NUR 445 Exam 4: Acute & Chronic Health Disruptions In
Adults III V2 - Arizona College Updated and Latest
Questions and Correct Answers with Rationale
1. A patient with septic shock has a mean arterial pressure (MAP) of 55 mmHg despite aggressive fluid
resuscitation. Which medication should the nurse anticipate administering first?
A. Nitroglycerin
B. Amiodarone
C. Norepinephrine
D. Furosemide
Ans: C
Explanation: Norepinephrine is the first-line vasopressor used to increase blood pressure in septic
shock when fluid resuscitation fails to achieve a MAP of at least 65 mmHg. It acts primarily on alpha-
adrenergic receptors to cause vasoconstriction. Nitroglycerin would be contraindicated as it is a
vasodilator and would lower blood pressure further. Furosemide is a diuretic and would decrease
intravascular volume, worsening the shock state. Maintaining adequate perfusion pressure is critical to
prevent multi-organ dysfunction syndrome.
2. A patient in the ICU is being treated for Acute Respiratory Distress Syndrome (ARDS). The nurse knows
that the primary physiological change in ARDS is:
A. Increased lung compliance
B. Decreased capillary permeability
C. Alveolar hyperventilation
D. Non-cardiogenic pulmonary edema
,Ans: D
Explanation: ARDS is characterized by a systemic inflammatory response that leads to non-cardiogenic
pulmonary edema and severe hypoxemia. Increased capillary permeability allows fluid to leak into the
alveoli, which is not caused by heart failure. Lung compliance actually decreases in ARDS, making the
lungs ‘stiff’ and difficult to ventilate. Alveolar hypoventilation, rather than hyperventilation, eventually
occurs as the work of breathing becomes unsustainable. The nurse must prioritize monitoring the
PaO2/FiO2 ratio to assess the severity of lung injury.
3. Which laboratory value is the most specific indicator of Disseminated Intravascular Coagulation (DIC)?
A. Elevated D-dimer
B. Increased Platelet count
C. Shortened Prothrombin Time (PT)
D. Decreased BUN
Ans: A
Explanation: An elevated D-dimer level is a hallmark of DIC because it indicates the presence of fibrin
degradation products resulting from clot breakdown. In DIC, platelets are consumed rapidly, leading to
thrombocytopenia rather than an increase. Prothrombin Time (PT) and Partial Thromboplastin Time
(PTT) are typically prolonged, not shortened, due to the depletion of clotting factors. BUN is not a direct
indicator of coagulation status but may rise if renal failure occurs secondary to microthrombi. Early
identification of these markers is essential for initiating life-saving anticoagulation or blood product
replacement.
4. A patient presents to the emergency department with a 40% Total Body Surface Area (TBSA) burn. Using
the Parkland formula (4mL/kg/%TBSA), what is the primary goal of fluid resuscitation in the first 8 hours?
A. Administer 100% of the total calculated volume
, B. Administer 50% of the total calculated volume
C. Administer 25% of the total calculated volume
D. Administer 75% of the total calculated volume
Ans: B
Explanation: The Parkland formula dictates that half of the total 24-hour fluid volume must be
administered within the first 8 hours following the burn injury. The remaining 50% is then distributed
over the subsequent 16 hours. This aggressive fluid resuscitation is necessary to combat the massive fluid
shifts and capillary leak associated with major burns. Administering too little fluid can lead to
hypovolemic shock and acute kidney injury. The nurse must calculate the 8-hour window from the time
the injury occurred, not the time of arrival at the hospital.
5. During the primary survey of a trauma patient, which assessment is the highest priority?
A. Blood glucose level
B. Airway patency with cervical spine stabilization
C. Abdominal bowel sounds
D. Range of motion in lower extremities
Ans: B
Explanation: Airway maintenance with simultaneous cervical spine protection is the ‘A’ in the ABCDE
primary survey and takes precedence over all other assessments. Failure to secure the airway can lead to
rapid hypoxia and death within minutes. Bowel sounds and range of motion are part of the secondary
survey performed only after the patient is stabilized. Blood glucose is important but is not an immediate
life-threat addressed in the initial seconds of trauma care. The nurse must assume a spinal injury exists in
all trauma patients until proven otherwise.
Adults III V2 - Arizona College Updated and Latest
Questions and Correct Answers with Rationale
1. A patient with septic shock has a mean arterial pressure (MAP) of 55 mmHg despite aggressive fluid
resuscitation. Which medication should the nurse anticipate administering first?
A. Nitroglycerin
B. Amiodarone
C. Norepinephrine
D. Furosemide
Ans: C
Explanation: Norepinephrine is the first-line vasopressor used to increase blood pressure in septic
shock when fluid resuscitation fails to achieve a MAP of at least 65 mmHg. It acts primarily on alpha-
adrenergic receptors to cause vasoconstriction. Nitroglycerin would be contraindicated as it is a
vasodilator and would lower blood pressure further. Furosemide is a diuretic and would decrease
intravascular volume, worsening the shock state. Maintaining adequate perfusion pressure is critical to
prevent multi-organ dysfunction syndrome.
2. A patient in the ICU is being treated for Acute Respiratory Distress Syndrome (ARDS). The nurse knows
that the primary physiological change in ARDS is:
A. Increased lung compliance
B. Decreased capillary permeability
C. Alveolar hyperventilation
D. Non-cardiogenic pulmonary edema
,Ans: D
Explanation: ARDS is characterized by a systemic inflammatory response that leads to non-cardiogenic
pulmonary edema and severe hypoxemia. Increased capillary permeability allows fluid to leak into the
alveoli, which is not caused by heart failure. Lung compliance actually decreases in ARDS, making the
lungs ‘stiff’ and difficult to ventilate. Alveolar hypoventilation, rather than hyperventilation, eventually
occurs as the work of breathing becomes unsustainable. The nurse must prioritize monitoring the
PaO2/FiO2 ratio to assess the severity of lung injury.
3. Which laboratory value is the most specific indicator of Disseminated Intravascular Coagulation (DIC)?
A. Elevated D-dimer
B. Increased Platelet count
C. Shortened Prothrombin Time (PT)
D. Decreased BUN
Ans: A
Explanation: An elevated D-dimer level is a hallmark of DIC because it indicates the presence of fibrin
degradation products resulting from clot breakdown. In DIC, platelets are consumed rapidly, leading to
thrombocytopenia rather than an increase. Prothrombin Time (PT) and Partial Thromboplastin Time
(PTT) are typically prolonged, not shortened, due to the depletion of clotting factors. BUN is not a direct
indicator of coagulation status but may rise if renal failure occurs secondary to microthrombi. Early
identification of these markers is essential for initiating life-saving anticoagulation or blood product
replacement.
4. A patient presents to the emergency department with a 40% Total Body Surface Area (TBSA) burn. Using
the Parkland formula (4mL/kg/%TBSA), what is the primary goal of fluid resuscitation in the first 8 hours?
A. Administer 100% of the total calculated volume
, B. Administer 50% of the total calculated volume
C. Administer 25% of the total calculated volume
D. Administer 75% of the total calculated volume
Ans: B
Explanation: The Parkland formula dictates that half of the total 24-hour fluid volume must be
administered within the first 8 hours following the burn injury. The remaining 50% is then distributed
over the subsequent 16 hours. This aggressive fluid resuscitation is necessary to combat the massive fluid
shifts and capillary leak associated with major burns. Administering too little fluid can lead to
hypovolemic shock and acute kidney injury. The nurse must calculate the 8-hour window from the time
the injury occurred, not the time of arrival at the hospital.
5. During the primary survey of a trauma patient, which assessment is the highest priority?
A. Blood glucose level
B. Airway patency with cervical spine stabilization
C. Abdominal bowel sounds
D. Range of motion in lower extremities
Ans: B
Explanation: Airway maintenance with simultaneous cervical spine protection is the ‘A’ in the ABCDE
primary survey and takes precedence over all other assessments. Failure to secure the airway can lead to
rapid hypoxia and death within minutes. Bowel sounds and range of motion are part of the secondary
survey performed only after the patient is stabilized. Blood glucose is important but is not an immediate
life-threat addressed in the initial seconds of trauma care. The nurse must assume a spinal injury exists in
all trauma patients until proven otherwise.
