Herzing University NSG233–238 Med Surg
Nursing III – Exam 2
,
,Question 1
A nurse in the intensive care unit is caring for a client admitted with acute respiratory distress
syndrome (ARDS) secondary to sepsis. The client is intubated and mechanically ventilated.
Which mechanical ventilator setting or intervention should the nurse anticipate to reduce the risk
of ventilator-induced lung injury (VILI) and barotrauma?
A. High tidal volume ($10-12 \text{ mL/kg}$) and high positive end-expiratory pressure (PEEP)
B. Low tidal volume ($4-8 \text{ mL/kg}$) and high positive end-expiratory pressure (PEEP)
C. Low tidal volume ($4-8 \text{ mL/kg}$) and zero positive end-expiratory pressure (ZEEP)
D. High tidal volume ($10-12 \text{ mL/kg}$) and low fraction of inspired oxygen
($\text{FiO}_2$)
Answer: B
Explanation:
Clients with ARDS have non-compliant, "stiff" lungs with damaged alveolar-capillary
membranes. Low tidal volume ventilation ($4-8 \text{ mL/kg}$ of predicted body weight)
prevents over-distension and volutrauma/barotrauma. High PEEP ($10-20 \text{ cm
H}_2\text{O}$) is utilized to recruit collapsed alveoli, improve ventilation-perfusion matching,
and reduce oxygen toxicity by allowing a lower $\text{FiO}_2$. High tidal volumes increase
lung injury risk, while zero PEEP leads to permissive atelectasis.
Question 2
A nurse is assessing a client admitted with acute decompensated heart failure (ADHF) who is
receiving intravenous furosemide. Which assessment finding requires immediate nursing
intervention?
A. Serum potassium level of $3.1 \text{ mEq/L}$
B. Blood pressure drop from $138/84 \text{ mmHg}$ to $122/76 \text{ mmHg}$
C. Urine output of $180 \text{ mL}$ over the past 3 hours
, D. Serum sodium level of $136 \text{ mEq/L}$
Answer: A
Explanation:
Furosemide is a loop diuretic that causes excretion of potassium, sodium, and chloride. A serum
potassium level of $3.1 \text{ mEq/L}$ indicates significant hypokalemia, which severely
increases the risk of life-threatening ventricular dysrhythmias (e.g., ventricular tachycardia,
VFib, or Torsades de Pointes), especially in cardiac clients. Hypokalemia must be reported and
corrected promptly. The blood pressure change is expected with diuresis, sodium is within
normal range ($135-145 \text{ mEq/L}$), and urine output ($60 \text{ mL/hr}$) is adequate.
Question 3
A client with a history of coronary artery disease presents to the emergency department
experiencing crushing substernal chest pain that radiates to the left jaw. The 12-lead
electrocardiogram (ECG) reveals ST-segment elevation in leads II, III, and aVF. Which wall of
the myocardium is affected, and which coronary artery is most likely occluded?
A. Anterior wall; Left Anterior Descending (LAD) artery
B. Lateral wall; Left Circumflex (LCx) artery
C. Inferior wall; Right Coronary Artery (RCA)
D. Posterior wall; Right Circumflex artery
Answer: C
Explanation:
Leads II, III, and aVF view the inferior surface of the heart. Inferior wall myocardial infarctions
(STEMIs) are most commonly caused by an occlusion of the Right Coronary Artery (RCA).
RCA occlusions can also impair the SA and AV nodes, making these clients prone to
bradycardia and AV heart blocks. Anterior wall STEMIs involve leads V1–V4 (LAD), and
lateral wall STEMIs involve leads I, aVL, V5, and V6 (LCx).
Question 4
A client admitted for diabetic ketoacidosis (DKA) is receiving a continuous intravenous infusion
of regular insulin at $0.1 \text{ units/kg/hr}$. The latest laboratory report shows a blood glucose
level of $230 \text{ mg/dL}$. Which nursing action is most appropriate at this time?
A. Discontinue the insulin infusion and switch to subcutaneous sliding-scale insulin
Nursing III – Exam 2
,
,Question 1
A nurse in the intensive care unit is caring for a client admitted with acute respiratory distress
syndrome (ARDS) secondary to sepsis. The client is intubated and mechanically ventilated.
Which mechanical ventilator setting or intervention should the nurse anticipate to reduce the risk
of ventilator-induced lung injury (VILI) and barotrauma?
A. High tidal volume ($10-12 \text{ mL/kg}$) and high positive end-expiratory pressure (PEEP)
B. Low tidal volume ($4-8 \text{ mL/kg}$) and high positive end-expiratory pressure (PEEP)
C. Low tidal volume ($4-8 \text{ mL/kg}$) and zero positive end-expiratory pressure (ZEEP)
D. High tidal volume ($10-12 \text{ mL/kg}$) and low fraction of inspired oxygen
($\text{FiO}_2$)
Answer: B
Explanation:
Clients with ARDS have non-compliant, "stiff" lungs with damaged alveolar-capillary
membranes. Low tidal volume ventilation ($4-8 \text{ mL/kg}$ of predicted body weight)
prevents over-distension and volutrauma/barotrauma. High PEEP ($10-20 \text{ cm
H}_2\text{O}$) is utilized to recruit collapsed alveoli, improve ventilation-perfusion matching,
and reduce oxygen toxicity by allowing a lower $\text{FiO}_2$. High tidal volumes increase
lung injury risk, while zero PEEP leads to permissive atelectasis.
Question 2
A nurse is assessing a client admitted with acute decompensated heart failure (ADHF) who is
receiving intravenous furosemide. Which assessment finding requires immediate nursing
intervention?
A. Serum potassium level of $3.1 \text{ mEq/L}$
B. Blood pressure drop from $138/84 \text{ mmHg}$ to $122/76 \text{ mmHg}$
C. Urine output of $180 \text{ mL}$ over the past 3 hours
, D. Serum sodium level of $136 \text{ mEq/L}$
Answer: A
Explanation:
Furosemide is a loop diuretic that causes excretion of potassium, sodium, and chloride. A serum
potassium level of $3.1 \text{ mEq/L}$ indicates significant hypokalemia, which severely
increases the risk of life-threatening ventricular dysrhythmias (e.g., ventricular tachycardia,
VFib, or Torsades de Pointes), especially in cardiac clients. Hypokalemia must be reported and
corrected promptly. The blood pressure change is expected with diuresis, sodium is within
normal range ($135-145 \text{ mEq/L}$), and urine output ($60 \text{ mL/hr}$) is adequate.
Question 3
A client with a history of coronary artery disease presents to the emergency department
experiencing crushing substernal chest pain that radiates to the left jaw. The 12-lead
electrocardiogram (ECG) reveals ST-segment elevation in leads II, III, and aVF. Which wall of
the myocardium is affected, and which coronary artery is most likely occluded?
A. Anterior wall; Left Anterior Descending (LAD) artery
B. Lateral wall; Left Circumflex (LCx) artery
C. Inferior wall; Right Coronary Artery (RCA)
D. Posterior wall; Right Circumflex artery
Answer: C
Explanation:
Leads II, III, and aVF view the inferior surface of the heart. Inferior wall myocardial infarctions
(STEMIs) are most commonly caused by an occlusion of the Right Coronary Artery (RCA).
RCA occlusions can also impair the SA and AV nodes, making these clients prone to
bradycardia and AV heart blocks. Anterior wall STEMIs involve leads V1–V4 (LAD), and
lateral wall STEMIs involve leads I, aVL, V5, and V6 (LCx).
Question 4
A client admitted for diabetic ketoacidosis (DKA) is receiving a continuous intravenous infusion
of regular insulin at $0.1 \text{ units/kg/hr}$. The latest laboratory report shows a blood glucose
level of $230 \text{ mg/dL}$. Which nursing action is most appropriate at this time?
A. Discontinue the insulin infusion and switch to subcutaneous sliding-scale insulin
