, Question 1
A patient with acute decompensated heart failure is receiving a continuous
infusion of nesiritide. Which parameter, if noted on the monitor, would require
immediate intervention?
A. Serum potassium of 3.2 mEq/L
B. Systolic blood pressure of 84 mm Hg
C. Urine output of 40 mL/hr
D. Heart rate of 110 beats/min
Correct Answer: B - Systolic blood pressure of 84 mm Hg
RATIONALE
Nesiritide is a recombinant B-type natriuretic peptide that causes
vasodilation and natriuresis. Its most significant adverse effect is
hypotension, which can be profound. A systolic BP of 84 mm Hg
indicates symptomatic hypotension requiring immediate intervention
(e.g., holding the infusion, fluid resuscitation). The other values, while
abnormal, are not directly life-threatening consequences of nesiritide.
Question 2
A patient with a new diagnosis of tuberculosis is prescribed isoniazid,
rifampin, pyrazinamide, and ethambutol. Which baseline laboratory test is
most critical before initiating this regimen?
A. Serum creatinine
B. Liver function tests
C. Complete blood count
D. Serum electrolytes
Correct Answer: B - Liver function tests
Page 2
, RATIONALE
Isoniazid, rifampin, and pyrazinamide are all hepatotoxic. Baseline
liver function tests (AST, ALT, bilirubin) are essential to detect
pre-existing hepatic impairment and to monitor for drug-induced
hepatitis, which is a major adverse effect of first-line antitubercular
therapy. While renal function and CBC are relevant, hepatotoxicity is
the most common and serious risk.
Question 3
A patient is admitted with severe sepsis. The provider orders a 30 mL/kg
crystalloid bolus. The patient weighs 70 kg. The nurse has 1 L bags of 0.9%
NaCl. How many bags will be needed to complete the bolus?
A. 1 bag
B. 2 bags
C. 3 bags
D. 4 bags
Correct Answer: C - 3 bags
RATIONALE
The calculated dose is 30 mL/kg × 70 kg = 2100 mL. Since each bag
contains 1000 mL, 3 bags are needed to deliver at least 2100 mL. This
is a standard initial resuscitation volume for sepsis-induced
hypoperfusion.
Question 4
Which assessment finding is most indicative of increased intracranial pressure
(ICP) in a patient with a traumatic brain injury?
A. Decerebrate posturing
B. Increased urine output
C. Tachycardia
D. Hyperreflexia
Page 3
, Correct Answer: A - Decerebrate posturing
RATIONALE
Decerebrate posturing (extension of all extremities) indicates severe
brainstem dysfunction and is a classic sign of increased ICP. It reflects
damage at the level of the midbrain or pons. Other signs include
decreased LOC, bradycardia, hypertension, and irregular respirations
(Cushing's triad).
Question 5
A patient with a history of heart failure is prescribed metformin for type 2
diabetes. Which condition, if present, would be an absolute contraindication to
metformin?
A. eGFR of 50 mL/min/1.73 m²
B. Serum creatinine of 1.8 mg/dL
C. Acute decompensated heart failure
D. Age over 65
Correct Answer: C - Acute decompensated heart failure
RATIONALE
Metformin is contraindicated in acute decompensated heart failure
because of the increased risk of lactic acidosis due to tissue
hypoperfusion and hypoxia. While renal impairment (eGFR <30) is an
absolute contraindication, an eGFR of 50 is a relative caution. Age
alone is not a contraindication.
Question 6
A nurse is caring for a patient receiving a blood transfusion. Ten minutes into
the transfusion, the patient develops fever, chills, and flank pain. Which action
should the nurse take first?
A. Administer acetaminophen for fever.
B. Stop the transfusion immediately.
Page 4
A patient with acute decompensated heart failure is receiving a continuous
infusion of nesiritide. Which parameter, if noted on the monitor, would require
immediate intervention?
A. Serum potassium of 3.2 mEq/L
B. Systolic blood pressure of 84 mm Hg
C. Urine output of 40 mL/hr
D. Heart rate of 110 beats/min
Correct Answer: B - Systolic blood pressure of 84 mm Hg
RATIONALE
Nesiritide is a recombinant B-type natriuretic peptide that causes
vasodilation and natriuresis. Its most significant adverse effect is
hypotension, which can be profound. A systolic BP of 84 mm Hg
indicates symptomatic hypotension requiring immediate intervention
(e.g., holding the infusion, fluid resuscitation). The other values, while
abnormal, are not directly life-threatening consequences of nesiritide.
Question 2
A patient with a new diagnosis of tuberculosis is prescribed isoniazid,
rifampin, pyrazinamide, and ethambutol. Which baseline laboratory test is
most critical before initiating this regimen?
A. Serum creatinine
B. Liver function tests
C. Complete blood count
D. Serum electrolytes
Correct Answer: B - Liver function tests
Page 2
, RATIONALE
Isoniazid, rifampin, and pyrazinamide are all hepatotoxic. Baseline
liver function tests (AST, ALT, bilirubin) are essential to detect
pre-existing hepatic impairment and to monitor for drug-induced
hepatitis, which is a major adverse effect of first-line antitubercular
therapy. While renal function and CBC are relevant, hepatotoxicity is
the most common and serious risk.
Question 3
A patient is admitted with severe sepsis. The provider orders a 30 mL/kg
crystalloid bolus. The patient weighs 70 kg. The nurse has 1 L bags of 0.9%
NaCl. How many bags will be needed to complete the bolus?
A. 1 bag
B. 2 bags
C. 3 bags
D. 4 bags
Correct Answer: C - 3 bags
RATIONALE
The calculated dose is 30 mL/kg × 70 kg = 2100 mL. Since each bag
contains 1000 mL, 3 bags are needed to deliver at least 2100 mL. This
is a standard initial resuscitation volume for sepsis-induced
hypoperfusion.
Question 4
Which assessment finding is most indicative of increased intracranial pressure
(ICP) in a patient with a traumatic brain injury?
A. Decerebrate posturing
B. Increased urine output
C. Tachycardia
D. Hyperreflexia
Page 3
, Correct Answer: A - Decerebrate posturing
RATIONALE
Decerebrate posturing (extension of all extremities) indicates severe
brainstem dysfunction and is a classic sign of increased ICP. It reflects
damage at the level of the midbrain or pons. Other signs include
decreased LOC, bradycardia, hypertension, and irregular respirations
(Cushing's triad).
Question 5
A patient with a history of heart failure is prescribed metformin for type 2
diabetes. Which condition, if present, would be an absolute contraindication to
metformin?
A. eGFR of 50 mL/min/1.73 m²
B. Serum creatinine of 1.8 mg/dL
C. Acute decompensated heart failure
D. Age over 65
Correct Answer: C - Acute decompensated heart failure
RATIONALE
Metformin is contraindicated in acute decompensated heart failure
because of the increased risk of lactic acidosis due to tissue
hypoperfusion and hypoxia. While renal impairment (eGFR <30) is an
absolute contraindication, an eGFR of 50 is a relative caution. Age
alone is not a contraindication.
Question 6
A nurse is caring for a patient receiving a blood transfusion. Ten minutes into
the transfusion, the patient develops fever, chills, and flank pain. Which action
should the nurse take first?
A. Administer acetaminophen for fever.
B. Stop the transfusion immediately.
Page 4
