NR341/NR 341 Exam 4 V1 | Complex Adult
Health Q&A with Rationale | Chamberlain
University
1. A patient in septic shock has received 30 mL/kg of crystalloid fluids but remains
hypotensive with a Mean Arterial Pressure (MAP) of 58 mmHg. Which medication should the
nurse anticipate administering next?
A. Dobutamine
B. Nitroprusside
C. Norepinephrine
D. Atropine
Correct Answer: C
Expert Explanation: Norepinephrine is the first-line vasopressor recommended for septic
shock when fluid resuscitation is insufficient to maintain a MAP of at least 65 mmHg. It
works primarily through alpha-adrenergic stimulation to cause vasoconstriction and
increase systemic vascular resistance. The nurse must monitor the patient closely for
improved tissue perfusion and potential complications such as digital ischemia.
2. Which hemodynamic parameter should the nurse expect to find in a patient experiencing
Cardiogenic Shock?
A. Decreased Pulmonary Capillary Wedge Pressure (PCWP)
,B. Increased Cardiac Index (CI)
C. Increased Pulmonary Capillary Wedge Pressure (PCWP)
D. Decreased Systemic Vascular Resistance (SVR)
Correct Answer: C
Expert Explanation: In cardiogenic shock, the heart’s inability to pump effectively leads to
a backup of blood into the pulmonary circulation, increasing the PCWP. This condition is
also characterized by a low cardiac output and high systemic vascular resistance as the
body attempts to compensate. Monitoring these values is essential for evaluating the
effectiveness of inotropic support or mechanical assist devices.
3. A patient arrives at the emergency department with partial-thickness burns to the entire
left arm and the entire anterior trunk. Using the Rule of Nines, what is the total body surface
area (TBSA) affected?
A. 18%
B. 27%
C. 36%
D. 45%
Correct Answer: B
Expert Explanation: According to the Rule of Nines, the entire arm accounts for 9% and
the anterior trunk accounts for 18% of the TBSA. Adding these two areas together (9 + 18)
,results in a total of 27%. Accurate TBSA calculation is critical for determining fluid
resuscitation requirements using the Parkland Formula.
4. The nurse is caring for a patient on mechanical ventilation with High-Efficiency Positive
End-Expiratory Pressure (PEEP). Which side effect should the nurse monitor for most closely?
A. Increased Cardiac Output
B. Hypernatremia
C. Respiratory Alkalosis
D. Pneumothorax
Correct Answer: D
Expert Explanation: High levels of PEEP increase intrathoracic pressure, which puts the
patient at risk for barotrauma, such as a tension pneumothorax. Additionally, this increased
pressure can decrease venous return to the heart, potentially lowering cardiac output and
blood pressure. The nurse should assess lung sounds and hemodynamic stability
frequently during PEEP titration.
5. A trauma patient presents with tracheal deviation to the right, absent breath sounds on
the left, and extreme hypotension. What is the nurse’s priority action?
A. Obtain a portable chest X-ray
B. Insert a large-bore orogastric tube
C. Prepare for immediate needle decompression
, D. Administer a rapid fluid bolus
Correct Answer: C
Expert Explanation: These clinical findings are classic indicators of a tension
pneumothorax, which is a life-threatening emergency requiring immediate intervention.
Needle decompression is performed to relieve the pressure before a formal chest tube is
inserted. Delaying treatment to wait for an X-ray can lead to obstructive shock and cardiac
arrest.
6. In the emergent phase of burn care, which electrolyte imbalance is most commonly
observed?
A. Hypokalemia
B. Hyperkalemia
C. Hypernatremia
D. Hypocalcemia
Correct Answer: B
Expert Explanation: Hyperkalemia occurs during the emergent phase because massive
cell destruction releases intracellular potassium into the extracellular fluid. The nurse must
monitor the patient’s EKG for peaked T-waves or other dysrhythmias associated with high
potassium. As fluid shifts stabilize and diuresis begins, potassium levels may later drop,
requiring careful trend analysis.
Health Q&A with Rationale | Chamberlain
University
1. A patient in septic shock has received 30 mL/kg of crystalloid fluids but remains
hypotensive with a Mean Arterial Pressure (MAP) of 58 mmHg. Which medication should the
nurse anticipate administering next?
A. Dobutamine
B. Nitroprusside
C. Norepinephrine
D. Atropine
Correct Answer: C
Expert Explanation: Norepinephrine is the first-line vasopressor recommended for septic
shock when fluid resuscitation is insufficient to maintain a MAP of at least 65 mmHg. It
works primarily through alpha-adrenergic stimulation to cause vasoconstriction and
increase systemic vascular resistance. The nurse must monitor the patient closely for
improved tissue perfusion and potential complications such as digital ischemia.
2. Which hemodynamic parameter should the nurse expect to find in a patient experiencing
Cardiogenic Shock?
A. Decreased Pulmonary Capillary Wedge Pressure (PCWP)
,B. Increased Cardiac Index (CI)
C. Increased Pulmonary Capillary Wedge Pressure (PCWP)
D. Decreased Systemic Vascular Resistance (SVR)
Correct Answer: C
Expert Explanation: In cardiogenic shock, the heart’s inability to pump effectively leads to
a backup of blood into the pulmonary circulation, increasing the PCWP. This condition is
also characterized by a low cardiac output and high systemic vascular resistance as the
body attempts to compensate. Monitoring these values is essential for evaluating the
effectiveness of inotropic support or mechanical assist devices.
3. A patient arrives at the emergency department with partial-thickness burns to the entire
left arm and the entire anterior trunk. Using the Rule of Nines, what is the total body surface
area (TBSA) affected?
A. 18%
B. 27%
C. 36%
D. 45%
Correct Answer: B
Expert Explanation: According to the Rule of Nines, the entire arm accounts for 9% and
the anterior trunk accounts for 18% of the TBSA. Adding these two areas together (9 + 18)
,results in a total of 27%. Accurate TBSA calculation is critical for determining fluid
resuscitation requirements using the Parkland Formula.
4. The nurse is caring for a patient on mechanical ventilation with High-Efficiency Positive
End-Expiratory Pressure (PEEP). Which side effect should the nurse monitor for most closely?
A. Increased Cardiac Output
B. Hypernatremia
C. Respiratory Alkalosis
D. Pneumothorax
Correct Answer: D
Expert Explanation: High levels of PEEP increase intrathoracic pressure, which puts the
patient at risk for barotrauma, such as a tension pneumothorax. Additionally, this increased
pressure can decrease venous return to the heart, potentially lowering cardiac output and
blood pressure. The nurse should assess lung sounds and hemodynamic stability
frequently during PEEP titration.
5. A trauma patient presents with tracheal deviation to the right, absent breath sounds on
the left, and extreme hypotension. What is the nurse’s priority action?
A. Obtain a portable chest X-ray
B. Insert a large-bore orogastric tube
C. Prepare for immediate needle decompression
, D. Administer a rapid fluid bolus
Correct Answer: C
Expert Explanation: These clinical findings are classic indicators of a tension
pneumothorax, which is a life-threatening emergency requiring immediate intervention.
Needle decompression is performed to relieve the pressure before a formal chest tube is
inserted. Delaying treatment to wait for an X-ray can lead to obstructive shock and cardiac
arrest.
6. In the emergent phase of burn care, which electrolyte imbalance is most commonly
observed?
A. Hypokalemia
B. Hyperkalemia
C. Hypernatremia
D. Hypocalcemia
Correct Answer: B
Expert Explanation: Hyperkalemia occurs during the emergent phase because massive
cell destruction releases intracellular potassium into the extracellular fluid. The nurse must
monitor the patient’s EKG for peaked T-waves or other dysrhythmias associated with high
potassium. As fluid shifts stabilize and diuresis begins, potassium levels may later drop,
requiring careful trend analysis.
