GALEN NUR 283 COMP 1–3 EXAMS
COMPREHENSIVE REVIEW
1. A patient is admitted with a diagnosis of Acute Respiratory Distress Syndrome (ARDS). The
nurse observes the patient is in the ‘fibrotic phase.’ Which clinical finding is most consistent
with this stage?
A. Decreased lung compliance and irreversible pulmonary hypertension.
B. Increased lung compliance and improving oxygenation.
C. Rapid resolution of pulmonary edema.
D. Interstitial edema with surfactant inactivation.
Answer: A
Conceptual Explanation: The fibrotic phase of ARDS occurs 2-3 weeks after injury and is
characterized by permanent lung remodeling, decreased compliance, and pulmonary
hypertension due to fibrosis.
2. Which hemodynamic parameter should the nurse expect to see in a patient experiencing
early Septic Shock?
A. Decreased Cardiac Output (CO).
,B. High Systemic Vascular Resistance (SVR).
C. Increased Cardiac Output (CO) with low SVR.
D. Elevated Pulmonary Artery Wedge Pressure (PAWP).
Answer: C
Conceptual Explanation: Early (hyperdynamic) septic shock is characterized by
‘distributive’ vasodilation, leading to low SVR and a compensatory high Cardiac Output.
3. A patient with a spinal cord injury at T4 reports a sudden, severe headache and is found to
have a blood pressure of 190/110 mmHg. What is the priority nursing intervention?
A. Administer PRN antihypertensive medication.
B. Assess for bladder distention or fecal impaction.
C. Lower the head of the bed to the supine position.
D. Check the patient’s temperature for signs of infection.
Answer: B
Conceptual Explanation: These are signs of Autonomic Dysreflexia. The priority is to sit
the patient up (to lower BP) and then identify/remove the stimulus, usually a full bladder
or bowel.
4. In the management of Diabetic Ketoacidosis (DKA), why is Potassium added to the
intravenous fluids even if the initial serum potassium level is normal?
A. Potassium prevents the development of metabolic alkalosis.
, B. The patient is losing potassium through excessive vomiting.
C. Insulin therapy causes potassium to shift from the extracellular to the intracellular
space.
D. To prevent renal failure caused by osmotic diuresis.
Answer: C
Conceptual Explanation: As insulin drives glucose into cells, it also drives potassium into
cells, which can lead to a rapid drop in serum potassium (hypokalemia) and cardiac
arrhythmias.
5. A patient with cirrhosis and esophageal varices is prescribed Lactulose. Which finding
indicates the medication is achieving the desired therapeutic effect?
A. The abdominal girth has decreased by 2 inches.
B. The patient’s prothrombin time (PT) returns to normal.
C. Serum bilirubin levels have decreased significantly.
D. The patient has 2-3 soft stools per day and improved mental status.
Answer: D
Conceptual Explanation: Lactulose is used to reduce ammonia levels in hepatic
encephalopathy. Success is measured by frequent stools (excreting ammonia) and
improved neurological status.
COMPREHENSIVE REVIEW
1. A patient is admitted with a diagnosis of Acute Respiratory Distress Syndrome (ARDS). The
nurse observes the patient is in the ‘fibrotic phase.’ Which clinical finding is most consistent
with this stage?
A. Decreased lung compliance and irreversible pulmonary hypertension.
B. Increased lung compliance and improving oxygenation.
C. Rapid resolution of pulmonary edema.
D. Interstitial edema with surfactant inactivation.
Answer: A
Conceptual Explanation: The fibrotic phase of ARDS occurs 2-3 weeks after injury and is
characterized by permanent lung remodeling, decreased compliance, and pulmonary
hypertension due to fibrosis.
2. Which hemodynamic parameter should the nurse expect to see in a patient experiencing
early Septic Shock?
A. Decreased Cardiac Output (CO).
,B. High Systemic Vascular Resistance (SVR).
C. Increased Cardiac Output (CO) with low SVR.
D. Elevated Pulmonary Artery Wedge Pressure (PAWP).
Answer: C
Conceptual Explanation: Early (hyperdynamic) septic shock is characterized by
‘distributive’ vasodilation, leading to low SVR and a compensatory high Cardiac Output.
3. A patient with a spinal cord injury at T4 reports a sudden, severe headache and is found to
have a blood pressure of 190/110 mmHg. What is the priority nursing intervention?
A. Administer PRN antihypertensive medication.
B. Assess for bladder distention or fecal impaction.
C. Lower the head of the bed to the supine position.
D. Check the patient’s temperature for signs of infection.
Answer: B
Conceptual Explanation: These are signs of Autonomic Dysreflexia. The priority is to sit
the patient up (to lower BP) and then identify/remove the stimulus, usually a full bladder
or bowel.
4. In the management of Diabetic Ketoacidosis (DKA), why is Potassium added to the
intravenous fluids even if the initial serum potassium level is normal?
A. Potassium prevents the development of metabolic alkalosis.
, B. The patient is losing potassium through excessive vomiting.
C. Insulin therapy causes potassium to shift from the extracellular to the intracellular
space.
D. To prevent renal failure caused by osmotic diuresis.
Answer: C
Conceptual Explanation: As insulin drives glucose into cells, it also drives potassium into
cells, which can lead to a rapid drop in serum potassium (hypokalemia) and cardiac
arrhythmias.
5. A patient with cirrhosis and esophageal varices is prescribed Lactulose. Which finding
indicates the medication is achieving the desired therapeutic effect?
A. The abdominal girth has decreased by 2 inches.
B. The patient’s prothrombin time (PT) returns to normal.
C. Serum bilirubin levels have decreased significantly.
D. The patient has 2-3 soft stools per day and improved mental status.
Answer: D
Conceptual Explanation: Lactulose is used to reduce ammonia levels in hepatic
encephalopathy. Success is measured by frequent stools (excreting ammonia) and
improved neurological status.
