NR324 EAQ Weeks 4-7 Questions and
Correct Answers with Rationales/ NR 324
Adaptive Quizzing Weeks 4-7 Questions
with Correct Answers/ NR 324 Adult
Health I MOST RECENT (GRADED A+)
1. Hyperkalemia Management
Question: A patient with chronic heart failure (HFrEF) on carvedilol,
lisinopril, furosemide, and spironolactone presents with serum potassium
5.8 mEq/L, creatinine 1.8 mg/dL, and mild orthostatic hypotension. Which
medication should the nurse hold pending further evaluation?
Answer: Spironolactone
Rationale:
Spironolactone is a potassium-sparing diuretic, and a potassium level of 5.8
mEq/L is a contraindication for its use, especially in the presence of renal
impairment (elevated creatinine).
While lisinopril (an ACE inhibitor) can also raise potassium, it is not the
immediate cause in this scenario. Furosemide promotes potassium loss and
would not contribute to hyperkalemia.
2. ARDS Management
Question: A patient is in severe ARDS with a PaO2/FiO2 ratio of 85, on a
ventilator with a PEEP of 15 cm H2O and a plateau pressure of 30 cm H2O.
Which intervention is most appropriate?
Answer: Prone positioning
, Rationale:
Prone positioning improves ventilation-perfusion (V/Q) matching and
oxygenation in severe ARDS without increasing ventilator pressures, thus
reducing the risk of further lung injury.
Increasing FiO2 to 1.0 poses a risk of oxygen toxicity, and increasing PEEP
or tidal volume could cause barotrauma or volutrauma, which is
contraindicated when plateau pressure is already high.
3. Heparin-Induced Thrombocytopenia (HIT)
Question: A patient with a pulmonary embolism (PE) on a heparin infusion
has an aPTT of 55 seconds (therapeutic range 60-80). The nurse notes new
hemoptysis and a drop in platelet count from 200,000 to 90,000/mm3.
Which condition should the nurse suspect?
Answer: Heparin-induced thrombocytopenia (HIT) type II
Rationale:
HIT type II is characterized by a >50% drop in platelets 5-10 days after
starting heparin therapy and can lead to thrombotic complications, such as
the new hemoptysis seen in this patient.
This condition is a known complication of heparin therapy, unlike the other
options provided.
4. Prerenal vs. Intrarenal Acute Kidney Injury (AKI)
Question: Which laboratory finding is most consistent with prerenal acute
kidney injury (AKI) rather than intrarenal AKI?
Answer: Low urine sodium (<20 mEq/L) and low fractional excretion of
sodium (FeNa <1%)
Rationale:
, In prerenal AKI, the kidneys are hypoperfused but still functional, leading to
a compensatory response of conserving sodium and water. This results in
concentrated urine with low sodium and a low FeNa.
In contrast, intrarenal AKI (e.g., acute tubular necrosis) typically presents
with high FeNa (>2%) and low urine osmolality.
5. Acute Pancreatitis Complication
Question: A patient with acute pancreatitis develops hypocalcemia. What is
the most likely underlying mechanism?
Answer: Calcium binding to free fatty acids released by fat necrosis
(saponification)
Rationale:
Hypocalcemia in acute pancreatitis is a marker of severe disease resulting
from the saponification process, where calcium binds to free fatty acids that
are released from necrotic fat tissue. This is not primarily related to renal or
hepatic failure
6. A client with a history of heart failure is prescribed carvedilol,
lisinopril, furosemide, and spironolactone. Which assessment finding
should prompt the nurse to hold the spironolactone?
A) Blood pressure of 100/60 mm Hg
B) Serum potassium of 5.8 mEq/L
C) Weight gain of 2 lbs in 24 hours
D) Heart rate of 58 bpm
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic, and a serum
potassium level of 5.8 mEq/L indicates hyperkalemia, a direct
contraindication to its use. While orthostatic hypotension and bradycardia
are potential side effects of other medications (furosemide and carvedilol),
, they are not the immediate concern in this scenario. Weight gain would
indicate fluid retention and may require further assessment, but
hyperkalemia poses an immediate risk of life-threatening cardiac
dysrhythmias.
7. A patient in severe ARDS has a PaO2/FiO2 ratio of 85 and is on a
ventilator with a PEEP of 15 cm H2O. Which intervention is most
appropriate to improve oxygenation without increasing lung injury?
A) Increase FiO2 to 1.0
B) Increase PEEP to 20 cm H2O
C) Place the patient in a prone position
D) Administer a neuromuscular blocking agent
Correct Answer: C
Rationale: Prone positioning is an evidence-based intervention that
improves ventilation-perfusion (V/Q) matching and oxygenation in severe
ARDS without increasing ventilator pressures, thus reducing the risk of
barotrauma or volutrauma. Increasing FiO2 to 1.0 poses a risk of oxygen
toxicity. Increasing PEEP could lead to barotrauma and reduced cardiac
output. While neuromuscular blocking agents may be used in severe cases,
prone positioning is the most direct and appropriate initial intervention for
this scenario.
8. A patient with a pulmonary embolism on a heparin infusion has an
aPTT of 55 seconds (therapeutic range 60-80). The nurse notes new
Correct Answers with Rationales/ NR 324
Adaptive Quizzing Weeks 4-7 Questions
with Correct Answers/ NR 324 Adult
Health I MOST RECENT (GRADED A+)
1. Hyperkalemia Management
Question: A patient with chronic heart failure (HFrEF) on carvedilol,
lisinopril, furosemide, and spironolactone presents with serum potassium
5.8 mEq/L, creatinine 1.8 mg/dL, and mild orthostatic hypotension. Which
medication should the nurse hold pending further evaluation?
Answer: Spironolactone
Rationale:
Spironolactone is a potassium-sparing diuretic, and a potassium level of 5.8
mEq/L is a contraindication for its use, especially in the presence of renal
impairment (elevated creatinine).
While lisinopril (an ACE inhibitor) can also raise potassium, it is not the
immediate cause in this scenario. Furosemide promotes potassium loss and
would not contribute to hyperkalemia.
2. ARDS Management
Question: A patient is in severe ARDS with a PaO2/FiO2 ratio of 85, on a
ventilator with a PEEP of 15 cm H2O and a plateau pressure of 30 cm H2O.
Which intervention is most appropriate?
Answer: Prone positioning
, Rationale:
Prone positioning improves ventilation-perfusion (V/Q) matching and
oxygenation in severe ARDS without increasing ventilator pressures, thus
reducing the risk of further lung injury.
Increasing FiO2 to 1.0 poses a risk of oxygen toxicity, and increasing PEEP
or tidal volume could cause barotrauma or volutrauma, which is
contraindicated when plateau pressure is already high.
3. Heparin-Induced Thrombocytopenia (HIT)
Question: A patient with a pulmonary embolism (PE) on a heparin infusion
has an aPTT of 55 seconds (therapeutic range 60-80). The nurse notes new
hemoptysis and a drop in platelet count from 200,000 to 90,000/mm3.
Which condition should the nurse suspect?
Answer: Heparin-induced thrombocytopenia (HIT) type II
Rationale:
HIT type II is characterized by a >50% drop in platelets 5-10 days after
starting heparin therapy and can lead to thrombotic complications, such as
the new hemoptysis seen in this patient.
This condition is a known complication of heparin therapy, unlike the other
options provided.
4. Prerenal vs. Intrarenal Acute Kidney Injury (AKI)
Question: Which laboratory finding is most consistent with prerenal acute
kidney injury (AKI) rather than intrarenal AKI?
Answer: Low urine sodium (<20 mEq/L) and low fractional excretion of
sodium (FeNa <1%)
Rationale:
, In prerenal AKI, the kidneys are hypoperfused but still functional, leading to
a compensatory response of conserving sodium and water. This results in
concentrated urine with low sodium and a low FeNa.
In contrast, intrarenal AKI (e.g., acute tubular necrosis) typically presents
with high FeNa (>2%) and low urine osmolality.
5. Acute Pancreatitis Complication
Question: A patient with acute pancreatitis develops hypocalcemia. What is
the most likely underlying mechanism?
Answer: Calcium binding to free fatty acids released by fat necrosis
(saponification)
Rationale:
Hypocalcemia in acute pancreatitis is a marker of severe disease resulting
from the saponification process, where calcium binds to free fatty acids that
are released from necrotic fat tissue. This is not primarily related to renal or
hepatic failure
6. A client with a history of heart failure is prescribed carvedilol,
lisinopril, furosemide, and spironolactone. Which assessment finding
should prompt the nurse to hold the spironolactone?
A) Blood pressure of 100/60 mm Hg
B) Serum potassium of 5.8 mEq/L
C) Weight gain of 2 lbs in 24 hours
D) Heart rate of 58 bpm
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic, and a serum
potassium level of 5.8 mEq/L indicates hyperkalemia, a direct
contraindication to its use. While orthostatic hypotension and bradycardia
are potential side effects of other medications (furosemide and carvedilol),
, they are not the immediate concern in this scenario. Weight gain would
indicate fluid retention and may require further assessment, but
hyperkalemia poses an immediate risk of life-threatening cardiac
dysrhythmias.
7. A patient in severe ARDS has a PaO2/FiO2 ratio of 85 and is on a
ventilator with a PEEP of 15 cm H2O. Which intervention is most
appropriate to improve oxygenation without increasing lung injury?
A) Increase FiO2 to 1.0
B) Increase PEEP to 20 cm H2O
C) Place the patient in a prone position
D) Administer a neuromuscular blocking agent
Correct Answer: C
Rationale: Prone positioning is an evidence-based intervention that
improves ventilation-perfusion (V/Q) matching and oxygenation in severe
ARDS without increasing ventilator pressures, thus reducing the risk of
barotrauma or volutrauma. Increasing FiO2 to 1.0 poses a risk of oxygen
toxicity. Increasing PEEP could lead to barotrauma and reduced cardiac
output. While neuromuscular blocking agents may be used in severe cases,
prone positioning is the most direct and appropriate initial intervention for
this scenario.
8. A patient with a pulmonary embolism on a heparin infusion has an
aPTT of 55 seconds (therapeutic range 60-80). The nurse notes new
