NSG 3850 EXAM with Questions and
Answers/Plus a Rationale Updated 2026
A+/Instant Download PDF
EXAM COVERAGE
1. Advanced Pharmacology and Pharmacokinetics
2. Complex Pathophysiology and Multisystem Failure
3. Critical Care Nursing Management
4. Evidence-Based Practice and Clinical Decision-Making
5. Mental Health and Psychiatric Emergency Interventions
6. Leadership and Nursing Informatics
1. A patient with congestive heart failure is prescribed digoxin. During the shift, the patient reports
visual disturbances and nausea. Which action should the nurse prioritize?
A. Administer the scheduled dose as the symptoms are likely related to the underlying cardiac
condition.
B. Check the patient’s serum digoxin level and assess the apical pulse rate for bradycardia.
C. Increase the patient’s potassium intake to counteract the potential electrolyte imbalance.
D. Notify the physician to increase the digoxin dose to reach a therapeutic steady state.
CORRECT ANSWER : B
Rationale: Visual disturbances (specifically yellow-green halos) and nausea are classic signs of
digoxin toxicity. Checking the serum level and pulse is critical to confirm toxicity and assess
cardiac stability, as digoxin can cause lethal arrhythmias. Option A is dangerous, Option C is
not the immediate priority, and Option D would exacerbate the toxicity.
,2. A patient in the ICU with sepsis begins to show signs of disseminated intravascular coagulation
(DIC). Which laboratory finding is most consistent with this diagnosis?
A. Prolonged prothrombin time (PT) and decreased fibrinogen levels.
B. Increased platelet count and shortened activated partial thromboplastin time (aPTT).
C. Elevated protein C levels and normal D-dimer.
D. Decreased D-dimer and elevated antithrombin III.
CORRECT ANSWER : A
Rationale: DIC is characterized by widespread activation of clotting, consuming platelets and
coagulation factors, leading to prolonged PT/PTT and low fibrinogen. Option B is incorrect as
platelets are consumed (decreased), and Option C/D are incorrect because D-dimer increases as
clots are broken down.
3. Which nursing intervention is most appropriate for a patient experiencing a thyroid storm?
A. Administering rapid-acting insulin to manage metabolic demand.
B. Increasing ambient room temperature to prevent shivering.
C. Administering beta-blockers and cooling measures to reduce metabolic rate.
D. Providing a high-calorie, low-protein diet to support organ function.
CORRECT ANSWER : C
Rationale: Thyroid storm is a life-threatening hypermetabolic state. Beta-blockers control the
sympathetic overactivity, and cooling measures reduce hyperpyrexia. Option A is not a primary
intervention, Option B would worsen hyperthermia, and Option D is not the priority during the
acute crisis phase.
4. A patient with acute respiratory distress syndrome (ARDS) is on mechanical ventilation with
high PEEP settings. The patient suddenly develops hypotension and tachycardia. What is the
most likely cause?
A. Pulmonary embolism due to immobility.
B. Tension pneumothorax resulting from barotrauma.
C. Septic shock from ventilator-associated pneumonia.
D. Myocardial infarction due to increased cardiac workload.
, CORRECT ANSWER : B
Rationale: High PEEP settings increase intrathoracic pressure, which can cause alveolar
rupture, leading to tension pneumothorax. This shifts the mediastinum, reduces venous return,
and causes immediate cardiovascular collapse. A, C, and D are possible in ICU patients but are
not the direct, acute result of high PEEP barotrauma.
5. A patient is receiving an infusion of dopamine at 10 mcg/kg/min for shock. The nurse notes the
site is cool, pale, and swollen. What is the priority intervention?
A. Apply a warm compress to the site to increase absorption.
B. Stop the infusion and administer phentolamine into the tissue.
C. Slow the infusion rate to allow for gradual reabsorption.
D. Elevate the extremity and continue monitoring the site hourly.
CORRECT ANSWER : B
Rationale: Dopamine is a vesicant that causes tissue necrosis if extravasated. Phentolamine is
an alpha-adrenergic blocker used to neutralize the vasoconstrictive effects. Options A, C, and D
are inappropriate and risk further tissue damage or systemic compromise.
6. Which assessment finding in a patient with a T4 spinal cord injury indicates the onset of
autonomic dysreflexia?
A. Bradycardia and hypotension.
B. Sudden onset of severe hypertension and bradycardia.
C. Flaccid paralysis of the lower extremities.
D. Absence of reflexes below the level of the injury.
CORRECT ANSWER : B
Rationale: Autonomic dysreflexia is a medical emergency characterized by a massive
sympathetic discharge triggered by a stimulus below the lesion (e.g., full bladder). The body
attempts to compensate, causing severe bradycardia. Option A is incorrect as it presents with
hypertension, and C/D are typical of spinal shock.
7. A patient with cirrhosis presents with hematemesis. Which medication should the nurse expect to
administer to decrease portal venous pressure?
A. Vitamin K.
, B. Octreotide.
C. Lactulose.
D. Spironolactone.
CORRECT ANSWER : B
Rationale: Octreotide is a somatostatin analog that causes selective splanchnic vasoconstriction,
effectively lowering portal pressure during esophageal variceal bleeding. Vitamin K is for
clotting, Lactulose for ammonia, and Spironolactone for ascites, none of which manage acute
variceal hemorrhage.
8. When managing a patient with acute kidney injury (AKI) in the oliguric phase, which fluid and
electrolyte adjustment is most critical?
A. Restrict potassium and monitor for hyperkalemia.
B. Increase sodium intake to correct hyponatremia.
C. Administer intravenous fluids to maintain a high urine output.
D. Supplement calcium to prevent hypocalcemia.
CORRECT ANSWER : A
Rationale: In the oliguric phase, the kidneys cannot excrete potassium, leading to dangerous
hyperkalemia that can trigger cardiac arrest. Option B and C would lead to fluid overload, and
D is a secondary concern compared to potassium-induced arrhythmias.
9. A patient is being monitored for increased intracranial pressure (ICP). Which position is best to
facilitate cerebral venous drainage?
A. Trendelenburg position.
B. Head of bed elevated to 30 degrees with neck in neutral alignment.
C. Supine with the head turned to the side.
D. Prone position to promote lung expansion.
CORRECT ANSWER : B
Rationale: Elevating the HOB to 30 degrees uses gravity to improve venous return from the
brain. Neutral alignment prevents jugular venous compression. The other positions either
increase ICP or obstruct venous flow.
Answers/Plus a Rationale Updated 2026
A+/Instant Download PDF
EXAM COVERAGE
1. Advanced Pharmacology and Pharmacokinetics
2. Complex Pathophysiology and Multisystem Failure
3. Critical Care Nursing Management
4. Evidence-Based Practice and Clinical Decision-Making
5. Mental Health and Psychiatric Emergency Interventions
6. Leadership and Nursing Informatics
1. A patient with congestive heart failure is prescribed digoxin. During the shift, the patient reports
visual disturbances and nausea. Which action should the nurse prioritize?
A. Administer the scheduled dose as the symptoms are likely related to the underlying cardiac
condition.
B. Check the patient’s serum digoxin level and assess the apical pulse rate for bradycardia.
C. Increase the patient’s potassium intake to counteract the potential electrolyte imbalance.
D. Notify the physician to increase the digoxin dose to reach a therapeutic steady state.
CORRECT ANSWER : B
Rationale: Visual disturbances (specifically yellow-green halos) and nausea are classic signs of
digoxin toxicity. Checking the serum level and pulse is critical to confirm toxicity and assess
cardiac stability, as digoxin can cause lethal arrhythmias. Option A is dangerous, Option C is
not the immediate priority, and Option D would exacerbate the toxicity.
,2. A patient in the ICU with sepsis begins to show signs of disseminated intravascular coagulation
(DIC). Which laboratory finding is most consistent with this diagnosis?
A. Prolonged prothrombin time (PT) and decreased fibrinogen levels.
B. Increased platelet count and shortened activated partial thromboplastin time (aPTT).
C. Elevated protein C levels and normal D-dimer.
D. Decreased D-dimer and elevated antithrombin III.
CORRECT ANSWER : A
Rationale: DIC is characterized by widespread activation of clotting, consuming platelets and
coagulation factors, leading to prolonged PT/PTT and low fibrinogen. Option B is incorrect as
platelets are consumed (decreased), and Option C/D are incorrect because D-dimer increases as
clots are broken down.
3. Which nursing intervention is most appropriate for a patient experiencing a thyroid storm?
A. Administering rapid-acting insulin to manage metabolic demand.
B. Increasing ambient room temperature to prevent shivering.
C. Administering beta-blockers and cooling measures to reduce metabolic rate.
D. Providing a high-calorie, low-protein diet to support organ function.
CORRECT ANSWER : C
Rationale: Thyroid storm is a life-threatening hypermetabolic state. Beta-blockers control the
sympathetic overactivity, and cooling measures reduce hyperpyrexia. Option A is not a primary
intervention, Option B would worsen hyperthermia, and Option D is not the priority during the
acute crisis phase.
4. A patient with acute respiratory distress syndrome (ARDS) is on mechanical ventilation with
high PEEP settings. The patient suddenly develops hypotension and tachycardia. What is the
most likely cause?
A. Pulmonary embolism due to immobility.
B. Tension pneumothorax resulting from barotrauma.
C. Septic shock from ventilator-associated pneumonia.
D. Myocardial infarction due to increased cardiac workload.
, CORRECT ANSWER : B
Rationale: High PEEP settings increase intrathoracic pressure, which can cause alveolar
rupture, leading to tension pneumothorax. This shifts the mediastinum, reduces venous return,
and causes immediate cardiovascular collapse. A, C, and D are possible in ICU patients but are
not the direct, acute result of high PEEP barotrauma.
5. A patient is receiving an infusion of dopamine at 10 mcg/kg/min for shock. The nurse notes the
site is cool, pale, and swollen. What is the priority intervention?
A. Apply a warm compress to the site to increase absorption.
B. Stop the infusion and administer phentolamine into the tissue.
C. Slow the infusion rate to allow for gradual reabsorption.
D. Elevate the extremity and continue monitoring the site hourly.
CORRECT ANSWER : B
Rationale: Dopamine is a vesicant that causes tissue necrosis if extravasated. Phentolamine is
an alpha-adrenergic blocker used to neutralize the vasoconstrictive effects. Options A, C, and D
are inappropriate and risk further tissue damage or systemic compromise.
6. Which assessment finding in a patient with a T4 spinal cord injury indicates the onset of
autonomic dysreflexia?
A. Bradycardia and hypotension.
B. Sudden onset of severe hypertension and bradycardia.
C. Flaccid paralysis of the lower extremities.
D. Absence of reflexes below the level of the injury.
CORRECT ANSWER : B
Rationale: Autonomic dysreflexia is a medical emergency characterized by a massive
sympathetic discharge triggered by a stimulus below the lesion (e.g., full bladder). The body
attempts to compensate, causing severe bradycardia. Option A is incorrect as it presents with
hypertension, and C/D are typical of spinal shock.
7. A patient with cirrhosis presents with hematemesis. Which medication should the nurse expect to
administer to decrease portal venous pressure?
A. Vitamin K.
, B. Octreotide.
C. Lactulose.
D. Spironolactone.
CORRECT ANSWER : B
Rationale: Octreotide is a somatostatin analog that causes selective splanchnic vasoconstriction,
effectively lowering portal pressure during esophageal variceal bleeding. Vitamin K is for
clotting, Lactulose for ammonia, and Spironolactone for ascites, none of which manage acute
variceal hemorrhage.
8. When managing a patient with acute kidney injury (AKI) in the oliguric phase, which fluid and
electrolyte adjustment is most critical?
A. Restrict potassium and monitor for hyperkalemia.
B. Increase sodium intake to correct hyponatremia.
C. Administer intravenous fluids to maintain a high urine output.
D. Supplement calcium to prevent hypocalcemia.
CORRECT ANSWER : A
Rationale: In the oliguric phase, the kidneys cannot excrete potassium, leading to dangerous
hyperkalemia that can trigger cardiac arrest. Option B and C would lead to fluid overload, and
D is a secondary concern compared to potassium-induced arrhythmias.
9. A patient is being monitored for increased intracranial pressure (ICP). Which position is best to
facilitate cerebral venous drainage?
A. Trendelenburg position.
B. Head of bed elevated to 30 degrees with neck in neutral alignment.
C. Supine with the head turned to the side.
D. Prone position to promote lung expansion.
CORRECT ANSWER : B
Rationale: Elevating the HOB to 30 degrees uses gravity to improve venous return from the
brain. Neutral alignment prevents jugular venous compression. The other positions either
increase ICP or obstruct venous flow.
