BSN 246 FINAL EXAM PREP (LATEST
2026/2027 UPDATE) QUESTIONS AND
VERIFIED ANSWERS |100% CORRECT|
GRADE A+ NIGHTINGALE
1. A patient in the ICU is diagnosed with Acute Respiratory Distress Syndrome (ARDS). The
nurse notes a significant drop in arterial oxygenation despite increasing PEEP. Which
physiological change is primarily responsible for the refractory hypoxemia seen in ARDS?
A. Increased pulmonary compliance
B. Right-to-left intrapulmonary shunting
C. Decreased alveolar surface tension
D. Hyperventilation-induced hypocapnia
Answer: B
Conceptual Explanation: In ARDS, fluid fills the alveoli, preventing gas exchange. Blood
flows past these non-ventilated alveoli without being oxygenated, a process known as
right-to-left shunting, which leads to refractory hypoxemia.
2. A client is admitted with suspected Neurogenic Shock following a high cervical spinal cord
injury. Which clinical finding would the nurse most likely observe?
A. Tachycardia and hypertension
,B. Bradycardia and warm, dry skin
C. Cool, clammy skin and tachypnea
D. Bounding pulses and increased cardiac output
Answer: B
Conceptual Explanation: Neurogenic shock results in the loss of sympathetic tone, leading
to vasodilation (warm/dry skin) and bradycardia due to unopposed parasympathetic
activity.
3. The nurse is caring for a patient with a massive pulmonary embolism. The patient’s blood
pressure is 82/40 mmHg, and the heart rate is 124 bpm. Which type of shock is this patient
experiencing?
A. Hypovolemic Shock
B. Distributive Shock
C. Cardiogenic Shock
D. Obstructive Shock
Answer: D
Conceptual Explanation: Obstructive shock occurs when a physical obstruction (like a
pulmonary embolism or cardiac tamponade) prevents the heart from pumping an adequate
amount of blood.
, 4. A patient with a history of heart failure presents with a potassium level of 6.8 mEq/L and
peaked T-waves on the EKG. Which medication should the nurse anticipate administering first
to protect the myocardium?
A. Sodium Polystyrene Sulfonate
B. Calcium Gluconate
C. Regular Insulin and Dextrose
D. Furosemide
Answer: B
Conceptual Explanation: Calcium gluconate does not lower potassium, but it stabilizes the
myocardial cell membrane to prevent lethal arrhythmias while other therapies work to
lower the K+ level.
5. During the emergent phase of a 40% Total Body Surface Area (TBSA) burn, which fluid shift
should the nurse prioritize monitoring?
A. Movement of sodium and water into the interstitial space
B. Movement of potassium from the interstitial space into the cells
C. Increase in vascular volume due to osmotic pressure
D. Decreased capillary permeability leading to dehydration
Answer: A
2026/2027 UPDATE) QUESTIONS AND
VERIFIED ANSWERS |100% CORRECT|
GRADE A+ NIGHTINGALE
1. A patient in the ICU is diagnosed with Acute Respiratory Distress Syndrome (ARDS). The
nurse notes a significant drop in arterial oxygenation despite increasing PEEP. Which
physiological change is primarily responsible for the refractory hypoxemia seen in ARDS?
A. Increased pulmonary compliance
B. Right-to-left intrapulmonary shunting
C. Decreased alveolar surface tension
D. Hyperventilation-induced hypocapnia
Answer: B
Conceptual Explanation: In ARDS, fluid fills the alveoli, preventing gas exchange. Blood
flows past these non-ventilated alveoli without being oxygenated, a process known as
right-to-left shunting, which leads to refractory hypoxemia.
2. A client is admitted with suspected Neurogenic Shock following a high cervical spinal cord
injury. Which clinical finding would the nurse most likely observe?
A. Tachycardia and hypertension
,B. Bradycardia and warm, dry skin
C. Cool, clammy skin and tachypnea
D. Bounding pulses and increased cardiac output
Answer: B
Conceptual Explanation: Neurogenic shock results in the loss of sympathetic tone, leading
to vasodilation (warm/dry skin) and bradycardia due to unopposed parasympathetic
activity.
3. The nurse is caring for a patient with a massive pulmonary embolism. The patient’s blood
pressure is 82/40 mmHg, and the heart rate is 124 bpm. Which type of shock is this patient
experiencing?
A. Hypovolemic Shock
B. Distributive Shock
C. Cardiogenic Shock
D. Obstructive Shock
Answer: D
Conceptual Explanation: Obstructive shock occurs when a physical obstruction (like a
pulmonary embolism or cardiac tamponade) prevents the heart from pumping an adequate
amount of blood.
, 4. A patient with a history of heart failure presents with a potassium level of 6.8 mEq/L and
peaked T-waves on the EKG. Which medication should the nurse anticipate administering first
to protect the myocardium?
A. Sodium Polystyrene Sulfonate
B. Calcium Gluconate
C. Regular Insulin and Dextrose
D. Furosemide
Answer: B
Conceptual Explanation: Calcium gluconate does not lower potassium, but it stabilizes the
myocardial cell membrane to prevent lethal arrhythmias while other therapies work to
lower the K+ level.
5. During the emergent phase of a 40% Total Body Surface Area (TBSA) burn, which fluid shift
should the nurse prioritize monitoring?
A. Movement of sodium and water into the interstitial space
B. Movement of potassium from the interstitial space into the cells
C. Increase in vascular volume due to osmotic pressure
D. Decreased capillary permeability leading to dehydration
Answer: A
