NURS 4581 EXAM 1 - HIGH ACUITY AND
COMPLEX HEALTH NEEDS QUESTIONS
AND ANSWERS
1. A patient’s arterial blood gas (ABG) results are as follows: pH 7.28, PaCO2 58 mmHg, HCO3
26 mEq/L. Which of the following is the correct interpretation?
A. Compensated Respiratory Acidosis
B. Uncompensated Respiratory Acidosis
C. Partially Compensated Metabolic Acidosis
D. Uncompensated Metabolic Alkalosis
Answer: B
Conceptual Explanation: The pH is low (<7.35) indicating acidosis. The PaCO2 is high
(>45) indicating a respiratory cause. The HCO3 is within the normal range (22-26),
meaning no compensation has occurred yet.
,2. A patient in the ICU is being monitored for shock. The nurse notes a Cardiac Index (CI) of
1.8 L/min/m2 and a Pulmonary Capillary Wedge Pressure (PCWP) of 22 mmHg. Which type of
shock is most likely?
A. Cardiogenic Shock
B. Septic Shock
C. Hypovolemic Shock
D. Anaphylactic Shock
Answer: A
Conceptual Explanation: Cardiogenic shock is characterized by a low Cardiac Index (<2.2)
and elevated filling pressures like PCWP (>18 mmHg) due to pump failure.
3. When managing a patient with Acute Respiratory Distress Syndrome (ARDS), which
ventilator setting is prioritized to prevent Volutrauma?
A. High Tidal Volumes
B. High FiO2 (>90%)
C. Low PEEP
D. Low Tidal Volumes (6 mL/kg)
Answer: D
Conceptual Explanation: Low tidal volume ventilation (lung-protective strategy) is the
gold standard for ARDS to prevent overdistension of alveoli and further lung injury.
, 4. A patient presents with a blood pressure of 80/50 mmHg, a heart rate of 120 bpm, and a
Central Venous Pressure (CVP) of 1 mmHg. What is the priority intervention?
A. Start a Norepinephrine infusion
B. Administer a 500 mL bolus of Isotonic Crystalloid
C. Administer Furosemide 40mg IV
D. Prepare for immediate intubation
Answer: B
Conceptual Explanation: The low CVP (<2 mmHg) and hypotension indicate hypovolemia.
Fluid resuscitation is the first-line treatment to restore volume.
5. Which of the following is a classic sign of Cushing’s Triad, indicating increased intracranial
pressure (ICP)?
A. Tachycardia, Hypotension, and Tachypnea
B. Tachycardia, Hypertension, and Kussmaul respirations
C. Bradycardia, Hypotension, and Bradypnea
D. Bradycardia, Hypertension with widening pulse pressure, and irregular respirations
Answer: D
Conceptual Explanation: Cushing’s Triad is a late sign of increased ICP and consists of
bradycardia, hypertension (widened pulse pressure), and irregular respiratory patterns.
COMPLEX HEALTH NEEDS QUESTIONS
AND ANSWERS
1. A patient’s arterial blood gas (ABG) results are as follows: pH 7.28, PaCO2 58 mmHg, HCO3
26 mEq/L. Which of the following is the correct interpretation?
A. Compensated Respiratory Acidosis
B. Uncompensated Respiratory Acidosis
C. Partially Compensated Metabolic Acidosis
D. Uncompensated Metabolic Alkalosis
Answer: B
Conceptual Explanation: The pH is low (<7.35) indicating acidosis. The PaCO2 is high
(>45) indicating a respiratory cause. The HCO3 is within the normal range (22-26),
meaning no compensation has occurred yet.
,2. A patient in the ICU is being monitored for shock. The nurse notes a Cardiac Index (CI) of
1.8 L/min/m2 and a Pulmonary Capillary Wedge Pressure (PCWP) of 22 mmHg. Which type of
shock is most likely?
A. Cardiogenic Shock
B. Septic Shock
C. Hypovolemic Shock
D. Anaphylactic Shock
Answer: A
Conceptual Explanation: Cardiogenic shock is characterized by a low Cardiac Index (<2.2)
and elevated filling pressures like PCWP (>18 mmHg) due to pump failure.
3. When managing a patient with Acute Respiratory Distress Syndrome (ARDS), which
ventilator setting is prioritized to prevent Volutrauma?
A. High Tidal Volumes
B. High FiO2 (>90%)
C. Low PEEP
D. Low Tidal Volumes (6 mL/kg)
Answer: D
Conceptual Explanation: Low tidal volume ventilation (lung-protective strategy) is the
gold standard for ARDS to prevent overdistension of alveoli and further lung injury.
, 4. A patient presents with a blood pressure of 80/50 mmHg, a heart rate of 120 bpm, and a
Central Venous Pressure (CVP) of 1 mmHg. What is the priority intervention?
A. Start a Norepinephrine infusion
B. Administer a 500 mL bolus of Isotonic Crystalloid
C. Administer Furosemide 40mg IV
D. Prepare for immediate intubation
Answer: B
Conceptual Explanation: The low CVP (<2 mmHg) and hypotension indicate hypovolemia.
Fluid resuscitation is the first-line treatment to restore volume.
5. Which of the following is a classic sign of Cushing’s Triad, indicating increased intracranial
pressure (ICP)?
A. Tachycardia, Hypotension, and Tachypnea
B. Tachycardia, Hypertension, and Kussmaul respirations
C. Bradycardia, Hypotension, and Bradypnea
D. Bradycardia, Hypertension with widening pulse pressure, and irregular respirations
Answer: D
Conceptual Explanation: Cushing’s Triad is a late sign of increased ICP and consists of
bradycardia, hypertension (widened pulse pressure), and irregular respiratory patterns.
