NR 341 EXAM 2 –
COMPLEX ADULT HEALTH –
(2026) ACTUAL QUESTIONS
& ANSWERS
(CHAMBERLAIN) 100%
GUARANTEE PASS
NR 341 Exam 2 – Complex Adult Health Practice Exam
(2026)
Section 1: Respiratory & Airway Management
1. A nurse teaches a client who had a supraglottic laryngectomy. Which technique
would the nurse teach the client to prevent aspiration?
A. Tilt the head back as far as possible when swallowing.
B. Swallow twice while bearing down.
C. Breathe slowly and deeply while swallowing.
D. Keep the head very still and straight while swallowing.
Rationale: The client post supraglottic laryngectomy has a high risk for aspiration. The
supraglottic method of swallowing includes placing a small amount of food in the
mouth, performing the Valsalva maneuver (bearing down), then swallowing twice. The
,client sits upright and holds the breath while swallowing. Tilting the head back would
increase aspiration risk, not decrease it. Keeping the head still does not address the
structural changes from surgery .
2. A nurse assesses clients on the medical-surgical unit. Which client is at greatest
risk for development of obstructive sleep apnea?
A. A 26-year-old woman who is 8 months pregnant.
B. A 42-year-old man with gastroesophageal reflux disease.
C. A 55-year-old woman who is 50 lb (23 kg) overweight.
D. A 73-year-old man with type 2 diabetes mellitus.
Rationale: The client at highest risk would be the one who is extremely overweight.
Obesity is the strongest modifiable risk factor for obstructive sleep apnea. While GERD
and diabetes can be associated with OSA, excessive weight carries the highest risk.
Pregnant women may experience sleep-disordered breathing, but the 50-lb overweight
client has the most significant risk factor .
3. A nurse cares for a client after radiation therapy for neck cancer. The client
reports extreme dry mouth. What action by the nurse is most appropriate?
A. Ask the client to gargle with mouthwash containing lidocaine.
B. Administer IV fluid boluses every 2 hours.
C. Explain that xerostomia may be a permanent side effect.
D. Assess the client's neck for redness and swelling.
Rationale: Xerostomia (dry mouth) is a potential side effect of radiation, particularly if
the salivary glands were in the radiation zone. Unfortunately, this may be long term or
even permanent. Gargling with lidocaine would not help with dry mouth and could
impair the gag reflex. Increasing fluids is helpful but does not address the permanent
nature of radiation-induced xerostomia. Neck redness and swelling are unrelated to the
reported dry mouth .
4. A nurse is assessing a client who has suffered a nasal fracture. Which assessment
would the nurse perform first?
A. Facial pain
B. Vital signs
C. Bone displacement
D. Airway patency
,Rationale: The priority assessment for any client with a nasal fracture is airway patency.
Nasal fractures can cause significant swelling, bleeding, or hematoma formation that can
obstruct the airway. Using the ABC (Airway, Breathing, Circulation) framework, airway is
always the first priority. Facial pain, vital signs, and bone displacement are important but
secondary to ensuring the client can breathe .
Section 2: Cardiovascular & Hemodynamic Monitoring
5. A patient with septic shock has a pulmonary artery catheter showing cardiac
index 2.1 L/min/m², systemic vascular resistance 800 dynes·s·cm⁻⁵, and pulmonary
artery wedge pressure 6 mmHg. Which intervention is most appropriate?
A. Norepinephrine infusion
B. Furosemide 40 mg IV
C. Nitroglycerin infusion
D. Fluid bolus of 500 mL crystalloid
Rationale: Low cardiac index, low wedge pressure, and low SVR indicate hypovolemia
with distributive shock. Fluid resuscitation is first-line to improve preload.
Norepinephrine would be added if hypotension persists after volume resuscitation.
Furosemide would worsen preload by removing fluid, and nitroglycerin would cause
further vasodilation, both of which would be harmful in this scenario .
6. A patient is receiving continuous cardiac monitoring and the nurse observes an
irregularly irregular rhythm with no discernible P waves and a heart rate of 142
bpm. The patient reports palpitations and mild lightheadedness. Which
dysrhythmia is the patient most likely experiencing?
A. Ventricular tachycardia
B. Atrial fibrillation with rapid ventricular response
C. Sinus tachycardia
D. Second-degree heart block, Type II
Rationale: Atrial fibrillation is characterized by an irregularly irregular rhythm, absence
of discernible P waves (fibrillatory waves instead), and a variable ventricular rate. When
the rate exceeds 100 bpm, it is classified as atrial fibrillation with rapid ventricular
response (RVR). Ventricular tachycardia presents with wide QRS complexes and a regular
, rhythm. Sinus tachycardia has identifiable P waves. Second-degree heart block Type II
has regular P waves with intermittent dropped QRS complexes .
7. A 55-year-old patient arrives in the emergency department with severe
substernal chest pain that began 2 hours ago. The 12-lead ECG shows ST-segment
elevation in leads II, III, and aVF. Troponin levels are elevated. Which diagnosis is
confirmed, and what is the most appropriate emergent intervention?
A. Unstable angina; administer nitroglycerin and schedule a stress test
B. NSTEMI; initiate anticoagulation with heparin and plan for PCI within 24 hours
C. STEMI; prepare the patient for emergent revascularization with PCI or
fibrinolytics
D. Pericarditis; administer NSAIDs and observe for cardiac tamponade
Rationale: ST-segment elevation in two contiguous leads (II, III, aVF indicates inferior
wall) combined with elevated troponins and persistent chest pain confirms a STEMI,
which requires emergent revascularization. PCI is the preferred reperfusion strategy if
available within 90 minutes of first medical contact; otherwise, fibrinolytic therapy
should be administered. Unstable angina presents with rest pain but no ST elevation and
negative troponins. NSTEMI has positive troponins but no ST elevation. Pericarditis
presents with diffuse ST elevation and pleuritic chest pain, not localized ST elevation
with positive troponins .
8. A patient with a subarachnoid hemorrhage develops sudden hemiparesis and
aphasia. Which complication is most likely, and what is the priority intervention?
A. Seizure; administer lorazepam
B. Cerebral vasospasm; initiate nimodipine and maintain euvolemia
C. Increased ICP; administer mannitol
D. Rebleeding; prepare for surgical clipping
Rationale: Sudden onset of focal neurologic deficits (hemiparesis, aphasia) after
subarachnoid hemorrhage is classic for cerebral vasospasm, which typically occurs 4-14
days after the initial bleed. The priority intervention is initiating nimodipine (a calcium
channel blocker that reduces vasospasm) and maintaining euvolemia to promote
cerebral perfusion. While seizures and increased ICP can occur, the sudden focal deficits
in this timeframe point to vasospasm. Rebleeding typically presents with sudden severe
headache and decreased level of consciousness .
9. A patient has a BP of 150/50 and ICP of 30. What is their CPP?
COMPLEX ADULT HEALTH –
(2026) ACTUAL QUESTIONS
& ANSWERS
(CHAMBERLAIN) 100%
GUARANTEE PASS
NR 341 Exam 2 – Complex Adult Health Practice Exam
(2026)
Section 1: Respiratory & Airway Management
1. A nurse teaches a client who had a supraglottic laryngectomy. Which technique
would the nurse teach the client to prevent aspiration?
A. Tilt the head back as far as possible when swallowing.
B. Swallow twice while bearing down.
C. Breathe slowly and deeply while swallowing.
D. Keep the head very still and straight while swallowing.
Rationale: The client post supraglottic laryngectomy has a high risk for aspiration. The
supraglottic method of swallowing includes placing a small amount of food in the
mouth, performing the Valsalva maneuver (bearing down), then swallowing twice. The
,client sits upright and holds the breath while swallowing. Tilting the head back would
increase aspiration risk, not decrease it. Keeping the head still does not address the
structural changes from surgery .
2. A nurse assesses clients on the medical-surgical unit. Which client is at greatest
risk for development of obstructive sleep apnea?
A. A 26-year-old woman who is 8 months pregnant.
B. A 42-year-old man with gastroesophageal reflux disease.
C. A 55-year-old woman who is 50 lb (23 kg) overweight.
D. A 73-year-old man with type 2 diabetes mellitus.
Rationale: The client at highest risk would be the one who is extremely overweight.
Obesity is the strongest modifiable risk factor for obstructive sleep apnea. While GERD
and diabetes can be associated with OSA, excessive weight carries the highest risk.
Pregnant women may experience sleep-disordered breathing, but the 50-lb overweight
client has the most significant risk factor .
3. A nurse cares for a client after radiation therapy for neck cancer. The client
reports extreme dry mouth. What action by the nurse is most appropriate?
A. Ask the client to gargle with mouthwash containing lidocaine.
B. Administer IV fluid boluses every 2 hours.
C. Explain that xerostomia may be a permanent side effect.
D. Assess the client's neck for redness and swelling.
Rationale: Xerostomia (dry mouth) is a potential side effect of radiation, particularly if
the salivary glands were in the radiation zone. Unfortunately, this may be long term or
even permanent. Gargling with lidocaine would not help with dry mouth and could
impair the gag reflex. Increasing fluids is helpful but does not address the permanent
nature of radiation-induced xerostomia. Neck redness and swelling are unrelated to the
reported dry mouth .
4. A nurse is assessing a client who has suffered a nasal fracture. Which assessment
would the nurse perform first?
A. Facial pain
B. Vital signs
C. Bone displacement
D. Airway patency
,Rationale: The priority assessment for any client with a nasal fracture is airway patency.
Nasal fractures can cause significant swelling, bleeding, or hematoma formation that can
obstruct the airway. Using the ABC (Airway, Breathing, Circulation) framework, airway is
always the first priority. Facial pain, vital signs, and bone displacement are important but
secondary to ensuring the client can breathe .
Section 2: Cardiovascular & Hemodynamic Monitoring
5. A patient with septic shock has a pulmonary artery catheter showing cardiac
index 2.1 L/min/m², systemic vascular resistance 800 dynes·s·cm⁻⁵, and pulmonary
artery wedge pressure 6 mmHg. Which intervention is most appropriate?
A. Norepinephrine infusion
B. Furosemide 40 mg IV
C. Nitroglycerin infusion
D. Fluid bolus of 500 mL crystalloid
Rationale: Low cardiac index, low wedge pressure, and low SVR indicate hypovolemia
with distributive shock. Fluid resuscitation is first-line to improve preload.
Norepinephrine would be added if hypotension persists after volume resuscitation.
Furosemide would worsen preload by removing fluid, and nitroglycerin would cause
further vasodilation, both of which would be harmful in this scenario .
6. A patient is receiving continuous cardiac monitoring and the nurse observes an
irregularly irregular rhythm with no discernible P waves and a heart rate of 142
bpm. The patient reports palpitations and mild lightheadedness. Which
dysrhythmia is the patient most likely experiencing?
A. Ventricular tachycardia
B. Atrial fibrillation with rapid ventricular response
C. Sinus tachycardia
D. Second-degree heart block, Type II
Rationale: Atrial fibrillation is characterized by an irregularly irregular rhythm, absence
of discernible P waves (fibrillatory waves instead), and a variable ventricular rate. When
the rate exceeds 100 bpm, it is classified as atrial fibrillation with rapid ventricular
response (RVR). Ventricular tachycardia presents with wide QRS complexes and a regular
, rhythm. Sinus tachycardia has identifiable P waves. Second-degree heart block Type II
has regular P waves with intermittent dropped QRS complexes .
7. A 55-year-old patient arrives in the emergency department with severe
substernal chest pain that began 2 hours ago. The 12-lead ECG shows ST-segment
elevation in leads II, III, and aVF. Troponin levels are elevated. Which diagnosis is
confirmed, and what is the most appropriate emergent intervention?
A. Unstable angina; administer nitroglycerin and schedule a stress test
B. NSTEMI; initiate anticoagulation with heparin and plan for PCI within 24 hours
C. STEMI; prepare the patient for emergent revascularization with PCI or
fibrinolytics
D. Pericarditis; administer NSAIDs and observe for cardiac tamponade
Rationale: ST-segment elevation in two contiguous leads (II, III, aVF indicates inferior
wall) combined with elevated troponins and persistent chest pain confirms a STEMI,
which requires emergent revascularization. PCI is the preferred reperfusion strategy if
available within 90 minutes of first medical contact; otherwise, fibrinolytic therapy
should be administered. Unstable angina presents with rest pain but no ST elevation and
negative troponins. NSTEMI has positive troponins but no ST elevation. Pericarditis
presents with diffuse ST elevation and pleuritic chest pain, not localized ST elevation
with positive troponins .
8. A patient with a subarachnoid hemorrhage develops sudden hemiparesis and
aphasia. Which complication is most likely, and what is the priority intervention?
A. Seizure; administer lorazepam
B. Cerebral vasospasm; initiate nimodipine and maintain euvolemia
C. Increased ICP; administer mannitol
D. Rebleeding; prepare for surgical clipping
Rationale: Sudden onset of focal neurologic deficits (hemiparesis, aphasia) after
subarachnoid hemorrhage is classic for cerebral vasospasm, which typically occurs 4-14
days after the initial bleed. The priority intervention is initiating nimodipine (a calcium
channel blocker that reduces vasospasm) and maintaining euvolemia to promote
cerebral perfusion. While seizures and increased ICP can occur, the sudden focal deficits
in this timeframe point to vasospasm. Rebleeding typically presents with sudden severe
headache and decreased level of consciousness .
9. A patient has a BP of 150/50 and ICP of 30. What is their CPP?
