NUR 6121 Exam 3 V1 | NUR 6121
Advanced Nursing II | Q&A with Rationale
(NUR6121 Exam 3) | William Paterson
University
1. A patient in the intensive care unit is being monitored for septic shock. The advanced
practice nurse notes a mean arterial pressure (MAP) of 55 mmHg and a serum lactate of 4.2
mmol/L. Which intervention should be the immediate priority?
A. Administer a 30 mL/kg isotonic crystalloid bolus
B. Initiate broad-spectrum antibiotic therapy
C. Start a norepinephrine infusion at 0.05 mcg/kg/min
D. Obtain blood cultures from two different sites
Answer: A
Rationale: The Surviving Sepsis Campaign guidelines recommend an immediate fluid bolus
of 30 mL/kg for patients with hypotension or a lactate level ≥4 mmol/L. This initial volume
resuscitation is critical to improve tissue perfusion and stabilize the MAP before initiating
vasopressors. While antibiotics and cultures are vital, restoring circulating volume is the
physiological priority in the early management of septic shock.
,2. When managing a patient with Acute Respiratory Distress Syndrome (ARDS), the clinician
utilizes high levels of Positive End-Expiratory Pressure (PEEP). What is the primary
physiological rationale for this intervention?
A. To decrease the work of breathing and improve patient comfort
B. To decrease the risk of ventilator-associated pneumonia
C. To increase the tidal volume delivered by the ventilator
D. To prevent the collapse of alveoli and improve recruitment
Answer: D
Rationale: PEEP is used in ARDS to keep the alveoli open at the end of expiration, which
prevents atelectasis and increases the functional residual capacity. By recruiting more
alveoli for gas exchange, PEEP significantly improves oxygenation in patients with
shunting. This strategy also helps prevent further lung injury caused by the repetitive
opening and closing of fragile air sacs.
3. An elderly patient presents with a sudden change in mental status, headache, and a blood
pressure of 210/120 mmHg. Which assessment finding would most strongly suggest a
hypertensive emergency rather than a hypertensive urgency?
A. A history of poorly controlled essential hypertension
B. Presence of papilledema on fundoscopic exam
C. Diastolic blood pressure greater than 110 mmHg
D. Report of a mild, generalized headache
,Answer: B
Rationale: A hypertensive emergency is distinguished from urgency by the presence of
acute, life-threatening target organ damage. Papilledema indicates increased intracranial
pressure and ocular damage, which are clear markers of end-organ involvement. In
contrast, urgency involves high blood pressure without immediate signs of organ
dysfunction.
4. In the management of Diabetic Ketoacidosis (DKA), at what point should the clinician add
5% dextrose to the intravenous fluid regimen?
A. When the serum potassium level drops below 3.5 mEq/L
B. Immediately upon the resolution of metabolic acidosis
C. When the serum glucose reaches 200 mg/dL
D. When the patient is able to tolerate oral intake
Answer: C
Rationale: Dextrose is added to the IV fluids once the blood glucose level reaches
approximately 200-250 mg/dL to prevent hypoglycemia during continued insulin
administration. The insulin infusion must continue until the anion gap closes and the
metabolic acidosis is resolved, regardless of the glucose level. This transition allows for the
safe administration of insulin needed to clear ketones while maintaining stable glucose
levels.
, 5. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22 mmHg and a
MAP of 85 mmHg. What is the calculated Cerebral Perfusion Pressure (CPP), and is it within
the recommended range?
A. CPP is 107 mmHg; this is above the recommended range
B. CPP is 107 mmHg; this is within the recommended range
C. CPP is 63 mmHg; this is below the recommended range
D. CPP is 63 mmHg; this is within the recommended range
Answer: D
Rationale: Cerebral Perfusion Pressure is calculated by subtracting the ICP from the MAP
(85 - 22 = 63). The standard target for CPP in brain-injured patients is typically between 60
and 70 mmHg. Maintaining this range ensures adequate blood flow to the brain tissues
while avoiding the risks of hyperperfusion or secondary ischemia.
6. Which laboratory finding is most characteristic of disseminated intravascular coagulation
(DIC) in the acute phase?
A. Shortened Prothrombin Time (PT)
B. Elevated D-dimer and decreased platelets
C. Increased fibrinogen levels
D. Decreased Partial Thromboplastin Time (PTT)
Answer: B
Advanced Nursing II | Q&A with Rationale
(NUR6121 Exam 3) | William Paterson
University
1. A patient in the intensive care unit is being monitored for septic shock. The advanced
practice nurse notes a mean arterial pressure (MAP) of 55 mmHg and a serum lactate of 4.2
mmol/L. Which intervention should be the immediate priority?
A. Administer a 30 mL/kg isotonic crystalloid bolus
B. Initiate broad-spectrum antibiotic therapy
C. Start a norepinephrine infusion at 0.05 mcg/kg/min
D. Obtain blood cultures from two different sites
Answer: A
Rationale: The Surviving Sepsis Campaign guidelines recommend an immediate fluid bolus
of 30 mL/kg for patients with hypotension or a lactate level ≥4 mmol/L. This initial volume
resuscitation is critical to improve tissue perfusion and stabilize the MAP before initiating
vasopressors. While antibiotics and cultures are vital, restoring circulating volume is the
physiological priority in the early management of septic shock.
,2. When managing a patient with Acute Respiratory Distress Syndrome (ARDS), the clinician
utilizes high levels of Positive End-Expiratory Pressure (PEEP). What is the primary
physiological rationale for this intervention?
A. To decrease the work of breathing and improve patient comfort
B. To decrease the risk of ventilator-associated pneumonia
C. To increase the tidal volume delivered by the ventilator
D. To prevent the collapse of alveoli and improve recruitment
Answer: D
Rationale: PEEP is used in ARDS to keep the alveoli open at the end of expiration, which
prevents atelectasis and increases the functional residual capacity. By recruiting more
alveoli for gas exchange, PEEP significantly improves oxygenation in patients with
shunting. This strategy also helps prevent further lung injury caused by the repetitive
opening and closing of fragile air sacs.
3. An elderly patient presents with a sudden change in mental status, headache, and a blood
pressure of 210/120 mmHg. Which assessment finding would most strongly suggest a
hypertensive emergency rather than a hypertensive urgency?
A. A history of poorly controlled essential hypertension
B. Presence of papilledema on fundoscopic exam
C. Diastolic blood pressure greater than 110 mmHg
D. Report of a mild, generalized headache
,Answer: B
Rationale: A hypertensive emergency is distinguished from urgency by the presence of
acute, life-threatening target organ damage. Papilledema indicates increased intracranial
pressure and ocular damage, which are clear markers of end-organ involvement. In
contrast, urgency involves high blood pressure without immediate signs of organ
dysfunction.
4. In the management of Diabetic Ketoacidosis (DKA), at what point should the clinician add
5% dextrose to the intravenous fluid regimen?
A. When the serum potassium level drops below 3.5 mEq/L
B. Immediately upon the resolution of metabolic acidosis
C. When the serum glucose reaches 200 mg/dL
D. When the patient is able to tolerate oral intake
Answer: C
Rationale: Dextrose is added to the IV fluids once the blood glucose level reaches
approximately 200-250 mg/dL to prevent hypoglycemia during continued insulin
administration. The insulin infusion must continue until the anion gap closes and the
metabolic acidosis is resolved, regardless of the glucose level. This transition allows for the
safe administration of insulin needed to clear ketones while maintaining stable glucose
levels.
, 5. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22 mmHg and a
MAP of 85 mmHg. What is the calculated Cerebral Perfusion Pressure (CPP), and is it within
the recommended range?
A. CPP is 107 mmHg; this is above the recommended range
B. CPP is 107 mmHg; this is within the recommended range
C. CPP is 63 mmHg; this is below the recommended range
D. CPP is 63 mmHg; this is within the recommended range
Answer: D
Rationale: Cerebral Perfusion Pressure is calculated by subtracting the ICP from the MAP
(85 - 22 = 63). The standard target for CPP in brain-injured patients is typically between 60
and 70 mmHg. Maintaining this range ensures adequate blood flow to the brain tissues
while avoiding the risks of hyperperfusion or secondary ischemia.
6. Which laboratory finding is most characteristic of disseminated intravascular coagulation
(DIC) in the acute phase?
A. Shortened Prothrombin Time (PT)
B. Elevated D-dimer and decreased platelets
C. Increased fibrinogen levels
D. Decreased Partial Thromboplastin Time (PTT)
Answer: B
