NR-341 – Complex Adult Health | Advanced Adult
Nursing Study Guide, Critical Care Concepts,
Complex Diseases, Clinical Judgment, and
Comprehensive Exam Preparation
1. A patient in the intensive care unit (ICU) has a pulmonary artery (Swan-
Ganz) catheter in place. The nurse notes a pulmonary artery wedge pressure
(PAWP) of 22 mmHg. Which condition does this finding most likely indicate?
A. Hypovolemia
B. Left-sided heart failure
C. Pulmonary embolism
D. Right-sided heart failure
Rationale: Pulmonary artery wedge pressure (PAWP) reflects left ventricular
end-diastolic pressure (LVEDP) and is an indicator of left ventricular function. A
normal PAWP is 4-12 mmHg. A PAWP of 22 mmHg indicates elevated left
ventricular filling pressure, which is characteristic of left-sided heart failure or
fluid overload. Hypovolemia would be associated with a low PAWP.
2. A patient in septic shock has a central venous pressure (CVP) of 2 mmHg.
Which nursing intervention is most appropriate?
A. Administer a vasopressor.
B. Administer a fluid bolus.
C. Administer a diuretic.
D. Place the patient in Trendelenburg position.
Rationale: Central venous pressure (CVP) reflects right ventricular preload and
volume status. A normal CVP is 2-6 mmHg. A CVP of 2 mmHg is low,
indicating hypovolemia. In septic shock, the initial management includes fluid
resuscitation to restore intravascular volume and improve cardiac output.
Vasopressors are used after fluid resuscitation if hypotension persists.
3. A patient is receiving continuous cardiac monitoring. The nurse notes a
rhythm with a heart rate of 160 bpm, absent P waves, and irregularly
irregular R-R intervals. Which rhythm is this?
A. Atrial flutter
B. Atrial fibrillation
,C. Sinus tachycardia
D. Ventricular tachycardia
Rationale: Atrial fibrillation is characterized by an irregularly
irregular rhythm, absent P waves (replaced by fibrillatory waves), and a variable
ventricular rate. Atrial flutter has a "sawtooth" pattern and typically has a regular
ventricular response. Ventricular tachycardia has wide QRS complexes.
4. A patient with acute respiratory distress syndrome (ARDS) is on
mechanical ventilation with a tidal volume of 6 mL/kg and a PEEP of 10 cm
H2O. The nurse notes a plateau pressure of 35 cm H2O. Which action is most
appropriate?
A. Increase the PEEP.
B. Notify the healthcare provider and assess for barotrauma.
C. Decrease the respiratory rate.
D. Increase the tidal volume.
Rationale: Plateau pressure reflects alveolar pressure and should be maintained
at < 30 cm H2O to prevent barotrauma (lung injury from high pressures). A
plateau pressure of 35 cm H2O is elevated and increases the risk of barotrauma.
The nurse should notify the healthcare provider immediately. PEEP and tidal
volume may need to be adjusted.
5. A patient is admitted with cardiogenic shock. Which hemodynamic
parameter would the nurse expect to find?
A. Low cardiac output and elevated PAWP
B. High cardiac output and low PAWP
C. Low cardiac output and low PAWP
D. High cardiac output and elevated PAWP
Rationale: In cardiogenic shock, the heart is unable to pump effectively, leading
to low cardiac output (CO) and elevated PAWP (due to backup of blood into the
pulmonary circulation). This is in contrast to hypovolemic shock (low CO, low
PAWP) and distributive shock (high or normal CO, low PAWP).
6. A patient in the ICU has an arterial line for continuous blood pressure
monitoring. The nurse notes that the arterial waveform is dampened. Which
action should the nurse take first?
A. Re-zero the transducer.
B. Check the line for air bubbles or kinks.
,C. Aspirate blood from the line.
D. Increase the pressure bag to 300 mmHg.
Rationale: A dampened arterial waveform indicates a problem with the pressure
monitoring system, most commonly air bubbles, kinks, or a clot in the line. The
nurse should first check the line for these issues. Re-zeroing may be needed after
resolving the mechanical issue. The pressure bag should be maintained at 300
mmHg.
7. A patient is receiving norepinephrine (Levophed) for septic shock. Which
assessment finding indicates the medication is having the desired effect?
A. Heart rate of 55 bpm.
B. Mean arterial pressure (MAP) of 70 mmHg.
C. Central venous pressure of 10 mmHg.
D. Cardiac output of 3 L/min.
Rationale: Norepinephrine is a potent vasopressor used to increase blood
pressure in septic shock. The desired effect is an improvement in mean arterial
pressure (MAP), with a target of ≥ 65 mmHg. A MAP of 70 mmHg indicates the
medication is effective. Bradycardia is an adverse effect of norepinephrine.
8. A patient with a pulmonary embolism has a sudden onset of severe dyspnea
and hypotension. The nurse suspects a massive pulmonary embolism. Which
treatment should the nurse anticipate?
A. Heparin infusion
B. Thrombolytic therapy
C. Warfarin therapy
D. Oxygen therapy
Rationale: Massive pulmonary embolism with hemodynamic instability
(hypotension, shock) is a life-threatening emergency. Thrombolytic therapy (e.g.,
alteplase) is indicated to rapidly dissolve the clot and restore perfusion. Heparin is
used for stable patients. Oxygen is supportive but does not address the clot.
9. The nurse is caring for a patient with status epilepticus. The patient is
prescribed lorazepam (Ativan) IV. Which adverse effect should the nurse
monitor for?
A. Hypertension
B. Respiratory depression
, C. Tachycardia
D. Hyperthermia
Rationale: Lorazepam is a benzodiazepine used to treat status epilepticus. The
most significant adverse effect is respiratory depression, especially when given
IV. The nurse should monitor respiratory rate, oxygen saturation, and level of
consciousness closely. Respiratory support may be needed.
10. A patient is admitted with a traumatic brain injury (TBI). The nurse
monitors intracranial pressure (ICP). Which intervention is most effective in
reducing ICP?
A. Keep the patient in a supine position.
B. Elevate the head of the bed to 30 degrees.
C. Encourage the patient to cough and deep breathe.
D. Administer an opioid for pain.
Rationale: Elevating the head of the bed to 30 degrees promotes venous
drainage from the brain, which helps reduce intracranial pressure (ICP) . The
supine position can increase ICP. Coughing, Valsalva maneuver, and suctioning
can increase ICP. Pain management is important but is not the primary intervention
for ICP reduction.
11. A patient in the ICU has a Glasgow Coma Scale (GCS) score of 8. Which
nursing intervention is the priority?
A. Administer pain medication.
B. Maintain a patent airway.
C. Assess pupillary response.
D. Insert a Foley catheter.
Rationale: A GCS score of 8 or less indicates a comatose state and the patient is
at high risk for airway compromise. The priority intervention is to maintain a
patent airway and ensure adequate ventilation. This may include positioning,
suctioning, or endotracheal intubation.
12. A patient with acute myocardial infarction (STEMI) is receiving
thrombolytic therapy. Which finding indicates a complication of this therapy?
A. Chest pain relief
B. Sudden onset of severe headache and vomiting
C. ST-segment resolution
D. T-wave inversion
Nursing Study Guide, Critical Care Concepts,
Complex Diseases, Clinical Judgment, and
Comprehensive Exam Preparation
1. A patient in the intensive care unit (ICU) has a pulmonary artery (Swan-
Ganz) catheter in place. The nurse notes a pulmonary artery wedge pressure
(PAWP) of 22 mmHg. Which condition does this finding most likely indicate?
A. Hypovolemia
B. Left-sided heart failure
C. Pulmonary embolism
D. Right-sided heart failure
Rationale: Pulmonary artery wedge pressure (PAWP) reflects left ventricular
end-diastolic pressure (LVEDP) and is an indicator of left ventricular function. A
normal PAWP is 4-12 mmHg. A PAWP of 22 mmHg indicates elevated left
ventricular filling pressure, which is characteristic of left-sided heart failure or
fluid overload. Hypovolemia would be associated with a low PAWP.
2. A patient in septic shock has a central venous pressure (CVP) of 2 mmHg.
Which nursing intervention is most appropriate?
A. Administer a vasopressor.
B. Administer a fluid bolus.
C. Administer a diuretic.
D. Place the patient in Trendelenburg position.
Rationale: Central venous pressure (CVP) reflects right ventricular preload and
volume status. A normal CVP is 2-6 mmHg. A CVP of 2 mmHg is low,
indicating hypovolemia. In septic shock, the initial management includes fluid
resuscitation to restore intravascular volume and improve cardiac output.
Vasopressors are used after fluid resuscitation if hypotension persists.
3. A patient is receiving continuous cardiac monitoring. The nurse notes a
rhythm with a heart rate of 160 bpm, absent P waves, and irregularly
irregular R-R intervals. Which rhythm is this?
A. Atrial flutter
B. Atrial fibrillation
,C. Sinus tachycardia
D. Ventricular tachycardia
Rationale: Atrial fibrillation is characterized by an irregularly
irregular rhythm, absent P waves (replaced by fibrillatory waves), and a variable
ventricular rate. Atrial flutter has a "sawtooth" pattern and typically has a regular
ventricular response. Ventricular tachycardia has wide QRS complexes.
4. A patient with acute respiratory distress syndrome (ARDS) is on
mechanical ventilation with a tidal volume of 6 mL/kg and a PEEP of 10 cm
H2O. The nurse notes a plateau pressure of 35 cm H2O. Which action is most
appropriate?
A. Increase the PEEP.
B. Notify the healthcare provider and assess for barotrauma.
C. Decrease the respiratory rate.
D. Increase the tidal volume.
Rationale: Plateau pressure reflects alveolar pressure and should be maintained
at < 30 cm H2O to prevent barotrauma (lung injury from high pressures). A
plateau pressure of 35 cm H2O is elevated and increases the risk of barotrauma.
The nurse should notify the healthcare provider immediately. PEEP and tidal
volume may need to be adjusted.
5. A patient is admitted with cardiogenic shock. Which hemodynamic
parameter would the nurse expect to find?
A. Low cardiac output and elevated PAWP
B. High cardiac output and low PAWP
C. Low cardiac output and low PAWP
D. High cardiac output and elevated PAWP
Rationale: In cardiogenic shock, the heart is unable to pump effectively, leading
to low cardiac output (CO) and elevated PAWP (due to backup of blood into the
pulmonary circulation). This is in contrast to hypovolemic shock (low CO, low
PAWP) and distributive shock (high or normal CO, low PAWP).
6. A patient in the ICU has an arterial line for continuous blood pressure
monitoring. The nurse notes that the arterial waveform is dampened. Which
action should the nurse take first?
A. Re-zero the transducer.
B. Check the line for air bubbles or kinks.
,C. Aspirate blood from the line.
D. Increase the pressure bag to 300 mmHg.
Rationale: A dampened arterial waveform indicates a problem with the pressure
monitoring system, most commonly air bubbles, kinks, or a clot in the line. The
nurse should first check the line for these issues. Re-zeroing may be needed after
resolving the mechanical issue. The pressure bag should be maintained at 300
mmHg.
7. A patient is receiving norepinephrine (Levophed) for septic shock. Which
assessment finding indicates the medication is having the desired effect?
A. Heart rate of 55 bpm.
B. Mean arterial pressure (MAP) of 70 mmHg.
C. Central venous pressure of 10 mmHg.
D. Cardiac output of 3 L/min.
Rationale: Norepinephrine is a potent vasopressor used to increase blood
pressure in septic shock. The desired effect is an improvement in mean arterial
pressure (MAP), with a target of ≥ 65 mmHg. A MAP of 70 mmHg indicates the
medication is effective. Bradycardia is an adverse effect of norepinephrine.
8. A patient with a pulmonary embolism has a sudden onset of severe dyspnea
and hypotension. The nurse suspects a massive pulmonary embolism. Which
treatment should the nurse anticipate?
A. Heparin infusion
B. Thrombolytic therapy
C. Warfarin therapy
D. Oxygen therapy
Rationale: Massive pulmonary embolism with hemodynamic instability
(hypotension, shock) is a life-threatening emergency. Thrombolytic therapy (e.g.,
alteplase) is indicated to rapidly dissolve the clot and restore perfusion. Heparin is
used for stable patients. Oxygen is supportive but does not address the clot.
9. The nurse is caring for a patient with status epilepticus. The patient is
prescribed lorazepam (Ativan) IV. Which adverse effect should the nurse
monitor for?
A. Hypertension
B. Respiratory depression
, C. Tachycardia
D. Hyperthermia
Rationale: Lorazepam is a benzodiazepine used to treat status epilepticus. The
most significant adverse effect is respiratory depression, especially when given
IV. The nurse should monitor respiratory rate, oxygen saturation, and level of
consciousness closely. Respiratory support may be needed.
10. A patient is admitted with a traumatic brain injury (TBI). The nurse
monitors intracranial pressure (ICP). Which intervention is most effective in
reducing ICP?
A. Keep the patient in a supine position.
B. Elevate the head of the bed to 30 degrees.
C. Encourage the patient to cough and deep breathe.
D. Administer an opioid for pain.
Rationale: Elevating the head of the bed to 30 degrees promotes venous
drainage from the brain, which helps reduce intracranial pressure (ICP) . The
supine position can increase ICP. Coughing, Valsalva maneuver, and suctioning
can increase ICP. Pain management is important but is not the primary intervention
for ICP reduction.
11. A patient in the ICU has a Glasgow Coma Scale (GCS) score of 8. Which
nursing intervention is the priority?
A. Administer pain medication.
B. Maintain a patent airway.
C. Assess pupillary response.
D. Insert a Foley catheter.
Rationale: A GCS score of 8 or less indicates a comatose state and the patient is
at high risk for airway compromise. The priority intervention is to maintain a
patent airway and ensure adequate ventilation. This may include positioning,
suctioning, or endotracheal intubation.
12. A patient with acute myocardial infarction (STEMI) is receiving
thrombolytic therapy. Which finding indicates a complication of this therapy?
A. Chest pain relief
B. Sudden onset of severe headache and vomiting
C. ST-segment resolution
D. T-wave inversion
