NURS 4581 NURSING OF ADULTS
2026/2027 ADVANCED PRACTICE EXAM
QUESTIONS AND ANSWERS
1. A patient in septic shock remains hypotensive despite receiving 30 mL/kg of isotonic
crystalloids. The nurse anticipates the initiation of which first-line vasopressor?
A. Dopamine
B. Norepinephrine
C. Epinephrine
D. Vasopressin
Answer: B
Conceptual Explanation: According to the Surviving Sepsis Campaign, norepinephrine is
the first-choice vasopressor to maintain a Mean Arterial Pressure (MAP) of at least 65
mmHg.
2. Which clinical manifestation is considered a late sign of increased intracranial pressure
(ICP)?
A. Restlessness and confusion
,B. Cushing’s Triad
C. Headache worsening with movement
D. Pupillary sluggishness
Answer: B
Conceptual Explanation: Cushing’s Triad (bradycardia, hypertension with widening pulse
pressure, and irregular respirations) is a late sign indicating brainstem compression.
3. A patient’s ABG results are: pH 7.30, PaCO2 55 mmHg, HCO3 28 mEq/L. How should the
nurse interpret these findings?
A. Compensated Respiratory Acidosis
B. Partially Compensated Metabolic Alkalosis
C. Uncompensated Metabolic Acidosis
D. Partially Compensated Respiratory Acidosis
Answer: D
Conceptual Explanation: The pH is low (acidosis), PaCO2 is high (respiratory cause), and
the HCO3 is high, indicating the kidneys are attempting to compensate but have not yet
returned the pH to normal.
, 4. When caring for a patient with Acute Respiratory Distress Syndrome (ARDS) on mechanical
ventilation, which PEEP setting change does the nurse monitor for most closely regarding
hemodynamics?
A. Increased cardiac output
B. Decreased venous return and hypotension
C. Increased renal perfusion
D. Decreased intracranial pressure
Answer: B
Conceptual Explanation: High PEEP increases intrathoracic pressure, which can decrease
venous return to the heart, leading to decreased cardiac output and hypotension.
5. A patient with Acute Kidney Injury (AKI) has a potassium level of 6.8 mEq/L. Which ECG
change is most characteristic of this finding?
A. Prominent U waves
B. ST-segment depression
C. Tall, peaked T waves
D. Prolonged QT interval
Answer: C
Conceptual Explanation: Hyperkalemia typically causes tall, peaked T waves. Prolonged
PR intervals and widened QRS complexes may follow as levels rise.
2026/2027 ADVANCED PRACTICE EXAM
QUESTIONS AND ANSWERS
1. A patient in septic shock remains hypotensive despite receiving 30 mL/kg of isotonic
crystalloids. The nurse anticipates the initiation of which first-line vasopressor?
A. Dopamine
B. Norepinephrine
C. Epinephrine
D. Vasopressin
Answer: B
Conceptual Explanation: According to the Surviving Sepsis Campaign, norepinephrine is
the first-choice vasopressor to maintain a Mean Arterial Pressure (MAP) of at least 65
mmHg.
2. Which clinical manifestation is considered a late sign of increased intracranial pressure
(ICP)?
A. Restlessness and confusion
,B. Cushing’s Triad
C. Headache worsening with movement
D. Pupillary sluggishness
Answer: B
Conceptual Explanation: Cushing’s Triad (bradycardia, hypertension with widening pulse
pressure, and irregular respirations) is a late sign indicating brainstem compression.
3. A patient’s ABG results are: pH 7.30, PaCO2 55 mmHg, HCO3 28 mEq/L. How should the
nurse interpret these findings?
A. Compensated Respiratory Acidosis
B. Partially Compensated Metabolic Alkalosis
C. Uncompensated Metabolic Acidosis
D. Partially Compensated Respiratory Acidosis
Answer: D
Conceptual Explanation: The pH is low (acidosis), PaCO2 is high (respiratory cause), and
the HCO3 is high, indicating the kidneys are attempting to compensate but have not yet
returned the pH to normal.
, 4. When caring for a patient with Acute Respiratory Distress Syndrome (ARDS) on mechanical
ventilation, which PEEP setting change does the nurse monitor for most closely regarding
hemodynamics?
A. Increased cardiac output
B. Decreased venous return and hypotension
C. Increased renal perfusion
D. Decreased intracranial pressure
Answer: B
Conceptual Explanation: High PEEP increases intrathoracic pressure, which can decrease
venous return to the heart, leading to decreased cardiac output and hypotension.
5. A patient with Acute Kidney Injury (AKI) has a potassium level of 6.8 mEq/L. Which ECG
change is most characteristic of this finding?
A. Prominent U waves
B. ST-segment depression
C. Tall, peaked T waves
D. Prolonged QT interval
Answer: C
Conceptual Explanation: Hyperkalemia typically causes tall, peaked T waves. Prolonged
PR intervals and widened QRS complexes may follow as levels rise.
