers | Updated
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SECTION 1: CRITICAL CARE & EMERGENCY NURSING (20 Questions)
Q1: A 68-year-old patient admitted with septic shock has the following hemodynamic
parameters: MAP 58 mmHg, CVP 4 mmHg, PAOP 6 mmHg, SVR 800 dynes/sec/cm⁻⁵,
and cardiac index 1.8 L/min/m². Which intervention should the nurse anticipate as the
priority?
A. Administering a beta-blocker to reduce myocardial oxygen demand
B. Initiating a vasopressor such as norepinephrine to increase SVR and MAP
C. Administering a diuretic to reduce preload and improve cardiac output
D. Starting a beta-agonist to increase heart rate and contractility
Correct Answer: B [CORRECT]
Rationale: The patient presents with classic signs of distributive shock (septic shock):
low MAP (<65 mmHg), low CVP/PAOP (indicating hypovolemia from capillary leak), low
SVR, and low cardiac index. The priority is to restore perfusion pressure. Norepinephrine
is the first-line vasopressor for septic shock per Surviving Sepsis Campaign guidelines.
Option A is incorrect because beta-blockers would further reduce cardiac output and BP.
Option C is incorrect because the patient is intravascularly depleted; diuretics would
worsen hypotension. Option D is incorrect because while dobutamine may be used later
,for persistent low output, restoring vascular tone and MAP takes priority over inotropy
alone.
Q2: A patient on mechanical ventilation has the following ABG results: pH 7.52, PaCO₂
30 mmHg, HCO₃⁻ 24 mEq/L, PaO₂ 88 mmHg. Which ventilator adjustment should the
nurse anticipate?
A. Increasing the respiratory rate
B. Increasing the tidal volume
C. Decreasing the respiratory rate or tidal volume
D. Adding positive end-expiratory pressure (PEEP)
Correct Answer: C [CORRECT]
Rationale: This ABG reveals acute respiratory alkalosis (pH elevated, PaCO₂ decreased,
normal HCO₃⁻). The patient is being hyperventilated. The nurse should anticipate
decreasing minute ventilation by reducing respiratory rate or tidal volume. Option A
would worsen alkalosis. Option B may be considered but tidal volume increases risk of
lung injury; rate reduction is preferred. Option D addresses oxygenation/atelectasis, not
the primary acid-base disturbance.
Q3: A patient with acute respiratory distress syndrome (ARDS) is on assist-control
ventilation with FiO₂ 80%, PEEP 12 cmH₂O, and SpO₂ 89%. The provider orders prone
positioning. Which nursing action is essential before proning?
A. Ensuring the endotracheal tube is secured with a new holder and marking the depth
B. Administering neuromuscular blocking agents to all ARDS patients
,C. Increasing the FiO₂ to 100% to prevent desaturation during the turn
D. Placing the patient in reverse Trendelenburg position
Correct Answer: A [CORRECT]
Rationale: Securing the airway is paramount before proning to prevent accidental
extubation, which would be catastrophic. Marking tube depth allows monitoring for
displacement. Option B is incorrect—while paralytics may be used for severe ARDS, they
are not required for all patients and increase risk of ICU-acquired weakness. Option C is
not standard; FiO₂ may be increased modestly but 100% is unnecessary and potentially
toxic. Option D is incorrect; prone positioning requires specific equipment and
technique, not reverse Trendelenburg.
Q4: A patient in the ED with a suspected cervical spine injury becomes hypotensive (BP
82/50) and bradycardic (HR 48) without signs of hemorrhage. Which intervention is
most appropriate?
A. Administering atropine 0.5 mg IV and preparing for pacing
B. Administering 1-2 liters of crystalloid fluid bolus
C. Initiating dopamine infusion for inotropic support
D. Applying a cervical collar and log-rolling the patient
Correct Answer: A [CORRECT]
Rationale: The presentation suggests neurogenic shock from cervical spinal cord injury
(above T6), causing loss of sympathetic tone with unopposed vagal response.
Bradycardia and hypotension without hypovolemia are hallmark signs. Atropine
addresses the bradycardia; pacing may be needed if unresponsive. Option B is incorrect
, because the patient is not hypovolemic; fluid may cause fluid overload. Option C is
incorrect because dopamine has variable effects; norepinephrine is preferred if
vasopressors are needed. Option D is already done and doesn't address the
hemodynamic emergency.
Q5: [Select All That Apply] A patient with a pulmonary artery catheter has the following
readings: RAP 14 mmHg, PAOP 18 mmHg, CI 2.1 L/min/m², SVR 1200 dynes/sec/cm⁻⁵.
Which conditions may be indicated by these values? Select all that apply.
A. Cardiogenic shock
B. Right ventricular failure
C. Volume overload
D. Hypovolemic shock
E. Septic shock
Correct Answers: A, B, C [CORRECT]
Rationale: Elevated RAP (CVP) and PAOP with low cardiac index indicates pump failure
(cardiogenic shock) or volume overload. Right ventricular failure elevates RAP
disproportionately. Option D (hypovolemic shock) would show low filling pressures.
Option E (septic shock) typically presents with low SVR and low/normal filling pressures
early; late sepsis may resemble cardiogenic shock but SVR would be low, not
elevated/normal.
Q6: A patient on a ventilator develops sudden high-pressure alarms, decreased breath
sounds on the right, subcutaneous emphysema, and tracheal deviation to the left.
Which action should the nurse take first?
Questions and Answers | 100% Correct Answers | Updated
Edition | Pass Guaranteed - A+ Graded
SECTION 1: CRITICAL CARE & EMERGENCY NURSING (20 Questions)
Q1: A 68-year-old patient admitted with septic shock has the following hemodynamic
parameters: MAP 58 mmHg, CVP 4 mmHg, PAOP 6 mmHg, SVR 800 dynes/sec/cm⁻⁵,
and cardiac index 1.8 L/min/m². Which intervention should the nurse anticipate as the
priority?
A. Administering a beta-blocker to reduce myocardial oxygen demand
B. Initiating a vasopressor such as norepinephrine to increase SVR and MAP
C. Administering a diuretic to reduce preload and improve cardiac output
D. Starting a beta-agonist to increase heart rate and contractility
Correct Answer: B [CORRECT]
Rationale: The patient presents with classic signs of distributive shock (septic shock):
low MAP (<65 mmHg), low CVP/PAOP (indicating hypovolemia from capillary leak), low
SVR, and low cardiac index. The priority is to restore perfusion pressure. Norepinephrine
is the first-line vasopressor for septic shock per Surviving Sepsis Campaign guidelines.
Option A is incorrect because beta-blockers would further reduce cardiac output and BP.
Option C is incorrect because the patient is intravascularly depleted; diuretics would
worsen hypotension. Option D is incorrect because while dobutamine may be used later
,for persistent low output, restoring vascular tone and MAP takes priority over inotropy
alone.
Q2: A patient on mechanical ventilation has the following ABG results: pH 7.52, PaCO₂
30 mmHg, HCO₃⁻ 24 mEq/L, PaO₂ 88 mmHg. Which ventilator adjustment should the
nurse anticipate?
A. Increasing the respiratory rate
B. Increasing the tidal volume
C. Decreasing the respiratory rate or tidal volume
D. Adding positive end-expiratory pressure (PEEP)
Correct Answer: C [CORRECT]
Rationale: This ABG reveals acute respiratory alkalosis (pH elevated, PaCO₂ decreased,
normal HCO₃⁻). The patient is being hyperventilated. The nurse should anticipate
decreasing minute ventilation by reducing respiratory rate or tidal volume. Option A
would worsen alkalosis. Option B may be considered but tidal volume increases risk of
lung injury; rate reduction is preferred. Option D addresses oxygenation/atelectasis, not
the primary acid-base disturbance.
Q3: A patient with acute respiratory distress syndrome (ARDS) is on assist-control
ventilation with FiO₂ 80%, PEEP 12 cmH₂O, and SpO₂ 89%. The provider orders prone
positioning. Which nursing action is essential before proning?
A. Ensuring the endotracheal tube is secured with a new holder and marking the depth
B. Administering neuromuscular blocking agents to all ARDS patients
,C. Increasing the FiO₂ to 100% to prevent desaturation during the turn
D. Placing the patient in reverse Trendelenburg position
Correct Answer: A [CORRECT]
Rationale: Securing the airway is paramount before proning to prevent accidental
extubation, which would be catastrophic. Marking tube depth allows monitoring for
displacement. Option B is incorrect—while paralytics may be used for severe ARDS, they
are not required for all patients and increase risk of ICU-acquired weakness. Option C is
not standard; FiO₂ may be increased modestly but 100% is unnecessary and potentially
toxic. Option D is incorrect; prone positioning requires specific equipment and
technique, not reverse Trendelenburg.
Q4: A patient in the ED with a suspected cervical spine injury becomes hypotensive (BP
82/50) and bradycardic (HR 48) without signs of hemorrhage. Which intervention is
most appropriate?
A. Administering atropine 0.5 mg IV and preparing for pacing
B. Administering 1-2 liters of crystalloid fluid bolus
C. Initiating dopamine infusion for inotropic support
D. Applying a cervical collar and log-rolling the patient
Correct Answer: A [CORRECT]
Rationale: The presentation suggests neurogenic shock from cervical spinal cord injury
(above T6), causing loss of sympathetic tone with unopposed vagal response.
Bradycardia and hypotension without hypovolemia are hallmark signs. Atropine
addresses the bradycardia; pacing may be needed if unresponsive. Option B is incorrect
, because the patient is not hypovolemic; fluid may cause fluid overload. Option C is
incorrect because dopamine has variable effects; norepinephrine is preferred if
vasopressors are needed. Option D is already done and doesn't address the
hemodynamic emergency.
Q5: [Select All That Apply] A patient with a pulmonary artery catheter has the following
readings: RAP 14 mmHg, PAOP 18 mmHg, CI 2.1 L/min/m², SVR 1200 dynes/sec/cm⁻⁵.
Which conditions may be indicated by these values? Select all that apply.
A. Cardiogenic shock
B. Right ventricular failure
C. Volume overload
D. Hypovolemic shock
E. Septic shock
Correct Answers: A, B, C [CORRECT]
Rationale: Elevated RAP (CVP) and PAOP with low cardiac index indicates pump failure
(cardiogenic shock) or volume overload. Right ventricular failure elevates RAP
disproportionately. Option D (hypovolemic shock) would show low filling pressures.
Option E (septic shock) typically presents with low SVR and low/normal filling pressures
early; late sepsis may resemble cardiogenic shock but SVR would be low, not
elevated/normal.
Q6: A patient on a ventilator develops sudden high-pressure alarms, decreased breath
sounds on the right, subcutaneous emphysema, and tracheal deviation to the left.
Which action should the nurse take first?
