NUR 334 ADVANCED NURSING
CONCEPTS FINAL EXAM QUESTIONS
AND DETAILED ANSWERS 2026/2027
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is on mechanical ventilation
with high PEEP. The nurse notes a sudden drop in oxygen saturation and absent breath
sounds on the right side. What is the priority intervention?
A. Increase the FiO2 to 100%
B. Prepare for immediate needle thoracostomy
C. Suction the endotracheal tube
D. Obtain a portable chest X-ray
Answer: B
Conceptual Explanation: High PEEP increases the risk of pneumothorax. Absent breath
sounds and desaturation suggest a tension pneumothorax, requiring emergent
decompression.
2. Which clinical finding is most indicative of a patient entering the compensatory stage of
shock?
A. Metabolic acidosis
B. Refractory hypoxemia
,C. Narrowing pulse pressure
D. Anuria
Answer: C
Conceptual Explanation: In the compensatory stage, the body attempts to maintain CO.
Narrowing pulse pressure is an early sign of sympathetic nervous system activation.
3. A patient with a history of cirrhosis presents with confusion and asterixis. Which lab value
should the nurse prioritize?
A. Serum Ammonia
B. Serum Bilirubin
C. Prothrombin Time (PT)
D. Serum Albumin
Answer: A
Conceptual Explanation: Confusion and asterixis (flapping tremors) are classic signs of
hepatic encephalopathy caused by elevated ammonia levels.
4. A patient is receiving a continuous IV infusion of Nitroprusside. The nurse monitors for
which specific toxicity after 48 hours of therapy?
A. Cyanide poisoning
B. Nephrotoxicity
C. Ototoxicity
, D. Cardiotoxicity
Answer: A
Conceptual Explanation: Nitroprusside is metabolized into cyanide; prolonged use or
high doses can lead to thiocyanate toxicity.
5. In a patient with SIADH, which electrolyte imbalance is the nurse most likely to observe?
A. Hyperkalemia
B. Hyponatremia
C. Hypernatremia
D. Hypocalcemia
Answer: B
Conceptual Explanation: SIADH involves excessive ADH, causing water retention and
dilutional hyponatremia.
6. Which EKG change is most characteristic of hyperkalemia?
A. Prominent U waves
B. ST-segment depression
C. Tall, peaked T waves
D. Shortened PR interval
Answer: C
CONCEPTS FINAL EXAM QUESTIONS
AND DETAILED ANSWERS 2026/2027
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is on mechanical ventilation
with high PEEP. The nurse notes a sudden drop in oxygen saturation and absent breath
sounds on the right side. What is the priority intervention?
A. Increase the FiO2 to 100%
B. Prepare for immediate needle thoracostomy
C. Suction the endotracheal tube
D. Obtain a portable chest X-ray
Answer: B
Conceptual Explanation: High PEEP increases the risk of pneumothorax. Absent breath
sounds and desaturation suggest a tension pneumothorax, requiring emergent
decompression.
2. Which clinical finding is most indicative of a patient entering the compensatory stage of
shock?
A. Metabolic acidosis
B. Refractory hypoxemia
,C. Narrowing pulse pressure
D. Anuria
Answer: C
Conceptual Explanation: In the compensatory stage, the body attempts to maintain CO.
Narrowing pulse pressure is an early sign of sympathetic nervous system activation.
3. A patient with a history of cirrhosis presents with confusion and asterixis. Which lab value
should the nurse prioritize?
A. Serum Ammonia
B. Serum Bilirubin
C. Prothrombin Time (PT)
D. Serum Albumin
Answer: A
Conceptual Explanation: Confusion and asterixis (flapping tremors) are classic signs of
hepatic encephalopathy caused by elevated ammonia levels.
4. A patient is receiving a continuous IV infusion of Nitroprusside. The nurse monitors for
which specific toxicity after 48 hours of therapy?
A. Cyanide poisoning
B. Nephrotoxicity
C. Ototoxicity
, D. Cardiotoxicity
Answer: A
Conceptual Explanation: Nitroprusside is metabolized into cyanide; prolonged use or
high doses can lead to thiocyanate toxicity.
5. In a patient with SIADH, which electrolyte imbalance is the nurse most likely to observe?
A. Hyperkalemia
B. Hyponatremia
C. Hypernatremia
D. Hypocalcemia
Answer: B
Conceptual Explanation: SIADH involves excessive ADH, causing water retention and
dilutional hyponatremia.
6. Which EKG change is most characteristic of hyperkalemia?
A. Prominent U waves
B. ST-segment depression
C. Tall, peaked T waves
D. Shortened PR interval
Answer: C
