Baton Rouge Community College NU335 Spring 2026 Final.
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Free Baton Rouge Community College NU335 Spring 2026 Final. Questions
A nurse is caring for a patient who is 12 hours post-op from a coronary artery bypass graft (CABG). The cardiac monitor shows new-onset atrial fibrillation with a rapid ventricular response. Which nursing actions should the nurse prioritize? Select all that apply.
- Assess the patient's blood pressure, oxygen saturation, and level of consciousness
- Notify the cardiac surgery team or provider immediately
- Encourage the patient to ambulate to improve circulation
- Prepare to administer prescribed beta blockers or calcium channel blockers
- Increase IV fluid rate to improve cardiac output
- Obtain a 12-lead ECG to confirm rhythm and guide treatment
Explanation
Correct Answers: A) Assess the patient's blood pressure, oxygen saturation, and level of consciousness, B) Notify the cardiac surgery team or provider immediately, D) Prepare to administer prescribed beta blockers or calcium channel blockers, F) Obtain a 12-lead ECG to confirm rhythm and guide treatment
New-onset atrial fibrillation with rapid ventricular response is a common but serious complication following CABG.
The priority actions are to first assess hemodynamic stability, immediately notify the surgical team, obtain a 12-lead ECG to confirm and characterize the rhythm, and prepare rate-controlling medications such as beta blockers or calcium channel blockers. Ambulation is inappropriate for an unstable post-op patient with a new arrhythmia. Increasing IV fluid rate is not indicated for atrial fibrillation with rapid ventricular response and could worsen the situation by increasing cardiac workload.
Four victims of an automobile accident are brought by the ambulance to the emergency department. Based on the principles of triage, the nurse determines that which patient has the highest priority for treatment?
- A sucking chest wound
- Absent pedal pulses
- Bleeding of head lacerations
- An open femur fracture
Explanation
Correct Answer: A) A sucking chest wound
In triage, priority is given to patients with life-threatening but survivable injuries. A sucking chest wound (open pneumothorax) directly compromises ventilation and oxygenation, as air enters the pleural space with each breath, collapsing the lung and potentially progressing to a tension pneumothorax — a rapidly fatal condition requiring immediate intervention.
This is the highest priority among the choices. Absent pedal pulses suggest vascular compromise but are not immediately life-threatening. Head lacerations bleed profusely but are rarely immediately fatal. An open femur fracture is serious but does not directly threaten airway or breathing as immediately as a sucking chest wound.
The nurse reviews the following orders for a patient admitted with infective endocarditis and fever. The nurse gives the highest priority to which order?
- Obtain blood cultures from two sites
- Schedule a transesophageal echocardiogram
- Administer ceftriaxone 1g IVPB Q 12 hours
- Give acetaminophen 650mg PO Q 6 hours PRN for fever
Explanation
Correct Answer: A) Obtain blood cultures from two sites
In infective endocarditis, blood cultures must be obtained before initiating antibiotic therapy. This is the highest priority because starting antibiotics first will sterilize the blood and yield false-negative cultures, making it impossible to identify the causative organism and guide targeted antibiotic treatment. Two sets from two different sites improve sensitivity and help distinguish true bacteremia from contamination. The echocardiogram, while essential for diagnosis, is not as time-sensitive as cultures. Ceftriaxone is urgently needed but must follow blood cultures. Acetaminophen for fever is a comfort measure and the lowest priority among these orders.
The nurse is assessing a patient with multiple traumas, who is at risk for developing respiratory distress syndrome. What assessment finding does the nurse expect as an early sign of respiratory distress syndrome?
- Inspiratory crackles
- Bilateral wheezing
- Increased respiratory rate
- Intercostal retractions
Explanation
Correct Answer: C) Increased respiratory rate
Tachypnea (increased respiratory rate) is the earliest clinical sign of acute respiratory distress syndrome (ARDS). As alveolar-capillary membrane damage begins and oxygenation becomes impaired, the body's initial compensatory response is to increase the respiratory rate in an attempt to maintain adequate gas exchange.
This occurs before overt hypoxemia, crackles, or visible respiratory distress become apparent. Inspiratory crackles and intercostal retractions are later signs indicating progressive fluid accumulation and increased work of breathing. Bilateral wheezing suggests bronchospasm and is not a characteristic early finding of ARDS.
During change-of-shift report, the nurse learns that a patient with a head injury has decorticate posturing to noxious stimulation. Which positioning shown in the accompanying figure will the nurse expect to observe?
[IMAGE_1]- 3
- 2
- 4
- 1
Explanation
Correct Answer: D) 1
Decorticate posturing is characterized by flexion of the arms, wrists, and fingers with adduction of the upper extremities, and extension and plantar flexion of the lower extremities. This posture results from a lesion at or above the upper brainstem, interrupting corticospinal pathways. In standard posturing figures, figure 1 typically depicts this flexed upper extremity and extended lower extremity position. Decerebrate posturing (figure 2) involves extension and outward rotation of all extremities and indicates a more severe, lower brainstem injury.
A patient is being treated for facial burns caused by a house fire. Which assessment should the nurse make a priority?
- Checking for airway patency
- Capillary refill time
- Ability to speak
- Presence of a gag reflex
Explanation
Correct Answer: A) Checking for airway patency
In a patient with facial burns from a house fire, the airway is always the top priority. Facial burns indicate potential inhalation injury, and the airway can become rapidly compromised due to mucosal edema, swelling of the oropharynx, and soot accumulation. Airway obstruction can develop quickly and become life-threatening within minutes to hours of the injury. While ability to speak (C) and gag reflex (D) are related assessments, they are secondary to directly assessing airway patency. Capillary refill time assesses peripheral circulation and is a lower priority compared to securing an open airway.
Prescribed: Begin propofol IV infusion at 9 mL/hr Available: propofol 1000 mg/100 mL Patient's weight: 75 kg Calculate how many mcg/kg/min the patient is receiving? Record your answer to whole number.
Explanation
Correct Answer: 20 mcg/kg/min
Step 1 — Convert concentration: 1000 mg/100 mL = 10 mg/mL = 10,000 mcg/mL.
Step 2 — Calculate mcg/min: 9 mL/hr ÷ 60 min/hr = 0.15 mL/min × 10,000 mcg/mL = 1,500 mcg/min.
Step 3 — Calculate mcg/kg/min: 1,500 mcg/min ÷ 75 kg = 20 mcg/kg/min.
To evaluate the effectiveness of prescribed therapies for a patient with ventilatory failure, which diagnostic test will be most useful to the nurse?
- Pulse oximetry
- Chest x-rays
- Pulmonary artery pressure monitoring
- Arterial blood gas (ABG) analysis
Explanation
Correct Answer: D) Arterial blood gas (ABG) analysis
ABG analysis is the gold standard for evaluating ventilatory effectiveness because it directly measures arterial oxygen (PaO₂), carbon dioxide (PaCO₂), and pH — the three key parameters that define ventilatory failure and the response to treatment. In ventilatory failure, CO₂ retention (hypercapnia) and respiratory acidosis are the hallmarks, and only ABG can quantify these values. Pulse oximetry only measures oxygen saturation and cannot detect hypercapnia or acid-base imbalance. Chest x-rays show structural changes but not ventilatory function. PA pressure monitoring assesses hemodynamics, not gas exchange or ventilation directly.
Prescribed: Heparin bolus 50 units/kg IV now then begin Heparin drip at 12 units/kg/hour. Available: Heparin 5000 units per mL. Patient weight: 70 kg. How many mL will the nurse administer for the prescribed bolus dose? Record your answer to the nearest tenth place.
Explanation
Correct Answer: 0.7 mL
Step 1 — Calculate the required bolus dose: 50 units/kg × 70 kg = 3,500 units
Step 2 — Calculate the volume to administer: 3,500 units ÷ 5,000 units/mL = 0.7 mL
The nurse will administer 0.7 mL for the heparin bolus dose.
What rationale best explains why the nurse should give narcotic analgesia intravenously to a patient in the emergent phase of a burn?
- Absorption of oral or IM drugs is diminished because of impaired circulation.
- Narcotic analgesics do not need to be administered as frequently when they are given IV.
- Larger doses of narcotics can be given when administered IV than when given IM.
- Respiratory depression is easier to diagnose and treat when narcotics are administered IV.
Explanation
Correct Answer: A) Absorption of oral or IM drugs is diminished because of impaired circulation.
During the emergent phase of a burn, massive fluid shifts, hypovolemia, and impaired peripheral circulation occur. This significantly reduces the absorption of oral and intramuscular medications because blood flow to the GI tract and peripheral muscles is severely compromised. IV administration bypasses this problem by delivering the medication directly into the bloodstream, ensuring reliable absorption and predictable drug levels. This is the primary clinical rationale for the IV route in burn patients during the emergent phase.
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