NUR 2755 MDC4 EXAM WITH WELL-VERIFIED
QUESTIONS AND ANSWERS|| ALREADY
GRADED A+|| GUARANTEED PASS
Section 1: Critical Care & Hemodynamics
1. A patient in the ICU has a pulmonary artery catheter (Swan-Ganz).
Which hemodynamic value indicates left ventricular preload?
A) Central venous pressure (CVP)
B) Pulmonary artery wedge pressure (PAWP)
C) Cardiac output (CO)
D) Systemic vascular resistance (SVR)
Correct Answer: B — Pulmonary artery wedge pressure (PAWP)
Rationale: PAWP reflects left ventricular end-diastolic pressure (LVEDP),
which is an indicator of left ventricular preload. CVP reflects right ventricular
preload. CO measures the heart's output, and SVR measures afterload.
2. A patient in septic shock has a mean arterial pressure (MAP) of 55 mm
Hg. Which action should the nurse take first?
A) Administer a bolus of 0.9% sodium chloride
B) Start a norepinephrine infusion
C) Obtain a lactate level
D) Place the patient in Trendelenburg position
Correct Answer: A — Administer a bolus of 0.9% sodium chloride
Rationale: For septic shock, fluid resuscitation is the first-line intervention to
restore intravascular volume and improve MAP. Vasopressors are added if
fluids are insufficient. Trendelenburg is no longer recommended.
3. A patient with septic shock remains hypotensive despite fluid
resuscitation and norepinephrine infusion. Which hemodynamic profile
would most support the addition of vasopressin as a second-line
vasopressor?
A) High cardiac output, low systemic vascular resistance (SVR), low central
venous pressure (CVP)
B) Low cardiac output, high SVR, high CVP
,C) High cardiac output, high SVR, low CVP
D) Low cardiac output, low SVR, low CVP
Correct Answer: A
Rationale: Vasopressin is indicated in distributive shock (e.g., septic) with high
cardiac output and low SVR, as it increases SVR via V1 receptors. Options B
and D reflect cardiogenic or hypovolemic shock.
4. A nurse is caring for a patient with acute respiratory distress syndrome
(ARDS) on volume-controlled ventilation. Which intervention should the
nurse question?
A) Increasing positive end-expiratory pressure (PEEP) to recruit alveoli
B) Administering a neuromuscular blocking agent to improve oxygenation
C) Increasing tidal volume to 8 mL/kg ideal body weight to improve minute
ventilation
D) Trialing prone positioning to enhance ventilation-perfusion matching
Correct Answer: C
Rationale: In ARDS, lung-protective ventilation uses low tidal volumes (4-6
mL/kg) to prevent volutrauma. Increasing tidal volume to 8 mL/kg would
worsen lung injury.
5. A patient with acute liver failure and hepatic encephalopathy shows a
change from asterixis to decerebrate posturing. What does this indicate?
A) Improvement in liver function
B) Worsening cerebral edema
C) Onset of seizures
D) Resolution of encephalopathy
Correct Answer: B — Worsening cerebral edema
Rationale: Worsening cerebral edema leads to brainstem herniation,
manifesting as abnormal posturing (decerebrate/decorticate). Asterixis is an
early sign of encephalopathy.
6. A nurse is caring for a patient with severe sepsis. Which laboratory value
requires immediate communication with the healthcare provider?
A) Creatinine: 0.9 mg/dL
B) Lactate: 54 mg/dL
C) Sodium: 145 mEq/L
D) White blood cell count: 11,000/mm³
Correct Answer: B — Lactate: 54 mg/dL
Rationale: An elevated lactate level indicates tissue hypoperfusion and is a
critical finding in sepsis that requires immediate intervention.
,7. A patient in the ICU has a MAP of 55 mm Hg and a heart rate of 120
bpm. Which intervention is the priority?
A) Administer a fluid bolus
B) Start a vasopressor
C) Obtain an ECG
D) Place the patient in a supine position
Correct Answer: A — Administer a fluid bolus
Rationale: Hypotension with tachycardia suggests hypovolemia or distributive
shock; fluid resuscitation is the first step.
8. A nurse is assessing a patient with a pulmonary artery catheter. Which
value indicates right ventricular preload?
A) Pulmonary artery wedge pressure (PAWP)
B) Central venous pressure (CVP)
C) Cardiac output (CO)
D) Systemic vascular resistance (SVR)
Correct Answer: B — Central venous pressure (CVP)
Rationale: CVP reflects right ventricular end-diastolic pressure and right
ventricular preload.
9. A patient with cardiogenic shock has a low cardiac output and high SVR.
Which medication is most appropriate?
A) Norepinephrine
B) Dobutamine
C) Vasopressin
D) Phenylephrine
Correct Answer: B — Dobutamine
Rationale: Dobutamine is an inotrope that increases cardiac contractility and
cardiac output, which is beneficial in cardiogenic shock.
10. A nurse is caring for a patient with a traumatic brain injury. Which
finding indicates Cushing's triad?
A) Hypertension, bradycardia, irregular respirations
B) Hypotension, tachycardia, tachypnea
C) Hypertension, tachycardia, regular respirations
D) Hypotension, bradycardia, apnea
Correct Answer: A — Hypertension, bradycardia, irregular respirations
Rationale: Cushing's triad is a late sign of increased ICP and indicates
impending brain herniation.
11. A patient with a basilar skull fracture is at risk for which complication?
A) Meningitis
, B) Seizures
C) Hydrocephalus
D) Diabetes insipidus
Correct Answer: A — Meningitis
Rationale: CSF leak from a basilar skull fracture increases the risk of
meningitis.
12. A nurse is assessing a patient with suspected meningitis. Which finding
is most characteristic?
A) Battle's sign and raccoon eyes
B) Kernig's sign and Brudzinski's sign
C) Hemiparesis and aphasia
D) Polyuria and polydipsia
Correct Answer: B — Kernig's sign and Brudzinski's sign
Rationale: These are classic signs of meningeal irritation seen in meningitis.
13. A patient with a spinal cord injury at T6 develops a severe headache,
hypertension, and diaphoresis. What complication should the nurse
suspect?
A) Neurogenic shock
B) Spinal shock
C) Autonomic dysreflexia
D) Orthostatic hypotension
Correct Answer: C — Autonomic dysreflexia
Rationale: Autonomic dysreflexia is a life-threatening condition in clients with
spinal cord injuries at or above T6, often triggered by bladder distention.
14. A nurse is caring for a patient in status epilepticus. Which medication
should be administered first?
A) Phenytoin
B) Lorazepam
C) Carbamazepine
D) Valproic acid
Correct Answer: B — Lorazepam
Rationale: Lorazepam (a benzodiazepine) is the first-line treatment to rapidly
stop seizure activity.
15. A client with Alzheimer's disease is in the moderate stage. Which
manifestation would the nurse expect?
A) Complete dependence for all ADLs
B) Difficulty with problem-solving and memory loss that interferes with daily
activities
QUESTIONS AND ANSWERS|| ALREADY
GRADED A+|| GUARANTEED PASS
Section 1: Critical Care & Hemodynamics
1. A patient in the ICU has a pulmonary artery catheter (Swan-Ganz).
Which hemodynamic value indicates left ventricular preload?
A) Central venous pressure (CVP)
B) Pulmonary artery wedge pressure (PAWP)
C) Cardiac output (CO)
D) Systemic vascular resistance (SVR)
Correct Answer: B — Pulmonary artery wedge pressure (PAWP)
Rationale: PAWP reflects left ventricular end-diastolic pressure (LVEDP),
which is an indicator of left ventricular preload. CVP reflects right ventricular
preload. CO measures the heart's output, and SVR measures afterload.
2. A patient in septic shock has a mean arterial pressure (MAP) of 55 mm
Hg. Which action should the nurse take first?
A) Administer a bolus of 0.9% sodium chloride
B) Start a norepinephrine infusion
C) Obtain a lactate level
D) Place the patient in Trendelenburg position
Correct Answer: A — Administer a bolus of 0.9% sodium chloride
Rationale: For septic shock, fluid resuscitation is the first-line intervention to
restore intravascular volume and improve MAP. Vasopressors are added if
fluids are insufficient. Trendelenburg is no longer recommended.
3. A patient with septic shock remains hypotensive despite fluid
resuscitation and norepinephrine infusion. Which hemodynamic profile
would most support the addition of vasopressin as a second-line
vasopressor?
A) High cardiac output, low systemic vascular resistance (SVR), low central
venous pressure (CVP)
B) Low cardiac output, high SVR, high CVP
,C) High cardiac output, high SVR, low CVP
D) Low cardiac output, low SVR, low CVP
Correct Answer: A
Rationale: Vasopressin is indicated in distributive shock (e.g., septic) with high
cardiac output and low SVR, as it increases SVR via V1 receptors. Options B
and D reflect cardiogenic or hypovolemic shock.
4. A nurse is caring for a patient with acute respiratory distress syndrome
(ARDS) on volume-controlled ventilation. Which intervention should the
nurse question?
A) Increasing positive end-expiratory pressure (PEEP) to recruit alveoli
B) Administering a neuromuscular blocking agent to improve oxygenation
C) Increasing tidal volume to 8 mL/kg ideal body weight to improve minute
ventilation
D) Trialing prone positioning to enhance ventilation-perfusion matching
Correct Answer: C
Rationale: In ARDS, lung-protective ventilation uses low tidal volumes (4-6
mL/kg) to prevent volutrauma. Increasing tidal volume to 8 mL/kg would
worsen lung injury.
5. A patient with acute liver failure and hepatic encephalopathy shows a
change from asterixis to decerebrate posturing. What does this indicate?
A) Improvement in liver function
B) Worsening cerebral edema
C) Onset of seizures
D) Resolution of encephalopathy
Correct Answer: B — Worsening cerebral edema
Rationale: Worsening cerebral edema leads to brainstem herniation,
manifesting as abnormal posturing (decerebrate/decorticate). Asterixis is an
early sign of encephalopathy.
6. A nurse is caring for a patient with severe sepsis. Which laboratory value
requires immediate communication with the healthcare provider?
A) Creatinine: 0.9 mg/dL
B) Lactate: 54 mg/dL
C) Sodium: 145 mEq/L
D) White blood cell count: 11,000/mm³
Correct Answer: B — Lactate: 54 mg/dL
Rationale: An elevated lactate level indicates tissue hypoperfusion and is a
critical finding in sepsis that requires immediate intervention.
,7. A patient in the ICU has a MAP of 55 mm Hg and a heart rate of 120
bpm. Which intervention is the priority?
A) Administer a fluid bolus
B) Start a vasopressor
C) Obtain an ECG
D) Place the patient in a supine position
Correct Answer: A — Administer a fluid bolus
Rationale: Hypotension with tachycardia suggests hypovolemia or distributive
shock; fluid resuscitation is the first step.
8. A nurse is assessing a patient with a pulmonary artery catheter. Which
value indicates right ventricular preload?
A) Pulmonary artery wedge pressure (PAWP)
B) Central venous pressure (CVP)
C) Cardiac output (CO)
D) Systemic vascular resistance (SVR)
Correct Answer: B — Central venous pressure (CVP)
Rationale: CVP reflects right ventricular end-diastolic pressure and right
ventricular preload.
9. A patient with cardiogenic shock has a low cardiac output and high SVR.
Which medication is most appropriate?
A) Norepinephrine
B) Dobutamine
C) Vasopressin
D) Phenylephrine
Correct Answer: B — Dobutamine
Rationale: Dobutamine is an inotrope that increases cardiac contractility and
cardiac output, which is beneficial in cardiogenic shock.
10. A nurse is caring for a patient with a traumatic brain injury. Which
finding indicates Cushing's triad?
A) Hypertension, bradycardia, irregular respirations
B) Hypotension, tachycardia, tachypnea
C) Hypertension, tachycardia, regular respirations
D) Hypotension, bradycardia, apnea
Correct Answer: A — Hypertension, bradycardia, irregular respirations
Rationale: Cushing's triad is a late sign of increased ICP and indicates
impending brain herniation.
11. A patient with a basilar skull fracture is at risk for which complication?
A) Meningitis
, B) Seizures
C) Hydrocephalus
D) Diabetes insipidus
Correct Answer: A — Meningitis
Rationale: CSF leak from a basilar skull fracture increases the risk of
meningitis.
12. A nurse is assessing a patient with suspected meningitis. Which finding
is most characteristic?
A) Battle's sign and raccoon eyes
B) Kernig's sign and Brudzinski's sign
C) Hemiparesis and aphasia
D) Polyuria and polydipsia
Correct Answer: B — Kernig's sign and Brudzinski's sign
Rationale: These are classic signs of meningeal irritation seen in meningitis.
13. A patient with a spinal cord injury at T6 develops a severe headache,
hypertension, and diaphoresis. What complication should the nurse
suspect?
A) Neurogenic shock
B) Spinal shock
C) Autonomic dysreflexia
D) Orthostatic hypotension
Correct Answer: C — Autonomic dysreflexia
Rationale: Autonomic dysreflexia is a life-threatening condition in clients with
spinal cord injuries at or above T6, often triggered by bladder distention.
14. A nurse is caring for a patient in status epilepticus. Which medication
should be administered first?
A) Phenytoin
B) Lorazepam
C) Carbamazepine
D) Valproic acid
Correct Answer: B — Lorazepam
Rationale: Lorazepam (a benzodiazepine) is the first-line treatment to rapidly
stop seizure activity.
15. A client with Alzheimer's disease is in the moderate stage. Which
manifestation would the nurse expect?
A) Complete dependence for all ADLs
B) Difficulty with problem-solving and memory loss that interferes with daily
activities
