NU 150 Final Exam | NU 150 Pharmacology |
Questions and Answers with Rationales
2026/2027 Update
QUESTION 1
Which hemodynamic parameter reflects left ventricular preload and is measured
using a pulmonary artery catheter with the balloon inflated?
A. Systemic vascular resistance
B. Pulmonary artery wedge pressure
C. Central venous pressure
D. Cardiac index
ANSWER: B
RATIONALE: Pulmonary artery wedge pressure measures the pressure in the left
atrium and reflects left ventricular end-diastolic pressure, serving as a primary
indicator of left ventricular preload.
QUESTION 2
What is the primary mechanism of action of norepinephrine when administered
as a continuous infusion in septic shock?
A. Potent alpha-1 and beta-1 adrenergic agonism, leading to systemic
vasoconstriction and increased mean arterial pressure
B. Selective beta-2 adrenergic agonism causing bronchodilation
C. Inhibition of angiotensin-converting enzyme in vascular beds
D. Direct stimulation of parasympathetic vagal nerve pathways
ANSWER: A
,RATIONALE: Norepinephrine is a potent alpha-1 agonist causing intense
peripheral vasoconstriction and moderate beta-1 inotropic effects, making it the
first-line vasopressor to restore perfusion pressure in septic shock.
QUESTION 3
What is the primary pharmacological action of dobutamine when used in acute
decompensated heart failure with low cardiac output?
A. Selective beta-1 adrenergic agonism resulting in increased myocardial
contractility and mild vasodilation
B. Intense alpha-1 vasoconstriction to raise systemic blood pressure
C. Direct inhibition of phosphodiesterase enzyme in smooth muscle
D. Blockade of beta receptors to reduce heart rate
ANSWER: A
RATIONALE: Dobutamine is a synthetic inotrope that stimulates beta-1 receptors
in the heart to increase myocardial contractility and stroke volume, with modest
beta-2-mediated vasodilation to reduce afterload.
QUESTION 4
Which nursing assessment finding indicates that a high-pressure ventilator alarm
is triggered by an acute mechanical obstruction in the endotracheal tube?
A. A sudden drop in exhaled tidal volume
B. The patient coughing, biting the tube, or excessive thick secretions in the
airway
C. Disconnection of the ventilator tubing from the endotracheal adapter
D. A cuff leak resulting in audible air sounds around the mouth
ANSWER: B
RATIONALE: High-pressure alarms activate when airway resistance or peak
inspiratory pressure increases suddenly, commonly caused by client coughing,
biting the tube, bronchospasm, mucus plugs, or tension pneumothorax.
,QUESTION 5
What is the defining arterial blood gas and oxygenation criterion for diagnosing
acute respiratory distress syndrome?
A. PaO2 to FiO2 ratio of 300 millimeters of mercury or less with bilateral
pulmonary infiltrates not explained by heart failure
B. PaO2 greater than 80 millimeters of mercury on room air
C. PaCO2 greater than 60 millimeters of mercury with a normal pH
D. Serum bicarbonate less than 15 milliequivalents per liter
ANSWER: A
RATIONALE: Acute respiratory distress syndrome is characterized by non-
cardiogenic pulmonary edema, bilateral infiltrates on chest imaging, and a ratio of
arterial oxygen partial pressure to fraction of inspired oxygen of 300 or less.
QUESTION 6
What is the recommended initial fluid resuscitation volume administered as
crystalloids within the first three hours for a patient presenting with septic shock?
A. 10 milliliters per kilogram
B. 30 milliliters per kilogram
C. 50 milliliters per kilogram
D. 100 milliliters per kilogram
ANSWER: B
RATIONALE: Surviving Sepsis Campaign guidelines recommend prompt
administration of at least 30 mL/kg of IV crystalloid fluid within the first three
hours of resuscitation for sepsis-induced hypoperfusion.
QUESTION 7
Which clinical manifestations comprise Cushing triad associated with increased
intracranial pressure?
A. Tachycardia, hypotension, and tachypnea
, B. Bradycardia, widened pulse pressure, and irregular respirations
C. Fever, nuchal rigidity, and photophobia
D. Rapid shallow breathing, muffled heart sounds, and hypotension
ANSWER: B
RATIONALE: Cushing triad is a late, life-threatening sign of severely elevated
intracranial pressure consisting of systolic hypertension with a widened pulse
pressure, bradycardia, and irregular respiratory patterns.
QUESTION 8
What is the primary mechanism of action of mannitol when administered
intravenously to lower elevated intracranial pressure?
A. Acting as an osmotic diuretic that draws water from brain tissue into the
intravascular space, reducing cerebral edema
B. Inhibiting sodium and chloride reabsorption in the loop of Henle
C. Blocking carbonic anhydrase enzymes in the cerebral cortex
D. Causing direct vasoconstriction of cerebral blood vessels
ANSWER: A
RATIONALE: Mannitol increases the osmotic pressure of glomerular filtrate,
drawing water out of interstitial and intracellular spaces of the brain parenchyma
into the bloodstream for renal excretion.
QUESTION 9
Which clinical assessment findings characterize a tension pneumothorax requiring
emergency intervention?
A. Tracheal deviation toward the unaffected side, absent breath sounds on the
affected side, jugular venous distension, and hemodynamic collapse
B. Bilateral equal breath sounds with mild wheezing
C. Bradycardia and constricted pupils
D. Diffuse crackles in bilateral lower lung fields
Questions and Answers with Rationales
2026/2027 Update
QUESTION 1
Which hemodynamic parameter reflects left ventricular preload and is measured
using a pulmonary artery catheter with the balloon inflated?
A. Systemic vascular resistance
B. Pulmonary artery wedge pressure
C. Central venous pressure
D. Cardiac index
ANSWER: B
RATIONALE: Pulmonary artery wedge pressure measures the pressure in the left
atrium and reflects left ventricular end-diastolic pressure, serving as a primary
indicator of left ventricular preload.
QUESTION 2
What is the primary mechanism of action of norepinephrine when administered
as a continuous infusion in septic shock?
A. Potent alpha-1 and beta-1 adrenergic agonism, leading to systemic
vasoconstriction and increased mean arterial pressure
B. Selective beta-2 adrenergic agonism causing bronchodilation
C. Inhibition of angiotensin-converting enzyme in vascular beds
D. Direct stimulation of parasympathetic vagal nerve pathways
ANSWER: A
,RATIONALE: Norepinephrine is a potent alpha-1 agonist causing intense
peripheral vasoconstriction and moderate beta-1 inotropic effects, making it the
first-line vasopressor to restore perfusion pressure in septic shock.
QUESTION 3
What is the primary pharmacological action of dobutamine when used in acute
decompensated heart failure with low cardiac output?
A. Selective beta-1 adrenergic agonism resulting in increased myocardial
contractility and mild vasodilation
B. Intense alpha-1 vasoconstriction to raise systemic blood pressure
C. Direct inhibition of phosphodiesterase enzyme in smooth muscle
D. Blockade of beta receptors to reduce heart rate
ANSWER: A
RATIONALE: Dobutamine is a synthetic inotrope that stimulates beta-1 receptors
in the heart to increase myocardial contractility and stroke volume, with modest
beta-2-mediated vasodilation to reduce afterload.
QUESTION 4
Which nursing assessment finding indicates that a high-pressure ventilator alarm
is triggered by an acute mechanical obstruction in the endotracheal tube?
A. A sudden drop in exhaled tidal volume
B. The patient coughing, biting the tube, or excessive thick secretions in the
airway
C. Disconnection of the ventilator tubing from the endotracheal adapter
D. A cuff leak resulting in audible air sounds around the mouth
ANSWER: B
RATIONALE: High-pressure alarms activate when airway resistance or peak
inspiratory pressure increases suddenly, commonly caused by client coughing,
biting the tube, bronchospasm, mucus plugs, or tension pneumothorax.
,QUESTION 5
What is the defining arterial blood gas and oxygenation criterion for diagnosing
acute respiratory distress syndrome?
A. PaO2 to FiO2 ratio of 300 millimeters of mercury or less with bilateral
pulmonary infiltrates not explained by heart failure
B. PaO2 greater than 80 millimeters of mercury on room air
C. PaCO2 greater than 60 millimeters of mercury with a normal pH
D. Serum bicarbonate less than 15 milliequivalents per liter
ANSWER: A
RATIONALE: Acute respiratory distress syndrome is characterized by non-
cardiogenic pulmonary edema, bilateral infiltrates on chest imaging, and a ratio of
arterial oxygen partial pressure to fraction of inspired oxygen of 300 or less.
QUESTION 6
What is the recommended initial fluid resuscitation volume administered as
crystalloids within the first three hours for a patient presenting with septic shock?
A. 10 milliliters per kilogram
B. 30 milliliters per kilogram
C. 50 milliliters per kilogram
D. 100 milliliters per kilogram
ANSWER: B
RATIONALE: Surviving Sepsis Campaign guidelines recommend prompt
administration of at least 30 mL/kg of IV crystalloid fluid within the first three
hours of resuscitation for sepsis-induced hypoperfusion.
QUESTION 7
Which clinical manifestations comprise Cushing triad associated with increased
intracranial pressure?
A. Tachycardia, hypotension, and tachypnea
, B. Bradycardia, widened pulse pressure, and irregular respirations
C. Fever, nuchal rigidity, and photophobia
D. Rapid shallow breathing, muffled heart sounds, and hypotension
ANSWER: B
RATIONALE: Cushing triad is a late, life-threatening sign of severely elevated
intracranial pressure consisting of systolic hypertension with a widened pulse
pressure, bradycardia, and irregular respiratory patterns.
QUESTION 8
What is the primary mechanism of action of mannitol when administered
intravenously to lower elevated intracranial pressure?
A. Acting as an osmotic diuretic that draws water from brain tissue into the
intravascular space, reducing cerebral edema
B. Inhibiting sodium and chloride reabsorption in the loop of Henle
C. Blocking carbonic anhydrase enzymes in the cerebral cortex
D. Causing direct vasoconstriction of cerebral blood vessels
ANSWER: A
RATIONALE: Mannitol increases the osmotic pressure of glomerular filtrate,
drawing water out of interstitial and intracellular spaces of the brain parenchyma
into the bloodstream for renal excretion.
QUESTION 9
Which clinical assessment findings characterize a tension pneumothorax requiring
emergency intervention?
A. Tracheal deviation toward the unaffected side, absent breath sounds on the
affected side, jugular venous distension, and hemodynamic collapse
B. Bilateral equal breath sounds with mild wheezing
C. Bradycardia and constricted pupils
D. Diffuse crackles in bilateral lower lung fields
