BSN445: CONCEPTS OF NURSING IN THE
COMPLEX PATIENT
Comprehensive Final Exam, Study Guide, Review &
Exam Bundle (200+ Questions, Verified Answers &
Rationales) 2026/2027 Updated for Guaranteed Pass
Already Graded A+
Term: 2026-3 (Final Term — December 11, 2026)
Level: BSN (Bachelor of Science in Nursing) - Advanced Medical-
Surgical / Complex Care
========================================
TABLE OF CONTENTS
========================================
1. Study Guide
- Multisystem Organ Failure (MSOF)
- Shock States (Hypovolemic, Cardiogenic, Distributive, Obstructive)
- Sepsis and Septic Shock (SIRS, qSOFA, SOFA, Surviving Sepsis
Campaign)
- Acute Respiratory Distress Syndrome (ARDS)
- Mechanical Ventilation (Settings, Modes, Complications, Weaning)
,
- Acute Kidney Injury (AKI) and Renal Replacement Therapy (CRRT,
HD, PD)
- Hepatic Failure (Cirrhosis, Hepatic Encephalopathy, Variceal
Bleeding)
- Coagulopathies (DIC, TTP, HIT)
- Complex Wound Care (Pressure Injuries, Surgical Wounds, Negative
Pressure Therapy)
- Neurocritical Care (Increased Intracranial Pressure, Stroke, Seizures,
Traumatic Brain Injury)
- Cardiac Critical Care (Acute Coronary Syndrome, Heart Failure,
Arrhythmias, Post-Cardiac Arrest Care)
- End-of-Life Care in the Complex Patient (Withdrawal of Life
Support, Palliative Sedation, Organ Donation)
2. Review Sheets (High-Yield Tables and Mnemonics)
3. Practice Exam with Rationales (200+ Questions)
- Part A: Multiple Choice (120 questions)
- Part B: Multiple Answer / SATA (80 questions)
========================================
SECTION 1: STUDY GUIDE
========================================
1.1 Multisystem Organ Failure (MSOF)
,
Definition: Progressive dysfunction of two or more organ systems in a
critically ill patient, often due to sepsis, shock, trauma, or burns.
Pathophysiology:
- Systemic inflammatory response syndrome (SIRS) → endothelial
injury → increased capillary permeability → tissue edema → impaired
oxygen delivery → cellular dysfunction → organ failure
- Ischemia-reperfusion injury
- Mitochondrial dysfunction
- Microvascular thrombosis (DIC)
Sequential Organ Failure Assessment (SOFA) Score:
| System | Parameter | Score 0 | Score 1 | Score 2 | Score 3 | Score 4 |
|--------|-----------|---------|---------|---------|---------|---------|
| Respiratory | PaO2/FiO2 (mmHg) | >400 | ≤400 | ≤300 | ≤200 (with
respiratory support) | ≤100 (with respiratory support) |
| Coagulation | Platelets (x10³/µL) | >150 | ≤150 | ≤100 | ≤50 | ≤20 |
| Liver | Bilirubin (mg/dL) | <1.2 | 1.2-1.9 | 2.0-5.9 | 6.0-11.9 | >12.0 |
| Cardiovascular | MAP or vasopressors | MAP ≥70 | MAP <70 |
Dopamine ≤5 or Dobutamine (any) | Dopamine >5 or Epi ≤0.1 or Norepi
≤0.1 | Dopamine >15 or Epi >0.1 or Norepi >0.1 |
| CNS | Glasgow Coma Scale (GCS) | 15 | 13-14 | 10-12 | 6-9 | <6 |
| Renal | Creatinine (mg/dL) or urine output | <1.2 | 1.2-1.9 | 2.0-3.4 | 3.5-
4.9 or <500 mL/day | >5.0 or <200 mL/day |
,
qSOFA (Quick SOFA) for bedside identification of suspected sepsis (2 or
more = high risk):
- Respiratory rate ≥22 breaths/min
- Altered mental status (GCS <15)
- Systolic blood pressure ≤100 mmHg
1.2 Shock States
Definition: Shock is a life-threatening condition of inadequate cellular
oxygen delivery.
Types of Shock:
| Type | Cause | Hemodynamics | Key Interventions |
|------|-------|--------------|-------------------|
| Hypovolemic | Hemorrhage, dehydration, burns, vomiting, diarrhea,
third spacing | CO ↓, SVR ↑, PCWP ↓ | Fluid resuscitation (NS, LR,
blood products), identify source of loss, vasopressors (if fluid refractory)
|
| Cardiogenic | Myocardial infarction, heart failure, arrhythmias,
cardiomyopathy, valve disease | CO ↓, SVR ↑, PCWP ↑ | Inotropes
(dobutamine, milrinone), vasopressors (norepinephrine),
revascularization (PCI, CABG), IABP, LVAD |
| Distributive (Septic) | Sepsis, anaphylaxis, neurogenic (spinal cord
injury) | CO ↑ (early septic), SVR ↓, PCWP ↓ | Fluids, vasopressors
COMPLEX PATIENT
Comprehensive Final Exam, Study Guide, Review &
Exam Bundle (200+ Questions, Verified Answers &
Rationales) 2026/2027 Updated for Guaranteed Pass
Already Graded A+
Term: 2026-3 (Final Term — December 11, 2026)
Level: BSN (Bachelor of Science in Nursing) - Advanced Medical-
Surgical / Complex Care
========================================
TABLE OF CONTENTS
========================================
1. Study Guide
- Multisystem Organ Failure (MSOF)
- Shock States (Hypovolemic, Cardiogenic, Distributive, Obstructive)
- Sepsis and Septic Shock (SIRS, qSOFA, SOFA, Surviving Sepsis
Campaign)
- Acute Respiratory Distress Syndrome (ARDS)
- Mechanical Ventilation (Settings, Modes, Complications, Weaning)
,
- Acute Kidney Injury (AKI) and Renal Replacement Therapy (CRRT,
HD, PD)
- Hepatic Failure (Cirrhosis, Hepatic Encephalopathy, Variceal
Bleeding)
- Coagulopathies (DIC, TTP, HIT)
- Complex Wound Care (Pressure Injuries, Surgical Wounds, Negative
Pressure Therapy)
- Neurocritical Care (Increased Intracranial Pressure, Stroke, Seizures,
Traumatic Brain Injury)
- Cardiac Critical Care (Acute Coronary Syndrome, Heart Failure,
Arrhythmias, Post-Cardiac Arrest Care)
- End-of-Life Care in the Complex Patient (Withdrawal of Life
Support, Palliative Sedation, Organ Donation)
2. Review Sheets (High-Yield Tables and Mnemonics)
3. Practice Exam with Rationales (200+ Questions)
- Part A: Multiple Choice (120 questions)
- Part B: Multiple Answer / SATA (80 questions)
========================================
SECTION 1: STUDY GUIDE
========================================
1.1 Multisystem Organ Failure (MSOF)
,
Definition: Progressive dysfunction of two or more organ systems in a
critically ill patient, often due to sepsis, shock, trauma, or burns.
Pathophysiology:
- Systemic inflammatory response syndrome (SIRS) → endothelial
injury → increased capillary permeability → tissue edema → impaired
oxygen delivery → cellular dysfunction → organ failure
- Ischemia-reperfusion injury
- Mitochondrial dysfunction
- Microvascular thrombosis (DIC)
Sequential Organ Failure Assessment (SOFA) Score:
| System | Parameter | Score 0 | Score 1 | Score 2 | Score 3 | Score 4 |
|--------|-----------|---------|---------|---------|---------|---------|
| Respiratory | PaO2/FiO2 (mmHg) | >400 | ≤400 | ≤300 | ≤200 (with
respiratory support) | ≤100 (with respiratory support) |
| Coagulation | Platelets (x10³/µL) | >150 | ≤150 | ≤100 | ≤50 | ≤20 |
| Liver | Bilirubin (mg/dL) | <1.2 | 1.2-1.9 | 2.0-5.9 | 6.0-11.9 | >12.0 |
| Cardiovascular | MAP or vasopressors | MAP ≥70 | MAP <70 |
Dopamine ≤5 or Dobutamine (any) | Dopamine >5 or Epi ≤0.1 or Norepi
≤0.1 | Dopamine >15 or Epi >0.1 or Norepi >0.1 |
| CNS | Glasgow Coma Scale (GCS) | 15 | 13-14 | 10-12 | 6-9 | <6 |
| Renal | Creatinine (mg/dL) or urine output | <1.2 | 1.2-1.9 | 2.0-3.4 | 3.5-
4.9 or <500 mL/day | >5.0 or <200 mL/day |
,
qSOFA (Quick SOFA) for bedside identification of suspected sepsis (2 or
more = high risk):
- Respiratory rate ≥22 breaths/min
- Altered mental status (GCS <15)
- Systolic blood pressure ≤100 mmHg
1.2 Shock States
Definition: Shock is a life-threatening condition of inadequate cellular
oxygen delivery.
Types of Shock:
| Type | Cause | Hemodynamics | Key Interventions |
|------|-------|--------------|-------------------|
| Hypovolemic | Hemorrhage, dehydration, burns, vomiting, diarrhea,
third spacing | CO ↓, SVR ↑, PCWP ↓ | Fluid resuscitation (NS, LR,
blood products), identify source of loss, vasopressors (if fluid refractory)
|
| Cardiogenic | Myocardial infarction, heart failure, arrhythmias,
cardiomyopathy, valve disease | CO ↓, SVR ↑, PCWP ↑ | Inotropes
(dobutamine, milrinone), vasopressors (norepinephrine),
revascularization (PCI, CABG), IABP, LVAD |
| Distributive (Septic) | Sepsis, anaphylaxis, neurogenic (spinal cord
injury) | CO ↑ (early septic), SVR ↓, PCWP ↓ | Fluids, vasopressors
