, Question 1
A patient with acute decompensated heart failure is receiving IV furosemide
and has a serum potassium of 3.1 mEq/L. Which finding best indicates the
patient is developing a life-threatening complication?
A. Flattened T waves with a prominent U wave on ECG
B. Peaked T waves and widened QRS
C. Prolonged PR interval with bradycardia
D. ST elevation in contiguous leads
Correct Answer: A - Flattened T waves with a prominent U wave
on ECG
RATIONALE
Hypokalemia from loop diuretics causes flattened T waves and U
waves, predisposing to lethal ventricular dysrhythmias such as
torsades de pointes. Peaked T waves (B) indicate hyperkalemia,
prolonged PR (C) suggests AV nodal block, and ST elevation (D)
indicates myocardial injury, not hypokalemia.
Question 2
Which assessment finding in a patient receiving IV mannitol for cerebral
edema most urgently requires provider notification?
A. Serum osmolality of 320 mOsm/kg
B. Urine output of 60 mL/hr
C. Blood pressure 138/82 mm Hg
D. Serum sodium of 142 mEq/L
Correct Answer: A - Serum osmolality of 320 mOsm/kg
RATIONALE
Mannitol-induced hyperosmolality above 320 mOsm/kg risks renal
failure, rebound intracranial hypertension, and hypernatremia; therapy
must be held and the provider notified. The other values are within
acceptable therapeutic ranges during mannitol administration.
Page 2
, Question 3
A patient with type 1 diabetes has a blood glucose of 640 mg/dL, pH 7.12, and
positive serum ketones. Which initial intervention is most appropriate?
A. IV regular insulin infusion with 0.9% NaCl
B. IV sodium bicarbonate bolus
C. Subcutaneous insulin glargine alone
D. Rapid IV push of 50% dextrose
Correct Answer: A - IV regular insulin infusion with 0.9% NaCl
RATIONALE
Diabetic ketoacidosis requires IV regular insulin infusion plus isotonic
saline to correct dehydration and halt ketogenesis. Bicarbonate (B) is
reserved for severe acidosis (pH <6.9), glargine alone (C) is too slow,
and dextrose (D) is added only when glucose falls below 200-250
mg/dL.
Question 4
Which laboratory trend in a patient with acute kidney injury best differentiates
prerenal azotemia from intrinsic renal injury?
A. BUN-to-creatinine ratio >20:1 with urine sodium <20 mEq/L
B. BUN-to-creatinine ratio <10:1 with urine sodium >40 mEq/L
C. Fractional excretion of sodium <1% with urine osmolality >500
mOsm/kg
D. Serum creatinine rising 0.3 mg/dL in 48 hours
Correct Answer: C - Fractional excretion of sodium <1% with
urine osmolality >500 mOsm/kg
Page 3
, RATIONALE
Prerenal azotemia causes avid sodium and water reabsorption,
yielding FENa <1% and concentrated urine >500 mOsm/kg; intrinsic
injury typically shows FENa >2% and dilute urine. Option A is
partially correct but less specific than FENa; B describes intrinsic
injury, and D is a diagnostic criterion for AKI, not a differentiator.
Question 5
A patient receiving chemotherapy for acute myeloid leukemia develops a
temperature of 38.3°C, absolute neutrophil count 400/mm³, and hypotension.
Which action should the nurse take first?
A. Obtain blood cultures and administer broad-spectrum IV antibiotics
B. Administer acetaminophen and reassess in 1 hour
C. Wait for culture results before starting antibiotics
D. Give granulocyte colony-stimulating factor (G-CSF) alone
Correct Answer: A - Obtain blood cultures and administer
broad-spectrum IV antibiotics
RATIONALE
Febrile neutropenia with hypotension is an oncologic emergency
requiring immediate cultures followed by empiric broad-spectrum
antibiotics within 60 minutes. Antipyretics (B) mask signs, waiting for
cultures (C) delays life-saving therapy, and G-CSF (D) is adjunctive,
not initial treatment.
Question 6
Which pathophysiologic mechanism best explains why a patient with a T6
spinal cord injury develops bradycardia and hypotension during a noxious
stimulus above the injury level?
A. Uninhibited sympathetic outflow causing vasoconstriction
B. Loss of supraspinal sympathetic modulation with intact vagal tone
C. Excessive parasympathetic outflow from the sacral cord
Page 4
A patient with acute decompensated heart failure is receiving IV furosemide
and has a serum potassium of 3.1 mEq/L. Which finding best indicates the
patient is developing a life-threatening complication?
A. Flattened T waves with a prominent U wave on ECG
B. Peaked T waves and widened QRS
C. Prolonged PR interval with bradycardia
D. ST elevation in contiguous leads
Correct Answer: A - Flattened T waves with a prominent U wave
on ECG
RATIONALE
Hypokalemia from loop diuretics causes flattened T waves and U
waves, predisposing to lethal ventricular dysrhythmias such as
torsades de pointes. Peaked T waves (B) indicate hyperkalemia,
prolonged PR (C) suggests AV nodal block, and ST elevation (D)
indicates myocardial injury, not hypokalemia.
Question 2
Which assessment finding in a patient receiving IV mannitol for cerebral
edema most urgently requires provider notification?
A. Serum osmolality of 320 mOsm/kg
B. Urine output of 60 mL/hr
C. Blood pressure 138/82 mm Hg
D. Serum sodium of 142 mEq/L
Correct Answer: A - Serum osmolality of 320 mOsm/kg
RATIONALE
Mannitol-induced hyperosmolality above 320 mOsm/kg risks renal
failure, rebound intracranial hypertension, and hypernatremia; therapy
must be held and the provider notified. The other values are within
acceptable therapeutic ranges during mannitol administration.
Page 2
, Question 3
A patient with type 1 diabetes has a blood glucose of 640 mg/dL, pH 7.12, and
positive serum ketones. Which initial intervention is most appropriate?
A. IV regular insulin infusion with 0.9% NaCl
B. IV sodium bicarbonate bolus
C. Subcutaneous insulin glargine alone
D. Rapid IV push of 50% dextrose
Correct Answer: A - IV regular insulin infusion with 0.9% NaCl
RATIONALE
Diabetic ketoacidosis requires IV regular insulin infusion plus isotonic
saline to correct dehydration and halt ketogenesis. Bicarbonate (B) is
reserved for severe acidosis (pH <6.9), glargine alone (C) is too slow,
and dextrose (D) is added only when glucose falls below 200-250
mg/dL.
Question 4
Which laboratory trend in a patient with acute kidney injury best differentiates
prerenal azotemia from intrinsic renal injury?
A. BUN-to-creatinine ratio >20:1 with urine sodium <20 mEq/L
B. BUN-to-creatinine ratio <10:1 with urine sodium >40 mEq/L
C. Fractional excretion of sodium <1% with urine osmolality >500
mOsm/kg
D. Serum creatinine rising 0.3 mg/dL in 48 hours
Correct Answer: C - Fractional excretion of sodium <1% with
urine osmolality >500 mOsm/kg
Page 3
, RATIONALE
Prerenal azotemia causes avid sodium and water reabsorption,
yielding FENa <1% and concentrated urine >500 mOsm/kg; intrinsic
injury typically shows FENa >2% and dilute urine. Option A is
partially correct but less specific than FENa; B describes intrinsic
injury, and D is a diagnostic criterion for AKI, not a differentiator.
Question 5
A patient receiving chemotherapy for acute myeloid leukemia develops a
temperature of 38.3°C, absolute neutrophil count 400/mm³, and hypotension.
Which action should the nurse take first?
A. Obtain blood cultures and administer broad-spectrum IV antibiotics
B. Administer acetaminophen and reassess in 1 hour
C. Wait for culture results before starting antibiotics
D. Give granulocyte colony-stimulating factor (G-CSF) alone
Correct Answer: A - Obtain blood cultures and administer
broad-spectrum IV antibiotics
RATIONALE
Febrile neutropenia with hypotension is an oncologic emergency
requiring immediate cultures followed by empiric broad-spectrum
antibiotics within 60 minutes. Antipyretics (B) mask signs, waiting for
cultures (C) delays life-saving therapy, and G-CSF (D) is adjunctive,
not initial treatment.
Question 6
Which pathophysiologic mechanism best explains why a patient with a T6
spinal cord injury develops bradycardia and hypotension during a noxious
stimulus above the injury level?
A. Uninhibited sympathetic outflow causing vasoconstriction
B. Loss of supraspinal sympathetic modulation with intact vagal tone
C. Excessive parasympathetic outflow from the sacral cord
Page 4
