NR 341 (Exam 1, Exam 2 & Final Exam) – Chamberlain
University Complete Package Bundle: Complex Adult
Health100% Verified Prep Guide
PART 1: EXAM 1 CONCEPTS (Shock, Oxygenation, Fluids/Electrolytes, Acid-Base)
1. A client with septic shock has a blood pressure of 82/40
mmHg, HR 118 bpm, and a lactate level of 4.2 mmol/L. Which
provider order should the nurse implement first?
A. Administer norepinephrine IV.
B. Draw blood cultures.
C. Administer 30 mL/kg of crystalloid IV fluids.
D. Administer broad-spectrum antibiotics.
Answer: C
Rationale: In the initial resuscitation phase of septic shock
(Surviving Sepsis Campaign), the priority is to restore tissue
perfusion by administering crystalloid IV fluids (30 mL/kg).
Vasopressors (norepinephrine) are next if fluids fail. Cultures
must be drawn before antibiotics, but fluid resuscitation is the
immediate life-saving priority for hypotension.
2. A client is admitted with severe vomiting. ABG results reveal
pH 7.50, PaCO2 46 mmHg, HCO3 32 mEq/L. Which acid-base
imbalance is the client experiencing?
,A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Answer: D
Rationale: The pH is elevated (alkalosis), and the bicarbonate
(HCO3) is elevated. This indicates a metabolic alkalosis,
commonly caused by the loss of gastric acid (HCl) through
severe vomiting.
3. The nurse is caring for a client with acute respiratory distress
syndrome (ARDS) who is on a mechanical ventilator. The
provider orders the implementation of positive end-expiratory
pressure (PEEP). The nurse understands that PEEP is used to:
A. Decrease the work of breathing.
B. Prevent alveolar collapse at the end of expiration.
C. Increase the fraction of inspired oxygen (FiO2).
D. Suction secretions from the airway.
Answer: B
,Rationale: PEEP keeps the alveoli open at the end of expiration,
preventing alveolar collapse (atelectasis) and improving
oxygenation in ARDS.
4. A client in the ICU has a central venous pressure (CVP)
reading of 2 mmHg. The nurse interprets this reading as
indicating which condition?
A. Right ventricular failure
B. Hypervolemia
C. Hypovolemia
D. Pulmonary edema
Answer: C
Rationale: Normal CVP is 2-8 mmHg. A reading of 2 mmHg or
lower indicates decreased right ventricular preload, which is
characteristic of hypovolemia (fluid volume deficit).
5. A client is receiving IV potassium chloride (KCl) for severe
hypokalemia. Which assessment finding requires the nurse to
stop the infusion immediately?
A. Potassium level of 3.5 mEq/L
B. Urine output of 50 mL/hr
, C. Flat T waves on the cardiac monitor
D. ST-segment elevation on the cardiac monitor
Answer: D
Rationale: ST-segment elevation is a sign of hyperkalemia
(potassium toxicity). The infusion must be stopped immediately.
Flat T waves indicate hypokalemia (need for the infusion). Urine
output of 50 mL/hr is adequate for potassium administration.
6. A client with a serum sodium level of 118 mEq/L is
complaining of a severe headache and nausea. The provider
orders 3% hypertonic saline. What is the priority nursing
intervention during this infusion?
A. Monitor for signs of hypokalemia.
B. Assess the IV site for infiltration.
C. Restrict oral fluid intake.
D. Monitor for signs of fluid volume excess and lung sounds.
Answer: B
Rationale: 3% hypertonic saline is highly vesicant. If it infiltrates,
it can cause severe tissue necrosis. While monitoring lung
sounds is important, assessing the IV site patency is the most
immediate priority to prevent severe tissue damage.
University Complete Package Bundle: Complex Adult
Health100% Verified Prep Guide
PART 1: EXAM 1 CONCEPTS (Shock, Oxygenation, Fluids/Electrolytes, Acid-Base)
1. A client with septic shock has a blood pressure of 82/40
mmHg, HR 118 bpm, and a lactate level of 4.2 mmol/L. Which
provider order should the nurse implement first?
A. Administer norepinephrine IV.
B. Draw blood cultures.
C. Administer 30 mL/kg of crystalloid IV fluids.
D. Administer broad-spectrum antibiotics.
Answer: C
Rationale: In the initial resuscitation phase of septic shock
(Surviving Sepsis Campaign), the priority is to restore tissue
perfusion by administering crystalloid IV fluids (30 mL/kg).
Vasopressors (norepinephrine) are next if fluids fail. Cultures
must be drawn before antibiotics, but fluid resuscitation is the
immediate life-saving priority for hypotension.
2. A client is admitted with severe vomiting. ABG results reveal
pH 7.50, PaCO2 46 mmHg, HCO3 32 mEq/L. Which acid-base
imbalance is the client experiencing?
,A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Answer: D
Rationale: The pH is elevated (alkalosis), and the bicarbonate
(HCO3) is elevated. This indicates a metabolic alkalosis,
commonly caused by the loss of gastric acid (HCl) through
severe vomiting.
3. The nurse is caring for a client with acute respiratory distress
syndrome (ARDS) who is on a mechanical ventilator. The
provider orders the implementation of positive end-expiratory
pressure (PEEP). The nurse understands that PEEP is used to:
A. Decrease the work of breathing.
B. Prevent alveolar collapse at the end of expiration.
C. Increase the fraction of inspired oxygen (FiO2).
D. Suction secretions from the airway.
Answer: B
,Rationale: PEEP keeps the alveoli open at the end of expiration,
preventing alveolar collapse (atelectasis) and improving
oxygenation in ARDS.
4. A client in the ICU has a central venous pressure (CVP)
reading of 2 mmHg. The nurse interprets this reading as
indicating which condition?
A. Right ventricular failure
B. Hypervolemia
C. Hypovolemia
D. Pulmonary edema
Answer: C
Rationale: Normal CVP is 2-8 mmHg. A reading of 2 mmHg or
lower indicates decreased right ventricular preload, which is
characteristic of hypovolemia (fluid volume deficit).
5. A client is receiving IV potassium chloride (KCl) for severe
hypokalemia. Which assessment finding requires the nurse to
stop the infusion immediately?
A. Potassium level of 3.5 mEq/L
B. Urine output of 50 mL/hr
, C. Flat T waves on the cardiac monitor
D. ST-segment elevation on the cardiac monitor
Answer: D
Rationale: ST-segment elevation is a sign of hyperkalemia
(potassium toxicity). The infusion must be stopped immediately.
Flat T waves indicate hypokalemia (need for the infusion). Urine
output of 50 mL/hr is adequate for potassium administration.
6. A client with a serum sodium level of 118 mEq/L is
complaining of a severe headache and nausea. The provider
orders 3% hypertonic saline. What is the priority nursing
intervention during this infusion?
A. Monitor for signs of hypokalemia.
B. Assess the IV site for infiltration.
C. Restrict oral fluid intake.
D. Monitor for signs of fluid volume excess and lung sounds.
Answer: B
Rationale: 3% hypertonic saline is highly vesicant. If it infiltrates,
it can cause severe tissue necrosis. While monitoring lung
sounds is important, assessing the IV site patency is the most
immediate priority to prevent severe tissue damage.
