NUR 417 Exam 2 V1 | NUR 417 Nursing Care of the
Adult II | Actual Q&A with Rationale (NUR417
Exam 2) | Concordia
1. A patient in the ICU is monitoring for signs of cardiogenic shock. Which hemodynamic
measurement most specifically indicates a failure of the left ventricle as a pump?
A. Decreased Central Venous Pressure (CVP)
B. Decreased Mean Arterial Pressure (MAP)
C. Increased Systemic Vascular Resistance (SVR)
D. Increased Pulmonary Artery Wedge Pressure (PAWP)
Correct Answer: D
Explanation: Pulmonary Artery Wedge Pressure (PAWP) reflects left-sided heart function,
and an elevation indicates left ventricular failure or fluid overload. In cardiogenic shock,
the heart cannot pump efficiently, leading to blood backing up into the pulmonary system
and increasing PAWP. While SVR and MAP change in shock, PAWP is the specific indicator
of left ventricular preload and pressure.
2. A nurse is caring for a patient with septic shock. Which of the following clinical findings
would the nurse expect during the early (hyperdynamic) phase? (Select All That Apply)
A. Increased Cardiac Output
B. Cold, clammy skin
,C. Decreased Systemic Vascular Resistance (SVR)
D. Tachycardia
E. Oliguria
F. Flushed, warm skin
Correct Answer: A, C, D, F
Explanation: Early septic shock is characterized by a hyperdynamic state where cardiac
output is elevated due to decreased peripheral resistance. Vasodilation leads to flushed,
warm skin and a significant drop in SVR. Tachycardia occurs as a compensatory mechanism
to maintain perfusion despite the massive vasodilation.
3. A patient is being treated for Acute Respiratory Distress Syndrome (ARDS) and is on
mechanical ventilation with High PEEP (15 cm H2O). The nurse should monitor for which
significant complication of high PEEP?
A. Metabolic Alkalosis
B. Pneumothorax due to barotrauma
C. Increased Cardiac Output
D. Hypoventilation
Correct Answer: B
Explanation: High levels of Positive End-Expiratory Pressure (PEEP) increase the risk of
barotrauma, which can result in a pneumothorax or subcutaneous emphysema. PEEP can
,also decrease cardiac output by increasing intrathoracic pressure and reducing venous
return to the heart. Monitoring breath sounds and hemodynamic stability is essential when
PEEP exceeds 10 cm H2O.
4. A patient’s EKG shows a PR interval of 0.24 seconds and a QRS complex of 0.08 seconds. All
P waves are followed by a QRS complex. How should the nurse interpret this rhythm?
A. Second-degree AV block, Type I
B. First-degree AV block
C. Normal Sinus Rhythm
D. Second-degree AV block, Type II
Correct Answer: B
Explanation: First-degree AV block is identified by a prolonged PR interval greater than
0.20 seconds with a consistent 1:1 P to QRS ratio. The QRS duration is typically normal
because the delay occurs in the AV node. This rhythm is often asymptomatic and usually
requires monitoring rather than immediate intervention.
5. The nurse is caring for a patient on a ventilator who is fighting the machine. The ‘High
Pressure’ alarm is sounding. Which action should the nurse take first?
A. Check for kinks in the tubing or patient biting the ET tube
B. Increase the oxygen concentration to 100%
C. Silence the alarm and observe the patient
, D. Call the respiratory therapist to adjust the sensitivity
Correct Answer: A
Explanation: The first action for a high-pressure alarm is to assess for causes of resistance,
such as kinks in the ventilator tubing or the patient biting the tube. Mucus plugs or the
patient coughing can also trigger this alarm. If the cause is not immediately found or
corrected and the patient is in distress, the nurse should disconnect the ventilator and use
a manual resuscitation bag.
6. A patient in the progressive stage of shock has developed Disseminated Intravascular
Coagulation (DIC). Which laboratory result is most indicative of DIC?
A. Increased Fibrinogen levels
B. Increased Fibrin Degradation Products (FDPs)
C. Decreased D-dimer levels
D. Decreased Prothrombin Time (PT)
Correct Answer: B
Explanation: In DIC, the body experiences simultaneous clotting and bleeding, leading to
the breakdown of clots and an increase in Fibrin Degradation Products (FDPs). D-dimer
levels will also be elevated, reflecting the presence of clot dissolution. Fibrinogen and
platelets will be decreased because they are consumed during the widespread clotting
process.
Adult II | Actual Q&A with Rationale (NUR417
Exam 2) | Concordia
1. A patient in the ICU is monitoring for signs of cardiogenic shock. Which hemodynamic
measurement most specifically indicates a failure of the left ventricle as a pump?
A. Decreased Central Venous Pressure (CVP)
B. Decreased Mean Arterial Pressure (MAP)
C. Increased Systemic Vascular Resistance (SVR)
D. Increased Pulmonary Artery Wedge Pressure (PAWP)
Correct Answer: D
Explanation: Pulmonary Artery Wedge Pressure (PAWP) reflects left-sided heart function,
and an elevation indicates left ventricular failure or fluid overload. In cardiogenic shock,
the heart cannot pump efficiently, leading to blood backing up into the pulmonary system
and increasing PAWP. While SVR and MAP change in shock, PAWP is the specific indicator
of left ventricular preload and pressure.
2. A nurse is caring for a patient with septic shock. Which of the following clinical findings
would the nurse expect during the early (hyperdynamic) phase? (Select All That Apply)
A. Increased Cardiac Output
B. Cold, clammy skin
,C. Decreased Systemic Vascular Resistance (SVR)
D. Tachycardia
E. Oliguria
F. Flushed, warm skin
Correct Answer: A, C, D, F
Explanation: Early septic shock is characterized by a hyperdynamic state where cardiac
output is elevated due to decreased peripheral resistance. Vasodilation leads to flushed,
warm skin and a significant drop in SVR. Tachycardia occurs as a compensatory mechanism
to maintain perfusion despite the massive vasodilation.
3. A patient is being treated for Acute Respiratory Distress Syndrome (ARDS) and is on
mechanical ventilation with High PEEP (15 cm H2O). The nurse should monitor for which
significant complication of high PEEP?
A. Metabolic Alkalosis
B. Pneumothorax due to barotrauma
C. Increased Cardiac Output
D. Hypoventilation
Correct Answer: B
Explanation: High levels of Positive End-Expiratory Pressure (PEEP) increase the risk of
barotrauma, which can result in a pneumothorax or subcutaneous emphysema. PEEP can
,also decrease cardiac output by increasing intrathoracic pressure and reducing venous
return to the heart. Monitoring breath sounds and hemodynamic stability is essential when
PEEP exceeds 10 cm H2O.
4. A patient’s EKG shows a PR interval of 0.24 seconds and a QRS complex of 0.08 seconds. All
P waves are followed by a QRS complex. How should the nurse interpret this rhythm?
A. Second-degree AV block, Type I
B. First-degree AV block
C. Normal Sinus Rhythm
D. Second-degree AV block, Type II
Correct Answer: B
Explanation: First-degree AV block is identified by a prolonged PR interval greater than
0.20 seconds with a consistent 1:1 P to QRS ratio. The QRS duration is typically normal
because the delay occurs in the AV node. This rhythm is often asymptomatic and usually
requires monitoring rather than immediate intervention.
5. The nurse is caring for a patient on a ventilator who is fighting the machine. The ‘High
Pressure’ alarm is sounding. Which action should the nurse take first?
A. Check for kinks in the tubing or patient biting the ET tube
B. Increase the oxygen concentration to 100%
C. Silence the alarm and observe the patient
, D. Call the respiratory therapist to adjust the sensitivity
Correct Answer: A
Explanation: The first action for a high-pressure alarm is to assess for causes of resistance,
such as kinks in the ventilator tubing or the patient biting the tube. Mucus plugs or the
patient coughing can also trigger this alarm. If the cause is not immediately found or
corrected and the patient is in distress, the nurse should disconnect the ventilator and use
a manual resuscitation bag.
6. A patient in the progressive stage of shock has developed Disseminated Intravascular
Coagulation (DIC). Which laboratory result is most indicative of DIC?
A. Increased Fibrinogen levels
B. Increased Fibrin Degradation Products (FDPs)
C. Decreased D-dimer levels
D. Decreased Prothrombin Time (PT)
Correct Answer: B
Explanation: In DIC, the body experiences simultaneous clotting and bleeding, leading to
the breakdown of clots and an increase in Fibrin Degradation Products (FDPs). D-dimer
levels will also be elevated, reflecting the presence of clot dissolution. Fibrinogen and
platelets will be decreased because they are consumed during the widespread clotting
process.
