TABLE OF CONTENTS
SECTION 1: CARDIOVASCULAR AND HEMATOLOGY
Questions 1 - 50
Key Topics: Heart failure, coronary artery disease, hypertension, anemia, coagulation
disorders
SECTION 2: RESPIRATORY
Questions 51 - 90
Key Topics: COPD, asthma, pneumonia, pulmonary embolism, chest tubes
SECTION 3: GASTROINTESTINAL AND NUTRITION
Questions 91 - 130
Key Topics: Bowel obstruction, pancreatitis, liver disease, enteral nutrition, ostomy care
SECTION 4: RENAL AND URINARY
Questions 131 - 160
Key Topics: Acute kidney injury, chronic kidney disease, urinary tract infections, dialysis
SECTION 5: ENDOCRINE AND METABOLIC
Questions 161 - 190
Key Topics: Diabetes mellitus, thyroid disorders, adrenal insufficiency, fluid and electrolyte
imbalances
SECTION 6: NEUROLOGICAL AND SENSORY
Questions 191 - 220
Key Topics: Stroke, traumatic brain injury, seizures, glaucoma, hearing loss
SECTION 7: MUSCULOSKELETAL, INTEGUMENTARY, AND PERIOPERATIVE
Questions 221 - 250
1
,Key Topics: Fractures, wound care, pressure injuries, preoperative and postoperative care
QUESTION 1
Q1. A patient with septic shock is receiving norepinephrine at 12 mcg/min via central line.
The mean arterial pressure (MAP) is 58 mm Hg. The nurse notes a heart rate of 128 bpm
and frequent premature ventricular contractions (PVCs). Which intervention should the
nurse anticipate?
A. Increase norepinephrine infusion rate to achieve MAP >65 mm Hg
B. Administer a 500 mL bolus of 0.9% normal saline over 15 minutes
C. Start an infusion of dobutamine at 5 mcg/kg/min
D. Prepare for transcutaneous pacing
Correct Answer: B. Administer a 500 mL bolus of 0.9% normal saline over 15 minutes
Detailed Rationale:
In septic shock, the foundational pathophysiology involves systemic vasodilation and
relative hypovolemia. When a patient is already receiving high-dose vasopressors
(norepinephrine at 12 mcg/min is a significant dose) and exhibiting signs of toxicity
(tachycardia at 128 bpm and PVCs), the nurse must first address volume depletion. Fluid
resuscitation with crystalloids (like normal saline) is the primary intervention to increase
preload and cardiac output, which will reduce the compensatory tachycardia and stabilize
the myocardial irritability. The goal is to optimize venous return before increasing the
vasopressor burden, which would only exacerbate the cardiac side effects.
Why Wrong:
2
,- A: Increasing norepinephrine will worsen the existing tachycardia and lower the
threshold for severe arrhythmias; it should only be considered after volume status has
been optimized.
- C: Dobutamine is an inotropic agent used as a second-line therapy for patients with
myocardial dysfunction who have adequate fluid volume; it is not the initial treatment for
hypovolemic symptoms.
- D: Transcutaneous pacing is reserved for bradycardic rhythms causing hemodynamic
collapse, not for managing tachyarrhythmias or PVCs.
References:
- Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic
Shock 2021.
- ATI Medical-Surgical Nursing, 12th ed., Ch. 10.
QUESTION 2
Q2. A patient with chronic kidney disease (CKD) stage 4 is admitted with hyperkalemia
(potassium 6.8 mEq/L). ECG shows peaked T waves. The nurse administers intravenous
calcium gluconate, regular insulin, dextrose 50%, and albuterol nebulized. Which finding
indicates that the most immediate life-threatening effect has been addressed?
A. Serum potassium level decreases to 5.5 mEq/L within 30 minutes
B. ECG shows normalization of T wave amplitude
C. Urine output increases to 40 mL/hour
D. Serum glucose rises to 250 mg/dL
Correct Answer: B. ECG shows normalization of T wave amplitude
Detailed Rationale:
3
, In hyperkalemia, the immediate life-threatening danger is not the elevated potassium level
itself, but the effect it has on myocardial depolarization, which can quickly lead to lethal
dysrhythmias (ventricular fibrillation or asystole). Intravenous calcium gluconate acts as a
membrane stabilizer; it does not remove potassium from the body, but rather immediately
antagonizes the effect of hyperkalemia on the cardiac myocytes. Therefore, the most
immediate clinical indicator that the "life-threatening effect" has been managed is the
normalization of the ECG (resolution of peaked T waves, prolongation of PR interval, or
widening of QRS). The other medications (insulin, dextrose, and albuterol) take longer to
shift potassium intracellularly.
Why Wrong:
- A: Potassium lowering is a slower process (taking hours, not minutes, with
insulin/albuterol) and does not directly measure the immediate arrhythmia risk.
- C: Increased urine output might indicate improved renal perfusion, but diuresis takes
time and does not address the acute cardiac toxicity.
- D: Hyperglycemia is an expected, transient side effect of dextrose administration to
prevent hypoglycemia and is not a positive indicator of resolving the medical crisis.
References:
- ATI Medical-Surgical Nursing, 12th ed., Ch. 57.
- Kidney Disease: Improving Global Outcomes (KDIGO) 2024 Guidelines.
QUESTION 3
Q3. A patient is 2 days post-operative following a total hip arthroplasty. The nurse assesses
a sudden onset of dyspnea, tachypnea, pleuritic chest pain, and oxygen saturation of 88%
on room air. The patient has a history of atrial fibrillation and is not on anticoagulation.
Which intervention should the nurse perform first?
A. Administer oxygen via non-rebreather mask at 15 L/min
B. Notify the healthcare provider immediately
4
SECTION 1: CARDIOVASCULAR AND HEMATOLOGY
Questions 1 - 50
Key Topics: Heart failure, coronary artery disease, hypertension, anemia, coagulation
disorders
SECTION 2: RESPIRATORY
Questions 51 - 90
Key Topics: COPD, asthma, pneumonia, pulmonary embolism, chest tubes
SECTION 3: GASTROINTESTINAL AND NUTRITION
Questions 91 - 130
Key Topics: Bowel obstruction, pancreatitis, liver disease, enteral nutrition, ostomy care
SECTION 4: RENAL AND URINARY
Questions 131 - 160
Key Topics: Acute kidney injury, chronic kidney disease, urinary tract infections, dialysis
SECTION 5: ENDOCRINE AND METABOLIC
Questions 161 - 190
Key Topics: Diabetes mellitus, thyroid disorders, adrenal insufficiency, fluid and electrolyte
imbalances
SECTION 6: NEUROLOGICAL AND SENSORY
Questions 191 - 220
Key Topics: Stroke, traumatic brain injury, seizures, glaucoma, hearing loss
SECTION 7: MUSCULOSKELETAL, INTEGUMENTARY, AND PERIOPERATIVE
Questions 221 - 250
1
,Key Topics: Fractures, wound care, pressure injuries, preoperative and postoperative care
QUESTION 1
Q1. A patient with septic shock is receiving norepinephrine at 12 mcg/min via central line.
The mean arterial pressure (MAP) is 58 mm Hg. The nurse notes a heart rate of 128 bpm
and frequent premature ventricular contractions (PVCs). Which intervention should the
nurse anticipate?
A. Increase norepinephrine infusion rate to achieve MAP >65 mm Hg
B. Administer a 500 mL bolus of 0.9% normal saline over 15 minutes
C. Start an infusion of dobutamine at 5 mcg/kg/min
D. Prepare for transcutaneous pacing
Correct Answer: B. Administer a 500 mL bolus of 0.9% normal saline over 15 minutes
Detailed Rationale:
In septic shock, the foundational pathophysiology involves systemic vasodilation and
relative hypovolemia. When a patient is already receiving high-dose vasopressors
(norepinephrine at 12 mcg/min is a significant dose) and exhibiting signs of toxicity
(tachycardia at 128 bpm and PVCs), the nurse must first address volume depletion. Fluid
resuscitation with crystalloids (like normal saline) is the primary intervention to increase
preload and cardiac output, which will reduce the compensatory tachycardia and stabilize
the myocardial irritability. The goal is to optimize venous return before increasing the
vasopressor burden, which would only exacerbate the cardiac side effects.
Why Wrong:
2
,- A: Increasing norepinephrine will worsen the existing tachycardia and lower the
threshold for severe arrhythmias; it should only be considered after volume status has
been optimized.
- C: Dobutamine is an inotropic agent used as a second-line therapy for patients with
myocardial dysfunction who have adequate fluid volume; it is not the initial treatment for
hypovolemic symptoms.
- D: Transcutaneous pacing is reserved for bradycardic rhythms causing hemodynamic
collapse, not for managing tachyarrhythmias or PVCs.
References:
- Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic
Shock 2021.
- ATI Medical-Surgical Nursing, 12th ed., Ch. 10.
QUESTION 2
Q2. A patient with chronic kidney disease (CKD) stage 4 is admitted with hyperkalemia
(potassium 6.8 mEq/L). ECG shows peaked T waves. The nurse administers intravenous
calcium gluconate, regular insulin, dextrose 50%, and albuterol nebulized. Which finding
indicates that the most immediate life-threatening effect has been addressed?
A. Serum potassium level decreases to 5.5 mEq/L within 30 minutes
B. ECG shows normalization of T wave amplitude
C. Urine output increases to 40 mL/hour
D. Serum glucose rises to 250 mg/dL
Correct Answer: B. ECG shows normalization of T wave amplitude
Detailed Rationale:
3
, In hyperkalemia, the immediate life-threatening danger is not the elevated potassium level
itself, but the effect it has on myocardial depolarization, which can quickly lead to lethal
dysrhythmias (ventricular fibrillation or asystole). Intravenous calcium gluconate acts as a
membrane stabilizer; it does not remove potassium from the body, but rather immediately
antagonizes the effect of hyperkalemia on the cardiac myocytes. Therefore, the most
immediate clinical indicator that the "life-threatening effect" has been managed is the
normalization of the ECG (resolution of peaked T waves, prolongation of PR interval, or
widening of QRS). The other medications (insulin, dextrose, and albuterol) take longer to
shift potassium intracellularly.
Why Wrong:
- A: Potassium lowering is a slower process (taking hours, not minutes, with
insulin/albuterol) and does not directly measure the immediate arrhythmia risk.
- C: Increased urine output might indicate improved renal perfusion, but diuresis takes
time and does not address the acute cardiac toxicity.
- D: Hyperglycemia is an expected, transient side effect of dextrose administration to
prevent hypoglycemia and is not a positive indicator of resolving the medical crisis.
References:
- ATI Medical-Surgical Nursing, 12th ed., Ch. 57.
- Kidney Disease: Improving Global Outcomes (KDIGO) 2024 Guidelines.
QUESTION 3
Q3. A patient is 2 days post-operative following a total hip arthroplasty. The nurse assesses
a sudden onset of dyspnea, tachypnea, pleuritic chest pain, and oxygen saturation of 88%
on room air. The patient has a history of atrial fibrillation and is not on anticoagulation.
Which intervention should the nurse perform first?
A. Administer oxygen via non-rebreather mask at 15 L/min
B. Notify the healthcare provider immediately
4
