NSG 4100 Exam 4 | Adult Health III
A D VA N C E D C R I T I C A L C A R E P R A C T I C E E X A M ( 2 0 2 0 2 7 ) - G A L E N C O L L E G E
(1) A nurse is caring for a client in septic shock. Which hemodynamic finding is most
characteristic of the 'warm' (early) phase of septic shock?
A. Increased Systemic Vascular Resistance (SVR).
B. Decreased Cardiac Output.
C. Decreased SVR and increased Cardiac Output.
D. Elevated Pulmonary Artery Wedge Pressure (PAWP).
CORRECT ANSWER: C
Critical Care Rationale: In early septic shock (hyperdynamic phase), massive vasodilation leads
to decreased SVR. To compensate, the heart rate and stroke volume increase, resulting in a high
cardiac output.
(2) A client is suspected of having cardiogenic shock. Which hemodynamic parameter
would best support this diagnosis?
A. Decreased Central Venous Pressure (CVP).
B. Increased PAWP and decreased Cardiac Index.
C. Decreased SVR.
D. Elevated Cardiac Output.
CORRECT ANSWER: B
Critical Care Rationale: Cardiogenic shock is characterized by pump failure. This leads to a low
Cardiac Index and a 'back-up' of fluid into the lungs, reflected by an increased PAWP.
,(3) A client is on mechanical ventilation with Positive End-Expiratory Pressure (PEEP). What
is the primary purpose of PEEP?
A. To decrease the work of breathing.
B. To prevent alveolar collapse at the end of expiration.
C. To increase the respiratory rate.
D. To provide 100% oxygen concentration.
CORRECT ANSWER: B
Critical Care Rationale: PEEP maintains a set amount of pressure in the lungs at the end of
expiration, keeping the alveoli open to improve gas exchange and oxygenation.
(4) The low-pressure alarm sounds on a client's ventilator. Which action should the nurse
take first?
A. Suction the client's airway.
B. Check for a disconnection in the ventilator tubing.
C. Manually bag the client with 100% oxygen.
D. Sedate the client to prevent 'fighting' the vent.
CORRECT ANSWER: B
Critical Care Rationale: A low-pressure alarm usually indicates a leak or a disconnection in the
circuit. The nurse should quickly check the tubing. If the problem isn't immediately found and the
client is in distress, manual bagging is the next step.
,(5) Using the Parkland Formula, a nurse is calculating the fluid resuscitation for a client
with 40% TBSA burns weighing 70 kg. How much fluid should be administered in the first 8
hours?
A. 11,200 mL
B. 5,600 mL
C. 2,800 mL
D. 7,000 mL
CORRECT ANSWER: B
Critical Care Rationale: Parkland Formula: 4mL x kg x %TBSA. Total = 4 x 70 x 40 = 11,200
mL. Half (5,600 mL) is given in the first 8 hours, and the other half over the remaining 16 hours.
(6) A client is admitted with electrical burns. Which complication is the nurse's priority to
monitor for?
A. Infection at the entry site.
B. Cardiac arrhythmias.
C. Low pain tolerance.
D. Superficial skin redness.
CORRECT ANSWER: B
Critical Care Rationale: Electrical currents follow the path of least resistance (nerves and
vessels) and can severely disrupt the heart's electrical system, causing immediate or delayed
life-threatening arrhythmias.
, (7) During a mass casualty event, a nurse is triaging victims. A victim has a sucking chest
wound and is in respiratory distress. Which triage tag color should the nurse assign?
A. Green (Minimal)
B. Yellow (Delayed)
C. Red (Immediate)
D. Black (Expectant)
CORRECT ANSWER: C
Critical Care Rationale: Red tags are for victims with life-threatening injuries who have a high
chance of survival if treated immediately (e.g., airway obstruction, tension pneumothorax, major
hemorrhage).
(8) A client is developing Disseminated Intravascular Coagulation (DIC). Which laboratory
finding is expected?
A. Increased Platelet count.
B. Decreased D-dimer levels.
C. Prolonged Prothrombin Time (PT) and PTT.
D. Decreased Fibrin Split Products.
CORRECT ANSWER: C
Critical Care Rationale: In DIC, clotting factors and platelets are consumed rapidly, leading to
prolonged clotting times (PT/PTT) and increased D-dimer/Fibrin Split Products due to clot
breakdown.
A D VA N C E D C R I T I C A L C A R E P R A C T I C E E X A M ( 2 0 2 0 2 7 ) - G A L E N C O L L E G E
(1) A nurse is caring for a client in septic shock. Which hemodynamic finding is most
characteristic of the 'warm' (early) phase of septic shock?
A. Increased Systemic Vascular Resistance (SVR).
B. Decreased Cardiac Output.
C. Decreased SVR and increased Cardiac Output.
D. Elevated Pulmonary Artery Wedge Pressure (PAWP).
CORRECT ANSWER: C
Critical Care Rationale: In early septic shock (hyperdynamic phase), massive vasodilation leads
to decreased SVR. To compensate, the heart rate and stroke volume increase, resulting in a high
cardiac output.
(2) A client is suspected of having cardiogenic shock. Which hemodynamic parameter
would best support this diagnosis?
A. Decreased Central Venous Pressure (CVP).
B. Increased PAWP and decreased Cardiac Index.
C. Decreased SVR.
D. Elevated Cardiac Output.
CORRECT ANSWER: B
Critical Care Rationale: Cardiogenic shock is characterized by pump failure. This leads to a low
Cardiac Index and a 'back-up' of fluid into the lungs, reflected by an increased PAWP.
,(3) A client is on mechanical ventilation with Positive End-Expiratory Pressure (PEEP). What
is the primary purpose of PEEP?
A. To decrease the work of breathing.
B. To prevent alveolar collapse at the end of expiration.
C. To increase the respiratory rate.
D. To provide 100% oxygen concentration.
CORRECT ANSWER: B
Critical Care Rationale: PEEP maintains a set amount of pressure in the lungs at the end of
expiration, keeping the alveoli open to improve gas exchange and oxygenation.
(4) The low-pressure alarm sounds on a client's ventilator. Which action should the nurse
take first?
A. Suction the client's airway.
B. Check for a disconnection in the ventilator tubing.
C. Manually bag the client with 100% oxygen.
D. Sedate the client to prevent 'fighting' the vent.
CORRECT ANSWER: B
Critical Care Rationale: A low-pressure alarm usually indicates a leak or a disconnection in the
circuit. The nurse should quickly check the tubing. If the problem isn't immediately found and the
client is in distress, manual bagging is the next step.
,(5) Using the Parkland Formula, a nurse is calculating the fluid resuscitation for a client
with 40% TBSA burns weighing 70 kg. How much fluid should be administered in the first 8
hours?
A. 11,200 mL
B. 5,600 mL
C. 2,800 mL
D. 7,000 mL
CORRECT ANSWER: B
Critical Care Rationale: Parkland Formula: 4mL x kg x %TBSA. Total = 4 x 70 x 40 = 11,200
mL. Half (5,600 mL) is given in the first 8 hours, and the other half over the remaining 16 hours.
(6) A client is admitted with electrical burns. Which complication is the nurse's priority to
monitor for?
A. Infection at the entry site.
B. Cardiac arrhythmias.
C. Low pain tolerance.
D. Superficial skin redness.
CORRECT ANSWER: B
Critical Care Rationale: Electrical currents follow the path of least resistance (nerves and
vessels) and can severely disrupt the heart's electrical system, causing immediate or delayed
life-threatening arrhythmias.
, (7) During a mass casualty event, a nurse is triaging victims. A victim has a sucking chest
wound and is in respiratory distress. Which triage tag color should the nurse assign?
A. Green (Minimal)
B. Yellow (Delayed)
C. Red (Immediate)
D. Black (Expectant)
CORRECT ANSWER: C
Critical Care Rationale: Red tags are for victims with life-threatening injuries who have a high
chance of survival if treated immediately (e.g., airway obstruction, tension pneumothorax, major
hemorrhage).
(8) A client is developing Disseminated Intravascular Coagulation (DIC). Which laboratory
finding is expected?
A. Increased Platelet count.
B. Decreased D-dimer levels.
C. Prolonged Prothrombin Time (PT) and PTT.
D. Decreased Fibrin Split Products.
CORRECT ANSWER: C
Critical Care Rationale: In DIC, clotting factors and platelets are consumed rapidly, leading to
prolonged clotting times (PT/PTT) and increased D-dimer/Fibrin Split Products due to clot
breakdown.
