,NU448/NU 448 Adult Health III Exam 3
| Herzing University |Q&A| 26/27
Actual (PDF)
1. A client with acute respiratory distress syndrome (ARDS) is receiving mechanical ventilation with
positive end-expiratory pressure (PEEP). The nurse notes that the client's cardiac output has
decreased. Which physiologic mechanism best explains this finding?
A) PEEP decreases venous return to the heart
B) PEEP increases left ventricular afterload
C) PEEP causes a reflex bradycardia
D) PEEP increases pulmonary vascular resistance
Correct Answer: PEEP decreases venous return to the heart
Rationale: Positive end-expiratory pressure (PEEP) increases intrathoracic pressure, which compresses
the superior and inferior vena cavae. This compression reduces venous return (preload) to the right
side of the heart. According to the Frank-Starling mechanism, a decrease in preload leads to a
decrease in stroke volume and, consequently, cardiac output. This is a well-recognized complication of
PEEP therapy. Distractor B is incorrect because PEEP primarily affects preload rather than afterload;
left ventricular afterload is typically reduced by PEEP due to the decrease in left ventricular transmural
pressure. Distractor C is incorrect because reflex bradycardia is not the primary mechanism;
tachycardia may actually occur as a compensatory response to decreased cardiac output. Distractor D
is incorrect because while PEEP can increase pulmonary vascular resistance in some cases, the primary
mechanism for decreased cardiac output is reduced venous return.
,2. A client with septic shock has a mean arterial pressure (MAP) of 58 mm Hg despite receiving 30
mL/kg of crystalloid fluid resuscitation. The provider orders norepinephrine to be initiated. Which
parameter should the nurse monitor most closely to evaluate the effectiveness of this therapy?
A) Central venous pressure (CVP)
B) Mean arterial pressure (MAP)
C) Pulmonary artery wedge pressure (PAWP)
D) Serum lactate level
Correct Answer: Mean arterial pressure (MAP)
Rationale: Norepinephrine is a potent vasoconstrictor used in septic shock to increase systemic
vascular resistance (SVR) and raise blood pressure. The primary goal of vasopressor therapy is to
achieve a mean arterial pressure (MAP) of at least 65 mm Hg to ensure adequate perfusion to vital
organs. Therefore, MAP is the most direct and immediate parameter to monitor for therapeutic
effectiveness. While CVP, PAWP, and serum lactate are important assessments in shock management,
MAP is the direct target of vasopressor therapy. Serum lactate is a marker of tissue perfusion and is
used to assess the overall response to resuscitation, but it is not the most immediate indicator of
norepinephrine's effectiveness. CVP and PAWP reflect filling pressures and are less directly affected by
norepinephrine's vasoconstrictive effects.
3. A client is admitted with acute respiratory failure from exacerbated COPD. The client's respiratory
rate has dropped to 10 breaths/min, and the oxygen saturation is 88% on room air. Which action
should the nurse take first?
A) Administer a prescribed bronchodilator
B) Prepare for endotracheal intubation
, C) Obtain an arterial blood gas (ABG) sample
D) Apply supplemental oxygen via nasal cannula
Correct Answer: Prepare for endotracheal intubation
Rationale: The client is demonstrating signs of impending respiratory failure, including a significant
decrease in respiratory rate (10 breaths/min) and hypoxemia (SpO₂ 88% on room air). A respiratory
rate of 10 breaths/min in a client with COPD exacerbation indicates that the client is tiring and losing
the ability to maintain adequate ventilation. This is a late sign of respiratory failure and impending
respiratory arrest. The priority is to prepare for endotracheal intubation and mechanical ventilation to
secure the airway and provide ventilatory support. Administering a bronchodilator and applying
oxygen are important interventions but do not address the impending respiratory arrest. Obtaining an
ABG sample is diagnostic but should not delay the initiation of definitive airway management.
Therefore, preparing for intubation is the priority.
4. A client with a burn injury covering 40% of the total body surface area is in the resuscitation phase.
Which assessment finding indicates that fluid resuscitation is adequate?
A) Urine output of 0.5 mL/kg/hr
B) Heart rate of 120 beats/min
C) Hematocrit of 55%
D) Central venous pressure of 2 mm Hg
Correct Answer: Urine output of 0.5 mL/kg/hr
Rationale: Adequate fluid resuscitation in the burn client is best assessed by urine output. The target
urine output for an adult burn client is 0.5 mL/kg/hr (or 30-50 mL/hr). A urine output of 0.5 mL/kg/hr
indicates adequate renal perfusion and effective circulating blood volume. A heart rate of 120
| Herzing University |Q&A| 26/27
Actual (PDF)
1. A client with acute respiratory distress syndrome (ARDS) is receiving mechanical ventilation with
positive end-expiratory pressure (PEEP). The nurse notes that the client's cardiac output has
decreased. Which physiologic mechanism best explains this finding?
A) PEEP decreases venous return to the heart
B) PEEP increases left ventricular afterload
C) PEEP causes a reflex bradycardia
D) PEEP increases pulmonary vascular resistance
Correct Answer: PEEP decreases venous return to the heart
Rationale: Positive end-expiratory pressure (PEEP) increases intrathoracic pressure, which compresses
the superior and inferior vena cavae. This compression reduces venous return (preload) to the right
side of the heart. According to the Frank-Starling mechanism, a decrease in preload leads to a
decrease in stroke volume and, consequently, cardiac output. This is a well-recognized complication of
PEEP therapy. Distractor B is incorrect because PEEP primarily affects preload rather than afterload;
left ventricular afterload is typically reduced by PEEP due to the decrease in left ventricular transmural
pressure. Distractor C is incorrect because reflex bradycardia is not the primary mechanism;
tachycardia may actually occur as a compensatory response to decreased cardiac output. Distractor D
is incorrect because while PEEP can increase pulmonary vascular resistance in some cases, the primary
mechanism for decreased cardiac output is reduced venous return.
,2. A client with septic shock has a mean arterial pressure (MAP) of 58 mm Hg despite receiving 30
mL/kg of crystalloid fluid resuscitation. The provider orders norepinephrine to be initiated. Which
parameter should the nurse monitor most closely to evaluate the effectiveness of this therapy?
A) Central venous pressure (CVP)
B) Mean arterial pressure (MAP)
C) Pulmonary artery wedge pressure (PAWP)
D) Serum lactate level
Correct Answer: Mean arterial pressure (MAP)
Rationale: Norepinephrine is a potent vasoconstrictor used in septic shock to increase systemic
vascular resistance (SVR) and raise blood pressure. The primary goal of vasopressor therapy is to
achieve a mean arterial pressure (MAP) of at least 65 mm Hg to ensure adequate perfusion to vital
organs. Therefore, MAP is the most direct and immediate parameter to monitor for therapeutic
effectiveness. While CVP, PAWP, and serum lactate are important assessments in shock management,
MAP is the direct target of vasopressor therapy. Serum lactate is a marker of tissue perfusion and is
used to assess the overall response to resuscitation, but it is not the most immediate indicator of
norepinephrine's effectiveness. CVP and PAWP reflect filling pressures and are less directly affected by
norepinephrine's vasoconstrictive effects.
3. A client is admitted with acute respiratory failure from exacerbated COPD. The client's respiratory
rate has dropped to 10 breaths/min, and the oxygen saturation is 88% on room air. Which action
should the nurse take first?
A) Administer a prescribed bronchodilator
B) Prepare for endotracheal intubation
, C) Obtain an arterial blood gas (ABG) sample
D) Apply supplemental oxygen via nasal cannula
Correct Answer: Prepare for endotracheal intubation
Rationale: The client is demonstrating signs of impending respiratory failure, including a significant
decrease in respiratory rate (10 breaths/min) and hypoxemia (SpO₂ 88% on room air). A respiratory
rate of 10 breaths/min in a client with COPD exacerbation indicates that the client is tiring and losing
the ability to maintain adequate ventilation. This is a late sign of respiratory failure and impending
respiratory arrest. The priority is to prepare for endotracheal intubation and mechanical ventilation to
secure the airway and provide ventilatory support. Administering a bronchodilator and applying
oxygen are important interventions but do not address the impending respiratory arrest. Obtaining an
ABG sample is diagnostic but should not delay the initiation of definitive airway management.
Therefore, preparing for intubation is the priority.
4. A client with a burn injury covering 40% of the total body surface area is in the resuscitation phase.
Which assessment finding indicates that fluid resuscitation is adequate?
A) Urine output of 0.5 mL/kg/hr
B) Heart rate of 120 beats/min
C) Hematocrit of 55%
D) Central venous pressure of 2 mm Hg
Correct Answer: Urine output of 0.5 mL/kg/hr
Rationale: Adequate fluid resuscitation in the burn client is best assessed by urine output. The target
urine output for an adult burn client is 0.5 mL/kg/hr (or 30-50 mL/hr). A urine output of 0.5 mL/kg/hr
indicates adequate renal perfusion and effective circulating blood volume. A heart rate of 120
