, Question 1
A patient with septic shock is receiving norepinephrine at 8 mcg/min via a
central line. The infusion is prepared as 4 mg norepinephrine in 250 mL D5W.
The provider orders to titrate to maintain a MAP 65 mm Hg. At what rate in
mL/hr should the nurse set the pump to deliver the ordered dose?
A. 30 mL/hr
B. 15 mL/hr
C. 60 mL/hr
D. 7.5 mL/hr
Correct Answer: A - 30 mL/hr
RATIONALE
Concentration = 4 mg/250 mL = 4000 mcg/250 mL = 16 mcg/mL.
Ordered 8 mcg/min = 480 mcg/hr. 480 mcg/hr ÷ 16 mcg/mL = 30
mL/hr. Distractors result from unit conversion errors or misplacing the
decimal.
Question 2
A patient with type 2 diabetes on metformin and empagliflozin presents with
nausea, vomiting, and Kussmaul respirations. Labs: glucose 210 mg/dL, pH
7.22, HCO3 12 mEq/L, anion gap 26, beta-hydroxybutyrate elevated, and
ketonuria. Which pathophysiologic mechanism best explains this presentation?
A. Metformin-induced lactic acidosis from tissue hypoperfusion
B. SGLT2 inhibitor-associated euglycemic diabetic ketoacidosis with
relative insulin deficiency
C. Hyperosmolar hyperglycemic state from profound dehydration
D. Starvation ketosis from decreased caloric intake
Correct Answer: B - SGLT2 inhibitor-associated euglycemic
diabetic ketoacidosis with relative insulin deficiency
Page 2
, RATIONALE
SGLT2 inhibitors can cause euglycemic DKA even with glucose <250
mg/dL; the elevated anion gap, ketonuria, and metabolic acidosis
confirm DKA. Lactic acidosis lacks ketonuria and
beta-hydroxybutyrate elevation. HHS has glucose >600 mg/dL and
minimal ketones.
Question 3
A community health nurse is evaluating a program aimed at reducing lead
exposure in an older housing district. Which epidemiologic measure best
quantifies the program's impact on new cases of elevated blood lead levels in
children over one year?
A. Point prevalence of elevated blood lead levels
B. Incidence rate of elevated blood lead levels
C. Case fatality rate of lead poisoning
D. Attack rate of lead exposure
Correct Answer: B - Incidence rate of elevated blood lead levels
RATIONALE
Incidence rate measures new cases over time, directly reflecting
prevention program impact. Prevalence includes existing cases and is
less sensitive to prevention. Case fatality and attack rate do not
measure new chronic disease occurrence.
Question 4
A patient on lithium therapy for bipolar disorder presents with coarse hand
tremors, ataxia, vomiting, and confusion. Lithium level is 2.1 mEq/L. Which
intervention should the nurse anticipate as the priority?
A. Administer sodium polystyrene sulfonate
B. Prepare for hemodialysis
C. Administer IV calcium gluconate
Page 3
, D. Initiate forced diuresis with furosemide
Correct Answer: B - Prepare for hemodialysis
RATIONALE
Lithium level >2.0 mEq/L with severe neurotoxicity indicates
life-threatening toxicity requiring hemodialysis. Sodium polystyrene is
for hyperkalemia; calcium gluconate is for hypermagnesemia or
calcium channel blocker toxicity; furosemide can increase lithium
reabsorption and worsen toxicity.
Question 5
A laboring patient at 41 weeks gestation has a Category III fetal heart tracing
with recurrent late decelerations, minimal variability, and baseline 170 bpm.
Which intrauterine resuscitation sequence is most appropriate?
A. Administer oxygen, increase oxytocin, position supine, and prepare for
delivery
B. Discontinue oxytocin, reposition left lateral, administer IV fluid bolus,
and notify provider
C. Perform sterile vaginal exam, apply fetal scalp electrode, and continue
monitoring
D. Administer terbutaline, decrease IV fluids, and place in Trendelenburg
Correct Answer: B - Discontinue oxytocin, reposition left lateral,
administer IV fluid bolus, and notify provider
RATIONALE
Category III tracing indicates acidemia risk; intrauterine resuscitation
includes stopping oxytocin, left lateral positioning, IV fluid bolus,
oxygen if hypoxemic, and provider notification for possible delivery.
Supine positioning causes aortocaval compression. Terbutaline is for
tachysystole, not late decelerations.
Page 4
A patient with septic shock is receiving norepinephrine at 8 mcg/min via a
central line. The infusion is prepared as 4 mg norepinephrine in 250 mL D5W.
The provider orders to titrate to maintain a MAP 65 mm Hg. At what rate in
mL/hr should the nurse set the pump to deliver the ordered dose?
A. 30 mL/hr
B. 15 mL/hr
C. 60 mL/hr
D. 7.5 mL/hr
Correct Answer: A - 30 mL/hr
RATIONALE
Concentration = 4 mg/250 mL = 4000 mcg/250 mL = 16 mcg/mL.
Ordered 8 mcg/min = 480 mcg/hr. 480 mcg/hr ÷ 16 mcg/mL = 30
mL/hr. Distractors result from unit conversion errors or misplacing the
decimal.
Question 2
A patient with type 2 diabetes on metformin and empagliflozin presents with
nausea, vomiting, and Kussmaul respirations. Labs: glucose 210 mg/dL, pH
7.22, HCO3 12 mEq/L, anion gap 26, beta-hydroxybutyrate elevated, and
ketonuria. Which pathophysiologic mechanism best explains this presentation?
A. Metformin-induced lactic acidosis from tissue hypoperfusion
B. SGLT2 inhibitor-associated euglycemic diabetic ketoacidosis with
relative insulin deficiency
C. Hyperosmolar hyperglycemic state from profound dehydration
D. Starvation ketosis from decreased caloric intake
Correct Answer: B - SGLT2 inhibitor-associated euglycemic
diabetic ketoacidosis with relative insulin deficiency
Page 2
, RATIONALE
SGLT2 inhibitors can cause euglycemic DKA even with glucose <250
mg/dL; the elevated anion gap, ketonuria, and metabolic acidosis
confirm DKA. Lactic acidosis lacks ketonuria and
beta-hydroxybutyrate elevation. HHS has glucose >600 mg/dL and
minimal ketones.
Question 3
A community health nurse is evaluating a program aimed at reducing lead
exposure in an older housing district. Which epidemiologic measure best
quantifies the program's impact on new cases of elevated blood lead levels in
children over one year?
A. Point prevalence of elevated blood lead levels
B. Incidence rate of elevated blood lead levels
C. Case fatality rate of lead poisoning
D. Attack rate of lead exposure
Correct Answer: B - Incidence rate of elevated blood lead levels
RATIONALE
Incidence rate measures new cases over time, directly reflecting
prevention program impact. Prevalence includes existing cases and is
less sensitive to prevention. Case fatality and attack rate do not
measure new chronic disease occurrence.
Question 4
A patient on lithium therapy for bipolar disorder presents with coarse hand
tremors, ataxia, vomiting, and confusion. Lithium level is 2.1 mEq/L. Which
intervention should the nurse anticipate as the priority?
A. Administer sodium polystyrene sulfonate
B. Prepare for hemodialysis
C. Administer IV calcium gluconate
Page 3
, D. Initiate forced diuresis with furosemide
Correct Answer: B - Prepare for hemodialysis
RATIONALE
Lithium level >2.0 mEq/L with severe neurotoxicity indicates
life-threatening toxicity requiring hemodialysis. Sodium polystyrene is
for hyperkalemia; calcium gluconate is for hypermagnesemia or
calcium channel blocker toxicity; furosemide can increase lithium
reabsorption and worsen toxicity.
Question 5
A laboring patient at 41 weeks gestation has a Category III fetal heart tracing
with recurrent late decelerations, minimal variability, and baseline 170 bpm.
Which intrauterine resuscitation sequence is most appropriate?
A. Administer oxygen, increase oxytocin, position supine, and prepare for
delivery
B. Discontinue oxytocin, reposition left lateral, administer IV fluid bolus,
and notify provider
C. Perform sterile vaginal exam, apply fetal scalp electrode, and continue
monitoring
D. Administer terbutaline, decrease IV fluids, and place in Trendelenburg
Correct Answer: B - Discontinue oxytocin, reposition left lateral,
administer IV fluid bolus, and notify provider
RATIONALE
Category III tracing indicates acidemia risk; intrauterine resuscitation
includes stopping oxytocin, left lateral positioning, IV fluid bolus,
oxygen if hypoxemic, and provider notification for possible delivery.
Supine positioning causes aortocaval compression. Terbutaline is for
tachysystole, not late decelerations.
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