, Question 1
A patient with septic shock is receiving norepinephrine at 0.5 mcg/kg/min. The
mean arterial pressure (MAP) remains 58 mmHg despite fluid resuscitation.
According to the 2026 Surviving Sepsis Campaign guidelines, which action is
most appropriate?
A. Administer a bolus of 1 L 0.9% sodium chloride.
B. Add vasopressin at 0.03 units/min.
C. Increase norepinephrine to 1 mcg/kg/min.
D. Initiate hydrocortisone 200 mg IV daily.
Correct Answer: B - Add vasopressin at 0.03 units/min.
RATIONALE
The 2026 SSC guidelines recommend adding vasopressin to
norepinephrine when MAP is inadequate despite high-dose
norepinephrine. Further fluid boluses may worsen edema without
benefit. Increasing norepinephrine alone may increase adverse effects.
Hydrocortisone is considered for refractory shock but is not the first
add-on.
Question 2
A patient on warfarin for atrial fibrillation has an INR of 6.5 and is not
bleeding. Which intervention is most appropriate based on current evidence?
A. Administer vitamin K 10 mg IV push.
B. Transfuse fresh frozen plasma (FFP).
C. Hold warfarin and administer oral vitamin K 2.5 mg.
D. Continue warfarin and recheck INR in 24 hours.
Correct Answer: C - Hold warfarin and administer oral vitamin
K 2.5 mg.
Page 2
, RATIONALE
For an INR >5 without bleeding, guidelines recommend holding
warfarin and giving low-dose oral vitamin K (2.5 mg) to reverse
anticoagulation gradually. IV vitamin K can cause anaphylaxis and is
reserved for serious bleeding. FFP is not indicated without bleeding.
Continuing warfarin risks bleeding.
Question 3
A patient with heart failure is prescribed furosemide. Which laboratory value
requires immediate intervention?
A. Potassium 3.1 mEq/L
B. Sodium 134 mEq/L
C. Magnesium 1.8 mg/dL
D. Calcium 9.0 mg/dL
Correct Answer: A - Potassium 3.1 mEq/L
RATIONALE
Furosemide can cause hypokalemia, and a potassium of 3.1 mEq/L
increases the risk of dysrhythmias, especially in heart failure. Sodium
134 is mild hyponatremia, often asymptomatic. Magnesium 1.8 is
within normal limits. Calcium 9.0 is normal.
Question 4
A patient is admitted with acute pancreatitis. Which nursing intervention is
priority within the first 24 hours?
A. Administer IV opioids for pain control.
B. Place the patient in a supine position.
C. Initiate a clear liquid diet.
D. Apply a heating pad to the abdomen.
Correct Answer: A - Administer IV opioids for pain control.
Page 3
, RATIONALE
Pain management with IV opioids is a priority in acute pancreatitis to
reduce pain and complications. Supine position may worsen pain; fetal
position is preferred. Clear liquids are not started until pain and nausea
subside. Heating pads are contraindicated due to risk of burns and
masking complications.
Question 5
A patient with a new colostomy has a stoma that is dark purple and dry. What
is the nurse's most appropriate action?
A. Document the finding as normal.
B. Apply a moist dressing to the stoma.
C. Notify the surgeon immediately.
D. Increase oral fluid intake.
Correct Answer: C - Notify the surgeon immediately.
RATIONALE
A dark purple, dry stoma indicates ischemia and possible necrosis,
requiring immediate surgical evaluation. Normal stomas are pink to
red and moist. Moist dressing or increased fluids will not resolve
ischemia.
Question 6
A patient is receiving continuous IV heparin. The aPTT is 120 seconds (control
30 seconds). Which action should the nurse take first?
A. Administer protamine sulfate.
B. Stop the heparin infusion.
C. Decrease the heparin rate by half.
D. Recheck aPTT in 4 hours.
Correct Answer: B - Stop the heparin infusion.
Page 4
A patient with septic shock is receiving norepinephrine at 0.5 mcg/kg/min. The
mean arterial pressure (MAP) remains 58 mmHg despite fluid resuscitation.
According to the 2026 Surviving Sepsis Campaign guidelines, which action is
most appropriate?
A. Administer a bolus of 1 L 0.9% sodium chloride.
B. Add vasopressin at 0.03 units/min.
C. Increase norepinephrine to 1 mcg/kg/min.
D. Initiate hydrocortisone 200 mg IV daily.
Correct Answer: B - Add vasopressin at 0.03 units/min.
RATIONALE
The 2026 SSC guidelines recommend adding vasopressin to
norepinephrine when MAP is inadequate despite high-dose
norepinephrine. Further fluid boluses may worsen edema without
benefit. Increasing norepinephrine alone may increase adverse effects.
Hydrocortisone is considered for refractory shock but is not the first
add-on.
Question 2
A patient on warfarin for atrial fibrillation has an INR of 6.5 and is not
bleeding. Which intervention is most appropriate based on current evidence?
A. Administer vitamin K 10 mg IV push.
B. Transfuse fresh frozen plasma (FFP).
C. Hold warfarin and administer oral vitamin K 2.5 mg.
D. Continue warfarin and recheck INR in 24 hours.
Correct Answer: C - Hold warfarin and administer oral vitamin
K 2.5 mg.
Page 2
, RATIONALE
For an INR >5 without bleeding, guidelines recommend holding
warfarin and giving low-dose oral vitamin K (2.5 mg) to reverse
anticoagulation gradually. IV vitamin K can cause anaphylaxis and is
reserved for serious bleeding. FFP is not indicated without bleeding.
Continuing warfarin risks bleeding.
Question 3
A patient with heart failure is prescribed furosemide. Which laboratory value
requires immediate intervention?
A. Potassium 3.1 mEq/L
B. Sodium 134 mEq/L
C. Magnesium 1.8 mg/dL
D. Calcium 9.0 mg/dL
Correct Answer: A - Potassium 3.1 mEq/L
RATIONALE
Furosemide can cause hypokalemia, and a potassium of 3.1 mEq/L
increases the risk of dysrhythmias, especially in heart failure. Sodium
134 is mild hyponatremia, often asymptomatic. Magnesium 1.8 is
within normal limits. Calcium 9.0 is normal.
Question 4
A patient is admitted with acute pancreatitis. Which nursing intervention is
priority within the first 24 hours?
A. Administer IV opioids for pain control.
B. Place the patient in a supine position.
C. Initiate a clear liquid diet.
D. Apply a heating pad to the abdomen.
Correct Answer: A - Administer IV opioids for pain control.
Page 3
, RATIONALE
Pain management with IV opioids is a priority in acute pancreatitis to
reduce pain and complications. Supine position may worsen pain; fetal
position is preferred. Clear liquids are not started until pain and nausea
subside. Heating pads are contraindicated due to risk of burns and
masking complications.
Question 5
A patient with a new colostomy has a stoma that is dark purple and dry. What
is the nurse's most appropriate action?
A. Document the finding as normal.
B. Apply a moist dressing to the stoma.
C. Notify the surgeon immediately.
D. Increase oral fluid intake.
Correct Answer: C - Notify the surgeon immediately.
RATIONALE
A dark purple, dry stoma indicates ischemia and possible necrosis,
requiring immediate surgical evaluation. Normal stomas are pink to
red and moist. Moist dressing or increased fluids will not resolve
ischemia.
Question 6
A patient is receiving continuous IV heparin. The aPTT is 120 seconds (control
30 seconds). Which action should the nurse take first?
A. Administer protamine sulfate.
B. Stop the heparin infusion.
C. Decrease the heparin rate by half.
D. Recheck aPTT in 4 hours.
Correct Answer: B - Stop the heparin infusion.
Page 4
