LEWIS ACTUAL EXAM SCRIPT 2026
COMPLETE QUESTIONS ANSWERS GRADED
A+
◉ A nurse is caring for a patient with shock of unknown etiology
whose hemodynamic monitoring indicates BP 92/54, pulse 64, and
an elevated pulmonary artery wedge pressure. Which collaborative
intervention ordered by the health care provider should the nurse
question?
a. Infuse normal saline at 250 mL/hr.
b. Keep head of bed elevated to 30 degrees.
c. Hold nitroprusside (Nipride) if systolic BP <90 mm Hg.
d. Titrate dobutamine (Dobutrex) to keep systolic BP >90 mm Hg.
Answer: ANS: A
The patient's elevated pulmonary artery wedge pressure indicates
volume excess. A saline infusion at 250 mL/hr will exacerbate the
volume excess. The other actions are appropriate for the patient.
◉ A 19-year-old patient with massive trauma and possible spinal
cord injury is admitted to the emergency department (ED). Which
assessment finding by the nurse will help confirm a diagnosis of
neurogenic shock?
a. Inspiratory crackles.
b. Cool, clammy extremities.
,c. Apical heart rate 45 beats/min.
d. Temperature 101.2° F (38.4° C). Answer: ANS: C
Neurogenic shock is characterized by hypotension and bradycardia.
The other findings would be more consistent with other types of
shock
◉ An older patient with cardiogenic shock is cool and clammy and
hemodynamic monitoring indicates a high systemic vascular
resistance (SVR). Which intervention should the nurse anticipate
doing next?
a. Increase the rate for the dopamine (Intropin) infusion.
b. Decrease the rate for the nitroglycerin (Tridil) infusion.
c. Increase the rate for the sodium nitroprusside (Nipride) infusion.
d. Decrease the rate for the 5% dextrose in normal saline (D5/.9 NS)
infusion. Answer: ANS: C
Nitroprusside is an arterial vasodilator and will decrease the SVR
and afterload, which will improve cardiac output. Changes in the
D5/.9 NS and nitroglycerin infusions will not directly decrease SVR.
Increasing the dopamine will tend to increase SVR.
◉ After receiving 2 L of normal saline, the central venous pressure
for a patient who has septic shock is 10 mm Hg, but the blood
pressure is still 82/40 mm Hg. The nurse will anticipate an order for
a. nitroglycerine (Tridil).
b. norepinephrine (Levophed).
, c. sodium nitroprusside (Nipride).
d. methylprednisolone (Solu-Medrol). Answer: ANS: B
When fluid resuscitation is unsuccessful, vasopressor drugs are
administered to increase the systemic vascular resistance (SVR) and
blood pressure, and improve tissue perfusion. Nitroglycerin would
decrease the preload and further drop cardiac output and BP.
Methylprednisolone (Solu-Medrol) is considered if blood pressure
does not respond first to fluids and vasopressors. Nitroprusside is
an arterial vasodilator and would further decrease SVR.
◉ To evaluate the effectiveness of the pantoprazole (Protonix)
ordered for a patient with systemic inflammatory response
syndrome (SIRS), which assessment will the nurse perform?
a. Auscultate bowel sounds.
b. Palpate for abdominal pain.
c. Ask the patient about nausea.
d. Check stools for occult blood. Answer: ANS: D
Proton pump inhibitors are given to decrease the risk for stress
ulcers in critically ill patients. The other assessments also will be
done, but these will not help in determining the effectiveness of the
pantoprazole administration.
◉ A patient with cardiogenic shock has the following vital signs: BP
102/50, pulse 128, respirations 28. The pulmonary artery wedge
COMPLETE QUESTIONS ANSWERS GRADED
A+
◉ A nurse is caring for a patient with shock of unknown etiology
whose hemodynamic monitoring indicates BP 92/54, pulse 64, and
an elevated pulmonary artery wedge pressure. Which collaborative
intervention ordered by the health care provider should the nurse
question?
a. Infuse normal saline at 250 mL/hr.
b. Keep head of bed elevated to 30 degrees.
c. Hold nitroprusside (Nipride) if systolic BP <90 mm Hg.
d. Titrate dobutamine (Dobutrex) to keep systolic BP >90 mm Hg.
Answer: ANS: A
The patient's elevated pulmonary artery wedge pressure indicates
volume excess. A saline infusion at 250 mL/hr will exacerbate the
volume excess. The other actions are appropriate for the patient.
◉ A 19-year-old patient with massive trauma and possible spinal
cord injury is admitted to the emergency department (ED). Which
assessment finding by the nurse will help confirm a diagnosis of
neurogenic shock?
a. Inspiratory crackles.
b. Cool, clammy extremities.
,c. Apical heart rate 45 beats/min.
d. Temperature 101.2° F (38.4° C). Answer: ANS: C
Neurogenic shock is characterized by hypotension and bradycardia.
The other findings would be more consistent with other types of
shock
◉ An older patient with cardiogenic shock is cool and clammy and
hemodynamic monitoring indicates a high systemic vascular
resistance (SVR). Which intervention should the nurse anticipate
doing next?
a. Increase the rate for the dopamine (Intropin) infusion.
b. Decrease the rate for the nitroglycerin (Tridil) infusion.
c. Increase the rate for the sodium nitroprusside (Nipride) infusion.
d. Decrease the rate for the 5% dextrose in normal saline (D5/.9 NS)
infusion. Answer: ANS: C
Nitroprusside is an arterial vasodilator and will decrease the SVR
and afterload, which will improve cardiac output. Changes in the
D5/.9 NS and nitroglycerin infusions will not directly decrease SVR.
Increasing the dopamine will tend to increase SVR.
◉ After receiving 2 L of normal saline, the central venous pressure
for a patient who has septic shock is 10 mm Hg, but the blood
pressure is still 82/40 mm Hg. The nurse will anticipate an order for
a. nitroglycerine (Tridil).
b. norepinephrine (Levophed).
, c. sodium nitroprusside (Nipride).
d. methylprednisolone (Solu-Medrol). Answer: ANS: B
When fluid resuscitation is unsuccessful, vasopressor drugs are
administered to increase the systemic vascular resistance (SVR) and
blood pressure, and improve tissue perfusion. Nitroglycerin would
decrease the preload and further drop cardiac output and BP.
Methylprednisolone (Solu-Medrol) is considered if blood pressure
does not respond first to fluids and vasopressors. Nitroprusside is
an arterial vasodilator and would further decrease SVR.
◉ To evaluate the effectiveness of the pantoprazole (Protonix)
ordered for a patient with systemic inflammatory response
syndrome (SIRS), which assessment will the nurse perform?
a. Auscultate bowel sounds.
b. Palpate for abdominal pain.
c. Ask the patient about nausea.
d. Check stools for occult blood. Answer: ANS: D
Proton pump inhibitors are given to decrease the risk for stress
ulcers in critically ill patients. The other assessments also will be
done, but these will not help in determining the effectiveness of the
pantoprazole administration.
◉ A patient with cardiogenic shock has the following vital signs: BP
102/50, pulse 128, respirations 28. The pulmonary artery wedge
