NUR 417 ACTUAL EXAM
WITH COMPLETE
QUESTIONS AND CORRECT
DETAILED
ANSWERSALREADY
GRADED A+
After change-of-shift report in the progressive care unit, for which patient would the nurse provide
care first?
1. Patient who had an inferior myocardial infarction 2 days ago and has crackles in the lung bases
2. Patient who had a T5 spinal cord injury 1 week ago and currently has a heart rate of 54
beats/minute
3. Patient with suspected urosepsis who has new prescriptions for urine and blood cultures and
antibiotics
4. Patient admitted with anaphylaxis 3 hours ago who has clear lung sounds and a blood pressure of
108/58 mm Hg
3. Patient with suspected urosepsis who has new prescriptions for urine and blood cultures and
antibiotics
Antibiotics should be given within the first hour for patients who have sepsis or suspected sepsis in
order to prevent progression to systemic inflammatory response syndrome and septic shock. The data
on the other patients indicate that they are more stable. Crackles heard only at the lung bases do not
require immediate intervention in a patient who has had a myocardial infarction. Mild bradycardia does
not usually require atropine in patients who have a spinal cord injury. The findings for the patient
admitted with anaphylaxis indicate resolution of bronchospasm and hypotension.
An 81-yr-old patient who has been in the intensive care unit (ICU) for a week with sepsis is now stable
and transfer to the progressive care unit is planned. On rounds, the nurse notices that the patient has
new onset confusion with stable vital signs and oxygen saturation. What would the nurse plan to do?
,1. Give PRN lorazepam (Ativan) and cancel the transfer.
2. Inform the receiving nurse and then transfer the patient.
3. Notify the health care provider and postpone the transfer.
4. Obtain an order for restraints as needed and transfer the patient.
2. Inform the receiving nurse and then transfer the patient.
The patient's history and symptoms most likely indicate delirium associated with the sleep deprivation
and sensory overload in the ICU environment. Informing the receiving nurse and transferring the patient
is appropriate. Postponing the transfer is likely to prolong the delirium. Benzodiazepines and restraints
contribute to delirium and agitation.
The central venous oxygen saturation (ScvO2) is decreasing in a patient who has severe pancreatitis.
Which information would the nurse analyze to determine the possible cause of the decreased ScvO2?
1. Lipase level
2. Temperature
3. Urinary output
4. Body mass index
2. Temperature
Elevated temperature increases metabolic demands and O2 use by tissues, resulting in a drop in O2
saturation of central venous blood. Information about the patient's body mass index, urinary output,
and lipase will not help in determining the cause of the patient's drop in ScvO2.
A 78-kg patient in septic shock has a pulse rate of 120 beats/min with low central venous pressure and
pulmonary artery wedge pressure. After initial fluid volume resuscitation, the patient's urine output
has been 30 mL/hr for the past 3 hours. Which intervention prescribed by the health care provider
would the nurse question?
1. Administer furosemide (Lasix) 40 mg IV.
2. Increase normal saline infusion to 250 mL/hr.
3. Give hydrocortisone (Solu-Cortef) 100 mg IV.
4. Use norepinephrine to keep systolic blood pressure (BP) above 90 mm Hg.
1. Administer furosemide (Lasix) 40 mg IV.
Furosemide will lower the filling pressures and renal perfusion further for the patient with septic shock.
Patients in septic shock require large amounts of fluid replacement. If the patient remains hypotensive
after initial volume resuscitation with minimally 30 mL/kg, vasopressors such as norepinephrine may be
added. IV corticosteroids may be considered for patients in septic shock who cannot maintain an
adequate BP with vasopressor therapy despite fluid resuscitation.
After a patient who has septic shock receives 2 L of IV normal saline, the central venous pressure is 10
mm Hg and the blood pressure is 82/40 mm Hg. Which medication would the nurse anticipate being
prescribed?
, 1. Furosemide
2. Nitroglycerin
3. Norepinephrine
4. Sodium nitroprusside
3. Norepinephrine
When fluid resuscitation is unsuccessful, vasopressor drugs are given to increase the systemic vascular
resistance (SVR) and blood pressure and improve tissue perfusion. Furosemide would cause diuresis and
further decrease the BP. Nitroglycerin would decrease the preload and further drop cardiac output and
BP. Nitroprusside is an arterial vasodilator and would further decrease SVR.
Which assessment will the nurse perform to evaluate the effectiveness of the pantoprazole given to a
patient with systemic inflammatory response syndrome (SIRS)?
1. Auscultate bowel sounds.
2. Ask the patient about nausea.
3. Check stools for occult blood.
4. Palpate for abdominal tenderness.
3. Check stools for occult blood.
Proton pump inhibitors are given to decrease the risk for stress ulcers in critically ill patients. The other
assessments will also be done, but these will not help in determining the effectiveness of the
pantoprazole administration.
Which data collected by the nurse caring for a patient who has cardiogenic shock indicate that the
patient may be developing multiple organ dysfunction syndrome (MODS)?
1. The patient's serum creatinine level is elevated.
2. The patient reports intermittent chest pressure.
3. The patient's extremities are cool and pulses are weak.
4. The patient has bilateral crackles throughout lung fields.
1. The patient's serum creatinine level is elevated.
The elevated serum creatinine level indicates that the patient has renal failure as well as heart failure.
The crackles, chest pressure, and cool extremities are all symptoms consistent with the patient's
diagnosis of cardiogenic shock.
A patient with septic shock has a BP of 70/46 mm Hg, pulse of 136 beats/min, respirations of 32
breaths/min, temperature of 104 F, and blood glucose of 246 mg/dL. Which intervention ordered by
the health care provider would the nurse implement first?
1. Acetaminophen (Tylenol) 650 mg rectally.
2. Administer normal saline IV at 500 mL/hr.
WITH COMPLETE
QUESTIONS AND CORRECT
DETAILED
ANSWERSALREADY
GRADED A+
After change-of-shift report in the progressive care unit, for which patient would the nurse provide
care first?
1. Patient who had an inferior myocardial infarction 2 days ago and has crackles in the lung bases
2. Patient who had a T5 spinal cord injury 1 week ago and currently has a heart rate of 54
beats/minute
3. Patient with suspected urosepsis who has new prescriptions for urine and blood cultures and
antibiotics
4. Patient admitted with anaphylaxis 3 hours ago who has clear lung sounds and a blood pressure of
108/58 mm Hg
3. Patient with suspected urosepsis who has new prescriptions for urine and blood cultures and
antibiotics
Antibiotics should be given within the first hour for patients who have sepsis or suspected sepsis in
order to prevent progression to systemic inflammatory response syndrome and septic shock. The data
on the other patients indicate that they are more stable. Crackles heard only at the lung bases do not
require immediate intervention in a patient who has had a myocardial infarction. Mild bradycardia does
not usually require atropine in patients who have a spinal cord injury. The findings for the patient
admitted with anaphylaxis indicate resolution of bronchospasm and hypotension.
An 81-yr-old patient who has been in the intensive care unit (ICU) for a week with sepsis is now stable
and transfer to the progressive care unit is planned. On rounds, the nurse notices that the patient has
new onset confusion with stable vital signs and oxygen saturation. What would the nurse plan to do?
,1. Give PRN lorazepam (Ativan) and cancel the transfer.
2. Inform the receiving nurse and then transfer the patient.
3. Notify the health care provider and postpone the transfer.
4. Obtain an order for restraints as needed and transfer the patient.
2. Inform the receiving nurse and then transfer the patient.
The patient's history and symptoms most likely indicate delirium associated with the sleep deprivation
and sensory overload in the ICU environment. Informing the receiving nurse and transferring the patient
is appropriate. Postponing the transfer is likely to prolong the delirium. Benzodiazepines and restraints
contribute to delirium and agitation.
The central venous oxygen saturation (ScvO2) is decreasing in a patient who has severe pancreatitis.
Which information would the nurse analyze to determine the possible cause of the decreased ScvO2?
1. Lipase level
2. Temperature
3. Urinary output
4. Body mass index
2. Temperature
Elevated temperature increases metabolic demands and O2 use by tissues, resulting in a drop in O2
saturation of central venous blood. Information about the patient's body mass index, urinary output,
and lipase will not help in determining the cause of the patient's drop in ScvO2.
A 78-kg patient in septic shock has a pulse rate of 120 beats/min with low central venous pressure and
pulmonary artery wedge pressure. After initial fluid volume resuscitation, the patient's urine output
has been 30 mL/hr for the past 3 hours. Which intervention prescribed by the health care provider
would the nurse question?
1. Administer furosemide (Lasix) 40 mg IV.
2. Increase normal saline infusion to 250 mL/hr.
3. Give hydrocortisone (Solu-Cortef) 100 mg IV.
4. Use norepinephrine to keep systolic blood pressure (BP) above 90 mm Hg.
1. Administer furosemide (Lasix) 40 mg IV.
Furosemide will lower the filling pressures and renal perfusion further for the patient with septic shock.
Patients in septic shock require large amounts of fluid replacement. If the patient remains hypotensive
after initial volume resuscitation with minimally 30 mL/kg, vasopressors such as norepinephrine may be
added. IV corticosteroids may be considered for patients in septic shock who cannot maintain an
adequate BP with vasopressor therapy despite fluid resuscitation.
After a patient who has septic shock receives 2 L of IV normal saline, the central venous pressure is 10
mm Hg and the blood pressure is 82/40 mm Hg. Which medication would the nurse anticipate being
prescribed?
, 1. Furosemide
2. Nitroglycerin
3. Norepinephrine
4. Sodium nitroprusside
3. Norepinephrine
When fluid resuscitation is unsuccessful, vasopressor drugs are given to increase the systemic vascular
resistance (SVR) and blood pressure and improve tissue perfusion. Furosemide would cause diuresis and
further decrease the BP. Nitroglycerin would decrease the preload and further drop cardiac output and
BP. Nitroprusside is an arterial vasodilator and would further decrease SVR.
Which assessment will the nurse perform to evaluate the effectiveness of the pantoprazole given to a
patient with systemic inflammatory response syndrome (SIRS)?
1. Auscultate bowel sounds.
2. Ask the patient about nausea.
3. Check stools for occult blood.
4. Palpate for abdominal tenderness.
3. Check stools for occult blood.
Proton pump inhibitors are given to decrease the risk for stress ulcers in critically ill patients. The other
assessments will also be done, but these will not help in determining the effectiveness of the
pantoprazole administration.
Which data collected by the nurse caring for a patient who has cardiogenic shock indicate that the
patient may be developing multiple organ dysfunction syndrome (MODS)?
1. The patient's serum creatinine level is elevated.
2. The patient reports intermittent chest pressure.
3. The patient's extremities are cool and pulses are weak.
4. The patient has bilateral crackles throughout lung fields.
1. The patient's serum creatinine level is elevated.
The elevated serum creatinine level indicates that the patient has renal failure as well as heart failure.
The crackles, chest pressure, and cool extremities are all symptoms consistent with the patient's
diagnosis of cardiogenic shock.
A patient with septic shock has a BP of 70/46 mm Hg, pulse of 136 beats/min, respirations of 32
breaths/min, temperature of 104 F, and blood glucose of 246 mg/dL. Which intervention ordered by
the health care provider would the nurse implement first?
1. Acetaminophen (Tylenol) 650 mg rectally.
2. Administer normal saline IV at 500 mL/hr.
