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NR 341 COMPLEX ADULT HEALTH EXAM 2
Comprehensive Multiple-Choice Question Bank
Advanced/Hard Difficulty | Chamberlain
University Nursing Curriculum
SECTION 1: HEMODYNAMIC MONITORING & CARDIAC FUNCTION (Questions 1-
30)
1. A patient with septic shock has a pulmonary artery catheter in place. The
nurse notes a cardiac index of 1.8 L/min/m², pulmonary artery wedge pressure
(PAWP) of 8 mmHg, and systemic vascular resistance (SVR) of 400
dynes/sec/cm⁻⁵. Which hemodynamic profile does this represent?
A. Hypovolemic shock with low preload and high afterload
B. Cardiogenic shock with high preload and high afterload
C. Distributive shock with low preload and low afterload
D. Obstructive shock with normal preload and high afterload
Correct Answer: C
Rationale: In distributive shock (septic), there is massive vasodilation resulting in
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low SVR (<800 dynes/sec/cm⁻⁵). The low PAWP (6-12 mmHg normal) and low
cardiac index (<2.8 L/min/m²) indicate inadequate preload and reduced cardiac
output despite the low afterload.
2. The nurse is caring for a patient with an arterial line in the radial artery. The
transducer is positioned 10 cm below the phlebostatic axis. Which action should
the nurse take?
A. Document the reading as accurate
B. Reposition the transducer to the level of the phlebostatic axis
C. Zero the transducer to atmospheric pressure
D. Notify the provider of the abnormal reading
Correct Answer: B
Rationale: Transducers positioned below the phlebostatic axis cause falsely high
blood pressure readings, while transducers positioned above cause falsely low
readings. The nurse must immediately reposition the transducer to the correct
level at the phlebostatic axis (intersection of the midaxillary line and fourth
intercostal space) to ensure accurate hemodynamic monitoring.
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3. A patient with heart failure has the following hemodynamic values: CVP 14
mmHg, PAWP 22 mmHg, cardiac output 3.2 L/min, SVR 1400 dynes/sec/cm⁻⁵.
Which intervention should the nurse anticipate?
A. Administration of intravenous fluids
B. Administration of a vasodilator and diuretic
C. Administration of a vasopressor
D. Placement of the patient in Trendelenburg position
Correct Answer: B
Rationale: Elevated CVP (>8 mmHg) and PAWP (>12 mmHg) indicate fluid
overload. High SVR (>1200 dynes/sec/cm⁻⁵) indicates increased afterload.
Treatment should include vasodilators to reduce afterload and diuretics to reduce
preload, thereby decreasing cardiac workload and improving cardiac output.
4. The nurse is preparing to perform an Allen test before radial artery
cannulation. Which finding indicates a positive (normal) Allen test?
A. Hand remains pale after releasing ulnar artery pressure
B. Hand pinkness returns within 6 seconds after releasing ulnar artery pressure
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C. Hand pinkness returns within 15 seconds after releasing radial artery pressure
D. Capillary refill is greater than 3 seconds in the affected hand
Correct Answer: B
Rationale: A normal Allen test result shows hand pinkness returning within 6
seconds after releasing pressure on the ulnar artery while maintaining radial
artery compression. This confirms adequate ulnar artery collateral circulation,
indicating that radial artery cannulation is safe.
5. A patient's hemodynamic monitoring shows CVP of 3 mmHg, PAWP of 5
mmHg, and blood pressure of 88/52 mmHg. The nurse should suspect which
condition?
A. Cardiogenic shock
B. Hypovolemic shock
C. Septic shock
D. Pulmonary embolism
Correct Answer: B
Rationale: Low CVP (<2 mmHg) and low PAWP (<6 mmHg) indicate decreased
preload consistent with hypovolemia. The low blood pressure reflects inadequate
NR 341 COMPLEX ADULT HEALTH EXAM 2
Comprehensive Multiple-Choice Question Bank
Advanced/Hard Difficulty | Chamberlain
University Nursing Curriculum
SECTION 1: HEMODYNAMIC MONITORING & CARDIAC FUNCTION (Questions 1-
30)
1. A patient with septic shock has a pulmonary artery catheter in place. The
nurse notes a cardiac index of 1.8 L/min/m², pulmonary artery wedge pressure
(PAWP) of 8 mmHg, and systemic vascular resistance (SVR) of 400
dynes/sec/cm⁻⁵. Which hemodynamic profile does this represent?
A. Hypovolemic shock with low preload and high afterload
B. Cardiogenic shock with high preload and high afterload
C. Distributive shock with low preload and low afterload
D. Obstructive shock with normal preload and high afterload
Correct Answer: C
Rationale: In distributive shock (septic), there is massive vasodilation resulting in
,2
low SVR (<800 dynes/sec/cm⁻⁵). The low PAWP (6-12 mmHg normal) and low
cardiac index (<2.8 L/min/m²) indicate inadequate preload and reduced cardiac
output despite the low afterload.
2. The nurse is caring for a patient with an arterial line in the radial artery. The
transducer is positioned 10 cm below the phlebostatic axis. Which action should
the nurse take?
A. Document the reading as accurate
B. Reposition the transducer to the level of the phlebostatic axis
C. Zero the transducer to atmospheric pressure
D. Notify the provider of the abnormal reading
Correct Answer: B
Rationale: Transducers positioned below the phlebostatic axis cause falsely high
blood pressure readings, while transducers positioned above cause falsely low
readings. The nurse must immediately reposition the transducer to the correct
level at the phlebostatic axis (intersection of the midaxillary line and fourth
intercostal space) to ensure accurate hemodynamic monitoring.
,3
3. A patient with heart failure has the following hemodynamic values: CVP 14
mmHg, PAWP 22 mmHg, cardiac output 3.2 L/min, SVR 1400 dynes/sec/cm⁻⁵.
Which intervention should the nurse anticipate?
A. Administration of intravenous fluids
B. Administration of a vasodilator and diuretic
C. Administration of a vasopressor
D. Placement of the patient in Trendelenburg position
Correct Answer: B
Rationale: Elevated CVP (>8 mmHg) and PAWP (>12 mmHg) indicate fluid
overload. High SVR (>1200 dynes/sec/cm⁻⁵) indicates increased afterload.
Treatment should include vasodilators to reduce afterload and diuretics to reduce
preload, thereby decreasing cardiac workload and improving cardiac output.
4. The nurse is preparing to perform an Allen test before radial artery
cannulation. Which finding indicates a positive (normal) Allen test?
A. Hand remains pale after releasing ulnar artery pressure
B. Hand pinkness returns within 6 seconds after releasing ulnar artery pressure
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C. Hand pinkness returns within 15 seconds after releasing radial artery pressure
D. Capillary refill is greater than 3 seconds in the affected hand
Correct Answer: B
Rationale: A normal Allen test result shows hand pinkness returning within 6
seconds after releasing pressure on the ulnar artery while maintaining radial
artery compression. This confirms adequate ulnar artery collateral circulation,
indicating that radial artery cannulation is safe.
5. A patient's hemodynamic monitoring shows CVP of 3 mmHg, PAWP of 5
mmHg, and blood pressure of 88/52 mmHg. The nurse should suspect which
condition?
A. Cardiogenic shock
B. Hypovolemic shock
C. Septic shock
D. Pulmonary embolism
Correct Answer: B
Rationale: Low CVP (<2 mmHg) and low PAWP (<6 mmHg) indicate decreased
preload consistent with hypovolemia. The low blood pressure reflects inadequate
