NURS 4581 FINAL EXAM 2026/2027
QUESTIONS AND ANSWERS
1. A patient in the ICU is diagnosed with Acute Respiratory Distress Syndrome (ARDS). The
nurse notes a PaO2/FiO2 ratio of 120. Which intervention is most appropriate for improving
oxygenation in this patient?
A. Increase the tidal volume to 12 mL/kg of ideal body weight.
B. Administer high-dose corticosteroids immediately.
C. Place the patient in the prone position for 16 hours a day.
D. Perform aggressive chest physiotherapy every 2 hours.
Answer: C
Conceptual Explanation: Prone positioning is evidence-based to improve oxygenation
and survival in moderate to severe ARDS by improving ventilation-perfusion matching and
reducing lung compression. High tidal volumes are contraindicated; low tidal volumes (6
mL/kg) are the standard for lung protection.
,2. A client is admitted with a suspected pheochromocytoma. Which assessment finding
should the nurse prioritize as the most immediate threat?
A. Profuse diaphoresis and tachycardia.
B. Blood pressure reading of 250/140 mmHg.
C. Report of a severe, throbbing headache.
D. Blood glucose level of 180 mg/dL.
Answer: B
Conceptual Explanation: While all are symptoms of pheochromocytoma, a hypertensive
crisis (250/140 mmHg) is a life-threatening emergency that can lead to stroke, myocardial
infarction, or organ damage and must be treated immediately with vasodilators like
nitroprusside.
3. The nurse is caring for a patient with a traumatic brain injury. The patient’s intracranial
pressure (ICP) is 22 mmHg, and the mean arterial pressure (MAP) is 65 mmHg. What is the
priority nursing action?
A. Increase the rate of the norepinephrine infusion as ordered to support MAP.
B. Continue to monitor; these values are within normal limits.
C. Perform endotracheal suctioning to clear the airway.
D. Lower the head of the bed to a flat position.
Answer: A
, Conceptual Explanation: Cerebral Perfusion Pressure (CPP) = MAP - ICP. Here, 65 - 22 =
43 mmHg. A normal CPP is 60-100 mmHg. A CPP below 50 mmHg results in cerebral
ischemia. Increasing MAP via vasopressors is necessary to improve cerebral perfusion. Flat
positioning and suctioning would both increase ICP further.
4. Which laboratory value is the most specific indicator of Heparin-Induced
Thrombocytopenia (HIT) Type II?
A. A drop in platelet count by 20% from baseline after 2 days of heparin.
B. A prolonged Prothrombin Time (PT) and International Normalized Ratio (INR).
C. The presence of heparin-PF4 antibodies in a functional assay.
D. An increased D-dimer and decreased fibrinogen level.
Answer: C
Conceptual Explanation: HIT Type II is an immune-mediated reaction. Diagnosis is
confirmed through the detection of heparin-PF4 antibodies, often via ELISA or the
serotonin release assay (SRA). A 50% drop in platelets is typical, not 20%.
5. A patient in septic shock remains hypotensive despite receiving a 30 mL/kg fluid bolus. The
nurse anticipates the initiation of which first-line vasopressor?
A. Dopamine
B. Epinephrine
C. Vasopressin
QUESTIONS AND ANSWERS
1. A patient in the ICU is diagnosed with Acute Respiratory Distress Syndrome (ARDS). The
nurse notes a PaO2/FiO2 ratio of 120. Which intervention is most appropriate for improving
oxygenation in this patient?
A. Increase the tidal volume to 12 mL/kg of ideal body weight.
B. Administer high-dose corticosteroids immediately.
C. Place the patient in the prone position for 16 hours a day.
D. Perform aggressive chest physiotherapy every 2 hours.
Answer: C
Conceptual Explanation: Prone positioning is evidence-based to improve oxygenation
and survival in moderate to severe ARDS by improving ventilation-perfusion matching and
reducing lung compression. High tidal volumes are contraindicated; low tidal volumes (6
mL/kg) are the standard for lung protection.
,2. A client is admitted with a suspected pheochromocytoma. Which assessment finding
should the nurse prioritize as the most immediate threat?
A. Profuse diaphoresis and tachycardia.
B. Blood pressure reading of 250/140 mmHg.
C. Report of a severe, throbbing headache.
D. Blood glucose level of 180 mg/dL.
Answer: B
Conceptual Explanation: While all are symptoms of pheochromocytoma, a hypertensive
crisis (250/140 mmHg) is a life-threatening emergency that can lead to stroke, myocardial
infarction, or organ damage and must be treated immediately with vasodilators like
nitroprusside.
3. The nurse is caring for a patient with a traumatic brain injury. The patient’s intracranial
pressure (ICP) is 22 mmHg, and the mean arterial pressure (MAP) is 65 mmHg. What is the
priority nursing action?
A. Increase the rate of the norepinephrine infusion as ordered to support MAP.
B. Continue to monitor; these values are within normal limits.
C. Perform endotracheal suctioning to clear the airway.
D. Lower the head of the bed to a flat position.
Answer: A
, Conceptual Explanation: Cerebral Perfusion Pressure (CPP) = MAP - ICP. Here, 65 - 22 =
43 mmHg. A normal CPP is 60-100 mmHg. A CPP below 50 mmHg results in cerebral
ischemia. Increasing MAP via vasopressors is necessary to improve cerebral perfusion. Flat
positioning and suctioning would both increase ICP further.
4. Which laboratory value is the most specific indicator of Heparin-Induced
Thrombocytopenia (HIT) Type II?
A. A drop in platelet count by 20% from baseline after 2 days of heparin.
B. A prolonged Prothrombin Time (PT) and International Normalized Ratio (INR).
C. The presence of heparin-PF4 antibodies in a functional assay.
D. An increased D-dimer and decreased fibrinogen level.
Answer: C
Conceptual Explanation: HIT Type II is an immune-mediated reaction. Diagnosis is
confirmed through the detection of heparin-PF4 antibodies, often via ELISA or the
serotonin release assay (SRA). A 50% drop in platelets is typical, not 20%.
5. A patient in septic shock remains hypotensive despite receiving a 30 mL/kg fluid bolus. The
nurse anticipates the initiation of which first-line vasopressor?
A. Dopamine
B. Epinephrine
C. Vasopressin
