NURS 4581 NURSING OF ADULTS WITH
COMPLEX NEEDS. EXAM QUESTIONS
AND ANSWERS
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is on mechanical ventilation
with high PEEP. The nurse notes a sudden drop in blood pressure and decreased breath
sounds on the right side. What is the priority action?
A. Increase the FiO2 to 100%
B. Prepare for needle decompression or chest tube insertion
C. Suction the patient to clear mucus plugs
D. Perform an arterial blood gas (ABG) analysis
Answer: B
Conceptual Explanation: High PEEP increases the risk of barotrauma, leading to tension
pneumothorax. A sudden drop in BP and unilateral decreased breath sounds are classic
signs requiring immediate decompression.
2. Which hemodynamic finding is most consistent with a diagnosis of Cardiogenic Shock?
A. Increased Cardiac Output and decreased PAWP
B. Decreased Systemic Vascular Resistance (SVR) and increased CO
,C. Decreased Cardiac Index and increased Pulmonary Artery Wedge Pressure (PAWP)
D. Decreased Central Venous Pressure (CVP) and increased Cardiac Output
Answer: C
Conceptual Explanation: Cardiogenic shock is characterized by pump failure, leading to a
low cardiac index and high filling pressures (PAWP) due to blood backing up into the lungs.
3. A patient in the ICU develops Disseminated Intravascular Coagulation (DIC). Which
laboratory result would the nurse expect to find?
A. Shortened Prothrombin Time (PT)
B. Increased Fibrinogen levels
C. Decreased D-dimer levels
D. Prolonged Partial Thromboplastin Time (PTT)
Answer: D
Conceptual Explanation: DIC involves the consumption of clotting factors, leading to
prolonged PT/PTT and elevated D-dimer levels as clots are broken down.
4. A patient with a T6 spinal cord injury reports a severe pounding headache and has a blood
pressure of 210/110. What is the nurse’s first intervention?
A. Assess the patient for bladder distention
B. Administer prescribed PRN Nifedipine
C. Place the patient in a supine position
, D. Notify the physician immediately
Answer: A
Conceptual Explanation: These are signs of Autonomic Dysreflexia. The priority is to
remove the triggering stimulus, most commonly a distended bladder or impacted bowel,
while sitting the patient up.
5. In the management of DKA, when blood glucose levels reach 250 mg/dL, the nurse should
anticipate which change in IV fluids?
A. Discontinuing insulin infusion
B. Adding 5% Dextrose to the IV solution
C. Switching to Normal Saline only
D. Increasing the rate of Normal Saline
Answer: B
Conceptual Explanation: Adding dextrose prevents hypoglycemia and cerebral edema as
blood sugar drops rapidly during insulin therapy for DKA.
6. A patient with Acute Kidney Injury (AKI) has a potassium level of 6.8 mEq/L and ECG
changes (peaked T waves). Which medication is given first to protect the heart?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Calcium Gluconate
C. IV Regular Insulin and Dextrose
COMPLEX NEEDS. EXAM QUESTIONS
AND ANSWERS
1. A patient with Acute Respiratory Distress Syndrome (ARDS) is on mechanical ventilation
with high PEEP. The nurse notes a sudden drop in blood pressure and decreased breath
sounds on the right side. What is the priority action?
A. Increase the FiO2 to 100%
B. Prepare for needle decompression or chest tube insertion
C. Suction the patient to clear mucus plugs
D. Perform an arterial blood gas (ABG) analysis
Answer: B
Conceptual Explanation: High PEEP increases the risk of barotrauma, leading to tension
pneumothorax. A sudden drop in BP and unilateral decreased breath sounds are classic
signs requiring immediate decompression.
2. Which hemodynamic finding is most consistent with a diagnosis of Cardiogenic Shock?
A. Increased Cardiac Output and decreased PAWP
B. Decreased Systemic Vascular Resistance (SVR) and increased CO
,C. Decreased Cardiac Index and increased Pulmonary Artery Wedge Pressure (PAWP)
D. Decreased Central Venous Pressure (CVP) and increased Cardiac Output
Answer: C
Conceptual Explanation: Cardiogenic shock is characterized by pump failure, leading to a
low cardiac index and high filling pressures (PAWP) due to blood backing up into the lungs.
3. A patient in the ICU develops Disseminated Intravascular Coagulation (DIC). Which
laboratory result would the nurse expect to find?
A. Shortened Prothrombin Time (PT)
B. Increased Fibrinogen levels
C. Decreased D-dimer levels
D. Prolonged Partial Thromboplastin Time (PTT)
Answer: D
Conceptual Explanation: DIC involves the consumption of clotting factors, leading to
prolonged PT/PTT and elevated D-dimer levels as clots are broken down.
4. A patient with a T6 spinal cord injury reports a severe pounding headache and has a blood
pressure of 210/110. What is the nurse’s first intervention?
A. Assess the patient for bladder distention
B. Administer prescribed PRN Nifedipine
C. Place the patient in a supine position
, D. Notify the physician immediately
Answer: A
Conceptual Explanation: These are signs of Autonomic Dysreflexia. The priority is to
remove the triggering stimulus, most commonly a distended bladder or impacted bowel,
while sitting the patient up.
5. In the management of DKA, when blood glucose levels reach 250 mg/dL, the nurse should
anticipate which change in IV fluids?
A. Discontinuing insulin infusion
B. Adding 5% Dextrose to the IV solution
C. Switching to Normal Saline only
D. Increasing the rate of Normal Saline
Answer: B
Conceptual Explanation: Adding dextrose prevents hypoglycemia and cerebral edema as
blood sugar drops rapidly during insulin therapy for DKA.
6. A patient with Acute Kidney Injury (AKI) has a potassium level of 6.8 mEq/L and ECG
changes (peaked T waves). Which medication is given first to protect the heart?
A. Sodium Polystyrene Sulfonate (Kayexalate)
B. Calcium Gluconate
C. IV Regular Insulin and Dextrose
