NR341/NR 341 Exam 2 V2 | Complex Adult Health
Q&A with Rationale | Chamberlain University
1. A patient in the ICU is diagnosed with Acute Respiratory Distress Syndrome (ARDS). Which
clinical manifestation would the nurse expect to find during the early stages of this condition?
A. Severe metabolic acidosis
B. Refractory hypoxemia despite high FiO2
C. Decreased heart rate and hypertension
D. Hypercapnia and respiratory acidosis
Correct Answer: B
Explanation: ARDS is characterized by refractory hypoxemia, which occurs when the
partial pressure of arterial oxygen remains low despite increasing levels of inspired
oxygen. In the early stages, patients often present with tachypnea and respiratory alkalosis
as they attempt to compensate for hypoxia. This condition results from increased capillary
permeability leading to non-cardiogenic pulmonary edema and surfactant inactivation.
2. The nurse is caring for a patient on a mechanical ventilator with the following settings:
Assist/Control (A/C) mode, rate 12, FiO2 50%, and PEEP 10 cm H2O. The high-pressure alarm
sounds. Which action should the nurse take first?
A. Check for a leak in the ventilator tubing
B. Decrease the PEEP setting to 5 cm H2O
,C. Auscultate the patient’s breath sounds and assess for secretions
D. Call the healthcare provider immediately
Correct Answer: C
Explanation: High-pressure alarms on a mechanical ventilator are typically caused by
resistance to airflow, such as secretions, biting the tube, or kinking of the circuit. The
nurse’s first priority is to assess the patient’s airway and physiological status, which
includes listening for adventitious breath sounds that might indicate the need for
suctioning. Once the patient is stabilized and the cause is identified, further interventions
can be implemented.
3. A patient with severe acute pancreatitis is admitted to the intensive care unit. Which
laboratory result would be most indicative of a poor prognosis according to Ranson’s Criteria
or clinical severity?
A. Serum amylase 300 U/L
B. Serum glucose < 110 mg/dL
C. Hypocalcemia (Serum calcium < 8 mg/dL)
D. WBC count 8,000/mm3
Correct Answer: C
Explanation: Hypocalcemia is a significant indicator of severity in acute pancreatitis
because it results from the saponification of calcium by fatty acids in the retroperitoneum.
Low calcium levels often correlate with extensive fat necrosis and are associated with a
,higher mortality rate. Monitoring electrolytes is crucial as levels below 8 mg/dL require
immediate attention to prevent tetany and cardiac arrhythmias.
4. A patient arrives in the emergency department with partial and full-thickness burns to the
chest, abdomen, and the entire front of both legs. Using the Rule of Nines, what is the
estimated total body surface area (TBSA) burned?
A. 27%
B. 45%
C. 36%
D. 54%
Correct Answer: C
Explanation: According to the Rule of Nines, the front of the trunk (chest and abdomen)
accounts for 18%. Each front of a leg accounts for 9%, and since both front legs are
involved, that adds another 18%. Adding these together (18% + 18%) equals 36% TBSA,
which is critical for calculating initial fluid resuscitation needs.
5. During the emergent phase of burn management, which electrolyte imbalance should the
nurse anticipate?
A. Hypoglycemia
B. Hypokalemia
C. Hypernatremia
, D. Hyperkalemia
Correct Answer: D
Explanation: Hyperkalemia occurs during the emergent phase because of massive cellular
destruction, which releases potassium from the intracellular space into the extracellular
fluid. This elevation in serum potassium poses a significant risk for cardiac dysrhythmias
and must be closely monitored. Additionally, sodium often moves into the interstitial space,
leading to hyponatremia as part of the fluid shift process.
6. A patient is being treated for Septic Shock. The nurse notes the patient’s blood pressure is
82/40 mmHg after receiving a 30 mL/kg fluid bolus. Which medication is the first-choice
vasopressor to be initiated?
A. Norepinephrine
B. Dobutamine
C. Dopamine
D. Vasopressin
Correct Answer: A
Explanation: Norepinephrine is the first-line vasopressor recommended by the Surviving
Sepsis Campaign for patients who remain hypotensive after adequate fluid resuscitation. It
primarily acts as an alpha-adrenergic agonist to increase systemic vascular resistance and
mean arterial pressure. While other vasopressors like vasopressin can be added,
norepinephrine remains the gold standard for initial management of septic shock.
Q&A with Rationale | Chamberlain University
1. A patient in the ICU is diagnosed with Acute Respiratory Distress Syndrome (ARDS). Which
clinical manifestation would the nurse expect to find during the early stages of this condition?
A. Severe metabolic acidosis
B. Refractory hypoxemia despite high FiO2
C. Decreased heart rate and hypertension
D. Hypercapnia and respiratory acidosis
Correct Answer: B
Explanation: ARDS is characterized by refractory hypoxemia, which occurs when the
partial pressure of arterial oxygen remains low despite increasing levels of inspired
oxygen. In the early stages, patients often present with tachypnea and respiratory alkalosis
as they attempt to compensate for hypoxia. This condition results from increased capillary
permeability leading to non-cardiogenic pulmonary edema and surfactant inactivation.
2. The nurse is caring for a patient on a mechanical ventilator with the following settings:
Assist/Control (A/C) mode, rate 12, FiO2 50%, and PEEP 10 cm H2O. The high-pressure alarm
sounds. Which action should the nurse take first?
A. Check for a leak in the ventilator tubing
B. Decrease the PEEP setting to 5 cm H2O
,C. Auscultate the patient’s breath sounds and assess for secretions
D. Call the healthcare provider immediately
Correct Answer: C
Explanation: High-pressure alarms on a mechanical ventilator are typically caused by
resistance to airflow, such as secretions, biting the tube, or kinking of the circuit. The
nurse’s first priority is to assess the patient’s airway and physiological status, which
includes listening for adventitious breath sounds that might indicate the need for
suctioning. Once the patient is stabilized and the cause is identified, further interventions
can be implemented.
3. A patient with severe acute pancreatitis is admitted to the intensive care unit. Which
laboratory result would be most indicative of a poor prognosis according to Ranson’s Criteria
or clinical severity?
A. Serum amylase 300 U/L
B. Serum glucose < 110 mg/dL
C. Hypocalcemia (Serum calcium < 8 mg/dL)
D. WBC count 8,000/mm3
Correct Answer: C
Explanation: Hypocalcemia is a significant indicator of severity in acute pancreatitis
because it results from the saponification of calcium by fatty acids in the retroperitoneum.
Low calcium levels often correlate with extensive fat necrosis and are associated with a
,higher mortality rate. Monitoring electrolytes is crucial as levels below 8 mg/dL require
immediate attention to prevent tetany and cardiac arrhythmias.
4. A patient arrives in the emergency department with partial and full-thickness burns to the
chest, abdomen, and the entire front of both legs. Using the Rule of Nines, what is the
estimated total body surface area (TBSA) burned?
A. 27%
B. 45%
C. 36%
D. 54%
Correct Answer: C
Explanation: According to the Rule of Nines, the front of the trunk (chest and abdomen)
accounts for 18%. Each front of a leg accounts for 9%, and since both front legs are
involved, that adds another 18%. Adding these together (18% + 18%) equals 36% TBSA,
which is critical for calculating initial fluid resuscitation needs.
5. During the emergent phase of burn management, which electrolyte imbalance should the
nurse anticipate?
A. Hypoglycemia
B. Hypokalemia
C. Hypernatremia
, D. Hyperkalemia
Correct Answer: D
Explanation: Hyperkalemia occurs during the emergent phase because of massive cellular
destruction, which releases potassium from the intracellular space into the extracellular
fluid. This elevation in serum potassium poses a significant risk for cardiac dysrhythmias
and must be closely monitored. Additionally, sodium often moves into the interstitial space,
leading to hyponatremia as part of the fluid shift process.
6. A patient is being treated for Septic Shock. The nurse notes the patient’s blood pressure is
82/40 mmHg after receiving a 30 mL/kg fluid bolus. Which medication is the first-choice
vasopressor to be initiated?
A. Norepinephrine
B. Dobutamine
C. Dopamine
D. Vasopressin
Correct Answer: A
Explanation: Norepinephrine is the first-line vasopressor recommended by the Surviving
Sepsis Campaign for patients who remain hypotensive after adequate fluid resuscitation. It
primarily acts as an alpha-adrenergic agonist to increase systemic vascular resistance and
mean arterial pressure. While other vasopressors like vasopressin can be added,
norepinephrine remains the gold standard for initial management of septic shock.
