NR 341/ NR341 COMPLEX ADULT HEALTH EXAM 2
LATEST EXAM COMPLETE QUESTIONS AND CORRECT
ANSWERS|ALREADY GRADED A +
Question 1
A nurse is caring for a client with acute respiratory distress syndrome (ARDS)
who is on a mechanical ventilator. The client's PaO2 is 55 mmHg on 100%
FiO2. The nurse anticipates an order for which intervention to improve
oxygenation?
A) Decrease positive end-expiratory pressure (PEEP).
B) Increase tidal volume.
C) Initiate prone positioning.
D) Decrease respiratory rate.
E) Administer a sedative to reduce ventilator synchrony.
Correct Answer: C) Initiate prone positioning.
Rationale: Prone positioning (placing the client on their stomach) is a
critical intervention for severe ARDS to improve oxygenation. It
helps to recruit collapsed alveoli, redistribute ventilation and
perfusion, and reduce ventilator-induced lung injury by promoting
more uniform lung inflation. Decreasing PEEP, increasing tidal
volume (which could cause volutrauma), or decreasing respiratory
rate would likely worsen oxygenation in severe ARDS.
Question 2
A client with a history of hypertension and hyperlipidemia is admitted with
sudden, severe chest pain radiating to the back, and a difference in blood
pressure between the arms. The nurse suspects:
A) Acute myocardial infarction.
B) Pulmonary embolism.
C) Aortic dissection.
D) Pericarditis.
E) Stable angina.
Correct Answer: C) Aortic dissection.
Rationale: Sudden, severe, tearing chest pain radiating to the back,
combined with a significant difference in blood pressure between
the arms, is a classic and highly concerning presentation of an acute
aortic dissection, which is a life-threatening emergency.
Question 3
A client with cirrhosis develops asterixis, fetor hepaticus, and confusion. The
nurse recognizes these as manifestations of:
A) Hepatorenal syndrome.
,B) Spontaneous bacterial peritonitis.
C) Esophageal varices.
D) Hepatic encephalopathy.
E) Cholecystitis.
Correct Answer: D) Hepatic encephalopathy.
Rationale: Hepatic encephalopathy is a decline in brain function that
occurs as a result of severe liver disease. The liver can't adequately
remove toxins (like ammonia) from the blood, which then
accumulate and affect brain function, leading to symptoms like
confusion, asterixis (flapping tremor), and fetor hepaticus (musty
breath).
Question 4
A nurse is managing a client with a new right-sided chest tube for a
pneumothorax. The nurse observes continuous bubbling in the water seal
chamber. Which of the following is the most appropriate initial nursing
action?
A) Document the finding as expected.
B) Clamp the chest tube immediately.
C) Increase the suction setting on the wall regulator.
D) Assess the client for signs of respiratory distress and check all
connections for leaks.
E) Request a stat chest X-ray.
Correct Answer: D) Assess the client for signs of respiratory distress
and check all connections for leaks.
Rationale: Continuous bubbling in the water seal chamber indicates
an air leak. The nurse's priority is to first assess the client's
respiratory status (to ensure they are stable) and then
systematically check all connections from the insertion site to the
chest drainage unit for potential disconnections or leaks before
calling the provider or performing other interventions. Clamping
without assessment can be dangerous.
Question 5
A client undergoes a total thyroidectomy. Postoperatively, the nurse should
closely monitor for which of the following signs of hypocalcemia?
A) Muscle weakness and lethargy.
B) Positive Chvostek's and Trousseau's signs.
C) Hyperactive bowel sounds.
D) Hypertension and tachycardia.
E) Weight gain and constipation.
,Correct Answer: B) Positive Chvostek's and Trousseau's signs.
Rationale: Accidental removal or damage to the parathyroid glands
during a thyroidectomy can lead to hypoparathyroidism and
subsequent hypocalcemia. Positive Chvostek's sign (facial muscle
twitching upon tapping the facial nerve) and Trousseau's sign
(carpal spasm induced by inflating a BP cuff) are classic signs of
neuromuscular excitability due to low calcium.
Question 6
A nurse is preparing to administer packed red blood cells to a client. What is
the maximum time a unit of blood can hang once removed from the blood
bank refrigerator?
A) 1 hour.
B) 2 hours.
C) 3 hours.
D) 4 hours.
E) 6 hours.
Correct Answer: D) 4 hours.
Rationale: To minimize the risk of bacterial proliferation and maintain
blood product integrity, a unit of packed red blood cells should not
hang for longer than 4 hours once it has been removed from
controlled refrigeration.
Question 7
A client with diabetic ketoacidosis (DKA) is receiving insulin infusion and IV
fluids. The nurse notes the client's blood glucose is 200 mg/dL. The next
anticipated order for IV fluids would likely be:
A) Continue 0.9% Sodium Chloride.
B) Administer Dextrose 5% in Water (D5W) or Dextrose 5% in 0.45% Sodium
Chloride.
C) Increase the insulin infusion rate.
D) Administer 3% Sodium Chloride.
E) Discontinue all IV fluids.
Correct Answer: B) Administer Dextrose 5% in Water (D5W) or
Dextrose 5% in 0.45% Sodium Chloride.
Rationale: In DKA management, once the blood glucose level reaches
approximately 200-250 mg/dL, dextrose (usually D5W or D5/0.45%
NaCl) is added to the IV fluids. This prevents hypoglycemia as
insulin continues to clear ketones and allows for continued insulin
infusion until the acidosis resolves, which is a slower process than
glucose normalization.
, Question 8
A nurse is assessing a client who underwent a laparoscopic cholecystectomy.
The client reports moderate shoulder pain. The nurse understands this pain
is likely due to:
A) Incisional pain from the surgery.
B) Referred pain from a retained gallstone.
C) Irritation of the phrenic nerve by carbon dioxide used during surgery.
D) Musculoskeletal strain from positioning during surgery.
E) Postoperative atelectasis.
Correct Answer: C) Irritation of the phrenic nerve by carbon dioxide
used during surgery.
Rationale: Shoulder pain after laparoscopic surgery (especially
cholecystectomy) is common and is caused by residual carbon
dioxide gas irritating the phrenic nerve, which innervates the
diaphragm and refers pain to the shoulder. It typically resolves
within a few days.
Question 9
A client with acute pancreatitis presents with severe abdominal pain, nausea,
vomiting, and a rigid, board-like abdomen. The nurse's immediate concern is:
A) Dehydration.
B) Hypoglycemia.
C) Peritonitis.
D) Pancreatic insufficiency.
E) Electrolyte imbalance.
Correct Answer: C) Peritonitis.
Rationale: A rigid, board-like abdomen, especially with severe
abdominal pain, in a client with pancreatitis is a classic sign of
peritonitis (inflammation of the peritoneum), often indicating a
severe complication such as pancreatic necrosis or rupture with
leakage of pancreatic enzymes into the abdominal cavity. This is a
surgical emergency.
Question 10
A nurse is caring for a client with a spinal cord injury at the T6 level who
suddenly develops a severe pounding headache, diaphoresis above the level
of injury, nasal congestion, and a blood pressure of 190/100 mmHg. The
nurse suspects:
A) Orthostatic hypotension.
B) Spinal shock.
C) Autonomic dysreflexia.
LATEST EXAM COMPLETE QUESTIONS AND CORRECT
ANSWERS|ALREADY GRADED A +
Question 1
A nurse is caring for a client with acute respiratory distress syndrome (ARDS)
who is on a mechanical ventilator. The client's PaO2 is 55 mmHg on 100%
FiO2. The nurse anticipates an order for which intervention to improve
oxygenation?
A) Decrease positive end-expiratory pressure (PEEP).
B) Increase tidal volume.
C) Initiate prone positioning.
D) Decrease respiratory rate.
E) Administer a sedative to reduce ventilator synchrony.
Correct Answer: C) Initiate prone positioning.
Rationale: Prone positioning (placing the client on their stomach) is a
critical intervention for severe ARDS to improve oxygenation. It
helps to recruit collapsed alveoli, redistribute ventilation and
perfusion, and reduce ventilator-induced lung injury by promoting
more uniform lung inflation. Decreasing PEEP, increasing tidal
volume (which could cause volutrauma), or decreasing respiratory
rate would likely worsen oxygenation in severe ARDS.
Question 2
A client with a history of hypertension and hyperlipidemia is admitted with
sudden, severe chest pain radiating to the back, and a difference in blood
pressure between the arms. The nurse suspects:
A) Acute myocardial infarction.
B) Pulmonary embolism.
C) Aortic dissection.
D) Pericarditis.
E) Stable angina.
Correct Answer: C) Aortic dissection.
Rationale: Sudden, severe, tearing chest pain radiating to the back,
combined with a significant difference in blood pressure between
the arms, is a classic and highly concerning presentation of an acute
aortic dissection, which is a life-threatening emergency.
Question 3
A client with cirrhosis develops asterixis, fetor hepaticus, and confusion. The
nurse recognizes these as manifestations of:
A) Hepatorenal syndrome.
,B) Spontaneous bacterial peritonitis.
C) Esophageal varices.
D) Hepatic encephalopathy.
E) Cholecystitis.
Correct Answer: D) Hepatic encephalopathy.
Rationale: Hepatic encephalopathy is a decline in brain function that
occurs as a result of severe liver disease. The liver can't adequately
remove toxins (like ammonia) from the blood, which then
accumulate and affect brain function, leading to symptoms like
confusion, asterixis (flapping tremor), and fetor hepaticus (musty
breath).
Question 4
A nurse is managing a client with a new right-sided chest tube for a
pneumothorax. The nurse observes continuous bubbling in the water seal
chamber. Which of the following is the most appropriate initial nursing
action?
A) Document the finding as expected.
B) Clamp the chest tube immediately.
C) Increase the suction setting on the wall regulator.
D) Assess the client for signs of respiratory distress and check all
connections for leaks.
E) Request a stat chest X-ray.
Correct Answer: D) Assess the client for signs of respiratory distress
and check all connections for leaks.
Rationale: Continuous bubbling in the water seal chamber indicates
an air leak. The nurse's priority is to first assess the client's
respiratory status (to ensure they are stable) and then
systematically check all connections from the insertion site to the
chest drainage unit for potential disconnections or leaks before
calling the provider or performing other interventions. Clamping
without assessment can be dangerous.
Question 5
A client undergoes a total thyroidectomy. Postoperatively, the nurse should
closely monitor for which of the following signs of hypocalcemia?
A) Muscle weakness and lethargy.
B) Positive Chvostek's and Trousseau's signs.
C) Hyperactive bowel sounds.
D) Hypertension and tachycardia.
E) Weight gain and constipation.
,Correct Answer: B) Positive Chvostek's and Trousseau's signs.
Rationale: Accidental removal or damage to the parathyroid glands
during a thyroidectomy can lead to hypoparathyroidism and
subsequent hypocalcemia. Positive Chvostek's sign (facial muscle
twitching upon tapping the facial nerve) and Trousseau's sign
(carpal spasm induced by inflating a BP cuff) are classic signs of
neuromuscular excitability due to low calcium.
Question 6
A nurse is preparing to administer packed red blood cells to a client. What is
the maximum time a unit of blood can hang once removed from the blood
bank refrigerator?
A) 1 hour.
B) 2 hours.
C) 3 hours.
D) 4 hours.
E) 6 hours.
Correct Answer: D) 4 hours.
Rationale: To minimize the risk of bacterial proliferation and maintain
blood product integrity, a unit of packed red blood cells should not
hang for longer than 4 hours once it has been removed from
controlled refrigeration.
Question 7
A client with diabetic ketoacidosis (DKA) is receiving insulin infusion and IV
fluids. The nurse notes the client's blood glucose is 200 mg/dL. The next
anticipated order for IV fluids would likely be:
A) Continue 0.9% Sodium Chloride.
B) Administer Dextrose 5% in Water (D5W) or Dextrose 5% in 0.45% Sodium
Chloride.
C) Increase the insulin infusion rate.
D) Administer 3% Sodium Chloride.
E) Discontinue all IV fluids.
Correct Answer: B) Administer Dextrose 5% in Water (D5W) or
Dextrose 5% in 0.45% Sodium Chloride.
Rationale: In DKA management, once the blood glucose level reaches
approximately 200-250 mg/dL, dextrose (usually D5W or D5/0.45%
NaCl) is added to the IV fluids. This prevents hypoglycemia as
insulin continues to clear ketones and allows for continued insulin
infusion until the acidosis resolves, which is a slower process than
glucose normalization.
, Question 8
A nurse is assessing a client who underwent a laparoscopic cholecystectomy.
The client reports moderate shoulder pain. The nurse understands this pain
is likely due to:
A) Incisional pain from the surgery.
B) Referred pain from a retained gallstone.
C) Irritation of the phrenic nerve by carbon dioxide used during surgery.
D) Musculoskeletal strain from positioning during surgery.
E) Postoperative atelectasis.
Correct Answer: C) Irritation of the phrenic nerve by carbon dioxide
used during surgery.
Rationale: Shoulder pain after laparoscopic surgery (especially
cholecystectomy) is common and is caused by residual carbon
dioxide gas irritating the phrenic nerve, which innervates the
diaphragm and refers pain to the shoulder. It typically resolves
within a few days.
Question 9
A client with acute pancreatitis presents with severe abdominal pain, nausea,
vomiting, and a rigid, board-like abdomen. The nurse's immediate concern is:
A) Dehydration.
B) Hypoglycemia.
C) Peritonitis.
D) Pancreatic insufficiency.
E) Electrolyte imbalance.
Correct Answer: C) Peritonitis.
Rationale: A rigid, board-like abdomen, especially with severe
abdominal pain, in a client with pancreatitis is a classic sign of
peritonitis (inflammation of the peritoneum), often indicating a
severe complication such as pancreatic necrosis or rupture with
leakage of pancreatic enzymes into the abdominal cavity. This is a
surgical emergency.
Question 10
A nurse is caring for a client with a spinal cord injury at the T6 level who
suddenly develops a severe pounding headache, diaphoresis above the level
of injury, nasal congestion, and a blood pressure of 190/100 mmHg. The
nurse suspects:
A) Orthostatic hypotension.
B) Spinal shock.
C) Autonomic dysreflexia.
