WSCC MEDSURG 2 EXAM 2 COMPREHENSIVE
TEST BANK - ADVANCED CRITICAL CARE
QUESTIONS, ANSWERS AND DETAILED
RATIONALES
This premium, high-yield study bank features
rigorous multiple-choice questions meticulously
aligned with advanced medical-surgical nursing
concepts, hemodynamic monitoring, complex
dysrhythmias, and multi-organ failure. Every single
question delivers immediate correct answers paired
with deep, bold-italicized rationales to reinforce
complex pathophysiological mechanisms and nursing
interventions. It is the ultimate diagnostic resource
designed to help nursing students master tough
critical care concepts, elevate their clinical judgment,
and ace their second major thematic examination.
Question 1
A client is admitted to the intensive care unit with acute respiratory
distress syndrome (ARDS) secondary to severe sepsis. The
mechanical ventilator is set to deliver a low tidal volume of 6
mL/kg. Which physiological outcome is the primary rationale for
this specific ventilatory strategy?
,A) Maximizing functional residual capacity
B) Preventing alveolar hyperventilation and respiratory alkalosis
C) Reducing the risk of ventilator-induced lung injury (volutrauma)
D) Increasing systemic oxygenation through recruitment
maneuvers
Answer: C
Rationale: Low tidal volume ventilation (6 mL/kg of ideal body
weight) is the gold standard for clients with ARDS. This lung-
protective strategy minimizes alveolar overdistention and
volutrauma, which decreases mortality. High tidal volumes can
tear fragile alveolar-capillary membranes, worsening inflammatory
lung injury.
Question 2
The nurse is managing a client with an arterial line. The monitor
displays a mean arterial pressure (MAP) of 54 mmHg. Which
immediate complication is this client at greatest risk for
experiencing?
A) Increased intracranial pressure
B) Acute kidney injury due to hypoperfusion
C) Decreased systemic vascular resistance
D) Pulmonary congestion and right-sided heart failure
Answer: B
Rationale: A mean arterial pressure (MAP) of at least 60 to 65
mmHg is strictly required to maintain basic tissue perfusion to vital
organs, especially the kidneys. A MAP of 54 mmHg indicates
severe systemic hypoperfusion, which can rapidly trigger acute
tubular necrosis and acute kidney injury.
,Question 3
A client in septic shock has a pulmonary artery catheter placed.
The parameters reveal a central venous pressure (CVP) of 2
mmHg, a pulmonary artery wedge pressure (PAWP) of 4 mmHg,
and a systemic vascular resistance (SVR) of 550 dynes/sec/cm⁻⁵.
Which intervention should the nurse anticipate first?
A) Administration of a high-dose loop diuretic
B) Continuous infusion of a potent vasoconstrictor like
norepinephrine
C) Rapid intravenous fluid resuscitation with isotonic crystalloids
D) Administration of a negative inotropic agent
Answer: C
Rationale: Both CVP (normal 2–8 mmHg) and PAWP (normal 6–
12 mmHg) are at the lowest limits or below normal, indicating
significant intravascular volume depletion (relative or absolute).
Although the SVR is low due to distributive vasodilation from
sepsis, fluid resuscitation must always be initiated first to fill the
dilated vascular bed before vasopressors are introduced.
Question 4
The nurse notes that a client’s cardiac telemetry strip displays a
sudden run of wide, bizarre QRS complexes occurring at a rate of
160 beats per minute. The complexes do not have preceding P
waves. The client remains conscious and alert. Which action
should the nurse take first?
A) Defibrillate the client immediately at 200 joules.
B) Check the client's carotid pulse and obtain a blood pressure.
, C) Administer a rapid intravenous push of 6 mg adenosine.
D) Initiate high-quality cardiopulmonary resuscitation (CPR).
Answer: B
Rationale: The strip description matches ventricular tachycardia
(VT). The nurse's very first action must be to assess the client's
hemodynamic status by checking for a pulse and evaluating blood
pressure. Treatment algorithms differ completely depending on
whether the ventricular tachycardia is stable, unstable, or
pulseless.
Question 5
A client with acute decompensated heart failure and severe
pulmonary edema has a pulmonary artery wedge pressure
(PAWP) of 26 mmHg. Which clinical manifestation matches this
hemodynamic finding?
A) Bounding peripheral pulses and warm extremities
B) Clear lung sounds upon bilateral auscultation
C) Jugular venous distention and bilateral pitting ankle edema
D) Bilateral crackles, dyspnea, and a cough with pink, frothy
sputum
Answer: D
Rationale: PAWP reflects left ventricular end-diastolic pressure
(left-sided filling pressure). A normal PAWP is 6–12 mmHg. An
elevated PAWP of 26 mmHg demonstrates severe fluid back-up
into the pulmonary vasculature, driving fluid out into the alveoli
and causing severe pulmonary edema, crackles, and classic pink,
frothy sputum.
TEST BANK - ADVANCED CRITICAL CARE
QUESTIONS, ANSWERS AND DETAILED
RATIONALES
This premium, high-yield study bank features
rigorous multiple-choice questions meticulously
aligned with advanced medical-surgical nursing
concepts, hemodynamic monitoring, complex
dysrhythmias, and multi-organ failure. Every single
question delivers immediate correct answers paired
with deep, bold-italicized rationales to reinforce
complex pathophysiological mechanisms and nursing
interventions. It is the ultimate diagnostic resource
designed to help nursing students master tough
critical care concepts, elevate their clinical judgment,
and ace their second major thematic examination.
Question 1
A client is admitted to the intensive care unit with acute respiratory
distress syndrome (ARDS) secondary to severe sepsis. The
mechanical ventilator is set to deliver a low tidal volume of 6
mL/kg. Which physiological outcome is the primary rationale for
this specific ventilatory strategy?
,A) Maximizing functional residual capacity
B) Preventing alveolar hyperventilation and respiratory alkalosis
C) Reducing the risk of ventilator-induced lung injury (volutrauma)
D) Increasing systemic oxygenation through recruitment
maneuvers
Answer: C
Rationale: Low tidal volume ventilation (6 mL/kg of ideal body
weight) is the gold standard for clients with ARDS. This lung-
protective strategy minimizes alveolar overdistention and
volutrauma, which decreases mortality. High tidal volumes can
tear fragile alveolar-capillary membranes, worsening inflammatory
lung injury.
Question 2
The nurse is managing a client with an arterial line. The monitor
displays a mean arterial pressure (MAP) of 54 mmHg. Which
immediate complication is this client at greatest risk for
experiencing?
A) Increased intracranial pressure
B) Acute kidney injury due to hypoperfusion
C) Decreased systemic vascular resistance
D) Pulmonary congestion and right-sided heart failure
Answer: B
Rationale: A mean arterial pressure (MAP) of at least 60 to 65
mmHg is strictly required to maintain basic tissue perfusion to vital
organs, especially the kidneys. A MAP of 54 mmHg indicates
severe systemic hypoperfusion, which can rapidly trigger acute
tubular necrosis and acute kidney injury.
,Question 3
A client in septic shock has a pulmonary artery catheter placed.
The parameters reveal a central venous pressure (CVP) of 2
mmHg, a pulmonary artery wedge pressure (PAWP) of 4 mmHg,
and a systemic vascular resistance (SVR) of 550 dynes/sec/cm⁻⁵.
Which intervention should the nurse anticipate first?
A) Administration of a high-dose loop diuretic
B) Continuous infusion of a potent vasoconstrictor like
norepinephrine
C) Rapid intravenous fluid resuscitation with isotonic crystalloids
D) Administration of a negative inotropic agent
Answer: C
Rationale: Both CVP (normal 2–8 mmHg) and PAWP (normal 6–
12 mmHg) are at the lowest limits or below normal, indicating
significant intravascular volume depletion (relative or absolute).
Although the SVR is low due to distributive vasodilation from
sepsis, fluid resuscitation must always be initiated first to fill the
dilated vascular bed before vasopressors are introduced.
Question 4
The nurse notes that a client’s cardiac telemetry strip displays a
sudden run of wide, bizarre QRS complexes occurring at a rate of
160 beats per minute. The complexes do not have preceding P
waves. The client remains conscious and alert. Which action
should the nurse take first?
A) Defibrillate the client immediately at 200 joules.
B) Check the client's carotid pulse and obtain a blood pressure.
, C) Administer a rapid intravenous push of 6 mg adenosine.
D) Initiate high-quality cardiopulmonary resuscitation (CPR).
Answer: B
Rationale: The strip description matches ventricular tachycardia
(VT). The nurse's very first action must be to assess the client's
hemodynamic status by checking for a pulse and evaluating blood
pressure. Treatment algorithms differ completely depending on
whether the ventricular tachycardia is stable, unstable, or
pulseless.
Question 5
A client with acute decompensated heart failure and severe
pulmonary edema has a pulmonary artery wedge pressure
(PAWP) of 26 mmHg. Which clinical manifestation matches this
hemodynamic finding?
A) Bounding peripheral pulses and warm extremities
B) Clear lung sounds upon bilateral auscultation
C) Jugular venous distention and bilateral pitting ankle edema
D) Bilateral crackles, dyspnea, and a cough with pink, frothy
sputum
Answer: D
Rationale: PAWP reflects left ventricular end-diastolic pressure
(left-sided filling pressure). A normal PAWP is 6–12 mmHg. An
elevated PAWP of 26 mmHg demonstrates severe fluid back-up
into the pulmonary vasculature, driving fluid out into the alveoli
and causing severe pulmonary edema, crackles, and classic pink,
frothy sputum.
