BSN445: CONCEPTS OF NURSING IN THE
COMPLEX PATIENT Complete Final Exam 200+
Questions, Verified Answers & Rationale 2026/2027
Updated Already Graded A+
Question 1:
A patient with septic shock has a mean arterial pressure (MAP) of 55
mmHg despite 30 mL/kg fluid resuscitation. Which vasopressor is first-
line?
A. Dopamine
B. Norepinephrine
C. Epinephrine
D. Vasopressin
Rationale: Correct answer: B. Norepinephrine is first-line vasopressor in
septic shock (Surviving Sepsis Campaign). It increases MAP via alpha-1
vasoconstriction with less tachycardia than dopamine or epinephrine.
Question 2:
A patient with acute respiratory distress syndrome (ARDS) is on
mechanical ventilation with a tidal volume of 10 mL/kg. What is the
priority change?
A. Increase tidal volume to 12 mL/kg
B. Decrease tidal volume to 6 mL/kg (low tidal volume ventilation,
ARDSnet protocol)
,
C. Increase PEEP to 20 cmH2O
D. Decrease respiratory rate to 8 breaths/min
Rationale: Correct answer: B. ARDS management (ARDSnet) uses low
tidal volume ventilation (6 mL/kg predicted body weight) to prevent
volutrauma (lung injury from overdistension). Higher tidal volumes (A)
increase mortality. High PEEP (C) may be used but tidal volume
reduction is priority.
Question 3:
A patient with cirrhosis and ascites develops fever, abdominal pain, and
altered mental status. Paracentesis shows ascitic fluid PMN count of
500/mm³. What is the most appropriate treatment?
A. IV albumin alone
B. IV antibiotics (cefotaxime) plus IV albumin
C. Oral antibiotics
D. Paracentesis only
Rationale: Correct answer: B. Spontaneous bacterial peritonitis (SBP) is
diagnosed with ascitic fluid PMN ≥250/mm³. Treatment: IV antibiotics
(third-generation cephalosporin: cefotaxime, ceftriaxone) PLUS IV
albumin (1.5 g/kg day 1, 1 g/kg day 3) to prevent hepatorenal syndrome.
Question 4:
A patient with status epilepticus has been seizing for 8 minutes. Which
medication should be administered first?
,
A. IV levetiracetam
B. IV lorazepam (benzodiazepine)
C. IV fosphenytoin
D. IV valproate
Rationale: Correct answer: B. First-line for status epilepticus (5-10
minutes) is a benzodiazepine (lorazepam IV, diazepam IV, midazolam
IM). Second-line: levetiracetam, fosphenytoin, or valproate. Time is
brain; do not delay with second-line agents first.
Question 5:
A patient with ischemic stroke arrives at the emergency department 2
hours after symptom onset. CT head shows no hemorrhage. Blood
pressure is 185/100 mmHg. Which intervention is most appropriate?
A. Lower BP to <130/80 before giving tPA
B. Administer tPA (alteplase) without BP treatment (SBP ≤185, DBP
≤110 meets criteria)
C. Wait 6 hours to see if symptoms resolve
D. Start aspirin only
Rationale: Correct answer: B. tPA window is 0-3 hours (0-4.5 hours for
select patients). BP criteria for tPA: SBP ≤185, DBP ≤110. This patient
meets criteria (185/100). Lowering BP further before tPA is not required
and may delay treatment. Administer tPA immediately after consent.
Question 6:
,
A patient in the intensive care unit has oliguria (urine output 20 mL over
2 hours), Cr 2.5 mg/dL (baseline 1.0), and K+ 6.2 mEq/L with peaked T
waves. What is the priority intervention?
A. Administer IV fluids (NS bolus)
B. Administer IV calcium gluconate (for K+ >6.5 with EKG changes)
C. Insert indwelling urinary catheter
D. Call nephrology for dialysis (next day)
Rationale: Correct answer: B. Hyperkalemia with EKG changes (peaked
T waves, widened QRS) requires immediate cardioprotection with IV
calcium gluconate. Insulin+dextrose and albuterol shift potassium
intracellularly. Kayexalate or dialysis remove potassium. Do not delay
calcium.
Question 7:
A patient with acute respiratory distress syndrome (ARDS) has a
PaO2/FiO2 ratio of 80 mmHg despite low tidal volume ventilation,
PEEP 14 cmH2O, and FiO2 0.80. Which intervention improves
mortality?
A. Increase PEEP to 20 cmH2O
B. Prone positioning (improves mortality in severe ARDS)
C. Increase FiO2 to 1.0
D. Neuromuscular blockade (cisatracurium) for 48 hours
Rationale: Correct answer: B. Prone positioning (16-18 hours/day)
improves mortality in severe ARDS (PaO2/FiO2 <150). Neuromuscular
blockade (D) for severe ARDS may improve outcomes but prone
COMPLEX PATIENT Complete Final Exam 200+
Questions, Verified Answers & Rationale 2026/2027
Updated Already Graded A+
Question 1:
A patient with septic shock has a mean arterial pressure (MAP) of 55
mmHg despite 30 mL/kg fluid resuscitation. Which vasopressor is first-
line?
A. Dopamine
B. Norepinephrine
C. Epinephrine
D. Vasopressin
Rationale: Correct answer: B. Norepinephrine is first-line vasopressor in
septic shock (Surviving Sepsis Campaign). It increases MAP via alpha-1
vasoconstriction with less tachycardia than dopamine or epinephrine.
Question 2:
A patient with acute respiratory distress syndrome (ARDS) is on
mechanical ventilation with a tidal volume of 10 mL/kg. What is the
priority change?
A. Increase tidal volume to 12 mL/kg
B. Decrease tidal volume to 6 mL/kg (low tidal volume ventilation,
ARDSnet protocol)
,
C. Increase PEEP to 20 cmH2O
D. Decrease respiratory rate to 8 breaths/min
Rationale: Correct answer: B. ARDS management (ARDSnet) uses low
tidal volume ventilation (6 mL/kg predicted body weight) to prevent
volutrauma (lung injury from overdistension). Higher tidal volumes (A)
increase mortality. High PEEP (C) may be used but tidal volume
reduction is priority.
Question 3:
A patient with cirrhosis and ascites develops fever, abdominal pain, and
altered mental status. Paracentesis shows ascitic fluid PMN count of
500/mm³. What is the most appropriate treatment?
A. IV albumin alone
B. IV antibiotics (cefotaxime) plus IV albumin
C. Oral antibiotics
D. Paracentesis only
Rationale: Correct answer: B. Spontaneous bacterial peritonitis (SBP) is
diagnosed with ascitic fluid PMN ≥250/mm³. Treatment: IV antibiotics
(third-generation cephalosporin: cefotaxime, ceftriaxone) PLUS IV
albumin (1.5 g/kg day 1, 1 g/kg day 3) to prevent hepatorenal syndrome.
Question 4:
A patient with status epilepticus has been seizing for 8 minutes. Which
medication should be administered first?
,
A. IV levetiracetam
B. IV lorazepam (benzodiazepine)
C. IV fosphenytoin
D. IV valproate
Rationale: Correct answer: B. First-line for status epilepticus (5-10
minutes) is a benzodiazepine (lorazepam IV, diazepam IV, midazolam
IM). Second-line: levetiracetam, fosphenytoin, or valproate. Time is
brain; do not delay with second-line agents first.
Question 5:
A patient with ischemic stroke arrives at the emergency department 2
hours after symptom onset. CT head shows no hemorrhage. Blood
pressure is 185/100 mmHg. Which intervention is most appropriate?
A. Lower BP to <130/80 before giving tPA
B. Administer tPA (alteplase) without BP treatment (SBP ≤185, DBP
≤110 meets criteria)
C. Wait 6 hours to see if symptoms resolve
D. Start aspirin only
Rationale: Correct answer: B. tPA window is 0-3 hours (0-4.5 hours for
select patients). BP criteria for tPA: SBP ≤185, DBP ≤110. This patient
meets criteria (185/100). Lowering BP further before tPA is not required
and may delay treatment. Administer tPA immediately after consent.
Question 6:
,
A patient in the intensive care unit has oliguria (urine output 20 mL over
2 hours), Cr 2.5 mg/dL (baseline 1.0), and K+ 6.2 mEq/L with peaked T
waves. What is the priority intervention?
A. Administer IV fluids (NS bolus)
B. Administer IV calcium gluconate (for K+ >6.5 with EKG changes)
C. Insert indwelling urinary catheter
D. Call nephrology for dialysis (next day)
Rationale: Correct answer: B. Hyperkalemia with EKG changes (peaked
T waves, widened QRS) requires immediate cardioprotection with IV
calcium gluconate. Insulin+dextrose and albuterol shift potassium
intracellularly. Kayexalate or dialysis remove potassium. Do not delay
calcium.
Question 7:
A patient with acute respiratory distress syndrome (ARDS) has a
PaO2/FiO2 ratio of 80 mmHg despite low tidal volume ventilation,
PEEP 14 cmH2O, and FiO2 0.80. Which intervention improves
mortality?
A. Increase PEEP to 20 cmH2O
B. Prone positioning (improves mortality in severe ARDS)
C. Increase FiO2 to 1.0
D. Neuromuscular blockade (cisatracurium) for 48 hours
Rationale: Correct answer: B. Prone positioning (16-18 hours/day)
improves mortality in severe ARDS (PaO2/FiO2 <150). Neuromuscular
blockade (D) for severe ARDS may improve outcomes but prone
