, Question 1
A patient in septic shock has received 30 mL/kg crystalloid and is now on
norepinephrine 12 mcg/min. MAP is 58 mm Hg, CVP 14 mm Hg, ScvO2 62%,
lactate rising. Which intervention best matches current Surviving Sepsis
Campaign guidance?
A. Administer 1 L additional crystalloid bolus
B. Add vasopressin 0.03 units/min
C. Start dobutamine 5 mcg/kg/min
D. Transfuse 1 unit PRBCs
Correct Answer: B - Add vasopressin 0.03 units/min
RATIONALE
When MAP remains below 65 mm Hg despite high-dose
norepinephrine and adequate fluid resuscitation, vasopressin is added
to achieve vasoconstriction via V1 receptors and reduce catecholamine
requirements. Additional fluid is unlikely to help with CVP already
elevated and may worsen pulmonary edema. Dobutamine is not
first-line for MAP; transfusion is only indicated for Hb <7 g/dL
without ischemia.
Question 2
A patient with ARDS on volume-control ventilation: VT 6 mL/kg PBW, PEEP
18 cm H2O, plateau pressure 32 cm H2O, driving pressure 14 cm H2O, SpO2
88%. Which action is most consistent with lung-protective ventilation
evidence?
A. Increase VT to 8 mL/kg PBW
B. Decrease PEEP to 10 cm H2O
C. Perform recruitment maneuver
D. Prone position for 16 hours
Correct Answer: D - Prone position for 16 hours
Page 2
, RATIONALE
Prone positioning improves oxygenation and reduces mortality in
moderate-severe ARDS (PaO2/FiO2 <150) by reducing ventral
alveolar overdistension and dorsal atelectasis. Increasing VT or
decreasing PEEP would worsen hypoxemia or atelectrauma.
Recruitment maneuvers are not routinely recommended due to risk of
barotrauma and hemodynamic compromise.
Question 3
A patient with acute ischemic stroke has BP 210/110 mm Hg and is being
evaluated for IV thrombolysis. Which blood pressure management is correct
per current AHA/ASA guidelines?
A. Lower BP to <185/110 mm Hg before thrombolysis
B. Withhold thrombolysis due to hypertension
C. Lower BP by 25% in first hour
D. Administer nitroprusside for rapid reduction
Correct Answer: A - Lower BP to <185/110 mm Hg before
thrombolysis
RATIONALE
IV thrombolysis requires BP <185/110 mm Hg; labetalol or
nicardipine is used to achieve this. Withholding thrombolysis solely
for hypertension is inappropriate if BP can be controlled. Rapid
reduction or nitroprusside is avoided due to risk of cerebral
hypoperfusion and toxicity.
Question 4
A patient with DKA has glucose 480 mg/dL, pH 7.12, HCO3 8 mEq/L, K+ 3.2
mEq/L, and is on an insulin infusion. Which prescription should the nurse
question?
A. 0.9% NaCl with 20 mEq KCl/L at 200 mL/hr
B. Insulin infusion at 0.1 units/kg/hr
Page 3
A patient in septic shock has received 30 mL/kg crystalloid and is now on
norepinephrine 12 mcg/min. MAP is 58 mm Hg, CVP 14 mm Hg, ScvO2 62%,
lactate rising. Which intervention best matches current Surviving Sepsis
Campaign guidance?
A. Administer 1 L additional crystalloid bolus
B. Add vasopressin 0.03 units/min
C. Start dobutamine 5 mcg/kg/min
D. Transfuse 1 unit PRBCs
Correct Answer: B - Add vasopressin 0.03 units/min
RATIONALE
When MAP remains below 65 mm Hg despite high-dose
norepinephrine and adequate fluid resuscitation, vasopressin is added
to achieve vasoconstriction via V1 receptors and reduce catecholamine
requirements. Additional fluid is unlikely to help with CVP already
elevated and may worsen pulmonary edema. Dobutamine is not
first-line for MAP; transfusion is only indicated for Hb <7 g/dL
without ischemia.
Question 2
A patient with ARDS on volume-control ventilation: VT 6 mL/kg PBW, PEEP
18 cm H2O, plateau pressure 32 cm H2O, driving pressure 14 cm H2O, SpO2
88%. Which action is most consistent with lung-protective ventilation
evidence?
A. Increase VT to 8 mL/kg PBW
B. Decrease PEEP to 10 cm H2O
C. Perform recruitment maneuver
D. Prone position for 16 hours
Correct Answer: D - Prone position for 16 hours
Page 2
, RATIONALE
Prone positioning improves oxygenation and reduces mortality in
moderate-severe ARDS (PaO2/FiO2 <150) by reducing ventral
alveolar overdistension and dorsal atelectasis. Increasing VT or
decreasing PEEP would worsen hypoxemia or atelectrauma.
Recruitment maneuvers are not routinely recommended due to risk of
barotrauma and hemodynamic compromise.
Question 3
A patient with acute ischemic stroke has BP 210/110 mm Hg and is being
evaluated for IV thrombolysis. Which blood pressure management is correct
per current AHA/ASA guidelines?
A. Lower BP to <185/110 mm Hg before thrombolysis
B. Withhold thrombolysis due to hypertension
C. Lower BP by 25% in first hour
D. Administer nitroprusside for rapid reduction
Correct Answer: A - Lower BP to <185/110 mm Hg before
thrombolysis
RATIONALE
IV thrombolysis requires BP <185/110 mm Hg; labetalol or
nicardipine is used to achieve this. Withholding thrombolysis solely
for hypertension is inappropriate if BP can be controlled. Rapid
reduction or nitroprusside is avoided due to risk of cerebral
hypoperfusion and toxicity.
Question 4
A patient with DKA has glucose 480 mg/dL, pH 7.12, HCO3 8 mEq/L, K+ 3.2
mEq/L, and is on an insulin infusion. Which prescription should the nurse
question?
A. 0.9% NaCl with 20 mEq KCl/L at 200 mL/hr
B. Insulin infusion at 0.1 units/kg/hr
Page 3
