, Question 1
A patient with acute decompensated heart failure is prescribed IV furosemide.
Which assessment finding best indicates the medication is achieving its
intended therapeutic effect?
A. Serum potassium increase from 3.2 to 4.0 mEq/L
B. Urine output of 1,200 mL over 4 hours with decreased dyspnea
C. Blood pressure decrease from 148/88 to 118/72 mm Hg
D. Serum sodium increase from 128 to 136 mEq/L
Correct Answer: B - Urine output of 1,200 mL over 4 hours with
decreased dyspnea
RATIONALE
Loop diuretics reduce preload by promoting diuresis, so increased
urine output with reduced dyspnea reflects effective decongestion.
Potassium and sodium shifts are secondary or potentially adverse
effects, and blood pressure reduction alone does not confirm diuretic
efficacy.
Question 2
Which pathophysiologic mechanism best explains why a patient with chronic
kidney disease develops anemia?
A. Impaired renal excretion of erythropoietin inhibitors
B. Decreased production of erythropoietin by damaged peritubular
fibroblasts
C. Increased destruction of red blood cells by uremic toxins
D. Iron malabsorption due to elevated hepcidin from inflammation
Correct Answer: B - Decreased production of erythropoietin by
damaged peritubular fibroblasts
Page 2
, RATIONALE
The kidneys produce erythropoietin from peritubular interstitial
fibroblasts; CKD damages these cells, reducing erythropoietin and
causing normocytic normochromic anemia. While iron deficiency and
hepcidin contribute, the primary mechanism is decreased
erythropoietin production, not increased destruction or inhibitor
retention.
Question 3
A patient receiving mechanical ventilation for acute respiratory distress
syndrome (ARDS) has the following arterial blood gas: pH 7.28, PaCO2 52
mm Hg, PaO2 58 mm Hg, HCO3- 24 mEq/L. Which action should the nurse
anticipate?
A. Increase the respiratory rate on the ventilator
B. Decrease the tidal volume to 4 mL/kg
C. Administer sodium bicarbonate IV bolus
D. Increase positive end-expiratory pressure (PEEP)
Correct Answer: D - Increase positive end-expiratory pressure
(PEEP)
RATIONALE
The ABG indicates respiratory acidosis with hypoxemia, common in
ARDS due to intrapulmonary shunting. Increasing PEEP recruits
collapsed alveoli and improves oxygenation. Increasing respiratory
rate may worsen air trapping, decreasing tidal volume is already low
in ARDS protocols, and bicarbonate is not indicated for this primary
oxygenation problem.
Question 4
Which assessment finding in a patient receiving IV heparin is most concerning
for heparin-induced thrombocytopenia (HIT)?
A. Platelet count drop from 250,000 to 140,000/mm³ with new
Page 3
, thrombosis
B. Platelet count drop from 250,000 to 200,000/mm³ without bleeding
C. International normalized ratio (INR) increase from 1.0 to 1.5
D. Activated partial thromboplastin time (aPTT) of 60 seconds
Correct Answer: A - Platelet count drop from 250,000 to
140,000/mm³ with new thrombosis
RATIONALE
HIT is a prothrombotic disorder caused by IgG antibodies against
platelet factor 4-heparin complexes, leading to a >50% platelet drop
and paradoxical thrombosis. A mild drop without thrombosis is not
characteristic, and INR/aPTT changes reflect heparin effect, not HIT.
Question 5
A patient with cirrhosis and ascites has a serum albumin of 2.1 g/dL. Which
intervention best addresses the underlying mechanism of ascites?
A. Administering IV albumin and a loop diuretic
B. Restricting fluid intake to 1,000 mL/day
C. Performing large-volume paracentesis without albumin
D. Administering lactulose to reduce ammonia
Correct Answer: A - Administering IV albumin and a loop
diuretic
RATIONALE
Ascites in cirrhosis results from portal hypertension and decreased
oncotic pressure due to hypoalbuminemia. IV albumin increases
oncotic pressure, and diuretics mobilize fluid. Fluid restriction alone is
ineffective, paracentesis without albumin can worsen hypovolemia,
and lactulose treats encephalopathy, not ascites.
Page 4
A patient with acute decompensated heart failure is prescribed IV furosemide.
Which assessment finding best indicates the medication is achieving its
intended therapeutic effect?
A. Serum potassium increase from 3.2 to 4.0 mEq/L
B. Urine output of 1,200 mL over 4 hours with decreased dyspnea
C. Blood pressure decrease from 148/88 to 118/72 mm Hg
D. Serum sodium increase from 128 to 136 mEq/L
Correct Answer: B - Urine output of 1,200 mL over 4 hours with
decreased dyspnea
RATIONALE
Loop diuretics reduce preload by promoting diuresis, so increased
urine output with reduced dyspnea reflects effective decongestion.
Potassium and sodium shifts are secondary or potentially adverse
effects, and blood pressure reduction alone does not confirm diuretic
efficacy.
Question 2
Which pathophysiologic mechanism best explains why a patient with chronic
kidney disease develops anemia?
A. Impaired renal excretion of erythropoietin inhibitors
B. Decreased production of erythropoietin by damaged peritubular
fibroblasts
C. Increased destruction of red blood cells by uremic toxins
D. Iron malabsorption due to elevated hepcidin from inflammation
Correct Answer: B - Decreased production of erythropoietin by
damaged peritubular fibroblasts
Page 2
, RATIONALE
The kidneys produce erythropoietin from peritubular interstitial
fibroblasts; CKD damages these cells, reducing erythropoietin and
causing normocytic normochromic anemia. While iron deficiency and
hepcidin contribute, the primary mechanism is decreased
erythropoietin production, not increased destruction or inhibitor
retention.
Question 3
A patient receiving mechanical ventilation for acute respiratory distress
syndrome (ARDS) has the following arterial blood gas: pH 7.28, PaCO2 52
mm Hg, PaO2 58 mm Hg, HCO3- 24 mEq/L. Which action should the nurse
anticipate?
A. Increase the respiratory rate on the ventilator
B. Decrease the tidal volume to 4 mL/kg
C. Administer sodium bicarbonate IV bolus
D. Increase positive end-expiratory pressure (PEEP)
Correct Answer: D - Increase positive end-expiratory pressure
(PEEP)
RATIONALE
The ABG indicates respiratory acidosis with hypoxemia, common in
ARDS due to intrapulmonary shunting. Increasing PEEP recruits
collapsed alveoli and improves oxygenation. Increasing respiratory
rate may worsen air trapping, decreasing tidal volume is already low
in ARDS protocols, and bicarbonate is not indicated for this primary
oxygenation problem.
Question 4
Which assessment finding in a patient receiving IV heparin is most concerning
for heparin-induced thrombocytopenia (HIT)?
A. Platelet count drop from 250,000 to 140,000/mm³ with new
Page 3
, thrombosis
B. Platelet count drop from 250,000 to 200,000/mm³ without bleeding
C. International normalized ratio (INR) increase from 1.0 to 1.5
D. Activated partial thromboplastin time (aPTT) of 60 seconds
Correct Answer: A - Platelet count drop from 250,000 to
140,000/mm³ with new thrombosis
RATIONALE
HIT is a prothrombotic disorder caused by IgG antibodies against
platelet factor 4-heparin complexes, leading to a >50% platelet drop
and paradoxical thrombosis. A mild drop without thrombosis is not
characteristic, and INR/aPTT changes reflect heparin effect, not HIT.
Question 5
A patient with cirrhosis and ascites has a serum albumin of 2.1 g/dL. Which
intervention best addresses the underlying mechanism of ascites?
A. Administering IV albumin and a loop diuretic
B. Restricting fluid intake to 1,000 mL/day
C. Performing large-volume paracentesis without albumin
D. Administering lactulose to reduce ammonia
Correct Answer: A - Administering IV albumin and a loop
diuretic
RATIONALE
Ascites in cirrhosis results from portal hypertension and decreased
oncotic pressure due to hypoalbuminemia. IV albumin increases
oncotic pressure, and diuretics mobilize fluid. Fluid restriction alone is
ineffective, paracentesis without albumin can worsen hypovolemia,
and lactulose treats encephalopathy, not ascites.
Page 4
