NUR 282 Advanced Clinical / Transition Nursing Exam 3
Comprehensive Study Guide 2026 |Galen College
1. A patient with septic shock is receiving large amounts of IV fluids. Which
finding would best indicate that the fluid resuscitation is effective?
A. Mean Arterial Pressure (MAP) of 68 mmHg
B. Urine output of 15 mL/hr
C. Heart rate of 115 bpm
D. CVP of 2 mmHg
Answer: A
Rationale: In shock management, a MAP > 65 mmHg is a primary goal indicating adequate
tissue perfusion.
2. The nurse is caring for a patient on mechanical ventilation. The ‘high
pressure’ alarm sounds. Which action should the nurse take first?
A. Check for a leak in the ventilator tubing
B. Manually ventilate the patient with a bag-valve mask
C. Increase the oxygen concentration
D. Suction the patient for possible secretions
Answer: D
Rationale: High pressure alarms are often caused by obstructions like secretions,
coughing, or biting the tube. Suctioning is a common first intervention.
,3. Which lab value is most characteristic of a patient in the early stages of
Disseminated Intravascular Coagulation (DIC)?
A. Increased Fibrin Degradation Products (FDPs)
B. Decreased Prothrombin Time (PT)
C. Increased Platelet count
D. Decreased D-dimer
Answer: A
Rationale: DIC involves excessive clotting followed by fibrinolysis, leading to elevated
fibrin degradation products and D-dimer.
4. A patient with Acute Respiratory Distress Syndrome (ARDS) is placed in the
prone position. What is the primary rationale for this intervention?
A. To decrease the patient’s work of breathing
B. To improve oxygenation by recruiting dorsal alveolar units
C. To prevent pressure ulcers on the sacrum
D. To facilitate easier suctioning of secretions
Answer: B
Rationale: Prone positioning improves V/Q matching by shifting perfusion to better-
ventilated anterior lung areas and recruiting posterior alveoli.
5. Which type of shock is characterized by a high Cardiac Output and a low
Systemic Vascular Resistance (SVR)?
A. Hypovolemic Shock
B. Cardiogenic Shock
C. Obstructive Shock
D. Early Septic Shock
Answer: D
Rationale: The ‘hyperdynamic’ or ‘warm’ phase of septic shock is unique because SVR
drops due to vasodilation, often causing a compensatory increase in Cardiac Output.
, 6. A patient is admitted with a traumatic brain injury and an ICP of 25 mmHg.
Which nursing intervention is appropriate?
A. Encourage the patient to perform isometric exercises
B. Keep the Head of Bed (HOB) flat
C. Maintain the head in a neutral, midline position
D. Perform vigorous tracheal suctioning every hour
Answer: C
Rationale: Neutral midline positioning facilitates venous drainage from the brain, helping
to lower intracranial pressure.
7. Which EKG rhythm is characterized by a ‘sawtooth’ appearance of P-waves?
A. Atrial Fibrillation
B. Ventricular Tachycardia
C. Atrial Flutter
D. First-Degree Heart Block
Answer: C
Rationale: Atrial flutter presents with consistent, rapid ‘F’ waves that look like teeth on a
saw.
8. A patient in Cardiogenic Shock is prescribed Dobutamine. The nurse knows
this medication is given primarily to:
A. Increase myocardial contractility
B. Cause profound peripheral vasoconstriction
C. Decrease the heart rate
D. Decrease the preload
Answer: A
Rationale: Dobutamine is a positive inotrope used to improve the pumping effectiveness of
the failing heart.
Comprehensive Study Guide 2026 |Galen College
1. A patient with septic shock is receiving large amounts of IV fluids. Which
finding would best indicate that the fluid resuscitation is effective?
A. Mean Arterial Pressure (MAP) of 68 mmHg
B. Urine output of 15 mL/hr
C. Heart rate of 115 bpm
D. CVP of 2 mmHg
Answer: A
Rationale: In shock management, a MAP > 65 mmHg is a primary goal indicating adequate
tissue perfusion.
2. The nurse is caring for a patient on mechanical ventilation. The ‘high
pressure’ alarm sounds. Which action should the nurse take first?
A. Check for a leak in the ventilator tubing
B. Manually ventilate the patient with a bag-valve mask
C. Increase the oxygen concentration
D. Suction the patient for possible secretions
Answer: D
Rationale: High pressure alarms are often caused by obstructions like secretions,
coughing, or biting the tube. Suctioning is a common first intervention.
,3. Which lab value is most characteristic of a patient in the early stages of
Disseminated Intravascular Coagulation (DIC)?
A. Increased Fibrin Degradation Products (FDPs)
B. Decreased Prothrombin Time (PT)
C. Increased Platelet count
D. Decreased D-dimer
Answer: A
Rationale: DIC involves excessive clotting followed by fibrinolysis, leading to elevated
fibrin degradation products and D-dimer.
4. A patient with Acute Respiratory Distress Syndrome (ARDS) is placed in the
prone position. What is the primary rationale for this intervention?
A. To decrease the patient’s work of breathing
B. To improve oxygenation by recruiting dorsal alveolar units
C. To prevent pressure ulcers on the sacrum
D. To facilitate easier suctioning of secretions
Answer: B
Rationale: Prone positioning improves V/Q matching by shifting perfusion to better-
ventilated anterior lung areas and recruiting posterior alveoli.
5. Which type of shock is characterized by a high Cardiac Output and a low
Systemic Vascular Resistance (SVR)?
A. Hypovolemic Shock
B. Cardiogenic Shock
C. Obstructive Shock
D. Early Septic Shock
Answer: D
Rationale: The ‘hyperdynamic’ or ‘warm’ phase of septic shock is unique because SVR
drops due to vasodilation, often causing a compensatory increase in Cardiac Output.
, 6. A patient is admitted with a traumatic brain injury and an ICP of 25 mmHg.
Which nursing intervention is appropriate?
A. Encourage the patient to perform isometric exercises
B. Keep the Head of Bed (HOB) flat
C. Maintain the head in a neutral, midline position
D. Perform vigorous tracheal suctioning every hour
Answer: C
Rationale: Neutral midline positioning facilitates venous drainage from the brain, helping
to lower intracranial pressure.
7. Which EKG rhythm is characterized by a ‘sawtooth’ appearance of P-waves?
A. Atrial Fibrillation
B. Ventricular Tachycardia
C. Atrial Flutter
D. First-Degree Heart Block
Answer: C
Rationale: Atrial flutter presents with consistent, rapid ‘F’ waves that look like teeth on a
saw.
8. A patient in Cardiogenic Shock is prescribed Dobutamine. The nurse knows
this medication is given primarily to:
A. Increase myocardial contractility
B. Cause profound peripheral vasoconstriction
C. Decrease the heart rate
D. Decrease the preload
Answer: A
Rationale: Dobutamine is a positive inotrope used to improve the pumping effectiveness of
the failing heart.
