NURS 221 EXAM 3 NEWEST 2025 ACTUAL EXAM 2 VERSIONS (VERSION
NUR 221 exam 3
A ANDStudy
B)online
COMPLETE QUESTIONS WITH DETAILED VERIFIED ANSWER
at https://quizlet.com/_gapklv
(100% CORRECT ANSWERS) /ALREADY GRADED A+
1. The nurse is caring for a patient admitted with hypo- A. Assess the blood pressure
volemic shock. The nurse palpates thready brachial palpation
pulses but is unable to auscultate a blood pressure.
What is the best nursing action?
A. Assess the blood pressure palpation
B. Estimate the systolic pressure as 60 mm Hg.
C. Obtain an electronic blood pressure monitor.
D. Record the blood pressure as "not assessable."
2. The nurse has just completed an infusion of a 1000 B. Lactate 6 mmol/L
mL bolus of 0.9% normal saline in a patient with
severe sepsis. One hour later, which laboratory result
requires immediate nursing action?
A. Creatinine 1.0 mg/dL
B. Lactate 6 mmol/L
C. Potassium 3.8 mEq/L
D. Sodium 140 mEq/L
3. The nurse has been administering 0.9% normal D. Right atrial pressure and
saline intravenous fluids as part of early goal- direct- urine output
ed therapy protocols in a patient with severe sepsis.
To evaluate the effectiveness of fluid therapy, which
physiological parameters would be most important
for the nurse to assess?
A. Breath sounds and capillary refill
B. Blood pressure and oral temperature
, NUR 221 exam 3
Study online at https://quizlet.com/_gapklv
C. Oral temperature and capillary refill
D. Right atrial pressure and urine output
4. A patient is admitted to the critical care unit fol- D. The patient is at risk
lowing coronary artery bypass surgery. Two hours for developing hypovolemic
postoperatively, the nurse assesses the following in- shock.
formation: pulse is 120 beats/min; blood pressure is
70/50 mm Hg; pulmonary artery diastolic pressure is
2 mm Hg; cardiac output is 4 L/min; urine output is
250 mL/hr; chest drainage is 200 mL/hr. What is the
best interpretation by the nurse?
A. The assessed values are within normal limits.
B. The patient is at risk for developing cardiogenic
shock.
C. The patient is at risk for developing fluid volume
overload.
D. The patient is at risk for developing hypovolemic
shock.
5. A patient is admitted after collapsing at the end of a C. Lactated Ringer's bolus
summer marathon. She is lethargic, with a heart rate
of 110 beats/min, respiratory rate of 30 breaths/min,
and a blood pressure of 78/46 mm Hg. The nurse
anticipates administering which therapeutic inter-
vention?
A. Human albumin infusion
B. Hypotonic saline solution
C. Lactated Ringer's bolus
D. Packed red blood cells
, NUR 221 exam 3
Study online at https://quizlet.com/_gapklv
6. The nurse is caring for a patient in the early stages D. Low systemic vascular re-
of septic shock. The patient is slightly confused and sistance and high cardiac
flushed, with bounding peripheral pulses. Which he- output
modynamic values is the nurse most likely to as-
sess?
A. High pulmonary artery occlusive pressure and
high cardiac output
B. High systemic vascular resistance and low cardiac
output
C. Low pulmonary artery occlusive pressure and low
cardiac output
D. Low systemic vascular resistance and high cardiac
output
7. The nurse is caring for a patient admitted with se- D. Isotonic fluid challenge
vere sepsis. Vital signs assessed by the nurse in-
clude blood pressure 80/50 mm Hg, heart rate 120
beats/min, respirations 28 breaths/min, oral temper-
ature of 102° F, and a right atrial pressure (RAP) of 1
mm Hg. Assuming physician orders, which interven-
tion should the nurse carry out first?
A. Acetaminophen suppository
B. Blood cultures from two sites
C. IV antibiotic administration
D. Isotonic fluid challenge
8. Which patient being cared for in the emergency de- C. A patient with a 2-day
partment is most at risk for developing hypovolemic history of nausea, vomiting,
shock? and diarrhea
, NUR 221 exam 3
Study online at https://quizlet.com/_gapklv
A. A patient admitted with abdominal pain and an
elevated white blood cell count
B. A patient with a temperature of 102° F and a
general dermal rash
C. A patient with a 2-day history of nausea, vomiting,
and diarrhea
D. A patient with slight rectal bleeding from inflamed
hemorrhoids
9. The nurse is caring for a patient admitted with car- A. Dobutamine
diogenic shock. Hemodynamic readings obtained
with a pulmonary artery catheter include a pul-
monary artery occlusion pressure (PAOP) of 18 mm
Hg and a cardiac index (CI) of 1.0 L/min/m 2 . What
is the priority pharmacological intervention?
A. Dobutamine
B. Furosemide
C. Phenylephrine
D. Sodium nitroprusside
10. Ten minutes following administration of an antibiot- B. Epinephrine 3 to 5 mL
ic, the nurse assesses a patient to have edematous of a 1:10,000 solution intra-
lips, hoarseness, and expiratory stridor. Vital signs venously
assessed by the nurse include blood pressure 70/40
mm Hg, heart rate 130 beats/min, and respirations
36 breaths/min. What is the priority intervention?
A. Diphenhydramine 50 mg intravenously
NUR 221 exam 3
A ANDStudy
B)online
COMPLETE QUESTIONS WITH DETAILED VERIFIED ANSWER
at https://quizlet.com/_gapklv
(100% CORRECT ANSWERS) /ALREADY GRADED A+
1. The nurse is caring for a patient admitted with hypo- A. Assess the blood pressure
volemic shock. The nurse palpates thready brachial palpation
pulses but is unable to auscultate a blood pressure.
What is the best nursing action?
A. Assess the blood pressure palpation
B. Estimate the systolic pressure as 60 mm Hg.
C. Obtain an electronic blood pressure monitor.
D. Record the blood pressure as "not assessable."
2. The nurse has just completed an infusion of a 1000 B. Lactate 6 mmol/L
mL bolus of 0.9% normal saline in a patient with
severe sepsis. One hour later, which laboratory result
requires immediate nursing action?
A. Creatinine 1.0 mg/dL
B. Lactate 6 mmol/L
C. Potassium 3.8 mEq/L
D. Sodium 140 mEq/L
3. The nurse has been administering 0.9% normal D. Right atrial pressure and
saline intravenous fluids as part of early goal- direct- urine output
ed therapy protocols in a patient with severe sepsis.
To evaluate the effectiveness of fluid therapy, which
physiological parameters would be most important
for the nurse to assess?
A. Breath sounds and capillary refill
B. Blood pressure and oral temperature
, NUR 221 exam 3
Study online at https://quizlet.com/_gapklv
C. Oral temperature and capillary refill
D. Right atrial pressure and urine output
4. A patient is admitted to the critical care unit fol- D. The patient is at risk
lowing coronary artery bypass surgery. Two hours for developing hypovolemic
postoperatively, the nurse assesses the following in- shock.
formation: pulse is 120 beats/min; blood pressure is
70/50 mm Hg; pulmonary artery diastolic pressure is
2 mm Hg; cardiac output is 4 L/min; urine output is
250 mL/hr; chest drainage is 200 mL/hr. What is the
best interpretation by the nurse?
A. The assessed values are within normal limits.
B. The patient is at risk for developing cardiogenic
shock.
C. The patient is at risk for developing fluid volume
overload.
D. The patient is at risk for developing hypovolemic
shock.
5. A patient is admitted after collapsing at the end of a C. Lactated Ringer's bolus
summer marathon. She is lethargic, with a heart rate
of 110 beats/min, respiratory rate of 30 breaths/min,
and a blood pressure of 78/46 mm Hg. The nurse
anticipates administering which therapeutic inter-
vention?
A. Human albumin infusion
B. Hypotonic saline solution
C. Lactated Ringer's bolus
D. Packed red blood cells
, NUR 221 exam 3
Study online at https://quizlet.com/_gapklv
6. The nurse is caring for a patient in the early stages D. Low systemic vascular re-
of septic shock. The patient is slightly confused and sistance and high cardiac
flushed, with bounding peripheral pulses. Which he- output
modynamic values is the nurse most likely to as-
sess?
A. High pulmonary artery occlusive pressure and
high cardiac output
B. High systemic vascular resistance and low cardiac
output
C. Low pulmonary artery occlusive pressure and low
cardiac output
D. Low systemic vascular resistance and high cardiac
output
7. The nurse is caring for a patient admitted with se- D. Isotonic fluid challenge
vere sepsis. Vital signs assessed by the nurse in-
clude blood pressure 80/50 mm Hg, heart rate 120
beats/min, respirations 28 breaths/min, oral temper-
ature of 102° F, and a right atrial pressure (RAP) of 1
mm Hg. Assuming physician orders, which interven-
tion should the nurse carry out first?
A. Acetaminophen suppository
B. Blood cultures from two sites
C. IV antibiotic administration
D. Isotonic fluid challenge
8. Which patient being cared for in the emergency de- C. A patient with a 2-day
partment is most at risk for developing hypovolemic history of nausea, vomiting,
shock? and diarrhea
, NUR 221 exam 3
Study online at https://quizlet.com/_gapklv
A. A patient admitted with abdominal pain and an
elevated white blood cell count
B. A patient with a temperature of 102° F and a
general dermal rash
C. A patient with a 2-day history of nausea, vomiting,
and diarrhea
D. A patient with slight rectal bleeding from inflamed
hemorrhoids
9. The nurse is caring for a patient admitted with car- A. Dobutamine
diogenic shock. Hemodynamic readings obtained
with a pulmonary artery catheter include a pul-
monary artery occlusion pressure (PAOP) of 18 mm
Hg and a cardiac index (CI) of 1.0 L/min/m 2 . What
is the priority pharmacological intervention?
A. Dobutamine
B. Furosemide
C. Phenylephrine
D. Sodium nitroprusside
10. Ten minutes following administration of an antibiot- B. Epinephrine 3 to 5 mL
ic, the nurse assesses a patient to have edematous of a 1:10,000 solution intra-
lips, hoarseness, and expiratory stridor. Vital signs venously
assessed by the nurse include blood pressure 70/40
mm Hg, heart rate 130 beats/min, and respirations
36 breaths/min. What is the priority intervention?
A. Diphenhydramine 50 mg intravenously
