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
SCHOLARSOURCE 1
,Key Topics: Fractures, wound care, pressure injuries, preoperative and postoperative care
QUESTION 1
Q1. A patient with cirrhosis and ascites is admitted with acute variceal hemorrhage. The
nurse administers octreotide, initiates a vasopressin infusion, and prepares for endoscopic
band ligation. Which assessment finding is most concerning during vasopressin therapy?
A. Heart rate 92 bpm
B. Blood pressure 160/90 mm Hg
C. Chest pain with ST-segment depression on ECG
D. Serum sodium 132 mEq/L
Correct Answer: C. Chest pain with ST-segment depression on ECG
Detailed Rationale:
Vasopressin is a potent non-selective vasoconstrictor used to reduce splanchnic blood flow
and lower portal pressure in acute variceal bleeding. While it effectively reduces bleeding,
its systemic side effects are severe, specifically causing intense coronary artery
vasoconstriction. Chest pain accompanied by ST-segment depression is a definitive
indication of acute myocardial ischemia. This is the most critical adverse effect of
vasopressin therapy and requires immediate action—often involving discontinuing the
infusion, administering sublingual nitroglycerin, and notifying the provider.
Why Wrong:
- A: A heart rate of 92 bpm is slightly elevated but is a common compensatory response to
blood loss. It is not immediately dangerous in comparison to cardiac ischemia.
SCHOLARSOURCE 2
,- B: Hypertension is a known, expected side effect of vasopressin due to systemic
vasoconstriction. While it requires monitoring, it is less immediately life-threatening than
myocardial ischemia.
- D: Serum sodium 132 mEq/L is mild hyponatremia, a common finding in cirrhosis due to
fluid retention and dilution. It does not present an immediate cardiac risk.
References:
- ATI Medical-Surgical Nursing, 12th ed., Ch. 51.
- AASLD Guidelines for the Management of Acute Variceal Hemorrhage.
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:
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
SCHOLARSOURCE 3
, 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
C. Prepare the patient for a spiral CT scan
D. Start an intravenous heparin infusion per protocol
SCHOLARSOURCE 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
SCHOLARSOURCE 1
,Key Topics: Fractures, wound care, pressure injuries, preoperative and postoperative care
QUESTION 1
Q1. A patient with cirrhosis and ascites is admitted with acute variceal hemorrhage. The
nurse administers octreotide, initiates a vasopressin infusion, and prepares for endoscopic
band ligation. Which assessment finding is most concerning during vasopressin therapy?
A. Heart rate 92 bpm
B. Blood pressure 160/90 mm Hg
C. Chest pain with ST-segment depression on ECG
D. Serum sodium 132 mEq/L
Correct Answer: C. Chest pain with ST-segment depression on ECG
Detailed Rationale:
Vasopressin is a potent non-selective vasoconstrictor used to reduce splanchnic blood flow
and lower portal pressure in acute variceal bleeding. While it effectively reduces bleeding,
its systemic side effects are severe, specifically causing intense coronary artery
vasoconstriction. Chest pain accompanied by ST-segment depression is a definitive
indication of acute myocardial ischemia. This is the most critical adverse effect of
vasopressin therapy and requires immediate action—often involving discontinuing the
infusion, administering sublingual nitroglycerin, and notifying the provider.
Why Wrong:
- A: A heart rate of 92 bpm is slightly elevated but is a common compensatory response to
blood loss. It is not immediately dangerous in comparison to cardiac ischemia.
SCHOLARSOURCE 2
,- B: Hypertension is a known, expected side effect of vasopressin due to systemic
vasoconstriction. While it requires monitoring, it is less immediately life-threatening than
myocardial ischemia.
- D: Serum sodium 132 mEq/L is mild hyponatremia, a common finding in cirrhosis due to
fluid retention and dilution. It does not present an immediate cardiac risk.
References:
- ATI Medical-Surgical Nursing, 12th ed., Ch. 51.
- AASLD Guidelines for the Management of Acute Variceal Hemorrhage.
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:
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
SCHOLARSOURCE 3
, 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
C. Prepare the patient for a spiral CT scan
D. Start an intravenous heparin infusion per protocol
SCHOLARSOURCE 4
