NUR 282 | Advanced Clinical / Transition Nursing | Exam 4
Comprehensive Practice 2026 |Galen College
1. A patient with a history of myocardial infarction is showing signs of
cardiogenic shock. Which hemodynamic parameter would the nurse expect to
find?
A. Decreased cardiac output and increased PAWP
B. Increased cardiac output and decreased PAWP
C. Decreased systemic vascular resistance
D. Increased mixed venous oxygen saturation (SvO2)
Answer: A
Rationale: In cardiogenic shock, the heart fails to pump effectively, leading to decreased
cardiac output and a backup of fluid in the lungs, which increases Pulmonary Artery Wedge
Pressure (PAWP).
2. A nurse is caring for a patient on a mechanical ventilator. The high-pressure
alarm sounds. Which action should the nurse take first?
A. Increase the tidal volume settings
B. Check for a leak in the cuff
C. Assess for a disconnected oxygen source
D. Check the tubing for kinks or patient biting
Answer: D
Rationale: High-pressure alarms are triggered by obstructions such as secretions, kinks in
the tubing, or the patient fighting/biting the tube. Leaks cause low-pressure alarms.
,3. Which of the following is an early clinical manifestation of septic shock?
A. Warm, flushed skin
B. Bradycardia
C. Cool, clammy skin
D. Severe peripheral edema
Answer: A
Rationale: The early (hyperdynamic) phase of septic shock is characterized by
vasodilation, which results in warm, flushed skin and a high cardiac output.
4. The nurse identifies Cushing’s Triad in a patient with a traumatic brain injury.
This includes which set of vital signs?
A. Tachycardia, hypotension, and tachypnea
B. Bradycardia, hypertension with widening pulse pressure, and irregular respirations
C. Bradycardia, hypotension, and apnea
D. Tachycardia, hypertension, and Cheyne-Stokes breathing
Answer: B
Rationale: Cushing’s Triad is a late sign of increased ICP and consists of bradycardia,
systolic hypertension with a widening pulse pressure, and irregular respiratory patterns.
5. A patient’s ABG results are: pH 7.30, PaCO2 55, HCO3 26. How should the
nurse interpret these results?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Respiratory acidosis
D. Metabolic alkalosis
Answer: C
Rationale: The pH is low (<7.35) indicating acidosis. The PaCO2 is high (>45) indicating a
respiratory cause. The HCO3 is normal, indicating no compensation yet.
, 6. Which medication is typically the first-line treatment for a patient in
symptomatic sinus bradycardia?
A. Amiodarone
B. Atropine
C. Epinephrine
D. Lidocaine
Answer: B
Rationale: Atropine is the primary drug used to increase heart rate in patients with
symptomatic bradycardia.
7. In the event of a mass casualty incident, which color tag is assigned to a
victim who requires immediate, life-saving intervention?
A. Green
B. Red
C. Yellow
D. Black
Answer: B
Rationale: Red tags (Immediate) are for patients with life-threatening injuries who have a
high chance of survival if treated immediately.
8. A patient with Acute Respiratory Distress Syndrome (ARDS) is placed in the
prone position. What is the primary rationale for this intervention?
A. To improve ventilation-perfusion (V/Q) matching and oxygenation
B. To decrease intracranial pressure
C. To prevent pressure ulcers on the sacrum
D. To make it easier for the patient to cough
Answer: A
Rationale: Prone positioning improves oxygenation in ARDS by recruiting collapsed alveoli
in the dorsal lung regions and improving V/Q matching.
Comprehensive Practice 2026 |Galen College
1. A patient with a history of myocardial infarction is showing signs of
cardiogenic shock. Which hemodynamic parameter would the nurse expect to
find?
A. Decreased cardiac output and increased PAWP
B. Increased cardiac output and decreased PAWP
C. Decreased systemic vascular resistance
D. Increased mixed venous oxygen saturation (SvO2)
Answer: A
Rationale: In cardiogenic shock, the heart fails to pump effectively, leading to decreased
cardiac output and a backup of fluid in the lungs, which increases Pulmonary Artery Wedge
Pressure (PAWP).
2. A nurse is caring for a patient on a mechanical ventilator. The high-pressure
alarm sounds. Which action should the nurse take first?
A. Increase the tidal volume settings
B. Check for a leak in the cuff
C. Assess for a disconnected oxygen source
D. Check the tubing for kinks or patient biting
Answer: D
Rationale: High-pressure alarms are triggered by obstructions such as secretions, kinks in
the tubing, or the patient fighting/biting the tube. Leaks cause low-pressure alarms.
,3. Which of the following is an early clinical manifestation of septic shock?
A. Warm, flushed skin
B. Bradycardia
C. Cool, clammy skin
D. Severe peripheral edema
Answer: A
Rationale: The early (hyperdynamic) phase of septic shock is characterized by
vasodilation, which results in warm, flushed skin and a high cardiac output.
4. The nurse identifies Cushing’s Triad in a patient with a traumatic brain injury.
This includes which set of vital signs?
A. Tachycardia, hypotension, and tachypnea
B. Bradycardia, hypertension with widening pulse pressure, and irregular respirations
C. Bradycardia, hypotension, and apnea
D. Tachycardia, hypertension, and Cheyne-Stokes breathing
Answer: B
Rationale: Cushing’s Triad is a late sign of increased ICP and consists of bradycardia,
systolic hypertension with a widening pulse pressure, and irregular respiratory patterns.
5. A patient’s ABG results are: pH 7.30, PaCO2 55, HCO3 26. How should the
nurse interpret these results?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Respiratory acidosis
D. Metabolic alkalosis
Answer: C
Rationale: The pH is low (<7.35) indicating acidosis. The PaCO2 is high (>45) indicating a
respiratory cause. The HCO3 is normal, indicating no compensation yet.
, 6. Which medication is typically the first-line treatment for a patient in
symptomatic sinus bradycardia?
A. Amiodarone
B. Atropine
C. Epinephrine
D. Lidocaine
Answer: B
Rationale: Atropine is the primary drug used to increase heart rate in patients with
symptomatic bradycardia.
7. In the event of a mass casualty incident, which color tag is assigned to a
victim who requires immediate, life-saving intervention?
A. Green
B. Red
C. Yellow
D. Black
Answer: B
Rationale: Red tags (Immediate) are for patients with life-threatening injuries who have a
high chance of survival if treated immediately.
8. A patient with Acute Respiratory Distress Syndrome (ARDS) is placed in the
prone position. What is the primary rationale for this intervention?
A. To improve ventilation-perfusion (V/Q) matching and oxygenation
B. To decrease intracranial pressure
C. To prevent pressure ulcers on the sacrum
D. To make it easier for the patient to cough
Answer: A
Rationale: Prone positioning improves oxygenation in ARDS by recruiting collapsed alveoli
in the dorsal lung regions and improving V/Q matching.
