, Question 1
A patient with septic shock has been resuscitated with 30 mL/kg of crystalloid
and is now on norepinephrine at 0.4 mcg/kg/min. Which finding best indicates
that the patient is transitioning from the 'C' (circulatory) to the 'H'
(hypoperfusion) phase of sepsis-induced organ dysfunction?
A. Central venous oxygen saturation (ScvO2) rising from 58% to 72%
B. Serum lactate rising from 2.1 to 4.6 mmol/L despite normalized mean
arterial pressure
C. Urine output increasing from 0.3 to 0.9 mL/kg/hr
D. Capillary refill decreasing from 4 seconds to 2 seconds
Correct Answer: B - Serum lactate rising from 2.1 to 4.6 mmol/L
despite normalized mean arterial pressure
RATIONALE
Rising lactate despite normalized MAP reflects ongoing tissue
hypoperfusion (cryptic shock) and progression to the
hypoperfusion/organ dysfunction phase of sepsis. The other options
represent improving perfusion (ScvO2, urine output, capillary refill)
and do not indicate deterioration.
Question 2
A nurse is analyzing a unit's quality dashboard. The central line-associated
bloodstream infection (CLABSI) rate is 2.1 per 1,000 catheter-days, up from
0.8. Which action best reflects the 'Check' phase of the PDSA cycle?
A. Implementing a new chlorhexidine bathing protocol for all ICU
patients
B. Comparing observed CLABSI rates against national benchmarks and
reviewing compliance audits
C. Educating staff on maximal sterile barrier precautions during insertion
D. Standardizing the central line insertion bundle across all units
Correct Answer: B - Comparing observed CLABSI rates against
Page 2
,national benchmarks and reviewing compliance audits
RATIONALE
The 'Check' phase involves analyzing data and comparing results to
benchmarks to evaluate whether the intervention worked.
Implementing, educating, and standardizing are 'Plan' or 'Do' phase
activities.
Question 3
A patient receiving continuous IV amiodarone develops a heart rate of 42 bpm,
blood pressure 78/44 mm Hg, and a new junctional rhythm. Which is the
priority nursing action?
A. Administer atropine 0.5 mg IV push
B. Stop the amiodarone infusion and notify the provider
C. Increase the infusion rate to stabilize the rhythm
D. Prepare for synchronized cardioversion
Correct Answer: B - Stop the amiodarone infusion and notify the
provider
RATIONALE
Amiodarone can cause symptomatic bradycardia and hypotension; the
priority is to stop the offending infusion and notify the provider.
Atropine may be used for symptomatic bradycardia but does not
address the cause; increasing the rate would worsen toxicity;
cardioversion is not indicated for bradycardia.
Question 4
A laboring patient at 38 weeks' gestation has a Category II fetal heart tracing
with recurrent late decelerations. Which intrauterine resuscitation measure
should the nurse implement FIRST?
A. Administer oxygen at 10 L/min via nonrebreather mask
B. Reposition the patient to left lateral position
Page 3
, C. Increase the IV oxytocin infusion rate
D. Prepare for immediate cesarean delivery
Correct Answer: B - Reposition the patient to left lateral position
RATIONALE
Late decelerations indicate uteroplacental insufficiency; the first
intervention is maternal repositioning (left lateral) to improve uterine
perfusion. Oxygen and IV fluids may follow, but repositioning is the
immediate priority. Oxytocin should be stopped, not increased;
cesarean is considered if measures fail.
Question 5
A patient with major depressive disorder has been taking fluoxetine for 4
weeks with minimal improvement. The provider adds mirtazapine. Which
assessment finding indicates a potential serotonin syndrome?
A. Increased appetite and weight gain
B. Clonus, hyperreflexia, and agitation
C. Sedation and dry mouth
D. Orthostatic hypotension and dizziness
Correct Answer: B - Clonus, hyperreflexia, and agitation
RATIONALE
Serotonin syndrome classically presents with neuromuscular
excitability (clonus, hyperreflexia), autonomic instability, and altered
mental status. Increased appetite, sedation, dry mouth, and orthostatic
hypotension are common side effects of mirtazapine but do not
indicate serotonin syndrome.
Question 6
A community health nurse is planning a program to reduce hypertension
disparities. Which strategy best reflects the principles of community-based
participatory research (CBPR)?
Page 4
A patient with septic shock has been resuscitated with 30 mL/kg of crystalloid
and is now on norepinephrine at 0.4 mcg/kg/min. Which finding best indicates
that the patient is transitioning from the 'C' (circulatory) to the 'H'
(hypoperfusion) phase of sepsis-induced organ dysfunction?
A. Central venous oxygen saturation (ScvO2) rising from 58% to 72%
B. Serum lactate rising from 2.1 to 4.6 mmol/L despite normalized mean
arterial pressure
C. Urine output increasing from 0.3 to 0.9 mL/kg/hr
D. Capillary refill decreasing from 4 seconds to 2 seconds
Correct Answer: B - Serum lactate rising from 2.1 to 4.6 mmol/L
despite normalized mean arterial pressure
RATIONALE
Rising lactate despite normalized MAP reflects ongoing tissue
hypoperfusion (cryptic shock) and progression to the
hypoperfusion/organ dysfunction phase of sepsis. The other options
represent improving perfusion (ScvO2, urine output, capillary refill)
and do not indicate deterioration.
Question 2
A nurse is analyzing a unit's quality dashboard. The central line-associated
bloodstream infection (CLABSI) rate is 2.1 per 1,000 catheter-days, up from
0.8. Which action best reflects the 'Check' phase of the PDSA cycle?
A. Implementing a new chlorhexidine bathing protocol for all ICU
patients
B. Comparing observed CLABSI rates against national benchmarks and
reviewing compliance audits
C. Educating staff on maximal sterile barrier precautions during insertion
D. Standardizing the central line insertion bundle across all units
Correct Answer: B - Comparing observed CLABSI rates against
Page 2
,national benchmarks and reviewing compliance audits
RATIONALE
The 'Check' phase involves analyzing data and comparing results to
benchmarks to evaluate whether the intervention worked.
Implementing, educating, and standardizing are 'Plan' or 'Do' phase
activities.
Question 3
A patient receiving continuous IV amiodarone develops a heart rate of 42 bpm,
blood pressure 78/44 mm Hg, and a new junctional rhythm. Which is the
priority nursing action?
A. Administer atropine 0.5 mg IV push
B. Stop the amiodarone infusion and notify the provider
C. Increase the infusion rate to stabilize the rhythm
D. Prepare for synchronized cardioversion
Correct Answer: B - Stop the amiodarone infusion and notify the
provider
RATIONALE
Amiodarone can cause symptomatic bradycardia and hypotension; the
priority is to stop the offending infusion and notify the provider.
Atropine may be used for symptomatic bradycardia but does not
address the cause; increasing the rate would worsen toxicity;
cardioversion is not indicated for bradycardia.
Question 4
A laboring patient at 38 weeks' gestation has a Category II fetal heart tracing
with recurrent late decelerations. Which intrauterine resuscitation measure
should the nurse implement FIRST?
A. Administer oxygen at 10 L/min via nonrebreather mask
B. Reposition the patient to left lateral position
Page 3
, C. Increase the IV oxytocin infusion rate
D. Prepare for immediate cesarean delivery
Correct Answer: B - Reposition the patient to left lateral position
RATIONALE
Late decelerations indicate uteroplacental insufficiency; the first
intervention is maternal repositioning (left lateral) to improve uterine
perfusion. Oxygen and IV fluids may follow, but repositioning is the
immediate priority. Oxytocin should be stopped, not increased;
cesarean is considered if measures fail.
Question 5
A patient with major depressive disorder has been taking fluoxetine for 4
weeks with minimal improvement. The provider adds mirtazapine. Which
assessment finding indicates a potential serotonin syndrome?
A. Increased appetite and weight gain
B. Clonus, hyperreflexia, and agitation
C. Sedation and dry mouth
D. Orthostatic hypotension and dizziness
Correct Answer: B - Clonus, hyperreflexia, and agitation
RATIONALE
Serotonin syndrome classically presents with neuromuscular
excitability (clonus, hyperreflexia), autonomic instability, and altered
mental status. Increased appetite, sedation, dry mouth, and orthostatic
hypotension are common side effects of mirtazapine but do not
indicate serotonin syndrome.
Question 6
A community health nurse is planning a program to reduce hypertension
disparities. Which strategy best reflects the principles of community-based
participatory research (CBPR)?
Page 4
