NUR 2790 Exam 3 Actual Exam V1 | NUR 2790 Professional Nursing III
/ PN3 (NUR2790 Exam 3) | Rasmussen
1. A patient in the Intensive Care Unit is experiencing Septic Shock. The nurse notes a Mean
Arterial Pressure (MAP) of 55 mmHg despite a 3L isotonic fluid bolus. Which medication
should the nurse anticipate administering next to maintain organ perfusion?
A. Norepinephrine
B. Nitroprusside
C. Furosemide
D. Amiodarone
Answer: A
Rationale: Norepinephrine is the first-line vasopressor used in septic shock when fluid
resuscitation fails to achieve a MAP of at least 65 mmHg. It acts primarily as an alpha-1
agonist to cause vasoconstriction and increase systemic vascular resistance. The nurse
must monitor the patient closely for peripheral ischemia and ensure adequate volume
status before initiation.
2. A patient with Acute Respiratory Distress Syndrome (ARDS) is being treated with
mechanical ventilation using high levels of Positive End-Expiratory Pressure (PEEP). The nurse
suddenly observes a drop in blood pressure and decreased breath sounds on the left side.
What is the priority nursing action?
A. Increase the oxygen concentration (FiO2) to 100%
B. Suction the endotracheal tube
C. Prepare for immediate needle thoracostomy
D. Obtain an arterial blood gas (ABG) sample
Answer: C
Rationale: High levels of PEEP increase the risk of barotrauma, which can lead to a tension
pneumothorax evidenced by hypotension and diminished breath sounds. A tension
pneumothorax is a life-threatening emergency that requires immediate decompression to
restore cardiac output. The nurse must prioritize airway and circulatory stability over
diagnostic tests like ABGs in this acute scenario.
3. When assessing a patient with a Pulmonary Artery Catheter, the nurse notes a Pulmonary
Artery Wedge Pressure (PAWP) of 22 mmHg and a Cardiac Index of 1.8 L/min/m². Which
clinical condition do these findings most likely indicate?
A. Hypovolemic Shock
,B. Septic Shock
C. Cardiogenic Shock
D. Anaphylactic Shock
Answer: C
Rationale: Cardiogenic shock is characterized by an elevated PAWP, which indicates left
ventricular end-diastolic pressure buildup, and a low Cardiac Index, indicating pump
failure. In contrast, hypovolemic shock would show a low PAWP due to lack of volume.
These hemodynamic markers are essential for the nurse to differentiate between various
types of circulatory failure and guide treatment.
4. A patient with a T4 spinal cord injury reports a sudden, throbbing headache and is found to
have a blood pressure of 190/110 mmHg and a heart rate of 52 bpm. Which action should the
nurse take first?
A. Administer an antihypertensive medication
B. Place the patient in a flat, supine position
C. Notify the healthcare provider immediately
D. Assess the patient for bladder distension
Answer: D
Rationale: The patient is exhibiting signs of Autonomic Dysreflexia, which is a medical
emergency triggered by noxious stimuli like a full bladder or impacted bowel. The first step
is to sit the patient up to lower blood pressure, followed immediately by identifying and
removing the trigger, such as checking for urinary retention. Immediate intervention is
required to prevent complications like stroke or myocardial infarction.
5. In a mass casualty incident triage, which patient should be assigned a ‘Red’ tag?
A. A patient with a compound fracture of the femur and controlled bleeding
B. A patient who is unresponsive with no palpable pulse or respirations
C. A patient with second-degree burns over 10% of the body
D. A patient with a sucking chest wound and labored respirations
Answer: D
Rationale: Red tags are assigned to patients with immediate life-threatening injuries who
have a high chance of survival with quick intervention, such as respiratory distress from a
sucking chest wound. Compound fractures are typically categorized as ‘Yellow’ (delayed)
because they are serious but not immediately life-threatening. The goal of disaster triage is
to do the greatest good for the greatest number of people.
, 6. A patient in the early stages of Burn Shock is admitted with 45% Total Body Surface Area
(TBSA) burns. Which electrolyte imbalance should the nurse prioritize for monitoring during
the first 24 hours?
A. Hypokalemia
B. Hypernatremia
C. Hyperkalemia
D. Hypocalcemia
Answer: C
Rationale: During the emergent phase of burn injury, massive cell destruction releases
potassium into the extracellular fluid, leading to hyperkalemia. This can cause dangerous
cardiac arrhythmias and requires close monitoring and potential treatment. Once the
diuretic phase begins, potassium levels may then drop as it is excreted by the kidneys.
7. The nurse is caring for a patient with Diabetic Ketoacidosis (DKA). The current blood
glucose is 240 mg/dL. Which change in IV fluid therapy should the nurse anticipate?
A. Stop the insulin infusion immediately
B. Increase the rate of Normal Saline infusion
C. Switch to a solution containing 5% dextrose
D. Administer IV sodium bicarbonate
Answer: C
Rationale: When blood glucose levels reach approximately 250 mg/dL in DKA, dextrose is
added to the IV fluids to prevent hypoglycemia and allow the insulin infusion to continue.
Continuing the insulin is necessary to resolve the ketosis and close the anion gap. Sudden
cessation of insulin would allow the patient to slide back into a state of metabolic acidosis.
8. A patient is admitted with Acute Pancreatitis and develops a respiratory rate of 32, a heart
rate of 118, and crackles throughout the lung fields. What complication is most likely
occurring?
A. Acute Respiratory Distress Syndrome (ARDS)
B. Pulmonary Embolism
C. Congestive Heart Failure
D. Aspiration Pneumonia
Answer: A
Rationale: Acute pancreatitis is a high-risk condition for the development of ARDS due to
the release of systemic inflammatory mediators. These mediators damage the alveolar-
/ PN3 (NUR2790 Exam 3) | Rasmussen
1. A patient in the Intensive Care Unit is experiencing Septic Shock. The nurse notes a Mean
Arterial Pressure (MAP) of 55 mmHg despite a 3L isotonic fluid bolus. Which medication
should the nurse anticipate administering next to maintain organ perfusion?
A. Norepinephrine
B. Nitroprusside
C. Furosemide
D. Amiodarone
Answer: A
Rationale: Norepinephrine is the first-line vasopressor used in septic shock when fluid
resuscitation fails to achieve a MAP of at least 65 mmHg. It acts primarily as an alpha-1
agonist to cause vasoconstriction and increase systemic vascular resistance. The nurse
must monitor the patient closely for peripheral ischemia and ensure adequate volume
status before initiation.
2. A patient with Acute Respiratory Distress Syndrome (ARDS) is being treated with
mechanical ventilation using high levels of Positive End-Expiratory Pressure (PEEP). The nurse
suddenly observes a drop in blood pressure and decreased breath sounds on the left side.
What is the priority nursing action?
A. Increase the oxygen concentration (FiO2) to 100%
B. Suction the endotracheal tube
C. Prepare for immediate needle thoracostomy
D. Obtain an arterial blood gas (ABG) sample
Answer: C
Rationale: High levels of PEEP increase the risk of barotrauma, which can lead to a tension
pneumothorax evidenced by hypotension and diminished breath sounds. A tension
pneumothorax is a life-threatening emergency that requires immediate decompression to
restore cardiac output. The nurse must prioritize airway and circulatory stability over
diagnostic tests like ABGs in this acute scenario.
3. When assessing a patient with a Pulmonary Artery Catheter, the nurse notes a Pulmonary
Artery Wedge Pressure (PAWP) of 22 mmHg and a Cardiac Index of 1.8 L/min/m². Which
clinical condition do these findings most likely indicate?
A. Hypovolemic Shock
,B. Septic Shock
C. Cardiogenic Shock
D. Anaphylactic Shock
Answer: C
Rationale: Cardiogenic shock is characterized by an elevated PAWP, which indicates left
ventricular end-diastolic pressure buildup, and a low Cardiac Index, indicating pump
failure. In contrast, hypovolemic shock would show a low PAWP due to lack of volume.
These hemodynamic markers are essential for the nurse to differentiate between various
types of circulatory failure and guide treatment.
4. A patient with a T4 spinal cord injury reports a sudden, throbbing headache and is found to
have a blood pressure of 190/110 mmHg and a heart rate of 52 bpm. Which action should the
nurse take first?
A. Administer an antihypertensive medication
B. Place the patient in a flat, supine position
C. Notify the healthcare provider immediately
D. Assess the patient for bladder distension
Answer: D
Rationale: The patient is exhibiting signs of Autonomic Dysreflexia, which is a medical
emergency triggered by noxious stimuli like a full bladder or impacted bowel. The first step
is to sit the patient up to lower blood pressure, followed immediately by identifying and
removing the trigger, such as checking for urinary retention. Immediate intervention is
required to prevent complications like stroke or myocardial infarction.
5. In a mass casualty incident triage, which patient should be assigned a ‘Red’ tag?
A. A patient with a compound fracture of the femur and controlled bleeding
B. A patient who is unresponsive with no palpable pulse or respirations
C. A patient with second-degree burns over 10% of the body
D. A patient with a sucking chest wound and labored respirations
Answer: D
Rationale: Red tags are assigned to patients with immediate life-threatening injuries who
have a high chance of survival with quick intervention, such as respiratory distress from a
sucking chest wound. Compound fractures are typically categorized as ‘Yellow’ (delayed)
because they are serious but not immediately life-threatening. The goal of disaster triage is
to do the greatest good for the greatest number of people.
, 6. A patient in the early stages of Burn Shock is admitted with 45% Total Body Surface Area
(TBSA) burns. Which electrolyte imbalance should the nurse prioritize for monitoring during
the first 24 hours?
A. Hypokalemia
B. Hypernatremia
C. Hyperkalemia
D. Hypocalcemia
Answer: C
Rationale: During the emergent phase of burn injury, massive cell destruction releases
potassium into the extracellular fluid, leading to hyperkalemia. This can cause dangerous
cardiac arrhythmias and requires close monitoring and potential treatment. Once the
diuretic phase begins, potassium levels may then drop as it is excreted by the kidneys.
7. The nurse is caring for a patient with Diabetic Ketoacidosis (DKA). The current blood
glucose is 240 mg/dL. Which change in IV fluid therapy should the nurse anticipate?
A. Stop the insulin infusion immediately
B. Increase the rate of Normal Saline infusion
C. Switch to a solution containing 5% dextrose
D. Administer IV sodium bicarbonate
Answer: C
Rationale: When blood glucose levels reach approximately 250 mg/dL in DKA, dextrose is
added to the IV fluids to prevent hypoglycemia and allow the insulin infusion to continue.
Continuing the insulin is necessary to resolve the ketosis and close the anion gap. Sudden
cessation of insulin would allow the patient to slide back into a state of metabolic acidosis.
8. A patient is admitted with Acute Pancreatitis and develops a respiratory rate of 32, a heart
rate of 118, and crackles throughout the lung fields. What complication is most likely
occurring?
A. Acute Respiratory Distress Syndrome (ARDS)
B. Pulmonary Embolism
C. Congestive Heart Failure
D. Aspiration Pneumonia
Answer: A
Rationale: Acute pancreatitis is a high-risk condition for the development of ARDS due to
the release of systemic inflammatory mediators. These mediators damage the alveolar-
