NR341/NR 341 Final Exam V1 | Complex Adult
Health Q&A with Rationale | Chamberlain
University
1. A patient is admitted with septic shock and has a blood pressure of 82/46 mmHg. After an
initial 30 mL/kg fluid bolus, the MAP remains below 65 mmHg. Which medication should the
nurse anticipate administering first?
A. Norepinephrine infusion
B. Dobutamine infusion
C. Nitroglycerin drip
D. Atropine intravenous push
Correct Answer: A
Explanation: Norepinephrine is the first-line vasopressor used in septic shock to maintain
a MAP of at least 65 mmHg. This medication works primarily as an alpha-1 agonist to cause
peripheral vasoconstriction and increase systemic vascular resistance. The nurse must
monitor the infusion site closely for extravasation and assess distal perfusion frequently.
2. When caring for a patient on mechanical ventilation, the ‘High Pressure’ alarm begins to
sound. Which action should the nurse take first?
A. Assess the patient’s breath sounds and check for tubing kinks
B. Disconnect the patient and manual bag ventilation
,C. Increase the oxygen concentration to 100%
D. Call the respiratory therapist to recalibrate the machine
Correct Answer: A
Explanation: A high-pressure alarm indicates that the ventilator is meeting resistance
when trying to deliver a breath. Common causes include the patient biting the tube,
secretions in the airway, or kinked tubing. The nurse must assess the patient first to ensure
safety and identify the source of resistance before taking other actions.
3. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22 mmHg.
Which nursing intervention is most appropriate to help decrease ICP?
A. Position the head of the bed flat
B. Keep the patient’s neck in a neutral, midline position
C. Encourage frequent coughing and deep breathing
D. Perform vigorous suctioning every hour
Correct Answer: B
Explanation: Maintaining the head in a neutral midline position facilitates venous drainage
from the brain, which helps reduce intracranial pressure. Flexion or rotation of the neck
can obstruct the jugular veins and lead to increased cerebral volume. The nurse should also
elevate the head of the bed to 30-45 degrees unless contraindicated by spinal injury.
, 4. A nurse is monitoring a patient with Acute Respiratory Distress Syndrome (ARDS). Which
finding indicates that the patient’s condition is deteriorating despite high FiO2 settings?
A. Increased PaO2 with decreased PEEP levels
B. Respiratory alkalosis on the arterial blood gas
C. SpO2 of 94% on room air
D. A PaO2/FiO2 ratio of less than 100
Correct Answer: D
Explanation: A PaO2/FiO2 ratio of less than 100 indicates severe ARDS and profound
refractory hypoxemia. This condition suggests that the alveoli are severely damaged and
gas exchange is failing despite supplemental oxygen. The nurse should prepare for
advanced interventions such as prone positioning or neuromuscular blockade.
5. During the compensatory stage of shock, which clinical manifestation would the nurse
expect to observe?
A. Cold, clammy skin and tachycardia
B. Anuria and metabolic acidosis
C. Bradycardia and hypertension
D. Lethargy and decreased bowel sounds
Correct Answer: A
Health Q&A with Rationale | Chamberlain
University
1. A patient is admitted with septic shock and has a blood pressure of 82/46 mmHg. After an
initial 30 mL/kg fluid bolus, the MAP remains below 65 mmHg. Which medication should the
nurse anticipate administering first?
A. Norepinephrine infusion
B. Dobutamine infusion
C. Nitroglycerin drip
D. Atropine intravenous push
Correct Answer: A
Explanation: Norepinephrine is the first-line vasopressor used in septic shock to maintain
a MAP of at least 65 mmHg. This medication works primarily as an alpha-1 agonist to cause
peripheral vasoconstriction and increase systemic vascular resistance. The nurse must
monitor the infusion site closely for extravasation and assess distal perfusion frequently.
2. When caring for a patient on mechanical ventilation, the ‘High Pressure’ alarm begins to
sound. Which action should the nurse take first?
A. Assess the patient’s breath sounds and check for tubing kinks
B. Disconnect the patient and manual bag ventilation
,C. Increase the oxygen concentration to 100%
D. Call the respiratory therapist to recalibrate the machine
Correct Answer: A
Explanation: A high-pressure alarm indicates that the ventilator is meeting resistance
when trying to deliver a breath. Common causes include the patient biting the tube,
secretions in the airway, or kinked tubing. The nurse must assess the patient first to ensure
safety and identify the source of resistance before taking other actions.
3. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22 mmHg.
Which nursing intervention is most appropriate to help decrease ICP?
A. Position the head of the bed flat
B. Keep the patient’s neck in a neutral, midline position
C. Encourage frequent coughing and deep breathing
D. Perform vigorous suctioning every hour
Correct Answer: B
Explanation: Maintaining the head in a neutral midline position facilitates venous drainage
from the brain, which helps reduce intracranial pressure. Flexion or rotation of the neck
can obstruct the jugular veins and lead to increased cerebral volume. The nurse should also
elevate the head of the bed to 30-45 degrees unless contraindicated by spinal injury.
, 4. A nurse is monitoring a patient with Acute Respiratory Distress Syndrome (ARDS). Which
finding indicates that the patient’s condition is deteriorating despite high FiO2 settings?
A. Increased PaO2 with decreased PEEP levels
B. Respiratory alkalosis on the arterial blood gas
C. SpO2 of 94% on room air
D. A PaO2/FiO2 ratio of less than 100
Correct Answer: D
Explanation: A PaO2/FiO2 ratio of less than 100 indicates severe ARDS and profound
refractory hypoxemia. This condition suggests that the alveoli are severely damaged and
gas exchange is failing despite supplemental oxygen. The nurse should prepare for
advanced interventions such as prone positioning or neuromuscular blockade.
5. During the compensatory stage of shock, which clinical manifestation would the nurse
expect to observe?
A. Cold, clammy skin and tachycardia
B. Anuria and metabolic acidosis
C. Bradycardia and hypertension
D. Lethargy and decreased bowel sounds
Correct Answer: A
