NUR 445 Exam 1: Acute & Chronic Health Disruptions In
Adults III V2 - Arizona College Updated and Latest
Questions and Correct Answers with Rationale
1. A patient in the intensive care unit has a Central Venous Pressure (CVP) of 1 mmHg. Which action should
the nurse prioritize?
A. Place the patient in a High-Fowler’s position
B. Increase the rate of a continuous furosemide infusion
C. Administer a prescribed 500 mL bolus of normal saline
D. Notify the provider to request a vasodilator
Ans: C
Explanation: A CVP of 1 mmHg is significantly below the normal range of 2 to 8 mmHg, indicating a state
of hypovolemia. The priority intervention is to increase the patient’s preload through fluid resuscitation
to maintain adequate cardiac output. Administering a diuretic like furosemide would further deplete the
volume and worsen the patient’s condition. High-Fowler’s position is generally used for respiratory
distress and could further decrease venous return in a hypovolemic patient. The nurse must closely
monitor the patient’s response to the fluid bolus to ensure the CVP returns to a therapeutic level.
2. Which hemodynamic parameter is the most sensitive indicator of the heart’s ability to pump blood
effectively to the tissues?
A. Central Venous Pressure (CVP)
B. Mean Arterial Pressure (MAP)
C. Systemic Vascular Resistance (SVR)
D. Cardiac Index (CI)
,Ans: D
Explanation: Cardiac Index is more accurate than Cardiac Output because it relates the output to the
patient’s body surface area. A low Cardiac Index suggests that the heart is failing to meet the metabolic
demands of the body. While CVP measures right-sided heart pressure and preload, it does not directly
reflect pumping efficiency. MAP measures perfusion pressure but can be maintained by high SVR even if
cardiac output is low. Calculating the CI allows for individualized assessment across patients of different
sizes and physical statures.
3. A patient with septic shock remains hypotensive after receiving 3 liters of crystalloid fluid. What is the
next expected intervention?
A. Administer broad-spectrum antibiotics
B. Administer a dose of IV nitroglycerin
C. Start a norepinephrine infusion
D. Place the patient in a Trendelenburg position
Ans: C
Explanation: Norepinephrine is the first-line vasopressor used for septic shock that is refractory to fluid
resuscitation. It works by causing vasoconstriction to increase systemic vascular resistance and blood
pressure. While antibiotics are crucial in sepsis, they do not provide the immediate hemodynamic
support needed for refractory hypotension. Nitroglycerin is a vasodilator and would dangerously lower
the blood pressure further in this clinical scenario. The nurse should titrate the norepinephrine to
maintain a target Mean Arterial Pressure of at least 65 mmHg.
4. A patient on a mechanical ventilator has a sudden ‘High Pressure’ alarm. Which condition should the
nurse assess for first?
A. A leak in the ventilator circuit
, B. Patient disconnection from the ventilator
C. Biting the endotracheal tube
D. Cuff deflation or rupture
Ans: C
Explanation: A high-pressure alarm indicates that the ventilator is meeting resistance when attempting
to deliver the set tidal volume. Biting the endotracheal tube or having excessive secretions are common
causes of increased resistance. Leaks and disconnections typically trigger a ‘Low Pressure’ alarm because
the pressure in the system drops. The nurse should immediately check the patient’s airway and assess
the need for suctioning or a bite block. If the cause is not quickly found, the patient should be manually
ventilated with a bag-valve-mask until the issue is resolved.
5. Which clinical finding is characteristic of the ‘Early’ or ‘Hyperdynamic’ phase of septic shock?
A. Warm, flushed skin and increased cardiac output
B. Decreased cardiac output and high SVR
C. Cool, clammy, and pale skin
D. Severe oliguria and metabolic acidosis
Ans: A
Explanation: In the early hyperdynamic phase of septic shock, vasodilation causes the skin to feel warm
and flushed. The body compensates for systemic vasodilation by increasing the heart rate and cardiac
output. This is a distributive shock state where systemic vascular resistance is low despite the high
cardiac output. Cool and clammy skin is typically associated with late shock or cardiogenic shock where
perfusion is severely compromised. Recognizing these early signs is critical for initiating early goal-
directed therapy to prevent multi-organ failure.
Adults III V2 - Arizona College Updated and Latest
Questions and Correct Answers with Rationale
1. A patient in the intensive care unit has a Central Venous Pressure (CVP) of 1 mmHg. Which action should
the nurse prioritize?
A. Place the patient in a High-Fowler’s position
B. Increase the rate of a continuous furosemide infusion
C. Administer a prescribed 500 mL bolus of normal saline
D. Notify the provider to request a vasodilator
Ans: C
Explanation: A CVP of 1 mmHg is significantly below the normal range of 2 to 8 mmHg, indicating a state
of hypovolemia. The priority intervention is to increase the patient’s preload through fluid resuscitation
to maintain adequate cardiac output. Administering a diuretic like furosemide would further deplete the
volume and worsen the patient’s condition. High-Fowler’s position is generally used for respiratory
distress and could further decrease venous return in a hypovolemic patient. The nurse must closely
monitor the patient’s response to the fluid bolus to ensure the CVP returns to a therapeutic level.
2. Which hemodynamic parameter is the most sensitive indicator of the heart’s ability to pump blood
effectively to the tissues?
A. Central Venous Pressure (CVP)
B. Mean Arterial Pressure (MAP)
C. Systemic Vascular Resistance (SVR)
D. Cardiac Index (CI)
,Ans: D
Explanation: Cardiac Index is more accurate than Cardiac Output because it relates the output to the
patient’s body surface area. A low Cardiac Index suggests that the heart is failing to meet the metabolic
demands of the body. While CVP measures right-sided heart pressure and preload, it does not directly
reflect pumping efficiency. MAP measures perfusion pressure but can be maintained by high SVR even if
cardiac output is low. Calculating the CI allows for individualized assessment across patients of different
sizes and physical statures.
3. A patient with septic shock remains hypotensive after receiving 3 liters of crystalloid fluid. What is the
next expected intervention?
A. Administer broad-spectrum antibiotics
B. Administer a dose of IV nitroglycerin
C. Start a norepinephrine infusion
D. Place the patient in a Trendelenburg position
Ans: C
Explanation: Norepinephrine is the first-line vasopressor used for septic shock that is refractory to fluid
resuscitation. It works by causing vasoconstriction to increase systemic vascular resistance and blood
pressure. While antibiotics are crucial in sepsis, they do not provide the immediate hemodynamic
support needed for refractory hypotension. Nitroglycerin is a vasodilator and would dangerously lower
the blood pressure further in this clinical scenario. The nurse should titrate the norepinephrine to
maintain a target Mean Arterial Pressure of at least 65 mmHg.
4. A patient on a mechanical ventilator has a sudden ‘High Pressure’ alarm. Which condition should the
nurse assess for first?
A. A leak in the ventilator circuit
, B. Patient disconnection from the ventilator
C. Biting the endotracheal tube
D. Cuff deflation or rupture
Ans: C
Explanation: A high-pressure alarm indicates that the ventilator is meeting resistance when attempting
to deliver the set tidal volume. Biting the endotracheal tube or having excessive secretions are common
causes of increased resistance. Leaks and disconnections typically trigger a ‘Low Pressure’ alarm because
the pressure in the system drops. The nurse should immediately check the patient’s airway and assess
the need for suctioning or a bite block. If the cause is not quickly found, the patient should be manually
ventilated with a bag-valve-mask until the issue is resolved.
5. Which clinical finding is characteristic of the ‘Early’ or ‘Hyperdynamic’ phase of septic shock?
A. Warm, flushed skin and increased cardiac output
B. Decreased cardiac output and high SVR
C. Cool, clammy, and pale skin
D. Severe oliguria and metabolic acidosis
Ans: A
Explanation: In the early hyperdynamic phase of septic shock, vasodilation causes the skin to feel warm
and flushed. The body compensates for systemic vasodilation by increasing the heart rate and cardiac
output. This is a distributive shock state where systemic vascular resistance is low despite the high
cardiac output. Cool and clammy skin is typically associated with late shock or cardiogenic shock where
perfusion is severely compromised. Recognizing these early signs is critical for initiating early goal-
directed therapy to prevent multi-organ failure.
