NR 464 Exam 4 (BoostGrade) – Study Guide, Practice Questions &
Revision Notes
A 78-kg patient with septic shock has a urine output of 30 mL/hr for the past 3 hours. The pulse
rate is 120/minute and the central venous pressure and pulmonary artery wedge pressure are
low. Which order by the health care provider will the nurse question?
a. Give PRN furosemide (Lasix) 40 mg IV.
b. Increase normal saline infusion to 250 mL/hr.
c. Administer hydrocortisone (Solu-Cortef) 100 mg IV.
d. Titrate norepinephrine (Levophed) to keep systolic BP >90 mm Hg. - ANS ✔✔a. Give PRN
furosemide (Lasix) 40 mg IV.
Furosemide will lower the filling pressures and renal perfusion further for the patient with
septic shock. The other orders are appropriate.
A nurse is caring for a patient with shock of unknown etiology whose hemodynamic monitoring
indicates BP 92/54, pulse 64, and an elevated pulmonary artery wedge pressure. Which
collaborative intervention ordered by the health care provider should the nurse question?
a. Infuse normal saline at 250 mL/hr.
b. Keep head of bed elevated to 30 degrees.
c. Hold nitroprusside (Nipride) if systolic BP <90 mm Hg.
,d. Titrate dobutamine (Dobutrex) to keep systolic BP >90 mm Hg. - ANS ✔✔a. Infuse normal
saline at 250 mL/hr.
The patient's elevated pulmonary artery wedge pressure indicates volume excess. A saline
infusion at 250 mL/hr will exacerbate the volume excess. The other actions are appropriate for
the patient.
An older patient with cardiogenic shock is cool and clammy and hemodynamic monitoring
indicates a high systemic vascular resistance (SVR). Which intervention should the nurse
anticipate doing next?
a. Increase the rate for the dopamine (Intropin) infusion.
b. Decrease the rate for the nitroglycerin (Tridil) infusion.
c. Increase the rate for the sodium nitroprusside (Nipride) infusion.
d. Decrease the rate for the 5% dextrose in normal saline (D5/.9 NS) infusion. - ANS ✔✔c.
Increase the rate for the sodium nitroprusside (Nipride) infusion.
Nitroprusside is an arterial vasodilator and will decrease the SVR and afterload, which will
improve cardiac output. Changes in the D5/.9 NS and nitroglycerin infusions will not directly
decrease SVR. Increasing the dopamine will tend to increase SVR.
After receiving 2 L of normal saline, the central venous pressure for a patient who has septic
shock is 10 mm Hg, but the blood pressure is still 82/40 mm Hg. The nurse will anticipate an
order for
,a. nitroglycerine (Tridil).
b. norepinephrine (Levophed).
c. sodium nitroprusside (Nipride).
d. methylprednisolone (Solu-Medrol). - ANS ✔✔b. norepinephrine (Levophed).
When fluid resuscitation is unsuccessful, vasopressor drugs are administered to increase the
systemic vascular resistance (SVR) and blood pressure, and improve tissue perfusion.
Nitroglycerin would decrease the preload and further drop cardiac output and BP.
Methylprednisolone (Solu-Medrol) is considered if blood pressure does not respond first to
fluids and vasopressors. Nitroprusside is an arterial vasodilator and would further decrease SVR
To evaluate the effectiveness of the pantoprazole (Protonix) ordered for a patient with systemic
inflammatory response syndrome (SIRS), which assessment will the nurse perform?
a. Auscultate bowel sounds.
b. Palpate for abdominal pain.
c. Ask the patient about nausea.
d. Check stools for occult blood. - ANS ✔✔d. Check stools for occult blood.
Proton pump inhibitors are given to decrease the risk for stress ulcers in critically ill patients.
The other assessments also will be done, but these will not help in determining the
effectiveness of the pantoprazole administration.
, A patient with cardiogenic shock has the following vital signs: BP 102/50, pulse 128, respirations
28. The pulmonary artery wedge pressure (PAWP) is increased and cardiac output is low. The
nurse will anticipate an order for which medication?
a. 5% human albumin
b. Furosemide (Lasix) IV
c. Epinephrine (Adrenalin) drip
d. Hydrocortisone (Solu-Cortef) - ANS ✔✔b. Furosemide (Lasix) IV
The PAWP indicates that the patient's preload is elevated, and furosemide is indicated to reduce
the preload and improve cardiac output. Epinephrine would further increase heart rate and
myocardial oxygen demand. 5% human albumin would also increase the PAWP. Hydrocortisone
might be considered for septic or anaphylactic shock.
The emergency department (ED) nurse receives report that a patient involved in a motor vehicle
crash is being transported to the facility with an estimated arrival in 1 minute. In preparation for
the patient's arrival, the nurse will obtain
a. hypothermia blanket.
b. lactated Ringer's solution.
c. two 14-gauge IV catheters.
Revision Notes
A 78-kg patient with septic shock has a urine output of 30 mL/hr for the past 3 hours. The pulse
rate is 120/minute and the central venous pressure and pulmonary artery wedge pressure are
low. Which order by the health care provider will the nurse question?
a. Give PRN furosemide (Lasix) 40 mg IV.
b. Increase normal saline infusion to 250 mL/hr.
c. Administer hydrocortisone (Solu-Cortef) 100 mg IV.
d. Titrate norepinephrine (Levophed) to keep systolic BP >90 mm Hg. - ANS ✔✔a. Give PRN
furosemide (Lasix) 40 mg IV.
Furosemide will lower the filling pressures and renal perfusion further for the patient with
septic shock. The other orders are appropriate.
A nurse is caring for a patient with shock of unknown etiology whose hemodynamic monitoring
indicates BP 92/54, pulse 64, and an elevated pulmonary artery wedge pressure. Which
collaborative intervention ordered by the health care provider should the nurse question?
a. Infuse normal saline at 250 mL/hr.
b. Keep head of bed elevated to 30 degrees.
c. Hold nitroprusside (Nipride) if systolic BP <90 mm Hg.
,d. Titrate dobutamine (Dobutrex) to keep systolic BP >90 mm Hg. - ANS ✔✔a. Infuse normal
saline at 250 mL/hr.
The patient's elevated pulmonary artery wedge pressure indicates volume excess. A saline
infusion at 250 mL/hr will exacerbate the volume excess. The other actions are appropriate for
the patient.
An older patient with cardiogenic shock is cool and clammy and hemodynamic monitoring
indicates a high systemic vascular resistance (SVR). Which intervention should the nurse
anticipate doing next?
a. Increase the rate for the dopamine (Intropin) infusion.
b. Decrease the rate for the nitroglycerin (Tridil) infusion.
c. Increase the rate for the sodium nitroprusside (Nipride) infusion.
d. Decrease the rate for the 5% dextrose in normal saline (D5/.9 NS) infusion. - ANS ✔✔c.
Increase the rate for the sodium nitroprusside (Nipride) infusion.
Nitroprusside is an arterial vasodilator and will decrease the SVR and afterload, which will
improve cardiac output. Changes in the D5/.9 NS and nitroglycerin infusions will not directly
decrease SVR. Increasing the dopamine will tend to increase SVR.
After receiving 2 L of normal saline, the central venous pressure for a patient who has septic
shock is 10 mm Hg, but the blood pressure is still 82/40 mm Hg. The nurse will anticipate an
order for
,a. nitroglycerine (Tridil).
b. norepinephrine (Levophed).
c. sodium nitroprusside (Nipride).
d. methylprednisolone (Solu-Medrol). - ANS ✔✔b. norepinephrine (Levophed).
When fluid resuscitation is unsuccessful, vasopressor drugs are administered to increase the
systemic vascular resistance (SVR) and blood pressure, and improve tissue perfusion.
Nitroglycerin would decrease the preload and further drop cardiac output and BP.
Methylprednisolone (Solu-Medrol) is considered if blood pressure does not respond first to
fluids and vasopressors. Nitroprusside is an arterial vasodilator and would further decrease SVR
To evaluate the effectiveness of the pantoprazole (Protonix) ordered for a patient with systemic
inflammatory response syndrome (SIRS), which assessment will the nurse perform?
a. Auscultate bowel sounds.
b. Palpate for abdominal pain.
c. Ask the patient about nausea.
d. Check stools for occult blood. - ANS ✔✔d. Check stools for occult blood.
Proton pump inhibitors are given to decrease the risk for stress ulcers in critically ill patients.
The other assessments also will be done, but these will not help in determining the
effectiveness of the pantoprazole administration.
, A patient with cardiogenic shock has the following vital signs: BP 102/50, pulse 128, respirations
28. The pulmonary artery wedge pressure (PAWP) is increased and cardiac output is low. The
nurse will anticipate an order for which medication?
a. 5% human albumin
b. Furosemide (Lasix) IV
c. Epinephrine (Adrenalin) drip
d. Hydrocortisone (Solu-Cortef) - ANS ✔✔b. Furosemide (Lasix) IV
The PAWP indicates that the patient's preload is elevated, and furosemide is indicated to reduce
the preload and improve cardiac output. Epinephrine would further increase heart rate and
myocardial oxygen demand. 5% human albumin would also increase the PAWP. Hydrocortisone
might be considered for septic or anaphylactic shock.
The emergency department (ED) nurse receives report that a patient involved in a motor vehicle
crash is being transported to the facility with an estimated arrival in 1 minute. In preparation for
the patient's arrival, the nurse will obtain
a. hypothermia blanket.
b. lactated Ringer's solution.
c. two 14-gauge IV catheters.
