, Question 1
A patient with acute decompensated heart failure is receiving IV furosemide.
Which assessment finding best indicates that the medication is achieving its
intended therapeutic effect?
A. Urine output of 40 mL/hr with decreased breath sounds
B. Serum potassium increase from 3.2 to 4.0 mEq/L
C. Weight loss of 0.5 kg over 24 hours
D. Decreased central venous pressure from 14 to 8 mm Hg
Correct Answer: D - Decreased central venous pressure from 14
to 8 mm Hg
RATIONALE
A decrease in CVP reflects reduced preload, the primary therapeutic
goal of diuresis in heart failure. Urine output alone does not confirm
effective decongestion, potassium changes are not the intended effect,
and 0.5 kg is insufficient to indicate significant fluid loss.
Question 2
A patient with type 1 diabetes is found unresponsive with a blood glucose of
42 mg/dL. After administering IV dextrose, which finding indicates the most
immediate concern for rebound hypoglycemia?
A. Serum potassium of 3.0 mEq/L
B. Rebound hyperglycemia within 30 minutes
C. Continued altered mental status after glucose administration
D. Development of hypoglycemia unawareness
Correct Answer: C - Continued altered mental status after
glucose administration
Page 2
, RATIONALE
Persistent altered mental status after glucose administration may
indicate cerebral edema or another cause, requiring urgent evaluation.
Rebound hyperglycemia is not the immediate concern, hypokalemia is
a side effect of insulin but not directly related to rebound
hypoglycemia, and unawareness is a chronic adaptation.
Question 3
A patient with chronic kidney disease (CKD) stage 4 has a hemoglobin of 9.2
g/dL, ferritin 120 ng/mL, and transferrin saturation 18%. Which prescribed
medication does the nurse anticipate will be most effective?
A. Epoetin alfa
B. Ferrous sulfate
C. Darbepoetin alfa
D. IV iron sucrose
Correct Answer: D - IV iron sucrose
RATIONALE
In CKD, iron deficiency is common; ferritin <100 ng/mL and TSAT
<20% indicate absolute iron deficiency. IV iron is preferred for rapid
repletion before erythropoiesis-stimulating agents. Oral iron is less
effective due to impaired absorption and GI side effects. ESAs are
used after iron stores are repleted.
Question 4
A patient with an acute ischemic stroke is being evaluated for thrombolytic
therapy. Which finding would contraindicate the use of IV alteplase?
A. Blood pressure 185/110 mm Hg
B. Platelet count 150,000/mm³
C. INR of 1.8
D. History of myocardial infarction 6 months ago
Page 3
, Correct Answer: C - INR of 1.8
RATIONALE
An INR >1.7 is a contraindication for IV alteplase due to increased
bleeding risk. Blood pressure >185/110 mm Hg is a relative
contraindication that can be treated, platelet count of 150,000 is
acceptable, and remote MI is not a contraindication.
Question 5
A patient with sepsis is receiving norepinephrine. Which parameter best
reflects adequate tissue perfusion?
A. Mean arterial pressure (MAP) 65 mm Hg
B. Urine output 0.5 mL/kg/hr
C. Central venous oxygen saturation (ScvO2) 70%
D. Capillary refill <3 seconds
Correct Answer: C - Central venous oxygen saturation (ScvO2)
70%
RATIONALE
ScvO2 reflects the balance between oxygen delivery and consumption,
making it a direct indicator of tissue perfusion. MAP is a target for
perfusion pressure but does not guarantee perfusion. Urine output and
capillary refill are indirect and can be affected by other factors.
Question 6
A patient receiving chemotherapy for leukemia has a neutrophil count of
400/mm³. Which intervention is the priority?
A. Administer granulocyte colony-stimulating factor (G-CSF)
B. Place in a private room with positive-pressure airflow
C. Initiate neutropenic precautions and monitor for infection
D. Encourage a diet high in fresh fruits and vegetables
Correct Answer: C - Initiate neutropenic precautions and
Page 4
A patient with acute decompensated heart failure is receiving IV furosemide.
Which assessment finding best indicates that the medication is achieving its
intended therapeutic effect?
A. Urine output of 40 mL/hr with decreased breath sounds
B. Serum potassium increase from 3.2 to 4.0 mEq/L
C. Weight loss of 0.5 kg over 24 hours
D. Decreased central venous pressure from 14 to 8 mm Hg
Correct Answer: D - Decreased central venous pressure from 14
to 8 mm Hg
RATIONALE
A decrease in CVP reflects reduced preload, the primary therapeutic
goal of diuresis in heart failure. Urine output alone does not confirm
effective decongestion, potassium changes are not the intended effect,
and 0.5 kg is insufficient to indicate significant fluid loss.
Question 2
A patient with type 1 diabetes is found unresponsive with a blood glucose of
42 mg/dL. After administering IV dextrose, which finding indicates the most
immediate concern for rebound hypoglycemia?
A. Serum potassium of 3.0 mEq/L
B. Rebound hyperglycemia within 30 minutes
C. Continued altered mental status after glucose administration
D. Development of hypoglycemia unawareness
Correct Answer: C - Continued altered mental status after
glucose administration
Page 2
, RATIONALE
Persistent altered mental status after glucose administration may
indicate cerebral edema or another cause, requiring urgent evaluation.
Rebound hyperglycemia is not the immediate concern, hypokalemia is
a side effect of insulin but not directly related to rebound
hypoglycemia, and unawareness is a chronic adaptation.
Question 3
A patient with chronic kidney disease (CKD) stage 4 has a hemoglobin of 9.2
g/dL, ferritin 120 ng/mL, and transferrin saturation 18%. Which prescribed
medication does the nurse anticipate will be most effective?
A. Epoetin alfa
B. Ferrous sulfate
C. Darbepoetin alfa
D. IV iron sucrose
Correct Answer: D - IV iron sucrose
RATIONALE
In CKD, iron deficiency is common; ferritin <100 ng/mL and TSAT
<20% indicate absolute iron deficiency. IV iron is preferred for rapid
repletion before erythropoiesis-stimulating agents. Oral iron is less
effective due to impaired absorption and GI side effects. ESAs are
used after iron stores are repleted.
Question 4
A patient with an acute ischemic stroke is being evaluated for thrombolytic
therapy. Which finding would contraindicate the use of IV alteplase?
A. Blood pressure 185/110 mm Hg
B. Platelet count 150,000/mm³
C. INR of 1.8
D. History of myocardial infarction 6 months ago
Page 3
, Correct Answer: C - INR of 1.8
RATIONALE
An INR >1.7 is a contraindication for IV alteplase due to increased
bleeding risk. Blood pressure >185/110 mm Hg is a relative
contraindication that can be treated, platelet count of 150,000 is
acceptable, and remote MI is not a contraindication.
Question 5
A patient with sepsis is receiving norepinephrine. Which parameter best
reflects adequate tissue perfusion?
A. Mean arterial pressure (MAP) 65 mm Hg
B. Urine output 0.5 mL/kg/hr
C. Central venous oxygen saturation (ScvO2) 70%
D. Capillary refill <3 seconds
Correct Answer: C - Central venous oxygen saturation (ScvO2)
70%
RATIONALE
ScvO2 reflects the balance between oxygen delivery and consumption,
making it a direct indicator of tissue perfusion. MAP is a target for
perfusion pressure but does not guarantee perfusion. Urine output and
capillary refill are indirect and can be affected by other factors.
Question 6
A patient receiving chemotherapy for leukemia has a neutrophil count of
400/mm³. Which intervention is the priority?
A. Administer granulocyte colony-stimulating factor (G-CSF)
B. Place in a private room with positive-pressure airflow
C. Initiate neutropenic precautions and monitor for infection
D. Encourage a diet high in fresh fruits and vegetables
Correct Answer: C - Initiate neutropenic precautions and
Page 4
