NUR417 / NUR 417 EXAM 1, 2, 3 & FINAL EXAM |
Actual Questions and Answers | Latest 2026/2027
Update | Graded A+ | 100% Assured Pass (Care of
Adult II at Concordia)
1. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled ventilation
with a tidal volume of 6 mL/kg ideal body weight, PEEP of 12 cm H2O, and FiO2 of 0.7. The
plateau pressure is 32 cm H2O. The patient's PaO2 is 55 mmHg. Which intervention should the
nurse anticipate as most appropriate to improve oxygenation while minimizing ventilator-induced
lung injury?
A. Increase tidal volume to 8 mL/kg to improve minute ventilation.
B. Increase PEEP to 15 cm H2O and monitor for hemodynamic compromise.
C. Switch to pressure-controlled ventilation with a peak inspiratory pressure of 35 cm H2O.
D. Administer a neuromuscular blocking agent to decrease oxygen consumption.
Answer: B
Rationale: In ARDS, lung-protective ventilation uses low tidal volumes (6 mL/kg) and sufficient PEEP to
recruit alveoli. Increasing PEEP may improve oxygenation by reducing shunt, but it must be balanced
against hemodynamic effects. Increasing tidal volume (A) would increase plateau pressure above 30 cm
H2O, risking barotrauma. Pressure-controlled ventilation (C) does not necessarily reduce risk and may
deliver variable volumes. Neuromuscular blockade (D) is reserved for refractory hypoxemia but is not
first-line.
2. A patient in the ICU develops new-onset atrial fibrillation with a ventricular rate of 150 bpm.
The blood pressure is 85/50 mmHg, and the patient is confused and oliguric. Which intervention
should the nurse prepare for first?
A. Administer intravenous amiodarone bolus and infusion.
B. Perform synchronized cardioversion at 100 J biphasic.
C. Administer intravenous metoprolol 5 mg over 2 minutes.
D. Start intravenous heparin infusion for stroke prophylaxis.
Answer: B
Rationale: This patient is hemodynamically unstable (hypotension, altered mental status, oliguria) due to
rapid atrial fibrillation. The immediate priority is synchronized cardioversion to restore sinus rhythm.
Amiodarone (A) or metoprolol (C) are rate or rhythm control options for stable patients. Heparin (D) is
important for stroke prevention but is not the first priority in unstable patients.
Page 1
,3. A patient with end-stage liver disease is admitted with acute variceal hemorrhage. The nurse
administers octreotide and prepares for endoscopic band ligation. Which laboratory finding would
most contraindicate the use of intravenous terlipressin if it were available?
A. Serum sodium 125 mEq/L
B. Platelet count 45,000/mm³
C. Serum creatinine 3.2 mg/dL
D. International normalized ratio (INR) 2.8
Answer: C
Rationale: Terlipressin is a vasopressin analogue used for variceal bleeding but can cause severe
vasoconstriction and is contraindicated in patients with significant renal impairment (e.g., serum
creatinine >2.5 mg/dL) due to risk of renal ischemia. Hyponatremia (A) is a common side effect but not
an absolute contraindication. Thrombocytopenia (B) and elevated INR (D) are common in liver disease
but do not specifically contraindicate terlipressin.
4. A patient with septic shock requires norepinephrine to maintain a mean arterial pressure (MAP)
of 65 mmHg. The current dose is 15 mcg/min. The nurse notes that the patient's cardiac index is
2.0 L/min/m² and systemic vascular resistance index (SVRI) is 800 dyn-s-cm-m². Which additional
intervention should the nurse anticipate?
A. Add vasopressin 0.04 units/min.
B. Increase norepinephrine to 20 mcg/min.
C. Start dobutamine 5 mcg/kg/min.
D. Administer a 500 mL normal saline bolus.
Answer: C
Rationale: This patient has a low cardiac index (normal 2.5-4.0 L/min/m²) and low SVRI (normal
1700-2400), indicating both vasodilation and myocardial depression. While norepinephrine raises MAP
by vasoconstriction, adding dobutamine improves cardiac output. Vasopressin (A) is a second-line
vasopressor but does not improve contractility. Increasing norepinephrine (B) may worsen cardiac
function. Fluid bolus (D) may be considered if hypovolemic, but the primary issue is pump failure.
5. A patient undergoing a right hemicolectomy develops a temperature of 38.5°C on postoperative
day 2. The nurse reviews the chart: white blood cell count 14,000/mm³, and the patient reports
incisional pain. Which assessment finding would most suggest a superficial surgical site infection
rather than a deep or organ-space infection?
A. Purulent drainage from the incision that cultures positive for Escherichia coli.
B. Erythema extending 5 cm from the wound edges with localized warmth.
C. Fever and leukocytosis without visible wound abnormalities.
D. Foul-smelling serosanguinous drainage from the drain site.
Answer: B
Rationale: Superficial surgical site infections (SSIs) involve only skin and subcutaneous tissue, typically
presenting with localized erythema, warmth, and purulent drainage. Erythema extending 5 cm from
wound edges (B) is consistent with superficial infection. Purulent drainage with E. coli (A) could be
superficial or deep, but the organism alone does not differentiate depth. Fever and leukocytosis without
wound changes (C) suggest deep or organ-space infection. Foul-smelling drainage from a drain site (D)
indicates possible deep infection or abscess.
Page 2
,6. A patient is admitted with severe acute pancreatitis (Ranson criteria score 5). The nurse
monitors for signs of intra-abdominal hypertension (IAH) and abdominal compartment syndrome
(ACS). Which finding would most likely indicate the need for surgical decompression?
A. Intra-abdominal pressure (IAP) of 18 mmHg with oliguria.
B. Intra-abdominal pressure (IAP) of 25 mmHg with peak airway pressure 50 cm H2O.
C. Intra-abdominal pressure (IAP) of 15 mmHg with normal urine output.
D. Intra-abdominal pressure (IAP) of 20 mmHg with a PaO2/FiO2 ratio of 250.
Answer: B
Rationale: Abdominal compartment syndrome is defined as sustained IAP >20 mmHg with new organ
dysfunction. An IAP of 25 mmHg with elevated peak airway pressures indicates respiratory compromise
from ACS, necessitating surgical decompression. IAP of 18 mmHg with oliguria (A) may represent IAH
but not yet ACS; medical measures (e.g., neuromuscular blockade) may be tried. IAP of 15 mmHg (C) is
elevated but not critical. IAP of 20 mmHg with PaO2/FiO2 250 (D) indicates mild lung injury but not
ACS without other organ failure.
7. A patient with a history of type 2 diabetes mellitus is started on total parenteral nutrition (TPN)
after a small bowel resection. The nurse monitors serum glucose levels. Which insulin regimen best
maintains euglycemia while minimizing hypoglycemia risk in this patient?
A. Regular insulin sliding scale every 6 hours based on blood glucose.
B. Neutral protamine Hagedorn (NPH) insulin 0.2 units/kg subcutaneously every 12 hours.
C. Insulin glargine 10 units subcutaneously once daily plus correctional insulin aspart.
D. Addition of regular insulin to the TPN bag at a ratio of 1 unit per 10 grams of dextrose.
Answer: D
Rationale: Adding regular insulin directly to the TPN bag provides continuous insulin delivery that
matches the continuous dextrose infusion, reducing the risk of both hyperglycemia and hypoglycemia.
Sliding scales (A) are reactive and can cause glucose fluctuations. NPH (B) has a peak that may not
align with TPN infusion, increasing hypoglycemia risk. Glargine (C) provides basal coverage but
requires additional correctional insulin and may not adequately cover the dextrose load.
8. A patient with acute kidney injury (AKI) secondary to sepsis has a serum potassium of 6.8
mEq/L, widened QRS complex on ECG, and muscle weakness. The nurse prepares to administer
intravenous calcium gluconate. Which statement accurately describes the mechanism of action of
this intervention?
A. Calcium gluconate shifts potassium from the extracellular space into the intracellular space.
B. Calcium gluconate directly binds to potassium ions in the serum to form an inactive complex.
C. Calcium gluconate stabilizes the cardiac cell membrane by antagonizing the effects of hyperkalemia on
myocardial conduction.
D. Calcium gluconate increases renal excretion of potassium by enhancing aldosterone secretion.
Answer: C
Rationale: Intravenous calcium gluconate does not lower serum potassium level but protects the heart by
raising the threshold for cardiac excitability, thus stabilizing the myocardial cell membrane against the
depolarizing effects of hyperkalemia. Option A describes the action of insulin and glucose, not calcium.
Option B is incorrect; calcium does not bind potassium. Option D is incorrect; calcium does not
enhance aldosterone secretion or renal potassium excretion.
Page 3
, 9. A patient with a traumatic brain injury (TBI) and an intracranial pressure (ICP) monitor has an
ICP of 22 mmHg and cerebral perfusion pressure (CPP) of 55 mmHg. The nurse implements
interventions to lower ICP. Which intervention would be most appropriate to increase CPP?
A. Administer mannitol 0.5 g/kg intravenously over 20 minutes.
B. Elevate the head of bed to 30 degrees and maintain midline head position.
C. Administer propofol infusion to sedate the patient and reduce metabolic demand.
D. Administer a 500 mL bolus of 0.9% normal saline.
Answer: A
Rationale: CPP = MAP - ICP. With ICP 22 and CPP 55, the MAP is approximately 77 mmHg. Mannitol
reduces ICP by osmotic diuresis, thereby increasing CPP if MAP is maintained. Elevating the head of
bed (B) and sedation (C) can lower ICP but may not improve CPP if MAP drops. A fluid bolus (D) may
increase MAP but could also increase ICP if blood-brain barrier is disrupted; mannitol is more
targeted.
10. A patient with a deep vein thrombosis (DVT) in the left lower extremity is receiving a
continuous infusion of unfractionated heparin. The nurse reviews the aPTT results: baseline 30
seconds, current aPTT 55 seconds. The prescribed therapeutic range is 60-80 seconds. According to
the institution's heparin protocol, what should the nurse do next?
A. Increase the infusion rate by 2 units/kg/hr.
B. Administer a bolus of 80 units/kg and increase infusion by 4 units/kg/hr.
C. Decrease the infusion rate by 2 units/kg/hr.
D. Continue the current infusion rate and recheck aPTT in 6 hours.
Answer: A
Rationale: The current aPTT (55 seconds) is below the therapeutic range (60-80 seconds), indicating
subtherapeutic anticoagulation. Standard heparin protocols typically call for an increase in infusion
rate (e.g., by 2 units/kg/hr) without a bolus if aPTT is just below range. A bolus (B) is reserved for aPTT
far below range or for initial treatment. Decreasing the rate (C) would worsen subtherapeutic levels.
Continuing (D) delays achieving therapeutic anticoagulation.
11. A patient with acute respiratory distress syndrome (ARDS) is on pressure-controlled
ventilation with a set FiO2 of 0.8 and positive end-expiratory pressure (PEEP) of 15 cm H2O.
Arterial blood gas results show pH 7.25, PaCO2 55 mm Hg, PaO2 60 mm Hg, HCO3- 24 mEq/L.
The ventilator is set to deliver a tidal volume of 6 mL/kg predicted body weight. Which
intervention should the nurse anticipate to improve oxygenation while minimizing
ventilator-induced lung injury?
A. Increase PEEP to 20 cm H2O and reassess PaO2
B. Increase tidal volume to 8 mL/kg to improve ventilation
C. Decrease FiO2 to 0.6 to reduce oxygen toxicity risk
D. Initiate prone positioning for 16 hours daily
Answer: D
Rationale: In ARDS with refractory hypoxemia despite high PEEP and FiO2, prone positioning improves
ventilation-perfusion matching and oxygenation. Increasing PEEP above 15 cm H2O may risk
barotrauma without clear benefit. Higher tidal volumes can cause volutrauma. Decreasing FiO2 would
worsen hypoxemia.
Page 4
Actual Questions and Answers | Latest 2026/2027
Update | Graded A+ | 100% Assured Pass (Care of
Adult II at Concordia)
1. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled ventilation
with a tidal volume of 6 mL/kg ideal body weight, PEEP of 12 cm H2O, and FiO2 of 0.7. The
plateau pressure is 32 cm H2O. The patient's PaO2 is 55 mmHg. Which intervention should the
nurse anticipate as most appropriate to improve oxygenation while minimizing ventilator-induced
lung injury?
A. Increase tidal volume to 8 mL/kg to improve minute ventilation.
B. Increase PEEP to 15 cm H2O and monitor for hemodynamic compromise.
C. Switch to pressure-controlled ventilation with a peak inspiratory pressure of 35 cm H2O.
D. Administer a neuromuscular blocking agent to decrease oxygen consumption.
Answer: B
Rationale: In ARDS, lung-protective ventilation uses low tidal volumes (6 mL/kg) and sufficient PEEP to
recruit alveoli. Increasing PEEP may improve oxygenation by reducing shunt, but it must be balanced
against hemodynamic effects. Increasing tidal volume (A) would increase plateau pressure above 30 cm
H2O, risking barotrauma. Pressure-controlled ventilation (C) does not necessarily reduce risk and may
deliver variable volumes. Neuromuscular blockade (D) is reserved for refractory hypoxemia but is not
first-line.
2. A patient in the ICU develops new-onset atrial fibrillation with a ventricular rate of 150 bpm.
The blood pressure is 85/50 mmHg, and the patient is confused and oliguric. Which intervention
should the nurse prepare for first?
A. Administer intravenous amiodarone bolus and infusion.
B. Perform synchronized cardioversion at 100 J biphasic.
C. Administer intravenous metoprolol 5 mg over 2 minutes.
D. Start intravenous heparin infusion for stroke prophylaxis.
Answer: B
Rationale: This patient is hemodynamically unstable (hypotension, altered mental status, oliguria) due to
rapid atrial fibrillation. The immediate priority is synchronized cardioversion to restore sinus rhythm.
Amiodarone (A) or metoprolol (C) are rate or rhythm control options for stable patients. Heparin (D) is
important for stroke prevention but is not the first priority in unstable patients.
Page 1
,3. A patient with end-stage liver disease is admitted with acute variceal hemorrhage. The nurse
administers octreotide and prepares for endoscopic band ligation. Which laboratory finding would
most contraindicate the use of intravenous terlipressin if it were available?
A. Serum sodium 125 mEq/L
B. Platelet count 45,000/mm³
C. Serum creatinine 3.2 mg/dL
D. International normalized ratio (INR) 2.8
Answer: C
Rationale: Terlipressin is a vasopressin analogue used for variceal bleeding but can cause severe
vasoconstriction and is contraindicated in patients with significant renal impairment (e.g., serum
creatinine >2.5 mg/dL) due to risk of renal ischemia. Hyponatremia (A) is a common side effect but not
an absolute contraindication. Thrombocytopenia (B) and elevated INR (D) are common in liver disease
but do not specifically contraindicate terlipressin.
4. A patient with septic shock requires norepinephrine to maintain a mean arterial pressure (MAP)
of 65 mmHg. The current dose is 15 mcg/min. The nurse notes that the patient's cardiac index is
2.0 L/min/m² and systemic vascular resistance index (SVRI) is 800 dyn-s-cm-m². Which additional
intervention should the nurse anticipate?
A. Add vasopressin 0.04 units/min.
B. Increase norepinephrine to 20 mcg/min.
C. Start dobutamine 5 mcg/kg/min.
D. Administer a 500 mL normal saline bolus.
Answer: C
Rationale: This patient has a low cardiac index (normal 2.5-4.0 L/min/m²) and low SVRI (normal
1700-2400), indicating both vasodilation and myocardial depression. While norepinephrine raises MAP
by vasoconstriction, adding dobutamine improves cardiac output. Vasopressin (A) is a second-line
vasopressor but does not improve contractility. Increasing norepinephrine (B) may worsen cardiac
function. Fluid bolus (D) may be considered if hypovolemic, but the primary issue is pump failure.
5. A patient undergoing a right hemicolectomy develops a temperature of 38.5°C on postoperative
day 2. The nurse reviews the chart: white blood cell count 14,000/mm³, and the patient reports
incisional pain. Which assessment finding would most suggest a superficial surgical site infection
rather than a deep or organ-space infection?
A. Purulent drainage from the incision that cultures positive for Escherichia coli.
B. Erythema extending 5 cm from the wound edges with localized warmth.
C. Fever and leukocytosis without visible wound abnormalities.
D. Foul-smelling serosanguinous drainage from the drain site.
Answer: B
Rationale: Superficial surgical site infections (SSIs) involve only skin and subcutaneous tissue, typically
presenting with localized erythema, warmth, and purulent drainage. Erythema extending 5 cm from
wound edges (B) is consistent with superficial infection. Purulent drainage with E. coli (A) could be
superficial or deep, but the organism alone does not differentiate depth. Fever and leukocytosis without
wound changes (C) suggest deep or organ-space infection. Foul-smelling drainage from a drain site (D)
indicates possible deep infection or abscess.
Page 2
,6. A patient is admitted with severe acute pancreatitis (Ranson criteria score 5). The nurse
monitors for signs of intra-abdominal hypertension (IAH) and abdominal compartment syndrome
(ACS). Which finding would most likely indicate the need for surgical decompression?
A. Intra-abdominal pressure (IAP) of 18 mmHg with oliguria.
B. Intra-abdominal pressure (IAP) of 25 mmHg with peak airway pressure 50 cm H2O.
C. Intra-abdominal pressure (IAP) of 15 mmHg with normal urine output.
D. Intra-abdominal pressure (IAP) of 20 mmHg with a PaO2/FiO2 ratio of 250.
Answer: B
Rationale: Abdominal compartment syndrome is defined as sustained IAP >20 mmHg with new organ
dysfunction. An IAP of 25 mmHg with elevated peak airway pressures indicates respiratory compromise
from ACS, necessitating surgical decompression. IAP of 18 mmHg with oliguria (A) may represent IAH
but not yet ACS; medical measures (e.g., neuromuscular blockade) may be tried. IAP of 15 mmHg (C) is
elevated but not critical. IAP of 20 mmHg with PaO2/FiO2 250 (D) indicates mild lung injury but not
ACS without other organ failure.
7. A patient with a history of type 2 diabetes mellitus is started on total parenteral nutrition (TPN)
after a small bowel resection. The nurse monitors serum glucose levels. Which insulin regimen best
maintains euglycemia while minimizing hypoglycemia risk in this patient?
A. Regular insulin sliding scale every 6 hours based on blood glucose.
B. Neutral protamine Hagedorn (NPH) insulin 0.2 units/kg subcutaneously every 12 hours.
C. Insulin glargine 10 units subcutaneously once daily plus correctional insulin aspart.
D. Addition of regular insulin to the TPN bag at a ratio of 1 unit per 10 grams of dextrose.
Answer: D
Rationale: Adding regular insulin directly to the TPN bag provides continuous insulin delivery that
matches the continuous dextrose infusion, reducing the risk of both hyperglycemia and hypoglycemia.
Sliding scales (A) are reactive and can cause glucose fluctuations. NPH (B) has a peak that may not
align with TPN infusion, increasing hypoglycemia risk. Glargine (C) provides basal coverage but
requires additional correctional insulin and may not adequately cover the dextrose load.
8. A patient with acute kidney injury (AKI) secondary to sepsis has a serum potassium of 6.8
mEq/L, widened QRS complex on ECG, and muscle weakness. The nurse prepares to administer
intravenous calcium gluconate. Which statement accurately describes the mechanism of action of
this intervention?
A. Calcium gluconate shifts potassium from the extracellular space into the intracellular space.
B. Calcium gluconate directly binds to potassium ions in the serum to form an inactive complex.
C. Calcium gluconate stabilizes the cardiac cell membrane by antagonizing the effects of hyperkalemia on
myocardial conduction.
D. Calcium gluconate increases renal excretion of potassium by enhancing aldosterone secretion.
Answer: C
Rationale: Intravenous calcium gluconate does not lower serum potassium level but protects the heart by
raising the threshold for cardiac excitability, thus stabilizing the myocardial cell membrane against the
depolarizing effects of hyperkalemia. Option A describes the action of insulin and glucose, not calcium.
Option B is incorrect; calcium does not bind potassium. Option D is incorrect; calcium does not
enhance aldosterone secretion or renal potassium excretion.
Page 3
, 9. A patient with a traumatic brain injury (TBI) and an intracranial pressure (ICP) monitor has an
ICP of 22 mmHg and cerebral perfusion pressure (CPP) of 55 mmHg. The nurse implements
interventions to lower ICP. Which intervention would be most appropriate to increase CPP?
A. Administer mannitol 0.5 g/kg intravenously over 20 minutes.
B. Elevate the head of bed to 30 degrees and maintain midline head position.
C. Administer propofol infusion to sedate the patient and reduce metabolic demand.
D. Administer a 500 mL bolus of 0.9% normal saline.
Answer: A
Rationale: CPP = MAP - ICP. With ICP 22 and CPP 55, the MAP is approximately 77 mmHg. Mannitol
reduces ICP by osmotic diuresis, thereby increasing CPP if MAP is maintained. Elevating the head of
bed (B) and sedation (C) can lower ICP but may not improve CPP if MAP drops. A fluid bolus (D) may
increase MAP but could also increase ICP if blood-brain barrier is disrupted; mannitol is more
targeted.
10. A patient with a deep vein thrombosis (DVT) in the left lower extremity is receiving a
continuous infusion of unfractionated heparin. The nurse reviews the aPTT results: baseline 30
seconds, current aPTT 55 seconds. The prescribed therapeutic range is 60-80 seconds. According to
the institution's heparin protocol, what should the nurse do next?
A. Increase the infusion rate by 2 units/kg/hr.
B. Administer a bolus of 80 units/kg and increase infusion by 4 units/kg/hr.
C. Decrease the infusion rate by 2 units/kg/hr.
D. Continue the current infusion rate and recheck aPTT in 6 hours.
Answer: A
Rationale: The current aPTT (55 seconds) is below the therapeutic range (60-80 seconds), indicating
subtherapeutic anticoagulation. Standard heparin protocols typically call for an increase in infusion
rate (e.g., by 2 units/kg/hr) without a bolus if aPTT is just below range. A bolus (B) is reserved for aPTT
far below range or for initial treatment. Decreasing the rate (C) would worsen subtherapeutic levels.
Continuing (D) delays achieving therapeutic anticoagulation.
11. A patient with acute respiratory distress syndrome (ARDS) is on pressure-controlled
ventilation with a set FiO2 of 0.8 and positive end-expiratory pressure (PEEP) of 15 cm H2O.
Arterial blood gas results show pH 7.25, PaCO2 55 mm Hg, PaO2 60 mm Hg, HCO3- 24 mEq/L.
The ventilator is set to deliver a tidal volume of 6 mL/kg predicted body weight. Which
intervention should the nurse anticipate to improve oxygenation while minimizing
ventilator-induced lung injury?
A. Increase PEEP to 20 cm H2O and reassess PaO2
B. Increase tidal volume to 8 mL/kg to improve ventilation
C. Decrease FiO2 to 0.6 to reduce oxygen toxicity risk
D. Initiate prone positioning for 16 hours daily
Answer: D
Rationale: In ARDS with refractory hypoxemia despite high PEEP and FiO2, prone positioning improves
ventilation-perfusion matching and oxygenation. Increasing PEEP above 15 cm H2O may risk
barotrauma without clear benefit. Higher tidal volumes can cause volutrauma. Decreasing FiO2 would
worsen hypoxemia.
Page 4
