Nightingale College BSN 445 Final Exam (pdf) | 2026/2027 | Complex
Patient Q&A | Nursing
1. A client with septic shock has a mean arterial pressure (MAP) of 55 mmHg
despite receiving 30 mL/kg of IV fluid resuscitation. Which vasopressor
should the nurse anticipate administering first?
A) Dopamine
B) Norepinephrine
C) Epinephrine
D) Vasopressin
Correct Answer: Norepinephrine
Rationale: Norepinephrine is the first-line vasopressor in septic shock
according to the Surviving Sepsis Campaign guidelines. It increases MAP
through alpha-1 vasoconstriction and has less tachycardia than dopamine or
epinephrine. Early vasopressor administration is critical in septic shock
management.
2. A client with Acute Respiratory Distress Syndrome (ARDS) is on
mechanical ventilation with a tidal volume of 10 mL/kg. What is the priority
change to the ventilator settings?
A) Increase tidal volume to 12 mL/kg
B) Decrease tidal volume to 6 mL/kg
C) Increase PEEP to 20 cm H2O
D) Decrease respiratory rate to 8 breaths/min
Correct Answer: Decrease tidal volume to 6 mL/kg
Rationale: ARDS management (ARDSnet protocol) uses low tidal volume
ventilation of 6 mL/kg predicted body weight to prevent volutrauma and
,ventilator-induced lung injury. Higher tidal volumes increase mortality. Low
tidal volume ventilation is the priority intervention in ARDS.
3. A client with cirrhosis and ascites develops fever, abdominal pain, and
altered mental status. Paracentesis shows ascitic fluid with a
polymorphonuclear (PMN) count of 500/mm³. What is the most likely
diagnosis?
A) Spontaneous bacterial peritonitis (SBP)
B) Hepatic encephalopathy
C) Hepatorenal syndrome
D) Ascitic fluid leakage
Correct Answer: Spontaneous bacterial peritonitis (SBP)
Rationale: SBP is diagnosed when ascitic fluid PMN count is ≥ 250/mm³.
Fever, abdominal pain, and altered mental status in a client with cirrhosis
and ascites are classic signs of SBP. Prompt antibiotic therapy is essential.
4. The nurse is caring for a client with a Swan-Ganz catheter. Which
hemodynamic parameter directly reflects left ventricular preload?
A) Central venous pressure (CVP)
B) Pulmonary artery wedge pressure (PAWP)
C) Cardiac output
D) Systemic vascular resistance
Correct Answer: Pulmonary artery wedge pressure (PAWP)
Rationale: PAWP (or pulmonary capillary wedge pressure) reflects left
ventricular end-diastolic pressure and serves as an indicator of left
ventricular preload. CVP reflects right ventricular preload. Cardiac output
,measures the volume of blood pumped by the heart per minute, and SVR
measures resistance in the peripheral vasculature.
5. A client with a severe traumatic brain injury has an intracranial pressure
(ICP) of 22 mmHg. Which intervention should the nurse implement first?
A) Administer mannitol
B) Elevate the head of the bed to 30 degrees
C) Hyperventilate the client
D) Administer a sedative
Correct Answer: Elevate the head of the bed to 30 degrees
Rationale: Elevating the head of the bed to 30 degrees promotes venous
drainage and helps reduce ICP. This is a first-line, non-invasive intervention
for elevated ICP. Hyperventilation is reserved for acute spikes, and mannitol
is used when ICP remains elevated despite positioning.
6. The nurse is monitoring a client with a chest tube. Which finding indicates
a tension pneumothorax?
A) Intermittent bubbling in the water seal chamber
B) Continuous bubbling in the water seal chamber
C) Absent breath sounds on the affected side with tracheal deviation
D) Tidaling in the water seal chamber
Correct Answer: Absent breath sounds on the affected side with tracheal
deviation
Rationale: Tension pneumothorax is a life-threatening emergency
characterized by absent breath sounds on the affected side, tracheal
deviation to the opposite side, hypotension, and distended neck veins.
, Immediate needle decompression or chest tube insertion is required.
Bubbling in the water seal chamber indicates an air leak, not necessarily
tension pneumothorax.
7. A client is receiving mechanical ventilation. The high-pressure alarm
sounds. Which action should the nurse take first?
A) Suction the endotracheal tube
B) Assess the client's respiratory status
C) Check the ventilator circuit for kinks
D) Silence the alarm
Correct Answer: Assess the client's respiratory status
Rationale: The priority action when any ventilator alarm sounds is to assess
the client. The nurse should check the client's oxygenation, ventilation, and
hemodynamic status before troubleshooting the ventilator. Client safety
always comes first.
8. A client is in cardiogenic shock. Which hemodynamic finding is expected?
A) High cardiac output and low systemic vascular resistance
B) Low cardiac output and high systemic vascular resistance
C) High cardiac output and high systemic vascular resistance
D) Low cardiac output and low systemic vascular resistance
Correct Answer: Low cardiac output and high systemic vascular resistance
Rationale: Cardiogenic shock is characterized by pump failure leading to low
cardiac output. The body compensates with peripheral vasoconstriction,
increasing systemic vascular resistance to maintain blood pressure. This
Patient Q&A | Nursing
1. A client with septic shock has a mean arterial pressure (MAP) of 55 mmHg
despite receiving 30 mL/kg of IV fluid resuscitation. Which vasopressor
should the nurse anticipate administering first?
A) Dopamine
B) Norepinephrine
C) Epinephrine
D) Vasopressin
Correct Answer: Norepinephrine
Rationale: Norepinephrine is the first-line vasopressor in septic shock
according to the Surviving Sepsis Campaign guidelines. It increases MAP
through alpha-1 vasoconstriction and has less tachycardia than dopamine or
epinephrine. Early vasopressor administration is critical in septic shock
management.
2. A client with Acute Respiratory Distress Syndrome (ARDS) is on
mechanical ventilation with a tidal volume of 10 mL/kg. What is the priority
change to the ventilator settings?
A) Increase tidal volume to 12 mL/kg
B) Decrease tidal volume to 6 mL/kg
C) Increase PEEP to 20 cm H2O
D) Decrease respiratory rate to 8 breaths/min
Correct Answer: Decrease tidal volume to 6 mL/kg
Rationale: ARDS management (ARDSnet protocol) uses low tidal volume
ventilation of 6 mL/kg predicted body weight to prevent volutrauma and
,ventilator-induced lung injury. Higher tidal volumes increase mortality. Low
tidal volume ventilation is the priority intervention in ARDS.
3. A client with cirrhosis and ascites develops fever, abdominal pain, and
altered mental status. Paracentesis shows ascitic fluid with a
polymorphonuclear (PMN) count of 500/mm³. What is the most likely
diagnosis?
A) Spontaneous bacterial peritonitis (SBP)
B) Hepatic encephalopathy
C) Hepatorenal syndrome
D) Ascitic fluid leakage
Correct Answer: Spontaneous bacterial peritonitis (SBP)
Rationale: SBP is diagnosed when ascitic fluid PMN count is ≥ 250/mm³.
Fever, abdominal pain, and altered mental status in a client with cirrhosis
and ascites are classic signs of SBP. Prompt antibiotic therapy is essential.
4. The nurse is caring for a client with a Swan-Ganz catheter. Which
hemodynamic parameter directly reflects left ventricular preload?
A) Central venous pressure (CVP)
B) Pulmonary artery wedge pressure (PAWP)
C) Cardiac output
D) Systemic vascular resistance
Correct Answer: Pulmonary artery wedge pressure (PAWP)
Rationale: PAWP (or pulmonary capillary wedge pressure) reflects left
ventricular end-diastolic pressure and serves as an indicator of left
ventricular preload. CVP reflects right ventricular preload. Cardiac output
,measures the volume of blood pumped by the heart per minute, and SVR
measures resistance in the peripheral vasculature.
5. A client with a severe traumatic brain injury has an intracranial pressure
(ICP) of 22 mmHg. Which intervention should the nurse implement first?
A) Administer mannitol
B) Elevate the head of the bed to 30 degrees
C) Hyperventilate the client
D) Administer a sedative
Correct Answer: Elevate the head of the bed to 30 degrees
Rationale: Elevating the head of the bed to 30 degrees promotes venous
drainage and helps reduce ICP. This is a first-line, non-invasive intervention
for elevated ICP. Hyperventilation is reserved for acute spikes, and mannitol
is used when ICP remains elevated despite positioning.
6. The nurse is monitoring a client with a chest tube. Which finding indicates
a tension pneumothorax?
A) Intermittent bubbling in the water seal chamber
B) Continuous bubbling in the water seal chamber
C) Absent breath sounds on the affected side with tracheal deviation
D) Tidaling in the water seal chamber
Correct Answer: Absent breath sounds on the affected side with tracheal
deviation
Rationale: Tension pneumothorax is a life-threatening emergency
characterized by absent breath sounds on the affected side, tracheal
deviation to the opposite side, hypotension, and distended neck veins.
, Immediate needle decompression or chest tube insertion is required.
Bubbling in the water seal chamber indicates an air leak, not necessarily
tension pneumothorax.
7. A client is receiving mechanical ventilation. The high-pressure alarm
sounds. Which action should the nurse take first?
A) Suction the endotracheal tube
B) Assess the client's respiratory status
C) Check the ventilator circuit for kinks
D) Silence the alarm
Correct Answer: Assess the client's respiratory status
Rationale: The priority action when any ventilator alarm sounds is to assess
the client. The nurse should check the client's oxygenation, ventilation, and
hemodynamic status before troubleshooting the ventilator. Client safety
always comes first.
8. A client is in cardiogenic shock. Which hemodynamic finding is expected?
A) High cardiac output and low systemic vascular resistance
B) Low cardiac output and high systemic vascular resistance
C) High cardiac output and high systemic vascular resistance
D) Low cardiac output and low systemic vascular resistance
Correct Answer: Low cardiac output and high systemic vascular resistance
Rationale: Cardiogenic shock is characterized by pump failure leading to low
cardiac output. The body compensates with peripheral vasoconstriction,
increasing systemic vascular resistance to maintain blood pressure. This
