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NR 341 - COMPLEX ADULT HEALTH FINAL UPDATED
ACTUAL EXAM 2025 COMPLETE QUESTIONS AND
CORRECT ANSWERS ALREADY RATED A+
Indication for arterial line placement? - CORRECT ANSWER >>> Hemodynamic monitoring Multiple blood samples Diagnostic or interventional radiology procedures Continuous cardiac output monitoring What test must be preformed prior to an arterial line placement? **- CORRECT ANSWER
** Allen's test How often should a fast flush test be preformed? - CORRECT ANSWER >>> Every 8 hours After blood draws If the hemodynamic status changes When changing tubing What are the most common sites for arterial line insertion? - CORRECT ANSWER >>> Radial Femoral Axillary Dorsalis Pedis Brachial Arteries Positioning for radial arterial line placement: - CORRECT ANSWER >>> 30 - 60 degrees of dorsiflexion with the aid of a roll of gauze and an armband. Avoid hyperabduction of the thumb.
How often should the atrial line catheter be changed out? - CORRECT ANSWER >>> Every 7 days Causes of inaccuracy in arterial line readings: - CORRECT ANSWER >>> Air bubbles in the catheter system Failure to zero the transducer air-fluid interface Blood in the catheter system Blood clot at the catheter tip Kinking of the tubing system Catheter tip lodging against the arterial wall Soft, compliant tubing Long tubing Too many stopckcks (>3) What is the pathology of afterload? - CORRECT ANSWER >>> The pressure in which the heart must pump against in order to eject blood during systole. Medications that reduce afterload/preload include? - CORRECT ANSWER >>> Vasodilators What is the pathology of preload? - CORRECT ANSWER >>> The filling pressure of the heart at end of diastole. What is systemic vascular resistance (SVR)? - CORRECT ANSWER >>> Resistance the left ventricle must overcome to open the aortic valve and eject a volume of blood into systemic circulation.
Nitrates: Sildenafil (Viagra) Nitroprusside (Nipride, Nitropress) ACE: Captopril (Capoten) Lisinopril (Prinivil, Zestril) Kayexalate - CORRECT ANSWER >>> Exchanges K+ ions for Na+ Excess K+ ions are fecally excreted Calcium Gluconate - CORRECT ANSWER >>> Prevents and treats cardiac toxicity related to increased K+ levels What is the purpose of Continuous Renal Replacement Therapy (CRRT)? **- CORRECT ANSWER
** Dialysis This is a blood filtering therapy that replaced the normal blood-filtering function of the kidneys in patients with renal failure and acute kidney injuries. The prerenal system - CORRECT ANSWER >>> Delivers blood to the kidneys. A prerenal block is: - CORRECT ANSWER >>> An interruption on the way to the kidneys. The intrarenal system - CORRECT ANSWER >>> Processes ultra-filtrate by tubular secretion & re-absorption. An intrarenal block is: - CORRECT ANSWER >>> Direct damage to the kidneys.
The postrenal system - CORRECT ANSWER >>> Excretes kidney waste products through the ureters, bladder, and urethra. A postrenal block is: - CORRECT ANSWER >>> Obstruction of urine output. Causes: Enlarged prostate Kidney stones Bladder tumor Bladder injury S/SX of the oliguric phase of acute kidney injury (AKI): - CORRECT ANSWER >>> <400 mL/24hr Increase BUN, Cr, uric acid, K, Mg Metabolic Acidosis S/SX of the diuretic phase of acute kidney injury (AKI): - CORRECT ANSWER >>> Urine output 1 - 3L/day Decreased K & Na S/SX of the risk stage of acute kidney injury (AKI): - CORRECT ANSWER >>> Cr >1.5xbaseline Urine output <0.5ml/kg/hr for 6+ hours S/SX of the injury stage of acute kidney injury (AKI): - CORRECT ANSWER >>> Cr >2xbaseline Urine output <0.5ml/kg/hr for 12+ hours S/SX of the risk failure of acute kidney injury (AKI): - CORRECT ANSWER >>> Cr >3xbaseline Urine output <0.3ml/kg/hr for 12+ hours
Initial shock - CORRECT ANSWER >>> Inadequate intravascular volume Initial shock clinical presentation: - CORRECT ANSWER >>> There are no obvious clinical indications of hypoperfusion seen in this stage of shock May see a drop in cardiac output Compensatory shock - CORRECT ANSWER >>> Inadequate myocardial contractility Compensatory shock neural compensation S/SX: - CORRECT ANSWER >>> HR & contractility increase Systemic vasoconstriction and redistribution of blood occurs Venous vasoconstriction augments venous return to the heart Blood is shunted from the kidneys, GI tract, and skin Respiratory rate and depth are increased Increased blood glucose levels Dilated pupils, peripheral vasoconstriction, Sweat gland activity causing cool moist skin Compensatory shock endocrine compensation S/SX: - CORRECT ANSWER >>> Increased blood glucose Reabsorbtion of salt and water increasing intracascular volume and BP RAAS >Renin > Angiotensinogen > Angiotensinogen 1 > Angiotensinogen 2 > increases BP and venous return to the heart Angiotensinogen 2 activates the adrenal cortex for the release of aldosterone Compensatory shock chemical compensation S/SX: - CORRECT ANSWER >>> Perfusion begins to decline Rate and depth of respiration increase
Hyperventillation >CO2 is released > Respiratory alkalosis occurs Vasoconstriction of cerebral blood vessels occurs > Cerebral hypoxia & ischemia may result Compensatory shock clinical presentation: - CORRECT ANSWER >>> Elevated HR Narrowed pulse pressure Rapid, deep respirations causing respiratory alkalosis Thirst Cool, moist skin Oliguria Diminished bowel sounds Restlessness > confusion Hyperglycemia Increased urine specific gravity Decreased creatinine clearance Progressive shock S/SX: - CORRECT ANSWER >>> Ischemia in extremities Weak or absent peripheral pulses Altered body defense Decreased capillary refil Cellular hypoxia Metabolic acidosis Failure of the sodium-potassium pump Edema Progressive shock - CORRECT ANSWER >>> Respiratory system is the first to fail Decrease cardiac output
Acute respiratory distress syndrome Disseminated intravascular coagulation Hepatic dysfunction or failure Acute kidney injury Myocardial ischemia, infarction, or failure Cerebral ischemia/infarction Systemic inflammatory response syndrome (SIRS) - CORRECT ANSWER >>> Widespread systemic inflammation Septic shock; early, warm, hyperdynamic S/SX: - CORRECT ANSWER >>> Septic shock with elevated HR, normal to decreased BP, widened pulse pressure, skin is warm and flushed, confusion, oliguria, elevated CO CI & SvO2, decreased RAP PAP PAOP SVR Septic chock; late, cold, hypodynamic S/SX: - CORRECT ANSWER >>> Septic shock, decreased BP & pulse pressure, decreased CO CI SvO2, skin is cool and pale, hypothermia, anuria, variable RAP PAP PAOP & SVR, positive blood cultures. Sepsis - CORRECT ANSWER >>> A life-threatening organ dysfunction resulting from a dysregulated host response to infection. Septic shock - CORRECT ANSWER >>> A subset of sepsis in which circulatory, cellular, and metabolic alterations are associated with a higher mortality rate than sepsis alone. 3 hour sepsis bundle includes: - CORRECT ANSWER >>> Measure lactate level Draw blood cultures Administer broad spectrum ABX Administer 30mL/kg crystalloid fluid bolus
6 hour sepsis bundle includes: - CORRECT ANSWER >>> Measure lactate level Draw blood cultures Administer broad spectrum ABX Administer 30mL/kg crystalloid fluid bolus If persistent hypotension after fluid resuscitation: Add vasopressors Measure CVP & SvO Remeasure lactate level Two types of distributive shock are: - CORRECT ANSWER >>> Neurogenic shock Anaphylactic shock Neurogenic shock is caused by: - CORRECT ANSWER >>> General or spinal anesthesia Epidural block Cervical spinal cord injury Neurogenic shock S/SX: - CORRECT ANSWER >>> Decreased HR & BP, hypothermia, dry and warm skin, oliguria, neurologic deficit, low CO CI RAP PAP PAOP SVR SvO Neurogenic shock TX: - CORRECT ANSWER >>> Eliminate and treat the cause Maintain MAP > Maintain adequate HR VTE prophylaxis Anaphylactic shock is caused by: - CORRECT ANSWER >>> An allergic reaction
Multiple organ dysfunction syndrome (MODS) risk factors include: - CORRECT ANSWER >>> 1. Patients with impaired immune responses
- Older adults (MODS can effect any age)
- Patients with chronic illnesses
- Patients with malnutrition 5.Patients with prolonged or exaggerated inflammatory responses
- Victims of severe trauma
- Patients with sepsis
- Patients with cancer
- Prolonged HTN, infection, major surgery, GI ischemia, pancreatitis, burns Multiple organ dysfunction syndrome (MODS) classifications include: **- CORRECT ANSWER
** Primary Multiple organ injury from a primary insult: trauma, burn, shock, infection Secondary Associated with SIRS Develops days - weeks after insult Sepsis and septic shock are the most common causes ABCDEFG's of trauma: - CORRECT ANSWER >>> Airway Breathing & ventilation Circulation with hemorrhage control Disability or neurological status Exposure with environmental considerations Full set of V/S and family presence Get resuscitation adjuncts
The 4 types of burns are: - CORRECT ANSWER >>> Thermal Chemical Electrical Inhalation Thermal burns are cause by: - CORRECT ANSWER >>> Flames Flash Scald Contact with hot objects Chemical burns are caused by: - CORRECT ANSWER >>> Acid Alkalis Organic compounds Electrical burns are caused by: - CORRECT ANSWER >>> Electrical current Inhalation burns are caused by: - CORRECT ANSWER >>> Carbon monoxide Hydrogen cyanide Emergent burn phase care: - CORRECT ANSWER >>> Begins at the time of burn Priority care includes: Airway Circulation Organ perfusion Pain prevention
Physiological response to burns: - CORRECT ANSWER >>> Fluid shifts into the extravascular space Edema will occur in burned and unburned areas Maximum edema will occur 24-48 hours after burn Orally tolerated nutrition requirements for burn patients: - CORRECT ANSWER >>> High- calorie High-protein Add supplements Perform daily calorie counts to monitor dietary intake Tube feeding nutritional requirements for burn patients: - CORRECT ANSWER >>> Initiate within 24 hours of burn injury Pass the stomach and place in small bowel Burn victim electrolyte imbalances include: - CORRECT ANSWER >>> Decreased HCT Hyponatremia from diuresis; resolves within 1 week after onset Hypokalemia Hypoproteinemia Leukopenia r/t topical antimicrobial agent silver sulfadiazine Hyperglycemia Spinal shock - CORRECT ANSWER >>> Electrical silence below the level of injury No motor, sensory, or reflex activity Onset within minutes of injury Lasts 4-6 weeks
Neurogenic shock - CORRECT ANSWER >>> Distribution of autonomic pathways Temporary loss of autonomic function below the injury Vasodilation Distributive shock (hypotension, bradycardia, hypothermia) Duration is variable What are the most common mechanisms of cervical spine injuries (CSI)? **- CORRECT ANSWER
** Hyperextension Rotation Hyperflexion Compression Respiratory impairments based on level of spinal cord injury (SCI): **- CORRECT ANSWER ** C1-C3: Dentialtior dependent C4-C5: phrenic nerve impairment; phrenic nerve pacemaker Below C5-C6: intact diaphragmatic breathing Priority nursing actions for traumatic brain injury (TBI) and intercranial pressure (ICP): - CORRECT ANSWER >>> Maintain airway Oxygen delivery Maintaining cerebral perfusion Traumatic brain injury (TBI) nursing interventions: - CORRECT ANSWER >>> Hypothermia treatment Nutrition support
Elevated intercranial pressure (ICP): - CORRECT ANSWER >>> >20 for 5+ minutes Elevated intercranial pressure (ICP) occurs from: - CORRECT ANSWER >>> Head injury Secondary response to: brain tumors, subarachnoid hemorrhage, toxic & viral encephalopathies What is Cushing Triad? - CORRECT ANSWER >>> A late sign of elevated ICP Systolic HTN Widening pulse pressure Bradycardia Irregular respiration It signifies irreversible damage Pulse Pressure (PP) formula: - CORRECT ANSWER >>> Systolic - Diastolic = pulse pressure Should be 30 - 50 Cerebral perfusion pressure (CPP) - CORRECT ANSWER >>> The pressure required to perfuse the brain CPP = MAP - ICP Normal is 60 - 100 mm Hg Ischemic stroke verses hemorrhagic stroke: - CORRECT ANSWER >>> Ischemic stroke: Results from embolism or thrombosis Hemorrhagic stroke: Rupture of cerebral vessel causing a brain bleed Stroke risk factors include: - CORRECT ANSWER >>> Hypertension
Previous stroke or TIA Cardiovascular disease A-Fib Oral contraceptives Stress Family HX Advance age DM Obesity Stroke assessment scales: - CORRECT ANSWER >>> FAST: F-ace A-rms S-peech T-time NIHSS: 0 - no stroke 0 - 4 - minor stroke 5 - 15 - moderate stroke 16 - 20 - moderate to severe stroke 21 - 42 - severe stroke What diagnostics would be used to diagnose a stroke? - CORRECT ANSWER >>> CT without contrast CT angio MRI
