Haemodynamics, ventilation, burns and unexpected responses

56 NCLEX-RN practice questions on Haemodynamics, ventilation, burns and unexpected responses, part of Physiological Adaptation. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Hard · Matrix

   For each oncology client, indicate the emergency the findings most likely show.

   For each row, choose: SIADH / Tumour lysis syndrome / Hypercalcaemia of malignancy

   1. Leukaemia on induction, uric acid 12 mg/dL, falling urine output
   2. Small cell lung cancer, weight gain, no oedema, new confusion
   3. Multiple myeloma, calcium 13.1 mg/dL, lethargy
   4. Lymphoma treated yesterday, potassium 6.1 mEq/L, phosphate 7.8 mg/dL
   5. Small cell lung cancer, sodium 121 mEq/L, concentrated urine

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   Answer:

   • Leukaemia on induction, uric acid 12 mg/dL, falling urine output: Tumour lysis syndrome
   • Small cell lung cancer, weight gain, no oedema, new confusion: SIADH
   • Multiple myeloma, calcium 13.1 mg/dL, lethargy: Hypercalcaemia of malignancy
   • Lymphoma treated yesterday, potassium 6.1 mEq/L, phosphate 7.8 mg/dL: Tumour lysis syndrome
   • Small cell lung cancer, sodium 121 mEq/L, concentrated urine: SIADH

   Analyse cues: SIADH (often small cell lung cancer) causes dilutional hyponatraemia; tumour lysis after treatment of fast-growing tumours raises potassium, phosphate and uric acid; bone metastases and myeloma cause hypercalcaemia with polyuria and lethargy.

   • Leukaemia on induction, uric acid 12 mg/dL, falling urine output: Uric acid crystals injure the kidney.
   • Small cell lung cancer, weight gain, no oedema, new confusion: Water retention without oedema and confusion fit SIADH.
   • Multiple myeloma, calcium 13.1 mg/dL, lethargy: Bone destruction releases calcium.
   • Lymphoma treated yesterday, potassium 6.1 mEq/L, phosphate 7.8 mg/dL: Lysed cells release potassium and phosphate.
   • Small cell lung cancer, sodium 121 mEq/L, concentrated urine: Ectopic ADH holds water and dilutes sodium.

2. Question 2 · Easy · Matrix

   For each haemodynamic value in an adult client, indicate whether it is within or outside the normal range.

   For each row, choose: Within normal range / Outside normal range

   1. CVP 6 mm Hg
   2. PAWP 10 mm Hg
   3. Cardiac index 1.8 L/min/m²
   4. Cardiac output 2.6 L/min
   5. SvO2 72%
   6. Mean arterial pressure 58 mm Hg

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   Answer:

   • CVP 6 mm Hg: Within normal range
   • PAWP 10 mm Hg: Within normal range
   • Cardiac index 1.8 L/min/m²: Outside normal range
   • Cardiac output 2.6 L/min: Outside normal range
   • SvO2 72%: Within normal range
   • Mean arterial pressure 58 mm Hg: Outside normal range

   Recognise cues: normal values are CVP 2-8 mm Hg, PAWP 6-12 mm Hg, MAP 70-105 mm Hg, cardiac output 4-8 L/min, cardiac index 2.5-4.0 L/min/m² and SvO2 60-80%.

   • CVP 6 mm Hg: Within 2-8 mm Hg.
   • PAWP 10 mm Hg: Within 6-12 mm Hg.
   • Cardiac index 1.8 L/min/m²: Below 2.5 L/min/m², a sign of poor pump function.
   • Cardiac output 2.6 L/min: Below 4-8 L/min.
   • SvO2 72%: Within 60-80%.
   • Mean arterial pressure 58 mm Hg: Below the level that keeps organs perfused.

3. Question 3 · Medium · Select all that apply

   During a fast vancomycin infusion, a client develops flushing and itching of the face, neck and upper chest with a slight BP drop. Which actions should the nurse take?

   1. AGive the prescribed antihistamine
   2. BStop the infusion
   3. CRecord the reaction as a severe drug allergy
   4. DRestart later at a slower rate as prescribed
   5. EGive the rest of the dose by IV push

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   Answer: A, B, D

   Take action: this is vancomycin infusion reaction, a rate-related histamine release rather than true allergy. Stop the infusion, give the prescribed antihistamine, and restart over at least 60 minutes once symptoms settle.

   • C: It is a rate reaction, not a contraindication.
   • E: Faster delivery would worsen the reaction.

4. Question 4 · Hard · Select all that apply

   A client rescued from a house fire has a headache and nausea. SpO2 is 98% on room air and the carboxyhaemoglobin level is 28%. Which actions should the nurse take?

   1. AMonitor for hoarseness and stridor
   2. BApply 100% oxygen by non-rebreather mask
   3. CTell the client the saturation is normal
   4. DApply oxygen at 2 L/min by nasal cannula
   5. EDisregard the SpO2 reading as a guide

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   Answer: A, B, E

   Take action: carbon monoxide binds haemoglobin far more tightly than oxygen, and pulse oximetry reads carboxyhaemoglobin as oxygenated. Give 100% oxygen by non-rebreather to shorten its half-life, and watch for airway compromise.

   • C: The SpO2 is falsely reassuring.
   • D: Low-flow oxygen is too little to clear carbon monoxide.

5. Question 5 · Medium · Select all that apply

   A ventilated client with copious secretions needs open endotracheal suctioning. Which steps are correct?

   1. AInstil 10 mL of saline before each pass
   2. BApply suction only while withdrawing the catheter
   3. CLimit each pass to about 10 seconds
   4. DSuction on a fixed schedule every hour
   5. EGive 100% oxygen before suctioning
   6. FUse sterile technique for an open system

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   Answer: B, C, E, F

   Take action: preoxygenate, keep the procedure sterile, apply suction only while withdrawing, and limit each pass to about 10 seconds to avoid hypoxaemia. Routine saline instillation is not recommended.

   • A: Routine saline raises infection risk and does not thin secretions.
   • D: Suction only when assessment shows a need.

6. Question 6 · Hard · Matrix

   On the fourth day after a 40% TBSA flame burn, the burn unit nurse reviews progress. Indicate whether each finding is expected at this stage or requires follow-up.

   For each row, choose: Expected / Requires follow-up

   1. Platelets falling from 210,000 to 95,000/mm³
   2. Oedema of the burned limbs starting to go down
   3. Pain with dressing changes
   4. New confusion and disorientation
   5. Core temperature of 95.9 °F (35.5 °C)
   6. Urine output higher than on day 2

   Answer and explanation in LearnFree account

7. Question 7 · Hard · Select all that apply

   A ventilated client suddenly becomes agitated. The peak pressure alarm sounds and the SpO2 falls to 84%. Which findings support a tension pneumothorax?

   1. APeak airway pressure rising with each breath
   2. BTrachea shifted to the left
   3. CAbsent breath sounds on the right
   4. DBP 78/50 mm Hg with distended neck veins
   5. EFine crackles in both lung bases

   Answer and explanation in LearnFree account

8. Question 8 · Medium · Matrix

   A woman receiving external beam radiation to the breast describes how she will care for the skin in the treatment field. Indicate whether each statement is correct or needs more teaching.

   For each row, choose: Shows understanding / Needs more teaching

   1. I will wear loose cotton shirts.
   2. I will rub on a scented lotion before each treatment.
   3. A heating pad will soothe the sore area.
   4. I will keep the area covered from the sun.
   5. I will wash the area with mild soap and lukewarm water.

   Answer and explanation in LearnFree account

9. Question 9 · Medium · Matrix

   An older adult with herpes zoster on the trunk is going home on an antiviral. For each statement, indicate whether it shows understanding or needs more teaching.

   For each row, choose: Shows understanding / Needs more teaching

   1. I will keep the blisters covered until they crust over.
   2. Once every blister has crusted, I am no longer contagious.
   3. My pregnant neighbour who never had chickenpox can visit now.
   4. I will start the antiviral tablets today.
   5. I can pop the blisters so they heal faster.

   Answer and explanation in LearnFree account

10. Question 10 · Hard · Select all that apply

    A client receives norepinephrine through a peripheral IV while a central line is being arranged. Which findings require immediate action?

    1. AUrine output 45 mL/h
    2. BBlanching of the skin around the IV site
    3. CMean arterial pressure 68 mm Hg
    4. DPain and coolness at the insertion site
    5. EMottled, cold fingers beyond the IV site

    Answer and explanation in LearnFree account

11. Question 11 · Hard · Select all that apply

    Ten days after a cycle of breast cancer chemotherapy, a woman calls the oncology unit with chills, then arrives with a temperature of 101.3 °F (38.5 °C) and a neutrophil count of 300/mm³. Which actions should the nurse take?

    1. AStart the IV antibiotic within an hour
    2. BObtain blood cultures as prescribed
    3. CTake the next temperature rectally
    4. DPlace the client in a private room
    5. EWait for a second fever before notifying
    6. FHold antibiotics until the cultures grow

    Answer and explanation in LearnFree account

12. Question 12 · Hard · Matrix

    A client has had a radial arterial line for 2 days. For each finding, indicate whether it requires follow-up or is expected.

    For each row, choose: Requires follow-up / Expected

    1. Mean arterial pressure 78 mm Hg
    2. Blood pooling under the dressing
    3. Flattened waveform with no dicrotic notch
    4. Fingers of that hand cool and pale
    5. Capillary refill of 2 seconds in the fingers

    Answer and explanation in LearnFree account

13. Question 13 · Easy · Select all that apply

    Which findings indicate a full-thickness burn?

    1. ARed skin that blanches with pressure
    2. BLarge fluid-filled blisters
    3. CWhite or charred appearance
    4. DLittle or no pain in the burned area
    5. EDry, leathery surface

    Answer and explanation in LearnFree account

14. Question 14 · Medium · Matrix

    For each cause, indicate which ventilator alarm it is most likely to trigger.

    For each row, choose: High-pressure alarm / Low-pressure or low-volume alarm

    1. Tubing disconnected at the endotracheal tube
    2. Pneumothorax that stiffens the lung
    3. Leak around an underinflated cuff
    4. Client biting the endotracheal tube
    5. Water collected in a kinked circuit
    6. Thick secretions in the airway

    Answer and explanation in LearnFree account

15. Question 15 · Hard · Matrix

    A client receiving IV ceftriaxone develops wheezing, hives and a BP of 80/46 mm Hg. For each action, indicate whether it is indicated or contraindicated.

    For each row, choose: Indicated / Contraindicated

    1. Give epinephrine IM into the outer thigh
    2. Give oral diphenhydramine instead of epinephrine
    3. Lay the client flat with the legs raised
    4. Flush the remaining drug in the tubing into the vein
    5. Stop the ceftriaxone infusion

    Answer and explanation in LearnFree account

16. Question 16 · Medium · Select all that apply

    Which actions help the nurse obtain accurate readings from a pressure-monitoring system?

    1. ARead the value at end-expiration
    2. BLevel the transducer at the phlebostatic axis
    3. CRead the value at peak inspiration
    4. DPerform a square-wave (fast-flush) test
    5. ERaise the transducer above the heart to reduce noise
    6. FZero the transducer to atmospheric pressure

    Answer and explanation in LearnFree account

17. Question 17 · Medium · Select all that apply

    A client has a sealed cervical radiation implant. Which actions should the nurse take?

    1. ALimit each visitor to about 30 minutes a day
    2. BAssign a pregnant nurse who has experience with implants
    3. CUse long forceps and a lead container for a dislodged source
    4. DKeep pregnant visitors out of the room
    5. EPick up a dislodged source with a gloved hand

    Answer and explanation in LearnFree account

18. Question 18 · Hard · Matrix

    For each set of findings, indicate the type of shock it most likely shows.

    For each row, choose: Hypovolaemic / Cardiogenic / Septic

    1. New crackles, S3 and jugular venous distension
    2. CVP 3 mm Hg, cardiac output high, SVR low
    3. CVP 1 mm Hg, cardiac output low, SVR high
    4. Flat neck veins and thirst after a long bowel obstruction
    5. Warm, flushed skin and bounding pulses with fever
    6. PAWP 24 mm Hg, cardiac output low, SVR high

    Answer and explanation in LearnFree account

19. Question 19 · Medium · Select all that apply

    A client with high-grade lymphoma started chemotherapy 2 days ago. Which results suggest tumour lysis syndrome?

    1. ASerum phosphate 7.2 mg/dL
    2. BSerum potassium 6.0 mEq/L
    3. CSerum sodium 128 mEq/L
    4. DUric acid 11 mg/dL
    5. ESerum calcium 7.4 mg/dL
    6. FSerum potassium 3.2 mEq/L

    Answer and explanation in LearnFree account

20. Question 20 · Medium · Select all that apply

    During the acute phase of a 35% TBSA burn, which wound findings suggest infection?

    1. ADry, intact donor-site dressing
    2. BPink, moist granulation tissue
    3. CMild itching of a healing area
    4. DA partial-thickness area has become full-thickness
    5. EGreen, foul-smelling exudate

    Answer and explanation in LearnFree account

21. Question 21 · Medium · Select all that apply

    A client has Clostridioides difficile diarrhoea. Which actions should the nurse take?

    1. AWash hands with soap and water after care
    2. BUse alcohol hand rub as the only hand hygiene
    3. CPlace the client in an airborne isolation room
    4. DClean surfaces with a bleach-based product
    5. EKeep a dedicated stethoscope in the room
    6. FWear a gown and gloves on entering the room

    Answer and explanation in LearnFree account

22. Question 22 · Medium · Select all that apply

    A worker has a dry chemical powder burn on both forearms. Which first-aid actions should the nurse take?

    1. AIrrigate with large amounts of water
    2. BBrush off the dry powder before irrigating
    3. CRemove contaminated clothing and jewellery
    4. DPour vinegar on the skin to neutralise it
    5. EApply ice packs to the forearms

    Answer and explanation in LearnFree account

23. Question 23 · Hard

    On day 3 after a 45% TBSA burn, the client's urine output rises from 50 mL/h to 180 mL/h while the IV rate is unchanged. The nurse should monitor most closely for:

    1. AFluid overload and hypokalemia
    2. BHypernatremia and dehydration
    3. CHypovolemia and hyperkalemia
    4. DHypercalcemia and oliguria

    Answer and explanation in LearnFree account

24. Question 24 · Easy

    Using the rule of nines, an adult with burns covering the whole of both legs, front and back, has burned about what percentage of total body surface area?

    1. A45%
    2. B36%
    3. C18%
    4. D27%

    Answer and explanation in LearnFree account

25. Question 25 · Easy

    A client receiving chemotherapy has an absolute neutrophil count of 400/mm³. Which item should the nurse remove from the room?

    1. AA vase of fresh flowers
    2. BA framed family photograph
    3. CAn electric razor
    4. DA pair of rubber-soled slippers

    Answer and explanation in LearnFree account