, Question 1
A patient with septic shock has been fluid-resuscitated and started on
norepinephrine. Which parameter best indicates that the norepinephrine is
achieving its intended therapeutic effect at the tissue level?
A. Mean arterial pressure sustained at 65 mm Hg or greater
B. Central venous oxygen saturation (ScvO2) of 70% or greater
C. Urine output of 0.5 mL/kg/hr or greater
D. Central venous pressure of 8 to 12 mm Hg
Correct Answer: B - Central venous oxygen saturation (ScvO2) of
70% or greater
RATIONALE
ScvO2 reflects the balance between oxygen delivery and consumption,
so a value 70% indicates improved tissue perfusion, the ultimate goal
of vasopressor therapy. MAP and urine output are targets but do not
directly confirm adequate tissue oxygenation, and CVP reflects
preload rather than the effect of norepinephrine.
Question 2
A patient on volume-control mechanical ventilation has the following data: PIP
42 cm H2O, plateau pressure 34 cm H2O, tidal volume 500 mL, PEEP 8 cm
H2O. Which action should the nurse anticipate?
A. Increase the respiratory rate to improve minute ventilation
B. Reduce tidal volume to 4-6 mL/kg predicted body weight
C. Increase PEEP to 12 cm H2O to recruit collapsed alveoli
D. Suction the airway to relieve a mucus plug
Correct Answer: B - Reduce tidal volume to 4-6 mL/kg predicted
body weight
Page 2
, RATIONALE
A plateau pressure >30 cm H2O indicates alveolar overdistention and
risk for ventilator-induced lung injury, so lung-protective ventilation
with 4-6 mL/kg predicted body weight is indicated. Increasing PEEP
or tidal volume would worsen overdistention, and suctioning
addresses airway resistance, not elevated plateau pressure.
Question 3
A patient in diabetic ketoacidosis has a serum potassium of 3.1 mEq/L. Which
prescription should the nurse question?
A. Administer 0.9% sodium chloride IV bolus
B. Start an insulin infusion at 0.1 units/kg/hr
C. Add 20 mEq KCl to the IV fluids
D. Monitor blood glucose every hour
Correct Answer: B - Start an insulin infusion at 0.1 units/kg/hr
RATIONALE
Insulin drives potassium intracellularly and can precipitate
life-threatening hypokalemia when serum potassium is already <3.3
mEq/L, so insulin should be withheld until potassium is corrected.
Fluid resuscitation, potassium replacement, and glucose monitoring
are appropriate in DKA management.
Question 4
A patient with acute kidney injury receiving continuous renal replacement
therapy (CRRT) develops a sudden drop in circuit pressure with dark, cloudy
effluent. Which complication should the nurse suspect?
A. Air embolism
B. Filter clotting
C. Hypophosphatemia
D. Dialysis disequilibrium syndrome
Page 3
, Correct Answer: B - Filter clotting
RATIONALE
A sudden pressure change with dark, cloudy effluent indicates clotting
within the hemofilter, which reduces clearance and requires circuit
change. Air embolism presents with cardiovascular collapse,
hypophosphatemia is a metabolic complication, and disequilibrium
syndrome occurs with rapid solute removal, not circuit pressure
changes.
Question 5
A patient receiving a blood transfusion develops fever, chills, and flank pain 15
minutes into the infusion. Which action should the nurse take first?
A. Administer acetaminophen and continue the transfusion
B. Stop the transfusion and maintain IV access with normal saline
C. Slow the transfusion rate and reassess in 15 minutes
D. Obtain a urine specimen for hemoglobinuria
Correct Answer: B - Stop the transfusion and maintain IV access
with normal saline
RATIONALE
Fever, chills, and flank pain suggest an acute hemolytic transfusion
reaction, so the transfusion must be stopped immediately and IV
access maintained with normal saline to support renal perfusion.
Continuing or slowing the transfusion delays treatment, and obtaining
a urine specimen is secondary to stopping the reaction.
Question 6
A patient with tumor lysis syndrome has a serum potassium of 6.2 mEq/L,
phosphorus of 6.8 mg/dL, and calcium of 7.1 mg/dL. Which prescription
should the nurse implement first?
A. Administer sodium polystyrene sulfonate orally
Page 4
A patient with septic shock has been fluid-resuscitated and started on
norepinephrine. Which parameter best indicates that the norepinephrine is
achieving its intended therapeutic effect at the tissue level?
A. Mean arterial pressure sustained at 65 mm Hg or greater
B. Central venous oxygen saturation (ScvO2) of 70% or greater
C. Urine output of 0.5 mL/kg/hr or greater
D. Central venous pressure of 8 to 12 mm Hg
Correct Answer: B - Central venous oxygen saturation (ScvO2) of
70% or greater
RATIONALE
ScvO2 reflects the balance between oxygen delivery and consumption,
so a value 70% indicates improved tissue perfusion, the ultimate goal
of vasopressor therapy. MAP and urine output are targets but do not
directly confirm adequate tissue oxygenation, and CVP reflects
preload rather than the effect of norepinephrine.
Question 2
A patient on volume-control mechanical ventilation has the following data: PIP
42 cm H2O, plateau pressure 34 cm H2O, tidal volume 500 mL, PEEP 8 cm
H2O. Which action should the nurse anticipate?
A. Increase the respiratory rate to improve minute ventilation
B. Reduce tidal volume to 4-6 mL/kg predicted body weight
C. Increase PEEP to 12 cm H2O to recruit collapsed alveoli
D. Suction the airway to relieve a mucus plug
Correct Answer: B - Reduce tidal volume to 4-6 mL/kg predicted
body weight
Page 2
, RATIONALE
A plateau pressure >30 cm H2O indicates alveolar overdistention and
risk for ventilator-induced lung injury, so lung-protective ventilation
with 4-6 mL/kg predicted body weight is indicated. Increasing PEEP
or tidal volume would worsen overdistention, and suctioning
addresses airway resistance, not elevated plateau pressure.
Question 3
A patient in diabetic ketoacidosis has a serum potassium of 3.1 mEq/L. Which
prescription should the nurse question?
A. Administer 0.9% sodium chloride IV bolus
B. Start an insulin infusion at 0.1 units/kg/hr
C. Add 20 mEq KCl to the IV fluids
D. Monitor blood glucose every hour
Correct Answer: B - Start an insulin infusion at 0.1 units/kg/hr
RATIONALE
Insulin drives potassium intracellularly and can precipitate
life-threatening hypokalemia when serum potassium is already <3.3
mEq/L, so insulin should be withheld until potassium is corrected.
Fluid resuscitation, potassium replacement, and glucose monitoring
are appropriate in DKA management.
Question 4
A patient with acute kidney injury receiving continuous renal replacement
therapy (CRRT) develops a sudden drop in circuit pressure with dark, cloudy
effluent. Which complication should the nurse suspect?
A. Air embolism
B. Filter clotting
C. Hypophosphatemia
D. Dialysis disequilibrium syndrome
Page 3
, Correct Answer: B - Filter clotting
RATIONALE
A sudden pressure change with dark, cloudy effluent indicates clotting
within the hemofilter, which reduces clearance and requires circuit
change. Air embolism presents with cardiovascular collapse,
hypophosphatemia is a metabolic complication, and disequilibrium
syndrome occurs with rapid solute removal, not circuit pressure
changes.
Question 5
A patient receiving a blood transfusion develops fever, chills, and flank pain 15
minutes into the infusion. Which action should the nurse take first?
A. Administer acetaminophen and continue the transfusion
B. Stop the transfusion and maintain IV access with normal saline
C. Slow the transfusion rate and reassess in 15 minutes
D. Obtain a urine specimen for hemoglobinuria
Correct Answer: B - Stop the transfusion and maintain IV access
with normal saline
RATIONALE
Fever, chills, and flank pain suggest an acute hemolytic transfusion
reaction, so the transfusion must be stopped immediately and IV
access maintained with normal saline to support renal perfusion.
Continuing or slowing the transfusion delays treatment, and obtaining
a urine specimen is secondary to stopping the reaction.
Question 6
A patient with tumor lysis syndrome has a serum potassium of 6.2 mEq/L,
phosphorus of 6.8 mg/dL, and calcium of 7.1 mg/dL. Which prescription
should the nurse implement first?
A. Administer sodium polystyrene sulfonate orally
Page 4
