NUR 6121 Exam 4 V1 | NUR 6121
Advanced Nursing II | Q&A with Rationale
(NUR6121 Exam 4) | William Paterson
University
1. A patient in the intensive care unit is exhibiting signs of Septic Shock. Which of the
following hemodynamic findings is most characteristic of early (warm) septic shock?
A. Decreased systemic vascular resistance (SVR)
B. Decreased cardiac output (CO)
C. Increased systemic vascular resistance (SVR)
D. Increased pulmonary artery wedge pressure (PAWP)
Answer: A
Rationale: In the early stages of septic shock, massive vasodilation occurs due to the
release of inflammatory mediators. This leads to a significant decrease in systemic vascular
resistance (SVR), making the skin feel warm and flushed. The cardiac output typically
increases as a compensatory mechanism to maintain tissue perfusion despite the drop in
resistance.
2. Which arterial blood gas (ABG) result would the nurse expect to see in a patient with early-
stage Acute Respiratory Distress Syndrome (ARDS)?
A. pH 7.35, PaCO2 40, HCO3 22
,B. pH 7.30, PaCO2 55, HCO3 28
C. pH 7.48, PaCO2 30, HCO3 24
D. pH 7.50, PaCO2 45, HCO3 35
Answer: C
Rationale: During the initial phase of ARDS, patients often present with tachypnea as they
attempt to compensate for hypoxia. This rapid breathing results in respiratory alkalosis,
characterized by a high pH and a low PaCO2. As the condition progresses and the patient
tires, they may eventually shift into respiratory acidosis.
3. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22 mmHg.
Which intervention is most appropriate for the nurse to implement first?
A. Administer a dose of morphine sulfate
B. Encourage the patient to perform the Valsalva maneuver
C. Perform vigorous endotracheal suctioning
D. Position the head of the bed to 30 degrees
Answer: D
Rationale: Elevating the head of the bed to 30-45 degrees promotes venous drainage from
the head and helps decrease intracranial pressure. Normal ICP is typically between 5 and
15 mmHg, so a reading of 22 mmHg requires immediate nursing intervention. Suctioning
and the Valsalva maneuver should be avoided as they can further increase ICP.
, 4. The nurse is monitoring a patient with a Swan-Ganz catheter. The Pulmonary Artery Wedge
Pressure (PAWP) is 20 mmHg. This finding is most indicative of which condition?
A. Hypovolemic shock
B. Right-sided heart failure
C. Pulmonary hypertension
D. Left-sided heart failure
Answer: D
Rationale: A normal PAWP ranges from 4 to 12 mmHg; therefore, a value of 20 mmHg
indicates fluid overload or impaired pumping in the left ventricle. This elevated pressure is
a hallmark sign of left-sided heart failure or cardiogenic shock. Monitoring these pressures
allows the clinical team to adjust diuretic or inotropic therapy effectively.
5. A patient is admitted with 40% total body surface area (TBSA) burns. Using the Parkland
formula (4mL x kg x %TBSA), how much fluid should a 70kg patient receive in the first 8
hours?
A. 11,200 mL
B. 5,600 mL
C. 2,800 mL
D. 7,400 mL
Answer: B
Advanced Nursing II | Q&A with Rationale
(NUR6121 Exam 4) | William Paterson
University
1. A patient in the intensive care unit is exhibiting signs of Septic Shock. Which of the
following hemodynamic findings is most characteristic of early (warm) septic shock?
A. Decreased systemic vascular resistance (SVR)
B. Decreased cardiac output (CO)
C. Increased systemic vascular resistance (SVR)
D. Increased pulmonary artery wedge pressure (PAWP)
Answer: A
Rationale: In the early stages of septic shock, massive vasodilation occurs due to the
release of inflammatory mediators. This leads to a significant decrease in systemic vascular
resistance (SVR), making the skin feel warm and flushed. The cardiac output typically
increases as a compensatory mechanism to maintain tissue perfusion despite the drop in
resistance.
2. Which arterial blood gas (ABG) result would the nurse expect to see in a patient with early-
stage Acute Respiratory Distress Syndrome (ARDS)?
A. pH 7.35, PaCO2 40, HCO3 22
,B. pH 7.30, PaCO2 55, HCO3 28
C. pH 7.48, PaCO2 30, HCO3 24
D. pH 7.50, PaCO2 45, HCO3 35
Answer: C
Rationale: During the initial phase of ARDS, patients often present with tachypnea as they
attempt to compensate for hypoxia. This rapid breathing results in respiratory alkalosis,
characterized by a high pH and a low PaCO2. As the condition progresses and the patient
tires, they may eventually shift into respiratory acidosis.
3. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22 mmHg.
Which intervention is most appropriate for the nurse to implement first?
A. Administer a dose of morphine sulfate
B. Encourage the patient to perform the Valsalva maneuver
C. Perform vigorous endotracheal suctioning
D. Position the head of the bed to 30 degrees
Answer: D
Rationale: Elevating the head of the bed to 30-45 degrees promotes venous drainage from
the head and helps decrease intracranial pressure. Normal ICP is typically between 5 and
15 mmHg, so a reading of 22 mmHg requires immediate nursing intervention. Suctioning
and the Valsalva maneuver should be avoided as they can further increase ICP.
, 4. The nurse is monitoring a patient with a Swan-Ganz catheter. The Pulmonary Artery Wedge
Pressure (PAWP) is 20 mmHg. This finding is most indicative of which condition?
A. Hypovolemic shock
B. Right-sided heart failure
C. Pulmonary hypertension
D. Left-sided heart failure
Answer: D
Rationale: A normal PAWP ranges from 4 to 12 mmHg; therefore, a value of 20 mmHg
indicates fluid overload or impaired pumping in the left ventricle. This elevated pressure is
a hallmark sign of left-sided heart failure or cardiogenic shock. Monitoring these pressures
allows the clinical team to adjust diuretic or inotropic therapy effectively.
5. A patient is admitted with 40% total body surface area (TBSA) burns. Using the Parkland
formula (4mL x kg x %TBSA), how much fluid should a 70kg patient receive in the first 8
hours?
A. 11,200 mL
B. 5,600 mL
C. 2,800 mL
D. 7,400 mL
Answer: B
