NUR 376 ADVANCED NURSING
COMPREHENSIVE REVIEW (EXAMS 1-4)
QUESTIONS AND ANSWERS
1. A patient with a history of chronic heart failure presents with a potassium level of 6.2
mEq/L and peaked T-waves on the ECG. Which medication should the nurse prioritize to
stabilize the cardiac membrane?
A. Sodium Polystyrene Sulfonate
B. Furosemide
C. Regular Insulin and D50
D. Calcium Gluconate
Answer: D
Conceptual Explanation: Calcium gluconate does not lower potassium but is used in
hyperkalemia to stabilize the myocardial cell membrane and prevent life-threatening
dysrhythmias.
,2. A client is in the progressive stage of hypovolemic shock. Which clinical finding should the
nurse anticipate?
A. Compensatory tachycardia and respiratory alkalosis
B. Narrowing pulse pressure and cold, clammy skin
C. Mean Arterial Pressure (MAP) within normal limits
D. Increased urinary output due to fluid resuscitation
Answer: B
Conceptual Explanation: In the progressive stage of shock, compensatory mechanisms
fail. Signs include decreased MAP, metabolic acidosis, and cold, clammy skin due to
profound peripheral vasoconstriction.
3. Using the Parkland formula, calculate the total fluid volume needed in the first 24 hours for
a 70kg patient with 40% Total Body Surface Area (TBSA) burns.
A. 5,600 mL
B. 8,400 mL
C. 11,200 mL
D. 14,000 mL
Answer: C
Conceptual Explanation: Parkland Formula: 4mL x kg x %TBSA. Calculation: 4 x 70 x 40 =
11,200 mL.
, 4. A patient is admitted with Acute Respiratory Distress Syndrome (ARDS). The nurse notes a
PaO2 of 50 mmHg while the patient is on 100% oxygen. This is an example of:
A. Ventilation-Perfusion (V/Q) mismatch
B. Diffusion limitation
C. Alveolar hypoventilation
D. Refractory hypoxemia
Answer: D
Conceptual Explanation: Refractory hypoxemia is a hallmark of ARDS, where arterial
oxygen levels remain low despite receiving high concentrations of supplemental oxygen.
5. Which hemodynamic parameter is most indicative of Cardiogenic Shock?
A. Decreased Systemic Vascular Resistance (SVR)
B. Increased Cardiac Index (CI)
C. Decreased Central Venous Pressure (CVP)
D. Increased Pulmonary Artery Wedge Pressure (PAWP)
Answer: D
Conceptual Explanation: In cardiogenic shock, the heart fails as a pump, leading to fluid
backing up into the lungs, which increases the PAWP (left-sided preload).
COMPREHENSIVE REVIEW (EXAMS 1-4)
QUESTIONS AND ANSWERS
1. A patient with a history of chronic heart failure presents with a potassium level of 6.2
mEq/L and peaked T-waves on the ECG. Which medication should the nurse prioritize to
stabilize the cardiac membrane?
A. Sodium Polystyrene Sulfonate
B. Furosemide
C. Regular Insulin and D50
D. Calcium Gluconate
Answer: D
Conceptual Explanation: Calcium gluconate does not lower potassium but is used in
hyperkalemia to stabilize the myocardial cell membrane and prevent life-threatening
dysrhythmias.
,2. A client is in the progressive stage of hypovolemic shock. Which clinical finding should the
nurse anticipate?
A. Compensatory tachycardia and respiratory alkalosis
B. Narrowing pulse pressure and cold, clammy skin
C. Mean Arterial Pressure (MAP) within normal limits
D. Increased urinary output due to fluid resuscitation
Answer: B
Conceptual Explanation: In the progressive stage of shock, compensatory mechanisms
fail. Signs include decreased MAP, metabolic acidosis, and cold, clammy skin due to
profound peripheral vasoconstriction.
3. Using the Parkland formula, calculate the total fluid volume needed in the first 24 hours for
a 70kg patient with 40% Total Body Surface Area (TBSA) burns.
A. 5,600 mL
B. 8,400 mL
C. 11,200 mL
D. 14,000 mL
Answer: C
Conceptual Explanation: Parkland Formula: 4mL x kg x %TBSA. Calculation: 4 x 70 x 40 =
11,200 mL.
, 4. A patient is admitted with Acute Respiratory Distress Syndrome (ARDS). The nurse notes a
PaO2 of 50 mmHg while the patient is on 100% oxygen. This is an example of:
A. Ventilation-Perfusion (V/Q) mismatch
B. Diffusion limitation
C. Alveolar hypoventilation
D. Refractory hypoxemia
Answer: D
Conceptual Explanation: Refractory hypoxemia is a hallmark of ARDS, where arterial
oxygen levels remain low despite receiving high concentrations of supplemental oxygen.
5. Which hemodynamic parameter is most indicative of Cardiogenic Shock?
A. Decreased Systemic Vascular Resistance (SVR)
B. Increased Cardiac Index (CI)
C. Decreased Central Venous Pressure (CVP)
D. Increased Pulmonary Artery Wedge Pressure (PAWP)
Answer: D
Conceptual Explanation: In cardiogenic shock, the heart fails as a pump, leading to fluid
backing up into the lungs, which increases the PAWP (left-sided preload).
