Nightingale College BSN 346 Final Exam (pdf) | 2026/2027 |
Concepts of Nursing III Q&A | Nursing
1. A client with Acute Respiratory Distress Syndrome (ARDS) is receiving
mechanical ventilation. Which ventilator setting is specifically used to keep
the alveoli open at the end of expiration to prevent alveolar collapse and
improve oxygenation?
A) Fraction of Inspired Oxygen (FiO2)
B) Tidal Volume (VT)
C) Positive End-Expiratory Pressure (PEEP)
D) Inspiratory Rate
Correct Answer: Positive End-Expiratory Pressure (PEEP)
Rationale: PEEP provides positive pressure at the end of expiration to prevent
alveolar collapse and improve oxygenation in clients with ARDS. FiO2
increases oxygen concentration, tidal volume determines the volume of each
breath, and inspiratory rate sets the number of breaths per minute.
2. A client is in the emergent phase of a major burn injury. Which electrolyte
imbalance is most commonly expected during this phase?
A) Hypokalemia
B) Hypernatremia
C) Hypophosphatemia
D) Hyperkalemia
Correct Answer: Hyperkalemia
Rationale: In the emergent phase of burns, cell destruction releases
potassium into the extracellular fluid, leading to hyperkalemia. Hypokalemia,
,hypernatremia, and hypophosphatemia are not characteristic of the
emergent burn phase.
3. Using the Parkland Formula, calculate the total fluid volume needed in the
first 24 hours for a 70 kg client with 40% Total Body Surface Area (TBSA)
burns.
A) 5,600 mL
B) 14,000 mL
C) 2,800 mL
D) 11,200 mL
Correct Answer: 11,200 mL
Rationale: The Parkland Formula is: 4 mL × kg × %TBSA. The calculation is 4
× 70 × 40 = 11,200 mL. The other options represent incorrect calculations of
the formula.
4. A client's arterial blood gas (ABG) results are: pH 7.30, PaCO2 55 mmHg,
HCO3 24 mEq/L. How should the nurse interpret these results?
A) Respiratory Acidosis
B) Respiratory Alkalosis
C) Metabolic Alkalosis
D) Metabolic Acidosis
Correct Answer: Respiratory Acidosis
Rationale: The pH is low (< 7.35) and the PaCO2 is high (> 45 mmHg),
indicating respiratory acidosis. The HCO3 is normal (22–26 mEq/L),
confirming that the primary problem is respiratory, not metabolic.
,5. The nurse is caring for a client with a burn injury. Which finding indicates
that fluid resuscitation is adequate?
A) Heart rate of 120 beats per minute
B) Urine output of 30 mL/hr
C) Blood pressure of 90/60 mmHg
D) Central venous pressure of 4 mmHg
Correct Answer: Urine output of 30 mL/hr
Rationale: Adequate fluid resuscitation in burn clients is indicated by a urine
output of at least 30 mL/hr. Tachycardia, hypotension, and low CVP suggest
inadequate fluid volume.
6. A client with severe burns develops a fever and leukocytosis on day 3
post-injury. The nurse should suspect which complication?
A) Fluid overload
B) Wound infection or sepsis
C) Hypovolemic shock
D) Hyperkalemia
Correct Answer: Wound infection or sepsis
Rationale: Fever and leukocytosis on day 3 post-burn are classic signs of
wound infection or sepsis. Burn wounds are susceptible to bacterial
colonization and infection due to loss of skin barrier function.
7. A client is being treated for hypovolemic shock after a traumatic injury.
Which assessment finding is the best indicator of improved tissue perfusion?
, A) Decreased heart rate
B) Increased urine output
C) Increased blood pressure
D) Decreased respiratory rate
Correct Answer: Increased urine output
Rationale: Urine output is a sensitive indicator of renal perfusion and reflects
overall tissue perfusion. A urine output of at least 30 mL/hr indicates
adequate perfusion. Blood pressure and heart rate can be affected by other
factors.
8. A client with sepsis is in the early stages of septic shock. Which
hemodynamic finding is expected?
A) Low cardiac output and high systemic vascular resistance
B) High cardiac output and low systemic vascular resistance
C) Low cardiac output and low systemic vascular resistance
D) High cardiac output and high systemic vascular resistance
Correct Answer: High cardiac output and low systemic vascular resistance
Rationale: Early septic shock is characterized by a hyperdynamic state with
high cardiac output (due to vasodilation and increased heart rate) and low
systemic vascular resistance (due to peripheral vasodilation). Low cardiac
output occurs in later stages.
9. A client is receiving mechanical ventilation with PEEP. The nurse should
monitor for which complication associated with PEEP?
A) Hypotension
Concepts of Nursing III Q&A | Nursing
1. A client with Acute Respiratory Distress Syndrome (ARDS) is receiving
mechanical ventilation. Which ventilator setting is specifically used to keep
the alveoli open at the end of expiration to prevent alveolar collapse and
improve oxygenation?
A) Fraction of Inspired Oxygen (FiO2)
B) Tidal Volume (VT)
C) Positive End-Expiratory Pressure (PEEP)
D) Inspiratory Rate
Correct Answer: Positive End-Expiratory Pressure (PEEP)
Rationale: PEEP provides positive pressure at the end of expiration to prevent
alveolar collapse and improve oxygenation in clients with ARDS. FiO2
increases oxygen concentration, tidal volume determines the volume of each
breath, and inspiratory rate sets the number of breaths per minute.
2. A client is in the emergent phase of a major burn injury. Which electrolyte
imbalance is most commonly expected during this phase?
A) Hypokalemia
B) Hypernatremia
C) Hypophosphatemia
D) Hyperkalemia
Correct Answer: Hyperkalemia
Rationale: In the emergent phase of burns, cell destruction releases
potassium into the extracellular fluid, leading to hyperkalemia. Hypokalemia,
,hypernatremia, and hypophosphatemia are not characteristic of the
emergent burn phase.
3. Using the Parkland Formula, calculate the total fluid volume needed in the
first 24 hours for a 70 kg client with 40% Total Body Surface Area (TBSA)
burns.
A) 5,600 mL
B) 14,000 mL
C) 2,800 mL
D) 11,200 mL
Correct Answer: 11,200 mL
Rationale: The Parkland Formula is: 4 mL × kg × %TBSA. The calculation is 4
× 70 × 40 = 11,200 mL. The other options represent incorrect calculations of
the formula.
4. A client's arterial blood gas (ABG) results are: pH 7.30, PaCO2 55 mmHg,
HCO3 24 mEq/L. How should the nurse interpret these results?
A) Respiratory Acidosis
B) Respiratory Alkalosis
C) Metabolic Alkalosis
D) Metabolic Acidosis
Correct Answer: Respiratory Acidosis
Rationale: The pH is low (< 7.35) and the PaCO2 is high (> 45 mmHg),
indicating respiratory acidosis. The HCO3 is normal (22–26 mEq/L),
confirming that the primary problem is respiratory, not metabolic.
,5. The nurse is caring for a client with a burn injury. Which finding indicates
that fluid resuscitation is adequate?
A) Heart rate of 120 beats per minute
B) Urine output of 30 mL/hr
C) Blood pressure of 90/60 mmHg
D) Central venous pressure of 4 mmHg
Correct Answer: Urine output of 30 mL/hr
Rationale: Adequate fluid resuscitation in burn clients is indicated by a urine
output of at least 30 mL/hr. Tachycardia, hypotension, and low CVP suggest
inadequate fluid volume.
6. A client with severe burns develops a fever and leukocytosis on day 3
post-injury. The nurse should suspect which complication?
A) Fluid overload
B) Wound infection or sepsis
C) Hypovolemic shock
D) Hyperkalemia
Correct Answer: Wound infection or sepsis
Rationale: Fever and leukocytosis on day 3 post-burn are classic signs of
wound infection or sepsis. Burn wounds are susceptible to bacterial
colonization and infection due to loss of skin barrier function.
7. A client is being treated for hypovolemic shock after a traumatic injury.
Which assessment finding is the best indicator of improved tissue perfusion?
, A) Decreased heart rate
B) Increased urine output
C) Increased blood pressure
D) Decreased respiratory rate
Correct Answer: Increased urine output
Rationale: Urine output is a sensitive indicator of renal perfusion and reflects
overall tissue perfusion. A urine output of at least 30 mL/hr indicates
adequate perfusion. Blood pressure and heart rate can be affected by other
factors.
8. A client with sepsis is in the early stages of septic shock. Which
hemodynamic finding is expected?
A) Low cardiac output and high systemic vascular resistance
B) High cardiac output and low systemic vascular resistance
C) Low cardiac output and low systemic vascular resistance
D) High cardiac output and high systemic vascular resistance
Correct Answer: High cardiac output and low systemic vascular resistance
Rationale: Early septic shock is characterized by a hyperdynamic state with
high cardiac output (due to vasodilation and increased heart rate) and low
systemic vascular resistance (due to peripheral vasodilation). Low cardiac
output occurs in later stages.
9. A client is receiving mechanical ventilation with PEEP. The nurse should
monitor for which complication associated with PEEP?
A) Hypotension
