NS 681
COMPLETE REVIEW
2026–2027 EDITION
COMPLETE STUDY GUIDE WITH VERIFIED QUESTIONS AND
ANSWERS
✓ 2026–2027 Updated Edition
✓ Complete Review
✓ Comprehensive Questions & Answers
✓ Ideal for Exam Preparation
✓ Organized for Quick Revision
This Document Description:
This document contains a comprehensive collection of practice questions with carefully prepared answers for
NS 681 Complete Review (2026–2027 Edition). It is designed to reinforce essential course concepts, support
structured revision, and help learners prepare confidently for quizzes, examinations, and course assessments.
The content provides broad topic coverage in an organized format, making it an effective resource for
academic review and self-study.
, 1. A 24-year-old female with a history of type 1 diabetes mellitus presents to the emergency
department with vomiting, abdominal pain, and Kussmaul respirations. Her blood glucose is
620 mg/dL, serum pH is 7.15, and her bicarbonate is 8 mEq/L. After initiating intravenous
fluids, the serum potassium level is reported as 3.1 mEq/L. What is the most critical next step
in management?
A. Administering an intravenous bolus of regular insulin.
B. Initiating a continuous intravenous infusion of regular insulin.
C. Administering intravenous potassium replacement therapy.
D. Administering intravenous sodium bicarbonate.
Correct Answer: C
Explanation:
In diabetic ketoacidosis, the absolute insulin deficiency causes severe total-body potassium
depletion due to urinary losses, even if initial serum levels appear normal or high. Once
intravenous insulin therapy is initiated, it drives potassium intracellularly via the Na+/K+-ATPase
pump; therefore, if serum potassium is below 3.3 mEq/L, insulin must be withheld and IV
potassium aggressively replaced to prevent lethal cardiac dysrhythmias.
2. A 45-year-old male with a known history of Addison's disease is brought to the emergency
department unconscious. His family reports he has had a severe gastrointestinal virus for
three days and stopped taking his oral medications. His blood pressure is 78/40 mmHg,
heart rate is 110 bpm, and laboratory results reveal hyponatremia and hyperkalemia. Which
intervention is the highest priority?
A. Administering intravenous hydrocortisone sodium succinate.
B. Administering an intravenous bolus of 50% dextrose.
C. Administering oral fludrocortisone acetate.
D. Administering intravenous potassium chloride.
Correct Answer: A
Explanation:
An Addisonian crisis is an acute life-threatening state of glucocorticoid and mineralocorticoid
deficiency, typically triggered by physical stress such as infection. Immediate intravenous
administration of high-dose hydrocortisone is the definitive treatment to restore systemic
vascular tone, correct electrolyte imbalances, and reverse the hypovolemic shock state, alongside
aggressive isotonic fluid resuscitation.
, 3. A 30-year-old male is actively seizing upon arrival to the emergency department. The seizure
has lasted 8 minutes, and intravenous access has just been successfully established. His
oxygen saturation is 92% on room air, blood pressure is 150/95 mmHg, and heart rate is 120
bpm. What is the first-line pharmacological intervention?
A. Administering intravenous lorazepam 4 mg.
B. Administering intravenous phenytoin 20 mg/kg.
C. Administering intravenous levetiracetam 60 mg/kg.
D. Preparing for rapid sequence intubation.
Correct Answer: A
Explanation:
Status epilepticus is defined as a continuous seizure lasting more than 5 minutes, requiring
immediate pharmacological termination to prevent permanent neuronal damage. Intravenous
lorazepam, a fast-acting benzodiazepine, is the first-line agent; it potentiates GABA-A receptors
to rapidly inhibit neuronal firing and halt the seizure activity, followed by the administration of a
longer-acting antiepileptic like phenytoin.
4. A 55-year-old male with a long history of alcohol abuse presents with massive hematemesis.
His blood pressure is 80/52 mmHg, heart rate is 124 bpm, and he is diaphoretic and
confused. Two large-bore IV catheters are inserted, and fluid resuscitation is initiated. Which
medication should be administered immediately to manage this acute upper gastrointestinal
hemorrhage?
A. Administering an intravenous bolus of octreotide.
B. Administering an intravenous infusion of pantoprazole.
C. Administering intravenous vasopressin.
D. Administering intravenous ceftriaxone.
Correct Answer: A
Explanation:
In acute variceal hemorrhage secondary to portal hypertension, intravenous octreotide acts as a
potent splanchnic vasoconstrictor by inhibiting the release of glucagon and other vasodilatory
peptides. This pharmacologically reduces portal venous inflow and portal pressure, actively
controlling the life-threatening hemorrhage concurrently with emergent endoscopic variceal
ligation or sclerotherapy.
, 5. A 68-year-old patient in the intensive care unit is being mechanically ventilated for acute
respiratory distress syndrome (ARDS). The ventilator settings indicate a tidal volume of 6
mL/kg of predicted body weight and a plateau pressure of 28 cm H2O. Despite an FiO2 of
80%, the patient's PaO2 remains at 55 mmHg. Which ventilator adjustment is required to
optimize oxygenation without causing further lung injury?
A. Increasing the tidal volume to 10 mL/kg.
B. Increasing the positive end-expiratory pressure (PEEP).
C. Increasing the respiratory rate to 35 breaths per minute.
D. Disconnecting the ventilator to manually bag the patient.
Correct Answer: B
Explanation:
In ARDS, low tidal volume ventilation is strictly maintained to prevent volutrauma and
barotrauma; thus, increasing tidal volume is contraindicated. To improve oxygenation without
increasing plateau pressure above the safe threshold of 30 cm H2O, positive end-expiratory
pressure (PEEP) must be carefully titrated upward to splint collapsed alveoli open, increasing
functional residual capacity and improving ventilation-perfusion matching.
6. A 28-year-old male is brought to the emergency department by police, exhibiting extreme
agitation, diaphoresis, and aggressive behavior. His vital signs are: blood pressure 210/120
mmHg, heart rate 142 bpm, temperature 103°F (39.4°C), and pupils are widely dilated. The
patient admits to ingesting an unknown substance obtained at a nightclub. What is the most
appropriate pharmacological intervention?
A. Administering intravenous naloxone.
B. Administering intravenous lorazepam.
C. Administering intravenous propranolol.
D. Administering intravenous flumazenil.
Correct Answer: B
Explanation:
The patient's presentation of severe sympathomimetic toxicity, likely from cocaine or
amphetamines, requires immediate administration of high-dose intravenous benzodiazepines.
Lorazepam acts as a GABA-A agonist to provide sedation, reduce sympathetically driven
tachycardia and hypertension, and lower body temperature, while pure beta-blockers like
propranolol are strictly contraindicated due to the risk of unopposed alpha-adrenergic
stimulation leading to paradoxical worsening of hypertension.
COMPLETE REVIEW
2026–2027 EDITION
COMPLETE STUDY GUIDE WITH VERIFIED QUESTIONS AND
ANSWERS
✓ 2026–2027 Updated Edition
✓ Complete Review
✓ Comprehensive Questions & Answers
✓ Ideal for Exam Preparation
✓ Organized for Quick Revision
This Document Description:
This document contains a comprehensive collection of practice questions with carefully prepared answers for
NS 681 Complete Review (2026–2027 Edition). It is designed to reinforce essential course concepts, support
structured revision, and help learners prepare confidently for quizzes, examinations, and course assessments.
The content provides broad topic coverage in an organized format, making it an effective resource for
academic review and self-study.
, 1. A 24-year-old female with a history of type 1 diabetes mellitus presents to the emergency
department with vomiting, abdominal pain, and Kussmaul respirations. Her blood glucose is
620 mg/dL, serum pH is 7.15, and her bicarbonate is 8 mEq/L. After initiating intravenous
fluids, the serum potassium level is reported as 3.1 mEq/L. What is the most critical next step
in management?
A. Administering an intravenous bolus of regular insulin.
B. Initiating a continuous intravenous infusion of regular insulin.
C. Administering intravenous potassium replacement therapy.
D. Administering intravenous sodium bicarbonate.
Correct Answer: C
Explanation:
In diabetic ketoacidosis, the absolute insulin deficiency causes severe total-body potassium
depletion due to urinary losses, even if initial serum levels appear normal or high. Once
intravenous insulin therapy is initiated, it drives potassium intracellularly via the Na+/K+-ATPase
pump; therefore, if serum potassium is below 3.3 mEq/L, insulin must be withheld and IV
potassium aggressively replaced to prevent lethal cardiac dysrhythmias.
2. A 45-year-old male with a known history of Addison's disease is brought to the emergency
department unconscious. His family reports he has had a severe gastrointestinal virus for
three days and stopped taking his oral medications. His blood pressure is 78/40 mmHg,
heart rate is 110 bpm, and laboratory results reveal hyponatremia and hyperkalemia. Which
intervention is the highest priority?
A. Administering intravenous hydrocortisone sodium succinate.
B. Administering an intravenous bolus of 50% dextrose.
C. Administering oral fludrocortisone acetate.
D. Administering intravenous potassium chloride.
Correct Answer: A
Explanation:
An Addisonian crisis is an acute life-threatening state of glucocorticoid and mineralocorticoid
deficiency, typically triggered by physical stress such as infection. Immediate intravenous
administration of high-dose hydrocortisone is the definitive treatment to restore systemic
vascular tone, correct electrolyte imbalances, and reverse the hypovolemic shock state, alongside
aggressive isotonic fluid resuscitation.
, 3. A 30-year-old male is actively seizing upon arrival to the emergency department. The seizure
has lasted 8 minutes, and intravenous access has just been successfully established. His
oxygen saturation is 92% on room air, blood pressure is 150/95 mmHg, and heart rate is 120
bpm. What is the first-line pharmacological intervention?
A. Administering intravenous lorazepam 4 mg.
B. Administering intravenous phenytoin 20 mg/kg.
C. Administering intravenous levetiracetam 60 mg/kg.
D. Preparing for rapid sequence intubation.
Correct Answer: A
Explanation:
Status epilepticus is defined as a continuous seizure lasting more than 5 minutes, requiring
immediate pharmacological termination to prevent permanent neuronal damage. Intravenous
lorazepam, a fast-acting benzodiazepine, is the first-line agent; it potentiates GABA-A receptors
to rapidly inhibit neuronal firing and halt the seizure activity, followed by the administration of a
longer-acting antiepileptic like phenytoin.
4. A 55-year-old male with a long history of alcohol abuse presents with massive hematemesis.
His blood pressure is 80/52 mmHg, heart rate is 124 bpm, and he is diaphoretic and
confused. Two large-bore IV catheters are inserted, and fluid resuscitation is initiated. Which
medication should be administered immediately to manage this acute upper gastrointestinal
hemorrhage?
A. Administering an intravenous bolus of octreotide.
B. Administering an intravenous infusion of pantoprazole.
C. Administering intravenous vasopressin.
D. Administering intravenous ceftriaxone.
Correct Answer: A
Explanation:
In acute variceal hemorrhage secondary to portal hypertension, intravenous octreotide acts as a
potent splanchnic vasoconstrictor by inhibiting the release of glucagon and other vasodilatory
peptides. This pharmacologically reduces portal venous inflow and portal pressure, actively
controlling the life-threatening hemorrhage concurrently with emergent endoscopic variceal
ligation or sclerotherapy.
, 5. A 68-year-old patient in the intensive care unit is being mechanically ventilated for acute
respiratory distress syndrome (ARDS). The ventilator settings indicate a tidal volume of 6
mL/kg of predicted body weight and a plateau pressure of 28 cm H2O. Despite an FiO2 of
80%, the patient's PaO2 remains at 55 mmHg. Which ventilator adjustment is required to
optimize oxygenation without causing further lung injury?
A. Increasing the tidal volume to 10 mL/kg.
B. Increasing the positive end-expiratory pressure (PEEP).
C. Increasing the respiratory rate to 35 breaths per minute.
D. Disconnecting the ventilator to manually bag the patient.
Correct Answer: B
Explanation:
In ARDS, low tidal volume ventilation is strictly maintained to prevent volutrauma and
barotrauma; thus, increasing tidal volume is contraindicated. To improve oxygenation without
increasing plateau pressure above the safe threshold of 30 cm H2O, positive end-expiratory
pressure (PEEP) must be carefully titrated upward to splint collapsed alveoli open, increasing
functional residual capacity and improving ventilation-perfusion matching.
6. A 28-year-old male is brought to the emergency department by police, exhibiting extreme
agitation, diaphoresis, and aggressive behavior. His vital signs are: blood pressure 210/120
mmHg, heart rate 142 bpm, temperature 103°F (39.4°C), and pupils are widely dilated. The
patient admits to ingesting an unknown substance obtained at a nightclub. What is the most
appropriate pharmacological intervention?
A. Administering intravenous naloxone.
B. Administering intravenous lorazepam.
C. Administering intravenous propranolol.
D. Administering intravenous flumazenil.
Correct Answer: B
Explanation:
The patient's presentation of severe sympathomimetic toxicity, likely from cocaine or
amphetamines, requires immediate administration of high-dose intravenous benzodiazepines.
Lorazepam acts as a GABA-A agonist to provide sedation, reduce sympathetically driven
tachycardia and hypertension, and lower body temperature, while pure beta-blockers like
propranolol are strictly contraindicated due to the risk of unopposed alpha-adrenergic
stimulation leading to paradoxical worsening of hypertension.
