NR-341/NR341 Exam 1 V1 | Complex Adult
Health Q&A with Rationale | Chamberlain
University
1. A patient in the ICU is being monitored after an acute myocardial infarction. The nurse
notes the following arterial blood gas (ABG) results: pH 7.30, PaCO2 52 mmHg, and HCO3 24
mEq/L. Which interpretation and intervention are most appropriate?
A. Metabolic acidosis; prepare to administer sodium bicarbonate.
B. Respiratory alkalosis; encourage the patient to breathe into a paper bag.
C. Respiratory acidosis; assess airway patency and consider increasing ventilation.
D. Metabolic alkalosis; monitor for hypokalemia and adjust diuretic therapy.
Correct Answer: C
Expert Explanation: The pH of 7.30 indicates acidosis, while the elevated PaCO2 of 52
mmHg indicates the primary cause is respiratory. Since the bicarbonate level is within the
normal range, the condition is uncompensated respiratory acidosis. The nurse must
prioritize airway and ventilation to facilitate CO2 removal.
2. A nurse is caring for a patient in septic shock. The patient’s hemodynamics reveal a Central
Venous Pressure (CVP) of 2 mmHg and a Mean Arterial Pressure (MAP) of 55 mmHg. Which
provider order should the nurse prioritize?
A. Administer a 500 mL Normal Saline bolus.
,B. Start Norepinephrine at 2 mcg/min.
C. Draw blood cultures from two different sites.
D. Administer broad-spectrum antibiotics.
Correct Answer: A
Expert Explanation: The low CVP and MAP indicate inadequate circulating volume and
perfusion. In the initial phase of septic shock resuscitation, fluid volume expansion is the
priority to improve preload and cardiac output. Vasopressors like norepinephrine should
typically be initiated only after fluid resuscitation has failed to achieve adequate MAP.
3. During an assessment of a patient with a pulmonary artery catheter, the nurse notes a
Pulmonary Artery Wedge Pressure (PAWP) of 22 mmHg. Which clinical manifestation is the
nurse likely to observe?
A. Crackles in the lungs and dyspnea.
B. Clear breath sounds and peripheral edema.
C. Flat neck veins and dry mucous membranes.
D. Increased urine output and hypertension.
Correct Answer: A
Expert Explanation: The PAWP is an indicator of left ventricular end-diastolic pressure,
with normal values ranging from 6 to 12 mmHg. A level of 22 mmHg indicates left-sided
, heart failure or fluid overload, leading to pulmonary congestion. The patient will likely
exhibit signs of pulmonary edema, such as crackles and shortness of breath.
4. The nurse is caring for a patient on mechanical ventilation using Positive End-Expiratory
Pressure (PEEP). What is the primary physiological benefit of PEEP?
A. It prevents alveolar collapse during expiration and improves oxygenation.
B. It increases the work of breathing to strengthen respiratory muscles.
C. It decreases the risk of barotrauma by lowering airway pressures.
D. It ensures that the patient receives a set tidal volume with every breath.
Correct Answer: A
Expert Explanation: PEEP provides pressure at the end of expiration to keep the alveoli
open, thereby increasing the functional residual capacity. This mechanism is crucial for
improving gas exchange and oxygenation in patients with conditions like ARDS. However,
high levels of PEEP must be monitored closely for complications like decreased cardiac
output.
5. A patient is admitted with Acute Respiratory Distress Syndrome (ARDS). Which of the
following is a hallmark clinical characteristic of this condition?
A. Hypoxemia that improves significantly with low-flow oxygen.
B. Refractory hypoxemia despite increasing concentrations of supplemental oxygen.
C. Elevated left-sided heart pressures as measured by PAWP (>18 mmHg).
Health Q&A with Rationale | Chamberlain
University
1. A patient in the ICU is being monitored after an acute myocardial infarction. The nurse
notes the following arterial blood gas (ABG) results: pH 7.30, PaCO2 52 mmHg, and HCO3 24
mEq/L. Which interpretation and intervention are most appropriate?
A. Metabolic acidosis; prepare to administer sodium bicarbonate.
B. Respiratory alkalosis; encourage the patient to breathe into a paper bag.
C. Respiratory acidosis; assess airway patency and consider increasing ventilation.
D. Metabolic alkalosis; monitor for hypokalemia and adjust diuretic therapy.
Correct Answer: C
Expert Explanation: The pH of 7.30 indicates acidosis, while the elevated PaCO2 of 52
mmHg indicates the primary cause is respiratory. Since the bicarbonate level is within the
normal range, the condition is uncompensated respiratory acidosis. The nurse must
prioritize airway and ventilation to facilitate CO2 removal.
2. A nurse is caring for a patient in septic shock. The patient’s hemodynamics reveal a Central
Venous Pressure (CVP) of 2 mmHg and a Mean Arterial Pressure (MAP) of 55 mmHg. Which
provider order should the nurse prioritize?
A. Administer a 500 mL Normal Saline bolus.
,B. Start Norepinephrine at 2 mcg/min.
C. Draw blood cultures from two different sites.
D. Administer broad-spectrum antibiotics.
Correct Answer: A
Expert Explanation: The low CVP and MAP indicate inadequate circulating volume and
perfusion. In the initial phase of septic shock resuscitation, fluid volume expansion is the
priority to improve preload and cardiac output. Vasopressors like norepinephrine should
typically be initiated only after fluid resuscitation has failed to achieve adequate MAP.
3. During an assessment of a patient with a pulmonary artery catheter, the nurse notes a
Pulmonary Artery Wedge Pressure (PAWP) of 22 mmHg. Which clinical manifestation is the
nurse likely to observe?
A. Crackles in the lungs and dyspnea.
B. Clear breath sounds and peripheral edema.
C. Flat neck veins and dry mucous membranes.
D. Increased urine output and hypertension.
Correct Answer: A
Expert Explanation: The PAWP is an indicator of left ventricular end-diastolic pressure,
with normal values ranging from 6 to 12 mmHg. A level of 22 mmHg indicates left-sided
, heart failure or fluid overload, leading to pulmonary congestion. The patient will likely
exhibit signs of pulmonary edema, such as crackles and shortness of breath.
4. The nurse is caring for a patient on mechanical ventilation using Positive End-Expiratory
Pressure (PEEP). What is the primary physiological benefit of PEEP?
A. It prevents alveolar collapse during expiration and improves oxygenation.
B. It increases the work of breathing to strengthen respiratory muscles.
C. It decreases the risk of barotrauma by lowering airway pressures.
D. It ensures that the patient receives a set tidal volume with every breath.
Correct Answer: A
Expert Explanation: PEEP provides pressure at the end of expiration to keep the alveoli
open, thereby increasing the functional residual capacity. This mechanism is crucial for
improving gas exchange and oxygenation in patients with conditions like ARDS. However,
high levels of PEEP must be monitored closely for complications like decreased cardiac
output.
5. A patient is admitted with Acute Respiratory Distress Syndrome (ARDS). Which of the
following is a hallmark clinical characteristic of this condition?
A. Hypoxemia that improves significantly with low-flow oxygen.
B. Refractory hypoxemia despite increasing concentrations of supplemental oxygen.
C. Elevated left-sided heart pressures as measured by PAWP (>18 mmHg).
