NURS 711 ADVANCED PRACTICE
NURSING - EXAM 4 COMPREHENSIVE
REVIEW QUESTIONS & VERIFIED
ANSWERS | UNIVERSITY OF SOUTH
CAROLINA | GUARANTEE PASS
1. A patient in the ICU presents with a Pulmonary Capillary Wedge Pressure (PCWP) of 22
mmHg, a Cardiac Index (CI) of 1.8 L/min/m2, and a Systemic Vascular Resistance Index (SVRI)
of 2800 dynes/sec/cm5/m2. Which type of shock is most likely?
A. Hypovolemic shock
B. Septic shock
C. Cardiogenic shock
D. Anaphylactic shock
Answer: C
Conceptual Explanation: Cardiogenic shock is characterized by an elevated PCWP
(reflecting left ventricular end-diastolic pressure), a low Cardiac Index, and a
compensatory increase in SVR.
2. When managing a patient with Acute Respiratory Distress Syndrome (ARDS), which
ventilator strategy is prioritized to minimize ventilator-associated lung injury?
A. High tidal volumes to maintain normocapnia
,B. Inverse ratio ventilation with high inspiratory pressures
C. Decreased PEEP to avoid barotrauma
D. Low tidal volume (6 mL/kg) and permissive hypercapnia
Answer: D
Conceptual Explanation: Low tidal volume ventilation (lung-protective ventilation)
reduces volutrauma and is associated with decreased mortality in ARDS patients.
3. A patient with a traumatic brain injury has an Intracranial Pressure (ICP) of 22 mmHg and a
Mean Arterial Pressure (MAP) of 85 mmHg. What is the calculated Cerebral Perfusion
Pressure (CPP)?
A. 63 mmHg
B. 107 mmHg
C. 70 mmHg
D. 45 mmHg
Answer: A
Conceptual Explanation: CPP is calculated as MAP minus ICP (85 - 22 = 63 mmHg). The
goal is typically to maintain CPP between 60-70 mmHg.
4. Which electrolyte abnormality is a hallmark finding in the early stages of refeeding
syndrome in a critically ill patient?
A. Hyperkalemia
, B. Hypermagnesemia
C. Hypophosphatemia
D. Hypocalcemia
Answer: C
Conceptual Explanation: Refeeding syndrome causes a shift from fat to carbohydrate
metabolism, leading to insulin release which drives phosphate into the cells, resulting in
severe hypophosphatemia.
5. In the context of the Renin-Angiotensin-Aldosterone System (RAAS), what is the primary
physiological effect of Angiotensin II on the efferent arteriole of the kidney?
A. Vasodilation to increase renal blood flow
B. Inhibition of antidiuretic hormone (ADH)
C. Decreased production of aldosterone
D. Vasoconstriction to maintain glomerular filtration rate (GFR)
Answer: D
Conceptual Explanation: Angiotensin II preferentially constricts the efferent arteriole,
which increases glomerular hydrostatic pressure to maintain GFR when renal perfusion is
low.
NURSING - EXAM 4 COMPREHENSIVE
REVIEW QUESTIONS & VERIFIED
ANSWERS | UNIVERSITY OF SOUTH
CAROLINA | GUARANTEE PASS
1. A patient in the ICU presents with a Pulmonary Capillary Wedge Pressure (PCWP) of 22
mmHg, a Cardiac Index (CI) of 1.8 L/min/m2, and a Systemic Vascular Resistance Index (SVRI)
of 2800 dynes/sec/cm5/m2. Which type of shock is most likely?
A. Hypovolemic shock
B. Septic shock
C. Cardiogenic shock
D. Anaphylactic shock
Answer: C
Conceptual Explanation: Cardiogenic shock is characterized by an elevated PCWP
(reflecting left ventricular end-diastolic pressure), a low Cardiac Index, and a
compensatory increase in SVR.
2. When managing a patient with Acute Respiratory Distress Syndrome (ARDS), which
ventilator strategy is prioritized to minimize ventilator-associated lung injury?
A. High tidal volumes to maintain normocapnia
,B. Inverse ratio ventilation with high inspiratory pressures
C. Decreased PEEP to avoid barotrauma
D. Low tidal volume (6 mL/kg) and permissive hypercapnia
Answer: D
Conceptual Explanation: Low tidal volume ventilation (lung-protective ventilation)
reduces volutrauma and is associated with decreased mortality in ARDS patients.
3. A patient with a traumatic brain injury has an Intracranial Pressure (ICP) of 22 mmHg and a
Mean Arterial Pressure (MAP) of 85 mmHg. What is the calculated Cerebral Perfusion
Pressure (CPP)?
A. 63 mmHg
B. 107 mmHg
C. 70 mmHg
D. 45 mmHg
Answer: A
Conceptual Explanation: CPP is calculated as MAP minus ICP (85 - 22 = 63 mmHg). The
goal is typically to maintain CPP between 60-70 mmHg.
4. Which electrolyte abnormality is a hallmark finding in the early stages of refeeding
syndrome in a critically ill patient?
A. Hyperkalemia
, B. Hypermagnesemia
C. Hypophosphatemia
D. Hypocalcemia
Answer: C
Conceptual Explanation: Refeeding syndrome causes a shift from fat to carbohydrate
metabolism, leading to insulin release which drives phosphate into the cells, resulting in
severe hypophosphatemia.
5. In the context of the Renin-Angiotensin-Aldosterone System (RAAS), what is the primary
physiological effect of Angiotensin II on the efferent arteriole of the kidney?
A. Vasodilation to increase renal blood flow
B. Inhibition of antidiuretic hormone (ADH)
C. Decreased production of aldosterone
D. Vasoconstriction to maintain glomerular filtration rate (GFR)
Answer: D
Conceptual Explanation: Angiotensin II preferentially constricts the efferent arteriole,
which increases glomerular hydrostatic pressure to maintain GFR when renal perfusion is
low.
