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NR 341 EXAM 2: COMPLEX ADULT
HEALTH NURSING –
COMPREHENSIVE PRACTICE
EXAMINATION
Exam Title: NR 341 Complex Adult Health Nursing – Exam 2: Advanced Critical Care Concepts,
Hemodynamic Monitoring, Shock States, Respiratory Failure, Renal Dysfunction, and
Multisystem Organ Dysfunction
SECTION 1: HEMODYNAMIC MONITORING & HEMODYNAMICS (Questions 1–30)
1. A patient with an arterial line displays a dampened waveform with a systolic
pressure reading of 164 mmHg. What is the nurse's priority action?
• A. Zero the transducer immediately
• B. Assess the patient's clinical status
• C. Flush the arterial line with normal saline
• D. Replace the pressure bag and tubing
Correct Answer: B. Assess the patient's clinical status
Rationale: Before assuming equipment malfunction, the nurse must assess the
patient's clinical condition to determine if the reading reflects true hemodynamic
status or an artifact. The priority is always patient assessment over equipment
troubleshooting.
2. Which hemodynamic parameter is the most reliable indicator of left
ventricular preload?
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• A. Central venous pressure (CVP)
• B. Pulmonary artery wedge pressure (PAWP)
• C. Cardiac output (CO)
• D. Systemic vascular resistance (SVR)
Correct Answer: B. Pulmonary artery wedge pressure (PAWP)
Rationale: PAWP reflects left ventricular end-diastolic pressure and is the most
direct measure of left ventricular preload. CVP reflects right ventricular preload.
CO measures cardiac function, and SVR measures afterload.
3. The nurse is caring for a patient with a pulmonary artery catheter. Which
finding indicates the catheter has migrated into a wedged position?
• A. A waveform with a dicrotic notch
• B. A waveform with an abrupt upstroke and descending limb
• C. A waveform with a sustained plateau
• D. A waveform that appears dampened and rounded
Correct Answer: C. A waveform with a sustained plateau
Rationale: A wedged pulmonary artery catheter produces a waveform with a
sustained plateau representing the pulmonary artery wedge pressure. The
dicrotic notch is seen in the arterial waveform. The abrupt upstroke is
characteristic of the arterial waveform.
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4. The normal range for central venous pressure (CVP) is:
• A. 2–6 mmHg
• B. 8–12 mmHg
• C. 15–20 mmHg
• D. 25–30 mmHg
Correct Answer: A. 2–6 mmHg
Rationale: Normal CVP ranges from 2–6 mmHg (or 4–8 cm H₂O). It reflects right
atrial pressure and right ventricular preload. Elevated CVP (>6 mmHg) may
indicate fluid overload or right-sided heart failure.
5. A patient with septic shock has a cardiac output of 2.8 L/min (normal: 4–8
L/min). What is the most appropriate nursing intervention?
• A. Administer a vasopressor as ordered
• B. Increase the rate of IV fluid administration
• C. Position the patient in Trendelenburg position
• D. Notify the provider and prepare for inotropic support
Correct Answer: D. Notify the provider and prepare for inotropic support
Rationale: Low cardiac output in septic shock indicates myocardial depression.
Inotropic agents (e.g., dobutamine) may be needed to improve contractility while
maintaining adequate fluid resuscitation.
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6. The nurse is calculating the systemic vascular resistance (SVR) for a patient.
Which formula is correct?
• A. (MAP – CVP) / CO × 80
• B. (PAP – PAWP) / CO × 80
• C. CO × (MAP – CVP) / 80
• D. (CO – CVP) / MAP × 80
Correct Answer: A. (MAP – CVP) / CO × 80
Rationale: SVR = (Mean Arterial Pressure – Central Venous Pressure) / Cardiac
Output × 80. Normal SVR is 800–1200 dynes·sec/cm⁵. This formula calculates
systemic vascular resistance.
7. A patient's arterial line transducer is positioned 5 cm below the phlebostatic
axis. How will this affect the blood pressure reading?
• A. Falsely elevated readings
• B. Falsely decreased readings
• C. No effect on readings
• D. Dampened waveform only
Correct Answer: A. Falsely elevated readings
Rationale: The transducer must be leveled at the phlebostatic axis (4th intercostal
space, mid-axillary line). If the transducer is below the axis, the hydrostatic
pressure causes falsely elevated readings. If above, readings are falsely decreased.
NR 341 EXAM 2: COMPLEX ADULT
HEALTH NURSING –
COMPREHENSIVE PRACTICE
EXAMINATION
Exam Title: NR 341 Complex Adult Health Nursing – Exam 2: Advanced Critical Care Concepts,
Hemodynamic Monitoring, Shock States, Respiratory Failure, Renal Dysfunction, and
Multisystem Organ Dysfunction
SECTION 1: HEMODYNAMIC MONITORING & HEMODYNAMICS (Questions 1–30)
1. A patient with an arterial line displays a dampened waveform with a systolic
pressure reading of 164 mmHg. What is the nurse's priority action?
• A. Zero the transducer immediately
• B. Assess the patient's clinical status
• C. Flush the arterial line with normal saline
• D. Replace the pressure bag and tubing
Correct Answer: B. Assess the patient's clinical status
Rationale: Before assuming equipment malfunction, the nurse must assess the
patient's clinical condition to determine if the reading reflects true hemodynamic
status or an artifact. The priority is always patient assessment over equipment
troubleshooting.
2. Which hemodynamic parameter is the most reliable indicator of left
ventricular preload?
, 2
• A. Central venous pressure (CVP)
• B. Pulmonary artery wedge pressure (PAWP)
• C. Cardiac output (CO)
• D. Systemic vascular resistance (SVR)
Correct Answer: B. Pulmonary artery wedge pressure (PAWP)
Rationale: PAWP reflects left ventricular end-diastolic pressure and is the most
direct measure of left ventricular preload. CVP reflects right ventricular preload.
CO measures cardiac function, and SVR measures afterload.
3. The nurse is caring for a patient with a pulmonary artery catheter. Which
finding indicates the catheter has migrated into a wedged position?
• A. A waveform with a dicrotic notch
• B. A waveform with an abrupt upstroke and descending limb
• C. A waveform with a sustained plateau
• D. A waveform that appears dampened and rounded
Correct Answer: C. A waveform with a sustained plateau
Rationale: A wedged pulmonary artery catheter produces a waveform with a
sustained plateau representing the pulmonary artery wedge pressure. The
dicrotic notch is seen in the arterial waveform. The abrupt upstroke is
characteristic of the arterial waveform.
, 3
4. The normal range for central venous pressure (CVP) is:
• A. 2–6 mmHg
• B. 8–12 mmHg
• C. 15–20 mmHg
• D. 25–30 mmHg
Correct Answer: A. 2–6 mmHg
Rationale: Normal CVP ranges from 2–6 mmHg (or 4–8 cm H₂O). It reflects right
atrial pressure and right ventricular preload. Elevated CVP (>6 mmHg) may
indicate fluid overload or right-sided heart failure.
5. A patient with septic shock has a cardiac output of 2.8 L/min (normal: 4–8
L/min). What is the most appropriate nursing intervention?
• A. Administer a vasopressor as ordered
• B. Increase the rate of IV fluid administration
• C. Position the patient in Trendelenburg position
• D. Notify the provider and prepare for inotropic support
Correct Answer: D. Notify the provider and prepare for inotropic support
Rationale: Low cardiac output in septic shock indicates myocardial depression.
Inotropic agents (e.g., dobutamine) may be needed to improve contractility while
maintaining adequate fluid resuscitation.
, 4
6. The nurse is calculating the systemic vascular resistance (SVR) for a patient.
Which formula is correct?
• A. (MAP – CVP) / CO × 80
• B. (PAP – PAWP) / CO × 80
• C. CO × (MAP – CVP) / 80
• D. (CO – CVP) / MAP × 80
Correct Answer: A. (MAP – CVP) / CO × 80
Rationale: SVR = (Mean Arterial Pressure – Central Venous Pressure) / Cardiac
Output × 80. Normal SVR is 800–1200 dynes·sec/cm⁵. This formula calculates
systemic vascular resistance.
7. A patient's arterial line transducer is positioned 5 cm below the phlebostatic
axis. How will this affect the blood pressure reading?
• A. Falsely elevated readings
• B. Falsely decreased readings
• C. No effect on readings
• D. Dampened waveform only
Correct Answer: A. Falsely elevated readings
Rationale: The transducer must be leveled at the phlebostatic axis (4th intercostal
space, mid-axillary line). If the transducer is below the axis, the hydrostatic
pressure causes falsely elevated readings. If above, readings are falsely decreased.
