PN 4006 Exam
Questions 1-100
Question 1
A patient with heart failure is prescribed furosemide 40 mg IV push. Prior to administration, which laboratory
value is most critical to assess?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Answer B: Serum potassium
Rationale: Furosemide is a loop diuretic that causes significant potassium wasting. Hypokalemia increases
the risk of cardiac arrhythmias, especially in patients with heart failure who may also be on digoxin.
Monitoring serum potassium is essential before each dose.
Question 2
A nurse is caring for a patient receiving a continuous heparin infusion. The patient’s aPTT is 110 seconds
(control 30 seconds). What is the priority action?
A) Increase the infusion rate by 2 mL/hour
B) Administer protamine sulfate
C) Hold the infusion and notify the provider
D) Continue infusion and recheck aPTT in 4 hours
Answer C: Hold the infusion and notify the provider
Rationale: Therapeutic aPTT for heparin is typically 1.5–2.5 times control (45–75 seconds). 110 seconds
indicates an excessive anticoagulant effect with high bleeding risk. The infusion should be held immediately
and the provider notified for possible dose adjustment or reversal.
Question 3
A postoperative patient reports sudden sharp chest pain and dyspnea. The nurse notes tachycardia and
petechiae over the chest wall. Which condition should be suspected first?
A) Atelectasis
B) Pulmonary embolism
C) Pneumothorax
D) Myocardial infarction
Answer B: Pulmonary embolism
Rationale: Sudden chest pain, dyspnea, tachycardia, and petechiae (from thrombocytopenia) are classic
signs of pulmonary embolism. Postoperative patients are at high risk due to venous stasis and
hypercoagulability. Atelectasis typically causes low-grade fever and crackles; pneumothorax presents with
absent breath sounds.
,Question 4
A diabetic patient’s blood glucose is 45 mg/dL. The patient is confused and unable to swallow. What is the
most appropriate intervention?
A) Administer 15 g of oral glucose gel
B) Give glucagon 1 mg IM or subcutaneously
C) Start an IV bolus of 50% dextrose
D) Offer orange juice with a straw
Answer B: Glucagon 1 mg IM or subcutaneously
Rationale: For severe hypoglycemia with altered mental status and inability to swallow, glucagon is
indicated. It stimulates hepatic glycogenolysis. IV dextrose (option C) is also effective but requires IV access;
glucagon can be given immediately by family or EMS. Oral glucose is contraindicated due to aspiration risk.
Question 5
Which finding in a patient receiving vancomycin IV requires immediate discontinuation of the infusion?
A) Serum creatinine 1.2 mg/dL
B) Red man syndrome (flushing, pruritus of upper body)
C) Tinnitus and high-frequency hearing loss
D) Mild hypotension (BP 100/70 mm Hg)
Answer C: Tinnitus and high-frequency hearing loss
Rationale: Tinnitus and hearing loss indicate ototoxicity, a potentially irreversible adverse effect of
vancomycin. The drug must be discontinued immediately. Red man syndrome is infusion rate-related and
can be managed by slowing infusion. Mild hypotension and early renal changes (creatinine 1.2) warrant
monitoring but not immediate discontinuation.
Question 6
A patient with chronic obstructive pulmonary disease (COPD) has an oxygen saturation of 88% on room air.
The nurse applies nasal cannula at 2 L/min. After 30 minutes, the patient becomes lethargic and drowsy.
What is the most likely cause?
A) Oxygen-induced hypoventilation due to loss of hypoxic drive
B) Carbon dioxide narcosis from retained CO₂
C) Acute exacerbation of COPD
D) Pulmonary embolism
Answer B: Carbon dioxide narcosis from retained CO₂
Rationale: COPD patients with chronic hypercapnia rely on hypoxic drive. Uncontrolled high-flow oxygen
can reduce hypoxic stimulus, leading to hypoventilation, worsening CO₂ retention, and narcosis. At 2 L/min,
this is less common but possible in severe disease. Loss of hypoxic drive is an older theory; current
understanding emphasizes V/Q mismatch and Haldane effect.
Question 7
, A patient on a mechanical ventilator has a sudden drop in oxygen saturation to 82%. The high-pressure alarm
sounds. Which action should the nurse take first?
A) Suction the patient’s airway
B) Check for a disconnection in the circuit
C) Manually ventilate with a bag-valve-mask
D) Increase the FiO₂ to 100%
Answer C: Manually ventilate with a bag-valve-mask
Rationale: High-pressure alarm with hypoxia indicates an obstruction (e.g., mucus plug, kinked tube,
pneumothorax). The priority is to disconnect the ventilator and manually ventilate the patient while
troubleshooting. This ensures oxygenation and ventilation. Suctioning may be needed but not before
securing manual ventilation.
Question 8
Which laboratory finding is most consistent with disseminated intravascular coagulation (DIC) in a septic
patient?
A) Elevated fibrinogen and normal platelet count
B) Prolonged PT, low fibrinogen, elevated D-dimer, thrombocytopenia
C) Normal PT, elevated platelets, low D-dimer
D) Shortened aPTT, elevated fibrinogen, normal D-dimer
Answer B: Prolonged PT, low fibrinogen, elevated D-dimer, thrombocytopenia
Rationale: DIC is characterized by widespread clotting followed by bleeding. Consumption of clotting
factors leads to prolonged PT/aPTT, low fibrinogen, and thrombocytopenia. Fibrin degradation products (D-
dimer) are elevated due to fibrinolysis. This pattern confirms DIC.
Question 9
A patient with cirrhosis presents with asterixis, confusion, and a serum ammonia level of 120 mcg/dL (normal
15–45). Which medication does the nurse expect to administer?
A) Spironolactone
B) Lactulose
C) Propranolol
D) Rifaximin alone
Answer B: Lactulose
Rationale: Lactulose is first-line for hepatic encephalopathy. It acidifies the colon, converting NH₃ to NH₄⁺
(trapped in gut) and promotes cathartic elimination of ammonia. Rifaximin (D) may be added for recurrent
encephalopathy but is not initial monotherapy. Spironolactone treats ascites; propranolol prevents variceal
bleeding.
Question 10
A patient with myasthenia gravis is admitted with respiratory distress. The nurse notes ptosis, diplopia, and
weak cough. Which medication should the nurse question if ordered?
Questions 1-100
Question 1
A patient with heart failure is prescribed furosemide 40 mg IV push. Prior to administration, which laboratory
value is most critical to assess?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Answer B: Serum potassium
Rationale: Furosemide is a loop diuretic that causes significant potassium wasting. Hypokalemia increases
the risk of cardiac arrhythmias, especially in patients with heart failure who may also be on digoxin.
Monitoring serum potassium is essential before each dose.
Question 2
A nurse is caring for a patient receiving a continuous heparin infusion. The patient’s aPTT is 110 seconds
(control 30 seconds). What is the priority action?
A) Increase the infusion rate by 2 mL/hour
B) Administer protamine sulfate
C) Hold the infusion and notify the provider
D) Continue infusion and recheck aPTT in 4 hours
Answer C: Hold the infusion and notify the provider
Rationale: Therapeutic aPTT for heparin is typically 1.5–2.5 times control (45–75 seconds). 110 seconds
indicates an excessive anticoagulant effect with high bleeding risk. The infusion should be held immediately
and the provider notified for possible dose adjustment or reversal.
Question 3
A postoperative patient reports sudden sharp chest pain and dyspnea. The nurse notes tachycardia and
petechiae over the chest wall. Which condition should be suspected first?
A) Atelectasis
B) Pulmonary embolism
C) Pneumothorax
D) Myocardial infarction
Answer B: Pulmonary embolism
Rationale: Sudden chest pain, dyspnea, tachycardia, and petechiae (from thrombocytopenia) are classic
signs of pulmonary embolism. Postoperative patients are at high risk due to venous stasis and
hypercoagulability. Atelectasis typically causes low-grade fever and crackles; pneumothorax presents with
absent breath sounds.
,Question 4
A diabetic patient’s blood glucose is 45 mg/dL. The patient is confused and unable to swallow. What is the
most appropriate intervention?
A) Administer 15 g of oral glucose gel
B) Give glucagon 1 mg IM or subcutaneously
C) Start an IV bolus of 50% dextrose
D) Offer orange juice with a straw
Answer B: Glucagon 1 mg IM or subcutaneously
Rationale: For severe hypoglycemia with altered mental status and inability to swallow, glucagon is
indicated. It stimulates hepatic glycogenolysis. IV dextrose (option C) is also effective but requires IV access;
glucagon can be given immediately by family or EMS. Oral glucose is contraindicated due to aspiration risk.
Question 5
Which finding in a patient receiving vancomycin IV requires immediate discontinuation of the infusion?
A) Serum creatinine 1.2 mg/dL
B) Red man syndrome (flushing, pruritus of upper body)
C) Tinnitus and high-frequency hearing loss
D) Mild hypotension (BP 100/70 mm Hg)
Answer C: Tinnitus and high-frequency hearing loss
Rationale: Tinnitus and hearing loss indicate ototoxicity, a potentially irreversible adverse effect of
vancomycin. The drug must be discontinued immediately. Red man syndrome is infusion rate-related and
can be managed by slowing infusion. Mild hypotension and early renal changes (creatinine 1.2) warrant
monitoring but not immediate discontinuation.
Question 6
A patient with chronic obstructive pulmonary disease (COPD) has an oxygen saturation of 88% on room air.
The nurse applies nasal cannula at 2 L/min. After 30 minutes, the patient becomes lethargic and drowsy.
What is the most likely cause?
A) Oxygen-induced hypoventilation due to loss of hypoxic drive
B) Carbon dioxide narcosis from retained CO₂
C) Acute exacerbation of COPD
D) Pulmonary embolism
Answer B: Carbon dioxide narcosis from retained CO₂
Rationale: COPD patients with chronic hypercapnia rely on hypoxic drive. Uncontrolled high-flow oxygen
can reduce hypoxic stimulus, leading to hypoventilation, worsening CO₂ retention, and narcosis. At 2 L/min,
this is less common but possible in severe disease. Loss of hypoxic drive is an older theory; current
understanding emphasizes V/Q mismatch and Haldane effect.
Question 7
, A patient on a mechanical ventilator has a sudden drop in oxygen saturation to 82%. The high-pressure alarm
sounds. Which action should the nurse take first?
A) Suction the patient’s airway
B) Check for a disconnection in the circuit
C) Manually ventilate with a bag-valve-mask
D) Increase the FiO₂ to 100%
Answer C: Manually ventilate with a bag-valve-mask
Rationale: High-pressure alarm with hypoxia indicates an obstruction (e.g., mucus plug, kinked tube,
pneumothorax). The priority is to disconnect the ventilator and manually ventilate the patient while
troubleshooting. This ensures oxygenation and ventilation. Suctioning may be needed but not before
securing manual ventilation.
Question 8
Which laboratory finding is most consistent with disseminated intravascular coagulation (DIC) in a septic
patient?
A) Elevated fibrinogen and normal platelet count
B) Prolonged PT, low fibrinogen, elevated D-dimer, thrombocytopenia
C) Normal PT, elevated platelets, low D-dimer
D) Shortened aPTT, elevated fibrinogen, normal D-dimer
Answer B: Prolonged PT, low fibrinogen, elevated D-dimer, thrombocytopenia
Rationale: DIC is characterized by widespread clotting followed by bleeding. Consumption of clotting
factors leads to prolonged PT/aPTT, low fibrinogen, and thrombocytopenia. Fibrin degradation products (D-
dimer) are elevated due to fibrinolysis. This pattern confirms DIC.
Question 9
A patient with cirrhosis presents with asterixis, confusion, and a serum ammonia level of 120 mcg/dL (normal
15–45). Which medication does the nurse expect to administer?
A) Spironolactone
B) Lactulose
C) Propranolol
D) Rifaximin alone
Answer B: Lactulose
Rationale: Lactulose is first-line for hepatic encephalopathy. It acidifies the colon, converting NH₃ to NH₄⁺
(trapped in gut) and promotes cathartic elimination of ammonia. Rifaximin (D) may be added for recurrent
encephalopathy but is not initial monotherapy. Spironolactone treats ascites; propranolol prevents variceal
bleeding.
Question 10
A patient with myasthenia gravis is admitted with respiratory distress. The nurse notes ptosis, diplopia, and
weak cough. Which medication should the nurse question if ordered?
