NR341/NR 341 Exam 4 V3 | Complex Adult Health
Q&A with Rationale | Chamberlain University
1. A patient is admitted to the ICU with a diagnosis of Septic Shock. The nurse notes a Mean
Arterial Pressure (MAP) of 55 mmHg despite aggressive fluid resuscitation with 3 liters of
Normal Saline. Which medication should the nurse anticipate administering next?
A. Furosemide
B. Atropine
C. Nitroglycerin
D. Norepinephrine
Correct Answer: D
Explanation: Norepinephrine is the first-line vasopressor used in septic shock to maintain
a MAP of at least 65 mmHg when fluid resuscitation is insufficient. Atropine is used for
bradycardia, while nitroglycerin is a vasodilator that would worsen hypotension.
Furosemide is a diuretic and is contraindicated in the initial resuscitative phase of shock.
2. An adult patient weighs 80 kg and has sustained partial-thickness burns to the entire left
arm and the anterior trunk. Using the Parkland Formula (4mL/kg/%TBSA), calculate the total
fluid volume required in the first 24 hours.
A. 8,640 mL
B. 5,760 mL
,C. 11,520 mL
D. 4,320 mL
Correct Answer: A
Explanation: Using the Rule of Nines, the entire left arm is 9% and the anterior trunk is
18%, totaling 27% TBSA. The Parkland Formula calculation is 4 mL x 80 kg x 27 = 8,640
mL. Half of this total (4,320 mL) must be administered within the first 8 hours from the
time of injury.
3. A nurse is caring for a patient with Acute Respiratory Distress Syndrome (ARDS) who is on
mechanical ventilation with High-Level Positive End-Expiratory Pressure (PEEP). What is the
primary physiological benefit of PEEP in this patient?
A. Preventing alveolar collapse at the end of expiration
B. Decreasing the risk of barotrauma
C. Increasing the fraction of inspired oxygen (FiO2)
D. Increasing cardiac output and venous return
Correct Answer: A
Explanation: PEEP functions by maintaining positive pressure in the airways at the end of
exhalation, which prevents alveolar collapse and improves gas exchange. By keeping alveoli
open (recruitment), it increases the surface area for oxygen diffusion, which is critical in
ARDS. High levels of PEEP can actually decrease cardiac output due to increased
intrathoracic pressure and increase the risk of barotrauma.
,4. A patient in the emergent phase of a major burn injury has the following laboratory results:
Sodium 132 mEq/L, Potassium 6.1 mEq/L, and Hematocrit 54%. Which interpretation by the
nurse is correct?
A. The patient is experiencing fluid volume excess.
B. The hematocrit is low, indicating a need for blood transfusion.
C. The patient has developed acute kidney injury and needs immediate dialysis.
D. The findings are expected during the emergent phase due to fluid shifts.
Correct Answer: D
Explanation: In the emergent burn phase, massive fluid shifts from the
intracellular/intravascular space to the interstitial space result in hyponatremia and
hyperkalemia (from cell destruction). The hematocrit increases (hemoconcentration) as
the plasma component of blood is lost. These findings are typical within the first 24 to 48
hours post-burn until capillary permeability restores.
5. During a mass casualty incident, the nurse triages a victim who is unconscious, has a
respiratory rate of 8 breaths/minute, and a thready radial pulse. Which color tag should the
nurse assign?
A. Green (Minimal)
B. Yellow (Delayed)
C. Red (Immediate)
D. Black (Expectant)
, Correct Answer: C
Explanation: The Red tag is for victims who require immediate life-saving intervention to
survive. This patient’s altered level of consciousness and respiratory distress meet the
criteria for ‘Immediate’ priority. Yellow is for stable injuries that can wait, while Black is for
those deceased or with non-survivable injuries.
6. The nurse is monitoring a patient with a Pulmonary Artery (PA) catheter. The current
readings are: CVP 1 mmHg, PAOP (Wedge) 3 mmHg, and Cardiac Index 1.8 L/min/m2. Which
type of shock do these parameters most likely indicate?
A. Cardiogenic shock
B. Hypovolemic shock
C. Septic shock
D. Neurogenic shock
Correct Answer: B
Explanation: Hypovolemic shock is characterized by low filling pressures (CVP and PAOP)
and a low cardiac index due to inadequate volume. In cardiogenic shock, filling pressures
(PAOP) would typically be high due to pump failure. In early septic shock, the cardiac index
is often high (hyperdynamic) while systemic vascular resistance is low.
7. A patient with a spinal cord injury at T3 is experiencing sudden hypertension, a severe
headache, and bradycardia. What is the priority nursing action?
A. Check the patient’s bladder for distension or a kinked catheter.
Q&A with Rationale | Chamberlain University
1. A patient is admitted to the ICU with a diagnosis of Septic Shock. The nurse notes a Mean
Arterial Pressure (MAP) of 55 mmHg despite aggressive fluid resuscitation with 3 liters of
Normal Saline. Which medication should the nurse anticipate administering next?
A. Furosemide
B. Atropine
C. Nitroglycerin
D. Norepinephrine
Correct Answer: D
Explanation: Norepinephrine is the first-line vasopressor used in septic shock to maintain
a MAP of at least 65 mmHg when fluid resuscitation is insufficient. Atropine is used for
bradycardia, while nitroglycerin is a vasodilator that would worsen hypotension.
Furosemide is a diuretic and is contraindicated in the initial resuscitative phase of shock.
2. An adult patient weighs 80 kg and has sustained partial-thickness burns to the entire left
arm and the anterior trunk. Using the Parkland Formula (4mL/kg/%TBSA), calculate the total
fluid volume required in the first 24 hours.
A. 8,640 mL
B. 5,760 mL
,C. 11,520 mL
D. 4,320 mL
Correct Answer: A
Explanation: Using the Rule of Nines, the entire left arm is 9% and the anterior trunk is
18%, totaling 27% TBSA. The Parkland Formula calculation is 4 mL x 80 kg x 27 = 8,640
mL. Half of this total (4,320 mL) must be administered within the first 8 hours from the
time of injury.
3. A nurse is caring for a patient with Acute Respiratory Distress Syndrome (ARDS) who is on
mechanical ventilation with High-Level Positive End-Expiratory Pressure (PEEP). What is the
primary physiological benefit of PEEP in this patient?
A. Preventing alveolar collapse at the end of expiration
B. Decreasing the risk of barotrauma
C. Increasing the fraction of inspired oxygen (FiO2)
D. Increasing cardiac output and venous return
Correct Answer: A
Explanation: PEEP functions by maintaining positive pressure in the airways at the end of
exhalation, which prevents alveolar collapse and improves gas exchange. By keeping alveoli
open (recruitment), it increases the surface area for oxygen diffusion, which is critical in
ARDS. High levels of PEEP can actually decrease cardiac output due to increased
intrathoracic pressure and increase the risk of barotrauma.
,4. A patient in the emergent phase of a major burn injury has the following laboratory results:
Sodium 132 mEq/L, Potassium 6.1 mEq/L, and Hematocrit 54%. Which interpretation by the
nurse is correct?
A. The patient is experiencing fluid volume excess.
B. The hematocrit is low, indicating a need for blood transfusion.
C. The patient has developed acute kidney injury and needs immediate dialysis.
D. The findings are expected during the emergent phase due to fluid shifts.
Correct Answer: D
Explanation: In the emergent burn phase, massive fluid shifts from the
intracellular/intravascular space to the interstitial space result in hyponatremia and
hyperkalemia (from cell destruction). The hematocrit increases (hemoconcentration) as
the plasma component of blood is lost. These findings are typical within the first 24 to 48
hours post-burn until capillary permeability restores.
5. During a mass casualty incident, the nurse triages a victim who is unconscious, has a
respiratory rate of 8 breaths/minute, and a thready radial pulse. Which color tag should the
nurse assign?
A. Green (Minimal)
B. Yellow (Delayed)
C. Red (Immediate)
D. Black (Expectant)
, Correct Answer: C
Explanation: The Red tag is for victims who require immediate life-saving intervention to
survive. This patient’s altered level of consciousness and respiratory distress meet the
criteria for ‘Immediate’ priority. Yellow is for stable injuries that can wait, while Black is for
those deceased or with non-survivable injuries.
6. The nurse is monitoring a patient with a Pulmonary Artery (PA) catheter. The current
readings are: CVP 1 mmHg, PAOP (Wedge) 3 mmHg, and Cardiac Index 1.8 L/min/m2. Which
type of shock do these parameters most likely indicate?
A. Cardiogenic shock
B. Hypovolemic shock
C. Septic shock
D. Neurogenic shock
Correct Answer: B
Explanation: Hypovolemic shock is characterized by low filling pressures (CVP and PAOP)
and a low cardiac index due to inadequate volume. In cardiogenic shock, filling pressures
(PAOP) would typically be high due to pump failure. In early septic shock, the cardiac index
is often high (hyperdynamic) while systemic vascular resistance is low.
7. A patient with a spinal cord injury at T3 is experiencing sudden hypertension, a severe
headache, and bradycardia. What is the priority nursing action?
A. Check the patient’s bladder for distension or a kinked catheter.
