Baton Rouge Community College NU335 Spring 2026 Final.
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Free Baton Rouge Community College NU335 Spring 2026 Final. Questions
A patient experiences a flail chest as a result of an automobile accident. Which finding during a respiratory assessment would the nurse expect?
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Paradoxic chest movement
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Laryngeal stridor
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Bloody sputum
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Deep, irregular respirations
Explanation
Correct Answer: A) Paradoxic chest movement
Flail chest occurs when three or more consecutive ribs are fractured in two or more places, causing a free-floating segment of the chest wall. This segment moves in the opposite direction to the rest of the chest during breathing — inward during inhalation and outward during exhalation — which is called paradoxical chest movement. This is the hallmark and defining clinical sign of flail chest. Laryngeal stridor suggests upper airway obstruction, not flail chest. Bloody sputum may indicate pulmonary contusion but is not the defining sign. Respirations in flail chest are typically shallow and rapid, not deep and irregular, due to pain and mechanical inefficiency.
A patient with cardiogenic shock requires an Intra-Aortic Balloon Pump (IABP). Which statement best describes the role of the balloon during diastole?
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The balloon inflates to increase coronary perfusion
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The balloon deflates to reduce afterload
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The balloon inflates to decrease myocardial oxygen demand
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The balloon inflates to increase cardiac output directly
Explanation
Correct Answer: A) The balloon inflates to increase coronary perfusion
During diastole, the IABP balloon inflates, causing counterpulsation that increases diastolic pressure in the aorta. This augments coronary artery perfusion, since coronary filling predominantly occurs during diastole. Balloon deflation occurs during systole (not diastole) to reduce afterload and decrease the workload of the left ventricle. While the IABP indirectly reduces myocardial oxygen demand and improves cardiac output, these are secondary effects — the primary and direct mechanism during diastole is enhanced coronary perfusion.
A nurse is providing discharge teaching to a patient who has undergone a mitral valve replacement with a mechanical prosthesis. Which statement by the patient indicates a need for further teaching?
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"I should monitor for signs of bleeding and report them to my provider."
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"I will need to take anticoagulants for the rest of my life."
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"I can stop taking antibiotics before dental procedures after I heal."
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"I should wear a medical alert bracelet indicating I have a mechanical valve."
Explanation
Correct Answer: C) "I can stop taking antibiotics before dental procedures after I heal."
This statement indicates a need for further teaching because patients with mechanical heart valve prostheses must take prophylactic antibiotics before dental procedures permanently — not just during the healing period. Dental procedures can introduce bacteria into the bloodstream, which can colonize the mechanical valve and cause infective endocarditis, a life-threatening complication.
This precaution never stops. Monitoring for bleeding is correct due to lifelong anticoagulation therapy. Lifelong anticoagulants are indeed required to prevent thrombus formation on the mechanical valve. Wearing a medical alert bracelet is an appropriate and important safety measure.
The nurse is administering an intravenous push medication and the patient begins to complain of itching. What is the priority nursing action?
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Notify the physician of the symptoms
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Administer diphenhydramine 25 mg po
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Stop administering the intravenous push medication
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Complete the intravenous push
Explanation
Correct Answer: C) Stop administering the intravenous push medication
Itching during IV push administration is a potential sign of an allergic or anaphylactic reaction. The priority nursing action is to immediately stop the medication to prevent further exposure to the potential allergen. Following the "stop" action, the nurse should then assess the patient, notify the physician, and prepare for further interventions such as antihistamines or emergency treatment if needed. Continuing the IV push or attempting treatment before stopping the causative agent would be dangerous and clinically inappropriate.
After receiving change-of-shift report, which patient will the nurse assess first?
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Cystic fibrosis who has thick, green-colored sputum
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Pneumonia who has coarse crackles in both lung bases
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Emphysema who has an oxygen saturation of 91% to 92%
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Septicemia who has intercostal and suprasternal retractions
Explanation
Correct Answer: D) Septicemia who has intercostal and suprasternal retractions
Intercostal and suprasternal retractions are signs of severe respiratory distress and increased work of breathing, indicating that accessory muscles are being recruited just to maintain ventilation. In a patient with septicemia, this suggests impending respiratory failure and hemodynamic compromise requiring immediate intervention. Green sputum in cystic fibrosis is expected and not immediately life-threatening. Crackles in pneumonia and an O₂ saturation of 91–92% in emphysema (which is the patient's baseline) are concerning but not as acutely critical as active respiratory distress with retractions.
Review the information in the electronic health record. The nurse is aware the client may have injuries not immediately visible on assessment. For which additional injuries is this patient at high risk?
Explanation
Correct Answers: Intracranial hemorrhage, Internal hemorrhage, Hemothorax, Rib fracture, Internal organ damage
Based on the EHR, this 45-year-old client was riding a motorcycle, was struck by a car, and thrown 15 feet. Reported injuries include open fractures to both lower legs, a possible closed fracture to the left upper leg with disfigurement, right forearm road rash, and possible spinal cord injury.
The mechanism of high-speed blunt trauma with multiple fractures places this patient at high risk for intracranial hemorrhage (head trauma/helmet use unknown initially), internal hemorrhage (massive blunt force), hemothorax (chest trauma from impact), rib fractures (common in high-speed MVC), and internal organ damage (abdominal organs vulnerable to blunt trauma). Embolic stroke and ischemic stroke are not high-priority immediate risks in acute blunt trauma without specific vascular injury indicators.
In a patient with shock showing worsening tachypnea, hypotension, and altered mental status, which laboratory trend must be prioritized and reported to the provider immediately?
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Stable ECG readings
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Decreasing lactate levels
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Increasing creatinine levels
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Elevated hemoglobin levels
Explanation
Correct Answer: C) Increasing creatinine levels
In a patient with worsening shock, rising creatinine levels indicate acute kidney injury (AKI) secondary to renal hypoperfusion — a sign of end-organ damage and deteriorating shock. This must be reported immediately as it signals that the shock is progressing and vital organs are beginning to fail, necessitating urgent escalation of care. Stable ECG readings are reassuring and do not require urgent reporting. Decreasing lactate levels are actually a positive trend, indicating improved tissue perfusion and response to treatment. Elevated hemoglobin is not a concerning finding in the context of shock; in fact, low hemoglobin would be more worrisome.
The nurse admits a patient to ICU with a gastrointestinal bleed with a week long history of vomiting and diarrhea. The patient has a Pulmonary Artery (PA) catheter in place. A fluid bolus is initiated to treat which underlying issue?
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Increased preload
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Decreased afterload
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Decreased preload
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Increased afterload
Explanation
Correct Answer: C) Decreased preload
This patient has experienced significant fluid losses from a GI bleed combined with a week of vomiting and diarrhea, resulting in hypovolemia. Preload refers to the volume of blood returning to the heart (ventricular end-diastolic volume). In hypovolemia, preload is decreased due to reduced circulating volume, as reflected by low PA catheter readings (low PAWP/CVP). A fluid bolus is administered to restore intravascular volume and increase preload, thereby improving stroke volume and cardiac output. Afterload relates to resistance against which the heart pumps and is not corrected by fluid administration.
A patient is admitted with acute pericarditis and reports severe chest pain. The nurse identifies the nursing diagnosis of Acute pain related to the inflammatory process. Which nursing action is most appropriate to relieve the patient's pain?
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Administer opioid analgesics every 4 hours.
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Increase fluid intake to reduce inflammation.
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Place the patient in Fowler's position, leaning forward.
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Encourage the patient to take deep, slow breaths.
Explanation
Correct Answer: C) Place the patient in Fowler's position, leaning forward.
In acute pericarditis, chest pain is caused by inflammation of the pericardial sac. The pain characteristically worsens when lying flat and improves when sitting upright and leaning forward, as this position reduces pressure on the inflamed pericardium by moving the heart away from the diaphragmatic surface. This is a classic, well-established nonpharmacologic comfort measure for pericarditis. Opioids are not first-line for pericarditis pain, increased fluids do not reduce pericardial inflammation, and deep breathing may worsen pleuritic-type chest pain.
The nurse is participating in a Code Blue where the patient's cardiac rhythm requires a shock. Following the delivery of the shock, which action is priority?
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Immediately resume chest compressions
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Make sure no one is touching the bed or patient
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Recharge to a higher level of joules
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Assess for return of respirations and blood pressure
Explanation
Correct Answer: A) Immediately resume chest compressions
According to current Advanced Cardiac Life Support (ACLS) guidelines, CPR — beginning with chest compressions — must be resumed immediately after defibrillation without pausing to check for a pulse or rhythm. The heart needs time after a shock to re-establish an organized, perfusing rhythm, and chest compressions maintain coronary and cerebral perfusion during this critical period. A rhythm and pulse check is performed after 2 minutes of CPR. Clearing the patient before delivering the shock is correct, but that step occurs before, not after, the shock. Recharging to higher joules is premature before reassessing rhythm after the initial shock and a cycle of CPR.
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