NUR 265 – EXAM 3 (ADVANCED MED-
SURG / CRITICAL CARE) –ACTUAL
PRACTICE EXAM| PDF
1. A patient in the ICU develops acute respiratory distress syndrome (ARDS).
The ventilator is set to high PEEP. Which priority complication should the
nurse monitor for?
A. Metabolic acidosis
B. Barotrauma
C. Hypoglycemia
D. Pulmonary embolism
Rationale: High PEEP increases risk for alveolar rupture → pneumothorax (barotrauma).
2. A patient with septic shock is receiving norepinephrine. Which finding
requires IMMEDIATE intervention?
A. Urine output 40 mL/hr
B. MAP 54 mmHg
C. Warm flushed skin
D. HR 118 bpm
Rationale: MAP < 65 = inadequate perfusion → increase vasopressor support.
3. A neuro ICU patient suddenly has a fixed, dilated pupil. What should the
nurse do first?
A. Reassess in 10 minutes
B. Call rapid response/emergency provider immediately
C. Decrease sensory stimulation
D. Administer IV fluids
Rationale: Fixed dilated pupil = brain herniation → emergency.
,4. A burn patient (45% TBSA) has a urine output of 10 mL/hr during the first
6 hours. What is the priority action?
A. Administer pain medication
B. Increase potassium intake
C. Increase IV fluid rate (parkland formula resuscitation)
D. Place patient in high Fowler’s position
Rationale: Low urine output early → inadequate fluid resuscitation.
5. Which finding in a ventilated patient indicates ARDS worsening?
A. Increasing PaCO₂
B. Refractory hypoxemia
C. Decreasing FiO₂ requirement
D. Increased lung compliance
Rationale: ARDS hallmark = profound hypoxemia unresponsive to O₂.
6. A patient in DKA is being treated with an insulin drip. Which must be
administered concurrently?
A. Bicarbonate
B. IV potassium
C. IV magnesium
D. IV calcium
Rationale: As insulin shifts K⁺ into cells → serum potassium drops.
7. Which dysrhythmia is MOST lethal?
A. Atrial fibrillation
B. PACs
C. First-degree AV block
D. Ventricular fibrillation
, 8. A patient with spinal cord injury at T4 develops pounding headache,
flushing, and bradycardia. What is the priority action?
A. Administer hydralazine
B. Increase IV fluids
C. Raise HOB & check for bladder distention
D. Call rapid response
Rationale: Autonomic dysreflexia → relieve triggers, usually bladder.
9. Which lab best indicates early acute kidney injury (AKI)?
A. Low calcium
B. Low hemoglobin
C. Rising creatinine
D. Rising lipase
10. A COPD patient becomes agitated and confused. ABG: pH 7.28, PaCO₂
72. The nurse anticipates:
A. Increase O₂ to 100%
B. Fluid bolus
C. Initiate BiPAP
D. Discontinue bronchodilators
11. A patient on a heparin infusion has an aPTT of 110 seconds (therapeutic goal 60–80).
The nurse should:
A. Increase the heparin infusion rate
B. Hold the infusion and notify provider
C. Give protamine immediately
D. Double the infusion rate
Rationale: Elevated aPTT requires holding and provider notification; protamine used for severe
bleeding or reversal per orders.
12. A client with pancreatitis is tachycardic, hypotensive, and has poor peripheral pulses.
Which IV fluid is best initially?
SURG / CRITICAL CARE) –ACTUAL
PRACTICE EXAM| PDF
1. A patient in the ICU develops acute respiratory distress syndrome (ARDS).
The ventilator is set to high PEEP. Which priority complication should the
nurse monitor for?
A. Metabolic acidosis
B. Barotrauma
C. Hypoglycemia
D. Pulmonary embolism
Rationale: High PEEP increases risk for alveolar rupture → pneumothorax (barotrauma).
2. A patient with septic shock is receiving norepinephrine. Which finding
requires IMMEDIATE intervention?
A. Urine output 40 mL/hr
B. MAP 54 mmHg
C. Warm flushed skin
D. HR 118 bpm
Rationale: MAP < 65 = inadequate perfusion → increase vasopressor support.
3. A neuro ICU patient suddenly has a fixed, dilated pupil. What should the
nurse do first?
A. Reassess in 10 minutes
B. Call rapid response/emergency provider immediately
C. Decrease sensory stimulation
D. Administer IV fluids
Rationale: Fixed dilated pupil = brain herniation → emergency.
,4. A burn patient (45% TBSA) has a urine output of 10 mL/hr during the first
6 hours. What is the priority action?
A. Administer pain medication
B. Increase potassium intake
C. Increase IV fluid rate (parkland formula resuscitation)
D. Place patient in high Fowler’s position
Rationale: Low urine output early → inadequate fluid resuscitation.
5. Which finding in a ventilated patient indicates ARDS worsening?
A. Increasing PaCO₂
B. Refractory hypoxemia
C. Decreasing FiO₂ requirement
D. Increased lung compliance
Rationale: ARDS hallmark = profound hypoxemia unresponsive to O₂.
6. A patient in DKA is being treated with an insulin drip. Which must be
administered concurrently?
A. Bicarbonate
B. IV potassium
C. IV magnesium
D. IV calcium
Rationale: As insulin shifts K⁺ into cells → serum potassium drops.
7. Which dysrhythmia is MOST lethal?
A. Atrial fibrillation
B. PACs
C. First-degree AV block
D. Ventricular fibrillation
, 8. A patient with spinal cord injury at T4 develops pounding headache,
flushing, and bradycardia. What is the priority action?
A. Administer hydralazine
B. Increase IV fluids
C. Raise HOB & check for bladder distention
D. Call rapid response
Rationale: Autonomic dysreflexia → relieve triggers, usually bladder.
9. Which lab best indicates early acute kidney injury (AKI)?
A. Low calcium
B. Low hemoglobin
C. Rising creatinine
D. Rising lipase
10. A COPD patient becomes agitated and confused. ABG: pH 7.28, PaCO₂
72. The nurse anticipates:
A. Increase O₂ to 100%
B. Fluid bolus
C. Initiate BiPAP
D. Discontinue bronchodilators
11. A patient on a heparin infusion has an aPTT of 110 seconds (therapeutic goal 60–80).
The nurse should:
A. Increase the heparin infusion rate
B. Hold the infusion and notify provider
C. Give protamine immediately
D. Double the infusion rate
Rationale: Elevated aPTT requires holding and provider notification; protamine used for severe
bleeding or reversal per orders.
12. A client with pancreatitis is tachycardic, hypotensive, and has poor peripheral pulses.
Which IV fluid is best initially?
