nsg-3850-exam-4-review-2026real-exam-practice-questions-and-a
nswersalready-graded-agalen-college — 200 Questions and
Answers Already Graded A+ Premium Exam Tested And
Verified
Subject Area Nursing (Critical Care, Pharmacology, Pathophysiology, Leadership)
Description This exam covers advanced nursing concepts for senior-level students, including
critical care management, pharmacotherapeutics, leadership and delegation,
ethical-legal issues, and evidence-based practice. Questions require synthesis of
pathophysiology, pharmacology, and nursing interventions across multiple body
systems, with emphasis on clinical reasoning and prioritization. The exam
includes screenshot-based exhibits that cannot be highlighted, reflecting
real-world clinical decision support tools.
Expected Grade A+
Total Questions 200
Duration 3 hours
Learning Outcomes 1. Apply advanced pathophysiology to complex patient scenarios
2. Analyze pharmacologic interventions including titration and adverse effects
3. Prioritize nursing actions using clinical reasoning and evidence
4. Interpret diagnostic data and adjust care plans accordingly
5. Demonstrate leadership and delegation skills in interdisciplinary settings
Accreditation This exam meets the standards of the Commission on Collegiate Nursing
Education (CCNE) and is designed to prepare students for NCLEX-RN and
graduate-level practice.
Page 1
,1. A 78-year-old patient with a history of heart failure (HFrEF) is admitted with
acute decompensation. The nurse reviews the electronic medical record and notes the
following: BP 88/52, HR 112, RR 24, SpO2 89% on room air, jugular venous
distention, and bilateral crackles up to the apices. The most recent labs show BNP
1200 pg/mL, potassium 3.2 mEq/L, creatinine 1.8 mg/dL (baseline 1.0). Which
intervention should the nurse question before implementing?
A. Administer metoprolol 25 mg orally as ordered
B. Start intravenous furosemide infusion at 10 mg/hour
C. Apply noninvasive positive pressure ventilation (BiPAP)
D. Obtain a stat echocardiogram
Answer: A. Administer metoprolol 25 mg orally as ordered
In acute decompensated heart failure with hypotension and low cardiac output,
beta-blockers (e.g., metoprolol) are contraindicated as they can further depress
myocardial contractility and worsen shock. Furosemide is indicated for volume
overload, BiPAP for respiratory distress, and echocardiogram to assess ventricular
function. The hypokalemia and acute kidney injury also warrant caution with diuresis,
but the beta-blocker is the most immediately dangerous.
2. A patient with septic shock is receiving norepinephrine at 20 mcg/min via central
line. The MAP remains 60 mm Hg. The prescriber orders a second vasopressor.
Which agent is most appropriate to add?
A. Dobutamine
B. Vasopressin
C. Epinephrine
D. Phenylephrine
Answer: B. Vasopressin
In septic shock refractory to norepinephrine, vasopressin is recommended as a
second-line agent due to its synergistic vasoconstrictive effect and ability to reduce
norepinephrine requirements. Dobutamine is an inotrope, not a vasopressor, and may
worsen hypotension. Epinephrine and phenylephrine are less preferred; epinephrine
can cause tachycardia and hyperlactatemia, while phenylephrine is a pure
alpha-agonist with limited evidence in sepsis.
Page 2
,3. A patient with acute respiratory distress syndrome (ARDS) is on
volume-controlled ventilation with the following settings: tidal volume 6 mL/kg,
PEEP 14 cm H2O, FiO2 0.7, plateau pressure 32 cm H2O. The arterial blood gas
shows pH 7.25, PaCO2 55 mm Hg, PaO2 68 mm Hg. Which adjustment should the
nurse anticipate?
A. Increase PEEP to 18 cm H2O
B. Increase respiratory rate to 24 breaths/min
C. Decrease tidal volume to 4 mL/kg
D. Switch to pressure-controlled ventilation
Answer: B. Increase respiratory rate to 24 breaths/min
The patient has hypercapnic respiratory failure (PaCO2 55) and acute respiratory
acidosis (pH 7.25). With plateau pressure already 32 cm H2O (near the safe limit of
30-35), increasing PEEP or decreasing tidal volume may further impair ventilation or
cause barotrauma. Increasing the respiratory rate will augment minute ventilation to
lower PaCO2. Pressure-controlled ventilation is not necessarily indicated unless plateau
pressure is excessive.
4. A nurse is preparing to administer packed red blood cells to a patient with
symptomatic anemia. The patient has a history of multiple transfusions and is
known to have anti-Jka antibodies. Which action is most important for the nurse to
take?
A. Obtain a type and crossmatch for Jka-negative blood
B. Premedicate with acetaminophen and diphenhydramine
C. Start a second IV line with normal saline
D. Verify the blood product with another nurse at the bedside
Answer: A. Obtain a type and crossmatch for Jka-negative blood
Anti-Jka (Kidd) antibodies can cause delayed hemolytic transfusion reactions and are
often missed in routine screening. The nurse must ensure that the blood is crossmatched
and negative for the Jka antigen to prevent hemolysis. Premedication (B) may reduce
allergic reactions but does not address the specific antibody. A second IV line (C) is not
standard for transfusions. Verification (D) is important but not the most critical step
given the antibody history.
Page 3
, 5. A patient with end-stage liver disease develops acute variceal hemorrhage. The
nurse administers octreotide and prepares for endoscopic band ligation. Which
additional medication should the nurse anticipate administering to reduce portal
pressure?
A. Vasopressin
B. Propranolol
C. Terlipressin
D. Somatostatin
Answer: C. Terlipressin
Terlipressin is a synthetic vasopressin analogue that reduces portal pressure and is
specifically indicated for variceal hemorrhage, though not available in all countries.
Vasopressin (A) is less selective and has more systemic side effects. Propranolol (B) is
used for primary prophylaxis, not acute bleeding. Octreotide (D) is a somatostatin
analogue already administered; terlipressin provides additional vasoconstrictive effect.
6. A patient with diabetic ketoacidosis (DKA) has the following initial labs: glucose
650 mg/dL, pH 7.0, bicarbonate 8 mEq/L, anion gap 22, potassium 3.0 mEq/L. The
nurse starts IV fluids and insulin drip. After 2 hours, the glucose is 350 mg/dL and
potassium is 3.2 mEq/L. Which intervention is most appropriate?
A. Continue insulin drip at same rate and add potassium to IV fluids
B. Decrease insulin drip rate and add potassium to IV fluids
C. Stop insulin drip and administer 50% dextrose
D. Increase insulin drip rate and administer oral potassium
Answer: A. Continue insulin drip at same rate and add potassium to IV fluids
In DKA, insulin therapy shifts potassium intracellularly, leading to hypokalemia. With
potassium already low (3.0-3.2), potassium replacement is critical to prevent cardiac
arrhythmias. The insulin drip should continue at the same rate because glucose is still
falling appropriately (not yet <250). Decreasing or stopping insulin risks recurrence of
ketosis. Oral potassium is inappropriate in an NPO patient with DKA due to potential
ileus.
Page 4
nswersalready-graded-agalen-college — 200 Questions and
Answers Already Graded A+ Premium Exam Tested And
Verified
Subject Area Nursing (Critical Care, Pharmacology, Pathophysiology, Leadership)
Description This exam covers advanced nursing concepts for senior-level students, including
critical care management, pharmacotherapeutics, leadership and delegation,
ethical-legal issues, and evidence-based practice. Questions require synthesis of
pathophysiology, pharmacology, and nursing interventions across multiple body
systems, with emphasis on clinical reasoning and prioritization. The exam
includes screenshot-based exhibits that cannot be highlighted, reflecting
real-world clinical decision support tools.
Expected Grade A+
Total Questions 200
Duration 3 hours
Learning Outcomes 1. Apply advanced pathophysiology to complex patient scenarios
2. Analyze pharmacologic interventions including titration and adverse effects
3. Prioritize nursing actions using clinical reasoning and evidence
4. Interpret diagnostic data and adjust care plans accordingly
5. Demonstrate leadership and delegation skills in interdisciplinary settings
Accreditation This exam meets the standards of the Commission on Collegiate Nursing
Education (CCNE) and is designed to prepare students for NCLEX-RN and
graduate-level practice.
Page 1
,1. A 78-year-old patient with a history of heart failure (HFrEF) is admitted with
acute decompensation. The nurse reviews the electronic medical record and notes the
following: BP 88/52, HR 112, RR 24, SpO2 89% on room air, jugular venous
distention, and bilateral crackles up to the apices. The most recent labs show BNP
1200 pg/mL, potassium 3.2 mEq/L, creatinine 1.8 mg/dL (baseline 1.0). Which
intervention should the nurse question before implementing?
A. Administer metoprolol 25 mg orally as ordered
B. Start intravenous furosemide infusion at 10 mg/hour
C. Apply noninvasive positive pressure ventilation (BiPAP)
D. Obtain a stat echocardiogram
Answer: A. Administer metoprolol 25 mg orally as ordered
In acute decompensated heart failure with hypotension and low cardiac output,
beta-blockers (e.g., metoprolol) are contraindicated as they can further depress
myocardial contractility and worsen shock. Furosemide is indicated for volume
overload, BiPAP for respiratory distress, and echocardiogram to assess ventricular
function. The hypokalemia and acute kidney injury also warrant caution with diuresis,
but the beta-blocker is the most immediately dangerous.
2. A patient with septic shock is receiving norepinephrine at 20 mcg/min via central
line. The MAP remains 60 mm Hg. The prescriber orders a second vasopressor.
Which agent is most appropriate to add?
A. Dobutamine
B. Vasopressin
C. Epinephrine
D. Phenylephrine
Answer: B. Vasopressin
In septic shock refractory to norepinephrine, vasopressin is recommended as a
second-line agent due to its synergistic vasoconstrictive effect and ability to reduce
norepinephrine requirements. Dobutamine is an inotrope, not a vasopressor, and may
worsen hypotension. Epinephrine and phenylephrine are less preferred; epinephrine
can cause tachycardia and hyperlactatemia, while phenylephrine is a pure
alpha-agonist with limited evidence in sepsis.
Page 2
,3. A patient with acute respiratory distress syndrome (ARDS) is on
volume-controlled ventilation with the following settings: tidal volume 6 mL/kg,
PEEP 14 cm H2O, FiO2 0.7, plateau pressure 32 cm H2O. The arterial blood gas
shows pH 7.25, PaCO2 55 mm Hg, PaO2 68 mm Hg. Which adjustment should the
nurse anticipate?
A. Increase PEEP to 18 cm H2O
B. Increase respiratory rate to 24 breaths/min
C. Decrease tidal volume to 4 mL/kg
D. Switch to pressure-controlled ventilation
Answer: B. Increase respiratory rate to 24 breaths/min
The patient has hypercapnic respiratory failure (PaCO2 55) and acute respiratory
acidosis (pH 7.25). With plateau pressure already 32 cm H2O (near the safe limit of
30-35), increasing PEEP or decreasing tidal volume may further impair ventilation or
cause barotrauma. Increasing the respiratory rate will augment minute ventilation to
lower PaCO2. Pressure-controlled ventilation is not necessarily indicated unless plateau
pressure is excessive.
4. A nurse is preparing to administer packed red blood cells to a patient with
symptomatic anemia. The patient has a history of multiple transfusions and is
known to have anti-Jka antibodies. Which action is most important for the nurse to
take?
A. Obtain a type and crossmatch for Jka-negative blood
B. Premedicate with acetaminophen and diphenhydramine
C. Start a second IV line with normal saline
D. Verify the blood product with another nurse at the bedside
Answer: A. Obtain a type and crossmatch for Jka-negative blood
Anti-Jka (Kidd) antibodies can cause delayed hemolytic transfusion reactions and are
often missed in routine screening. The nurse must ensure that the blood is crossmatched
and negative for the Jka antigen to prevent hemolysis. Premedication (B) may reduce
allergic reactions but does not address the specific antibody. A second IV line (C) is not
standard for transfusions. Verification (D) is important but not the most critical step
given the antibody history.
Page 3
, 5. A patient with end-stage liver disease develops acute variceal hemorrhage. The
nurse administers octreotide and prepares for endoscopic band ligation. Which
additional medication should the nurse anticipate administering to reduce portal
pressure?
A. Vasopressin
B. Propranolol
C. Terlipressin
D. Somatostatin
Answer: C. Terlipressin
Terlipressin is a synthetic vasopressin analogue that reduces portal pressure and is
specifically indicated for variceal hemorrhage, though not available in all countries.
Vasopressin (A) is less selective and has more systemic side effects. Propranolol (B) is
used for primary prophylaxis, not acute bleeding. Octreotide (D) is a somatostatin
analogue already administered; terlipressin provides additional vasoconstrictive effect.
6. A patient with diabetic ketoacidosis (DKA) has the following initial labs: glucose
650 mg/dL, pH 7.0, bicarbonate 8 mEq/L, anion gap 22, potassium 3.0 mEq/L. The
nurse starts IV fluids and insulin drip. After 2 hours, the glucose is 350 mg/dL and
potassium is 3.2 mEq/L. Which intervention is most appropriate?
A. Continue insulin drip at same rate and add potassium to IV fluids
B. Decrease insulin drip rate and add potassium to IV fluids
C. Stop insulin drip and administer 50% dextrose
D. Increase insulin drip rate and administer oral potassium
Answer: A. Continue insulin drip at same rate and add potassium to IV fluids
In DKA, insulin therapy shifts potassium intracellularly, leading to hypokalemia. With
potassium already low (3.0-3.2), potassium replacement is critical to prevent cardiac
arrhythmias. The insulin drip should continue at the same rate because glucose is still
falling appropriately (not yet <250). Decreasing or stopping insulin risks recurrence of
ketosis. Oral potassium is inappropriate in an NPO patient with DKA due to potential
ileus.
Page 4
