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NUR 521 Exam 4 EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS LATEST UPDATE THIS YEAR
Exam Coverage – NUR 521 Exam 4
NUR 521 (Advanced Nursing Care of Adults with Complex Conditions, or similar advanced
medical-surgical/graduate nursing course) Exam 4 typically covers high-acuity and complex
management of patients with multi-system disorders. Key topics include: shock
states (hypovolemic, cardiogenic, distributive (septic, neurogenic, anaphylactic), obstructive) –
pathophysiology, stages, hemodynamic monitoring, and nursing interventions; multi-organ
dysfunction syndrome (MODS) ; disseminated intravascular coagulation (DIC) ; acute
respiratory distress syndrome (ARDS) – mechanical ventilation, PEEP, prone positioning; acute
kidney injury (AKI) – prerenal, intrarenal, postrenal, renal replacement therapy (CRRT,
hemodialysis); liver failure – cirrhosis, hepatic encephalopathy, variceal bleeding,
paracentesis; pancreatitis ; endocrine emergencies (thyroid storm, myxedema coma, diabetic
ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS), adrenal crisis); neurological
emergencies (increased ICP, status epilepticus, stroke (ischemic vs. hemorrhagic), spinal cord
injury); hemodynamic monitoring (arterial lines, pulmonary artery catheters, CVP, cardiac
output, preload/afterload); vasoactive medications (dopamine, norepinephrine, dobutamine,
vasopressin, milrinone); acid-base disorders (metabolic acidosis/alkalosis, respiratory
acidosis/alkalosis, compensation, anion gap); electrolyte imbalances (sodium, potassium,
calcium, magnesium, phosphorus) – causes, signs, treatments; critical care
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pharmacology (sedation, analgesia, neuromuscular blockers); code management (ACLS
protocols, defibrillation, post-resuscitation care, therapeutic hypothermia); palliative and
end-of-life care in the ICU ; ethics and legal issues (informed consent, withdrawal of life
support, surrogate decision-making, futility); and interdisciplinary collaboration (rapid response
teams, code teams, critical care rounding).
200 Randomized, Scenario-Based MCQs for NUR 521 Exam 4
1. A patient in the medical ICU has a heart rate of 120 bpm, blood pressure 80/50 mmHg, and a
pulmonary artery wedge pressure (PAWP) of 4 mmHg. What type of shock is most likely?
A) Cardiogenic shock
B) Distributive shock
C) Obstructive shock
D) Hypovolemic shock
Answer: D
RATIONALE: A low PAWP (< 8 mmHg) with hypotension and tachycardia indicates hypovolemia;
cardiogenic shock would have elevated PAWP.
2. A mechanically ventilated patient with severe sepsis has a PaO₂/FiO₂ ratio of 140. Which lung
protective strategy should be implemented?
A) Increase the FiO₂ to 100% without changing PEEP
B) Use a tidal volume of 12 mL/kg to recruit alveoli
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C) Use a low tidal volume (6 mL/kg predicted body weight) and limit plateau pressure to ≤ 30 cm
H₂O
D) Use pressure control with a driving pressure of 30 cm H₂O
Answer: C
RATIONALE: ARDS management (PaO₂/FiO₂ < 300) includes low tidal volumes (6 mL/kg PBW)
and plateau pressure ≤ 30 to prevent ventilator-induced lung injury.
3. A patient with DIC is bleeding from venipuncture sites and has a PT of 20 seconds, PTT of 60
seconds, fibrinogen of 80 mg/dL, and platelet count of 40,000/µL. Which blood product is the
priority for active bleeding?
A) Platelets only
B) Cryoprecipitate
C) Packed red blood cells alone
D) Fresh frozen plasma (FFP) and platelets and cryoprecipitate as needed (massive transfusion
approach)
Answer: D
RATIONALE: DIC with active bleeding requires replacement of coagulation factors (FFP),
fibrinogen (cryoprecipitate), and platelets; a balanced resuscitation is indicated.
4. A patient with cirrhosis develops confusion, asterixis, and a serum ammonia level of 180
mcg/dL. Which first-line medication should be given to reduce ammonia?
A) Rifaximin only
B) Lactulose and possibly rifaximin
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C) Furosemide
D) Octreotide
Answer: B
RATIONALE: Hepatic encephalopathy is treated with lactulose (acidifies colon to trap
ammonium) and often rifaximin; lactulose is first line.
5. A patient admitted with acute pancreatitis has a serum calcium level of 6.8 mg/dL. What is
the most likely cause of this hypocalcemia?
A) Primary hyperparathyroidism
B) Saponification of calcium in necrotic fat (fat necrosis)
C) Chronic kidney disease
D) Overuse of calcium supplements
Answer: B
RATIONALE: In pancreatitis, lipase breaks down triglycerides into fatty acids, which bind calcium
(saponification), causing hypocalcemia, a poor prognostic sign.
6. A patient with septic shock is started on norepinephrine. The nurse assesses the patient’s
blood pressure every 5 minutes. What is the primary expected effect of this medication?
A) Decreased systemic vascular resistance (SVR)
B) Increased cardiac contractility only
C) Increased SVR (vasoconstriction) and increased mean arterial pressure
D) Decreased heart rate
Answer: C
NUR 521 Exam 4 EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS LATEST UPDATE THIS YEAR
Exam Coverage – NUR 521 Exam 4
NUR 521 (Advanced Nursing Care of Adults with Complex Conditions, or similar advanced
medical-surgical/graduate nursing course) Exam 4 typically covers high-acuity and complex
management of patients with multi-system disorders. Key topics include: shock
states (hypovolemic, cardiogenic, distributive (septic, neurogenic, anaphylactic), obstructive) –
pathophysiology, stages, hemodynamic monitoring, and nursing interventions; multi-organ
dysfunction syndrome (MODS) ; disseminated intravascular coagulation (DIC) ; acute
respiratory distress syndrome (ARDS) – mechanical ventilation, PEEP, prone positioning; acute
kidney injury (AKI) – prerenal, intrarenal, postrenal, renal replacement therapy (CRRT,
hemodialysis); liver failure – cirrhosis, hepatic encephalopathy, variceal bleeding,
paracentesis; pancreatitis ; endocrine emergencies (thyroid storm, myxedema coma, diabetic
ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS), adrenal crisis); neurological
emergencies (increased ICP, status epilepticus, stroke (ischemic vs. hemorrhagic), spinal cord
injury); hemodynamic monitoring (arterial lines, pulmonary artery catheters, CVP, cardiac
output, preload/afterload); vasoactive medications (dopamine, norepinephrine, dobutamine,
vasopressin, milrinone); acid-base disorders (metabolic acidosis/alkalosis, respiratory
acidosis/alkalosis, compensation, anion gap); electrolyte imbalances (sodium, potassium,
calcium, magnesium, phosphorus) – causes, signs, treatments; critical care
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pharmacology (sedation, analgesia, neuromuscular blockers); code management (ACLS
protocols, defibrillation, post-resuscitation care, therapeutic hypothermia); palliative and
end-of-life care in the ICU ; ethics and legal issues (informed consent, withdrawal of life
support, surrogate decision-making, futility); and interdisciplinary collaboration (rapid response
teams, code teams, critical care rounding).
200 Randomized, Scenario-Based MCQs for NUR 521 Exam 4
1. A patient in the medical ICU has a heart rate of 120 bpm, blood pressure 80/50 mmHg, and a
pulmonary artery wedge pressure (PAWP) of 4 mmHg. What type of shock is most likely?
A) Cardiogenic shock
B) Distributive shock
C) Obstructive shock
D) Hypovolemic shock
Answer: D
RATIONALE: A low PAWP (< 8 mmHg) with hypotension and tachycardia indicates hypovolemia;
cardiogenic shock would have elevated PAWP.
2. A mechanically ventilated patient with severe sepsis has a PaO₂/FiO₂ ratio of 140. Which lung
protective strategy should be implemented?
A) Increase the FiO₂ to 100% without changing PEEP
B) Use a tidal volume of 12 mL/kg to recruit alveoli
, Page 3 of 93
C) Use a low tidal volume (6 mL/kg predicted body weight) and limit plateau pressure to ≤ 30 cm
H₂O
D) Use pressure control with a driving pressure of 30 cm H₂O
Answer: C
RATIONALE: ARDS management (PaO₂/FiO₂ < 300) includes low tidal volumes (6 mL/kg PBW)
and plateau pressure ≤ 30 to prevent ventilator-induced lung injury.
3. A patient with DIC is bleeding from venipuncture sites and has a PT of 20 seconds, PTT of 60
seconds, fibrinogen of 80 mg/dL, and platelet count of 40,000/µL. Which blood product is the
priority for active bleeding?
A) Platelets only
B) Cryoprecipitate
C) Packed red blood cells alone
D) Fresh frozen plasma (FFP) and platelets and cryoprecipitate as needed (massive transfusion
approach)
Answer: D
RATIONALE: DIC with active bleeding requires replacement of coagulation factors (FFP),
fibrinogen (cryoprecipitate), and platelets; a balanced resuscitation is indicated.
4. A patient with cirrhosis develops confusion, asterixis, and a serum ammonia level of 180
mcg/dL. Which first-line medication should be given to reduce ammonia?
A) Rifaximin only
B) Lactulose and possibly rifaximin
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C) Furosemide
D) Octreotide
Answer: B
RATIONALE: Hepatic encephalopathy is treated with lactulose (acidifies colon to trap
ammonium) and often rifaximin; lactulose is first line.
5. A patient admitted with acute pancreatitis has a serum calcium level of 6.8 mg/dL. What is
the most likely cause of this hypocalcemia?
A) Primary hyperparathyroidism
B) Saponification of calcium in necrotic fat (fat necrosis)
C) Chronic kidney disease
D) Overuse of calcium supplements
Answer: B
RATIONALE: In pancreatitis, lipase breaks down triglycerides into fatty acids, which bind calcium
(saponification), causing hypocalcemia, a poor prognostic sign.
6. A patient with septic shock is started on norepinephrine. The nurse assesses the patient’s
blood pressure every 5 minutes. What is the primary expected effect of this medication?
A) Decreased systemic vascular resistance (SVR)
B) Increased cardiac contractility only
C) Increased SVR (vasoconstriction) and increased mean arterial pressure
D) Decreased heart rate
Answer: C
