NUR 445 EXAM 1 NEWEST 2026 ACTUAL EXAM
COMPLETE 100 QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS) |
ALREADY GRADED A+ | ARIZONA COLLEGE OF
NURSING
Core Domains
• Hemodynamics and Shock Management
• Cardiovascular Disorders and Interventions
• Respiratory Failure and Mechanical Ventilation
• Neurological and Sensory Alterations
• Ethical, Legal, and Professional Standards
• Patient and Family-Centered Care in High Acuity Settings
• Interprofessional Collaboration and Care Coordination
• End-of-Life and Palliative Care
Introduction
This examination assesses the learner's readiness to deliver safe, evidence-
based nursing care to adults and older adults experiencing complex, multi-
system health disruptions. It evaluates foundational and applied knowledge
across critical care domains, including hemodynamic monitoring, shock
management, cardiac and respiratory emergencies, and ethical decision-
making. Questions are structured in multiple-choice and scenario-based
formats to emphasize clinical judgment, prioritization, and real-world
application. A strong emphasis is placed on regulatory compliance,
professional accountability, and patient-centered outcomes. Candidates must
demonstrate the ability to synthesize assessment data, generate appropriate
nursing interventions, and evaluate care effectiveness.
,SECTION ONE: QUESTIONS 1–100
1. A patient with septic shock has a mean arterial pressure (MAP) of 55
mmHg despite fluid resuscitation. What is the priority intervention?
A. Administer vasopressors as ordered
B. Increase the rate of IV fluids
C. Reposition the patient supine
D. Obtain a blood culture
A
RATIONALE: A MAP of less than 65 mmHg indicates inadequate organ
perfusion. After fluid resuscitation, vasopressors such as norepinephrine are
indicated to restore MAP to at least 65 mmHg and maintain tissue perfusion.
2. Which hemodynamic parameter is most indicative of left ventricular
preload?
A. Central venous pressure (CVP)
B. Pulmonary artery wedge pressure (PAWP)
C. Cardiac output (CO)
D. Systemic vascular resistance (SVR)
B
RATIONALE: PAWP reflects left atrial pressure and is the best measure of
left ventricular preload. CVP reflects right ventricular preload.
3. A patient in cardiogenic shock has a cardiac index of 1.8 L/min/m².
Which finding would the nurse expect?
A. Bounding pulses and warm extremities
B. Cool, clammy skin and decreased urine output
C. Increased urine output and clear lung sounds
D. Flushed skin and bounding pulses
B
, RATIONALE: A low cardiac index indicates poor tissue perfusion,
resulting in compensatory vasoconstriction (cool, clammy skin) and
decreased renal perfusion (low urine output).
4. Which type of shock is characterized by a low CVP, low PAWP, and
low SVR?
A. Cardiogenic shock
B. Obstructive shock
C. Distributive shock (septic)
D. Hypovolemic shock
C
RATIONALE: Septic (distributive) shock typically shows low CVP and
PAWP due to relative hypovolemia, and low SVR due to vasodilation.
Cardiogenic shock shows high filling pressures.
5. A patient in hypovolemic shock receives 2 L of lactated Ringer's
solution. MAP increases from 48 to 62 mmHg. What does this indicate?
A. The patient is fluid responsive
B. The patient needs blood transfusion
C. Vasopressors are now contraindicated
D. The patient has developed fluid overload
A
RATIONALE: A positive response to a fluid challenge, indicated by an
increase in MAP and improvement in heart rate and urine output, indicates
the patient is fluid responsive and hypovolemia is a contributing factor.
6. Which medication is the first-line vasopressor for septic shock?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Vasopressin
, C
RATIONALE: Norepinephrine is the first-line vasopressor for septic shock
per Surviving Sepsis Campaign guidelines due to its potent vasoconstrictive
effects with less tachycardia than dopamine.
7. A patient with an intra-aortic balloon pump (IABP) has a waveform
with early deflation. What is the most likely consequence?
A. Increased afterload
B. Decreased coronary perfusion
C. Increased cardiac output
D. Decreased left ventricular workload
B
RATIONALE: Early deflation of the IABP balloon causes the balloon to
deflate before the aortic valve opens, which can decrease coronary perfusion
pressure and reduce the effectiveness of diastolic augmentation.
8. A nurse is caring for a patient with a pulmonary artery catheter.
Which intervention is essential to prevent complications?
A. Maintain the balloon inflated at all times
B. Flush the catheter with heparinized saline every hour
C. Monitor for dysrhythmias during catheter insertion
D. Position the patient supine during all measurements
C
RATIONALE: Dysrhythmias are a common complication during
pulmonary artery catheter insertion and advancement. Continuous cardiac
monitoring is essential. The balloon should only be inflated briefly for PAWP
measurement.
9. Which assessment finding indicates improved tissue perfusion in a
patient recovering from shock?
COMPLETE 100 QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS) |
ALREADY GRADED A+ | ARIZONA COLLEGE OF
NURSING
Core Domains
• Hemodynamics and Shock Management
• Cardiovascular Disorders and Interventions
• Respiratory Failure and Mechanical Ventilation
• Neurological and Sensory Alterations
• Ethical, Legal, and Professional Standards
• Patient and Family-Centered Care in High Acuity Settings
• Interprofessional Collaboration and Care Coordination
• End-of-Life and Palliative Care
Introduction
This examination assesses the learner's readiness to deliver safe, evidence-
based nursing care to adults and older adults experiencing complex, multi-
system health disruptions. It evaluates foundational and applied knowledge
across critical care domains, including hemodynamic monitoring, shock
management, cardiac and respiratory emergencies, and ethical decision-
making. Questions are structured in multiple-choice and scenario-based
formats to emphasize clinical judgment, prioritization, and real-world
application. A strong emphasis is placed on regulatory compliance,
professional accountability, and patient-centered outcomes. Candidates must
demonstrate the ability to synthesize assessment data, generate appropriate
nursing interventions, and evaluate care effectiveness.
,SECTION ONE: QUESTIONS 1–100
1. A patient with septic shock has a mean arterial pressure (MAP) of 55
mmHg despite fluid resuscitation. What is the priority intervention?
A. Administer vasopressors as ordered
B. Increase the rate of IV fluids
C. Reposition the patient supine
D. Obtain a blood culture
A
RATIONALE: A MAP of less than 65 mmHg indicates inadequate organ
perfusion. After fluid resuscitation, vasopressors such as norepinephrine are
indicated to restore MAP to at least 65 mmHg and maintain tissue perfusion.
2. Which hemodynamic parameter is most indicative of left ventricular
preload?
A. Central venous pressure (CVP)
B. Pulmonary artery wedge pressure (PAWP)
C. Cardiac output (CO)
D. Systemic vascular resistance (SVR)
B
RATIONALE: PAWP reflects left atrial pressure and is the best measure of
left ventricular preload. CVP reflects right ventricular preload.
3. A patient in cardiogenic shock has a cardiac index of 1.8 L/min/m².
Which finding would the nurse expect?
A. Bounding pulses and warm extremities
B. Cool, clammy skin and decreased urine output
C. Increased urine output and clear lung sounds
D. Flushed skin and bounding pulses
B
, RATIONALE: A low cardiac index indicates poor tissue perfusion,
resulting in compensatory vasoconstriction (cool, clammy skin) and
decreased renal perfusion (low urine output).
4. Which type of shock is characterized by a low CVP, low PAWP, and
low SVR?
A. Cardiogenic shock
B. Obstructive shock
C. Distributive shock (septic)
D. Hypovolemic shock
C
RATIONALE: Septic (distributive) shock typically shows low CVP and
PAWP due to relative hypovolemia, and low SVR due to vasodilation.
Cardiogenic shock shows high filling pressures.
5. A patient in hypovolemic shock receives 2 L of lactated Ringer's
solution. MAP increases from 48 to 62 mmHg. What does this indicate?
A. The patient is fluid responsive
B. The patient needs blood transfusion
C. Vasopressors are now contraindicated
D. The patient has developed fluid overload
A
RATIONALE: A positive response to a fluid challenge, indicated by an
increase in MAP and improvement in heart rate and urine output, indicates
the patient is fluid responsive and hypovolemia is a contributing factor.
6. Which medication is the first-line vasopressor for septic shock?
A. Dopamine
B. Epinephrine
C. Norepinephrine
D. Vasopressin
, C
RATIONALE: Norepinephrine is the first-line vasopressor for septic shock
per Surviving Sepsis Campaign guidelines due to its potent vasoconstrictive
effects with less tachycardia than dopamine.
7. A patient with an intra-aortic balloon pump (IABP) has a waveform
with early deflation. What is the most likely consequence?
A. Increased afterload
B. Decreased coronary perfusion
C. Increased cardiac output
D. Decreased left ventricular workload
B
RATIONALE: Early deflation of the IABP balloon causes the balloon to
deflate before the aortic valve opens, which can decrease coronary perfusion
pressure and reduce the effectiveness of diastolic augmentation.
8. A nurse is caring for a patient with a pulmonary artery catheter.
Which intervention is essential to prevent complications?
A. Maintain the balloon inflated at all times
B. Flush the catheter with heparinized saline every hour
C. Monitor for dysrhythmias during catheter insertion
D. Position the patient supine during all measurements
C
RATIONALE: Dysrhythmias are a common complication during
pulmonary artery catheter insertion and advancement. Continuous cardiac
monitoring is essential. The balloon should only be inflated briefly for PAWP
measurement.
9. Which assessment finding indicates improved tissue perfusion in a
patient recovering from shock?
