ACUTE CARE NURSING THEORY 3
Comprehensive Examination – 75 Questions
Covering Complex Multi-System Disorders in Acute Care
�OVERVIEW
Section Topic Focus Questions
1 Neurologic Disorders (CVA/Neuro, SIADH, Diabetes Insipidus) 15
2 Endocrine Disorders (Addison's, Diabetes, Thyroid) 15
3 Respiratory Disorders (COPD, Asthma, Oxygenation) 15
4 Cardiovascular Disorders (Arrhythmias, Perfusion, Clotting) 15
5 Fluid, Electrolytes, and Renal Disorders 10
6 Gastrointestinal and Burns 5
TOTAL 75 Questions
SECTION 1: NEUROLOGIC DISORDERS
,Questions 1-15
1. The nurse is assessing a patient with Syndrome of Inappropriate
Antidiuretic Hormone (SIADH). Which laboratory finding is most
characteristic?
A) Hyponatremia and concentrated urine
B) Hypernatremia and dilute urine
C) Hypokalemia and metabolic alkalosis
D) Hypercalcemia and polyuria
Answer: A
Rationale: SIADH causes excessive ADH release, leading to water retention
and dilutional hyponatremia. Urine is inappropriately concentrated (high
specific gravity) despite low serum sodium. Option B describes diabetes
insipidus. Options C and D are not characteristic of SIADH .
Cognitive Level: Remembering
Nursing Process: Assessment
2. A patient with diabetes insipidus has a urine output of 400 mL/hr for
3 consecutive hours. Which assessment finding is most important for the
nurse to monitor?
A) Serum sodium and level of consciousness
B) Blood glucose and ketones
C) Serum potassium and cardiac rhythm
D) Temperature and white blood cell count
Answer: A
Rationale: Diabetes insipidus causes massive fluid loss, leading to
hypernatremia and hyperosmolality. The most immediate risks are neurologic
changes from hypernatremia (confusion, seizures, coma). Serum sodium and
,LOC must be monitored closely. Potassium (C) may be affected but is not the
priority .
Cognitive Level: Analyzing
Nursing Process: Assessment
3. The nurse is caring for a patient 2 hours after onset of ischemic stroke.
The patient's blood pressure is 210/110 mm Hg. Which action should
the nurse take first?
A) Administer IV antihypertensive medication
B) Notify the healthcare provider
C) Recheck blood pressure in 15 minutes
D) Lower head of bed flat
Answer: C
Rationale: In acute ischemic stroke, elevated blood pressure may be
necessary to maintain cerebral perfusion. Guidelines recommend monitoring
and rechecking before intervention unless BP is >220/120 or there is
evidence of end-organ damage. Rapid lowering can worsen ischemia. Option D
would increase ICP .
Cognitive Level: Applying
Nursing Process: Implementation
4. The nurse is assessing a patient with Guillain-Barré syndrome. Which
finding requires immediate action?
A) Weakness in the lower extremities
B) Decreased vital capacity and inability to cough effectively
C) Absent deep tendon reflexes
D) Paresthesia in the feet
Answer: B
, Rationale: Guillain-Barré causes ascending paralysis that can rapidly
progress to respiratory failure. Decreasing vital capacity and ineffective cough
indicate impending respiratory failure requiring intubation. Extremity
weakness (A), areflexia (C), and paresthesia (D) are expected findings .
Cognitive Level: Analyzing
Nursing Process: Assessment
5. The nurse is administering mannitol to a patient with increased
intracranial pressure. Which assessment finding indicates therapeutic
effect?
A) Increased urine output and decreased ICP
B) Decreased urine output and increased blood pressure
C) Increased serum sodium and decreased LOC
D) Decreased heart rate and increased respiratory rate
Answer: A
Rationale: Mannitol is an osmotic diuretic that reduces ICP by drawing fluid
from brain tissue into the vasculature, then excreting it. Increased urine
output and decreased ICP indicate therapeutic effect. Option B suggests
inadequate response. Option C indicates hypernatremia, a potential adverse
effect .
Cognitive Level: Evaluating
Nursing Process: Evaluation
6. The nurse is caring for a patient with myasthenia gravis who is
experiencing respiratory distress. Which medication should the nurse
anticipate administering?
A) Atropine
B) Edrophonium (Tensilon)
Comprehensive Examination – 75 Questions
Covering Complex Multi-System Disorders in Acute Care
�OVERVIEW
Section Topic Focus Questions
1 Neurologic Disorders (CVA/Neuro, SIADH, Diabetes Insipidus) 15
2 Endocrine Disorders (Addison's, Diabetes, Thyroid) 15
3 Respiratory Disorders (COPD, Asthma, Oxygenation) 15
4 Cardiovascular Disorders (Arrhythmias, Perfusion, Clotting) 15
5 Fluid, Electrolytes, and Renal Disorders 10
6 Gastrointestinal and Burns 5
TOTAL 75 Questions
SECTION 1: NEUROLOGIC DISORDERS
,Questions 1-15
1. The nurse is assessing a patient with Syndrome of Inappropriate
Antidiuretic Hormone (SIADH). Which laboratory finding is most
characteristic?
A) Hyponatremia and concentrated urine
B) Hypernatremia and dilute urine
C) Hypokalemia and metabolic alkalosis
D) Hypercalcemia and polyuria
Answer: A
Rationale: SIADH causes excessive ADH release, leading to water retention
and dilutional hyponatremia. Urine is inappropriately concentrated (high
specific gravity) despite low serum sodium. Option B describes diabetes
insipidus. Options C and D are not characteristic of SIADH .
Cognitive Level: Remembering
Nursing Process: Assessment
2. A patient with diabetes insipidus has a urine output of 400 mL/hr for
3 consecutive hours. Which assessment finding is most important for the
nurse to monitor?
A) Serum sodium and level of consciousness
B) Blood glucose and ketones
C) Serum potassium and cardiac rhythm
D) Temperature and white blood cell count
Answer: A
Rationale: Diabetes insipidus causes massive fluid loss, leading to
hypernatremia and hyperosmolality. The most immediate risks are neurologic
changes from hypernatremia (confusion, seizures, coma). Serum sodium and
,LOC must be monitored closely. Potassium (C) may be affected but is not the
priority .
Cognitive Level: Analyzing
Nursing Process: Assessment
3. The nurse is caring for a patient 2 hours after onset of ischemic stroke.
The patient's blood pressure is 210/110 mm Hg. Which action should
the nurse take first?
A) Administer IV antihypertensive medication
B) Notify the healthcare provider
C) Recheck blood pressure in 15 minutes
D) Lower head of bed flat
Answer: C
Rationale: In acute ischemic stroke, elevated blood pressure may be
necessary to maintain cerebral perfusion. Guidelines recommend monitoring
and rechecking before intervention unless BP is >220/120 or there is
evidence of end-organ damage. Rapid lowering can worsen ischemia. Option D
would increase ICP .
Cognitive Level: Applying
Nursing Process: Implementation
4. The nurse is assessing a patient with Guillain-Barré syndrome. Which
finding requires immediate action?
A) Weakness in the lower extremities
B) Decreased vital capacity and inability to cough effectively
C) Absent deep tendon reflexes
D) Paresthesia in the feet
Answer: B
, Rationale: Guillain-Barré causes ascending paralysis that can rapidly
progress to respiratory failure. Decreasing vital capacity and ineffective cough
indicate impending respiratory failure requiring intubation. Extremity
weakness (A), areflexia (C), and paresthesia (D) are expected findings .
Cognitive Level: Analyzing
Nursing Process: Assessment
5. The nurse is administering mannitol to a patient with increased
intracranial pressure. Which assessment finding indicates therapeutic
effect?
A) Increased urine output and decreased ICP
B) Decreased urine output and increased blood pressure
C) Increased serum sodium and decreased LOC
D) Decreased heart rate and increased respiratory rate
Answer: A
Rationale: Mannitol is an osmotic diuretic that reduces ICP by drawing fluid
from brain tissue into the vasculature, then excreting it. Increased urine
output and decreased ICP indicate therapeutic effect. Option B suggests
inadequate response. Option C indicates hypernatremia, a potential adverse
effect .
Cognitive Level: Evaluating
Nursing Process: Evaluation
6. The nurse is caring for a patient with myasthenia gravis who is
experiencing respiratory distress. Which medication should the nurse
anticipate administering?
A) Atropine
B) Edrophonium (Tensilon)
