NURS 481 | NURS481 Exam 1: Advanced Med Surg -
WCU Updated and Latest Questions and Correct
Answers with Rationale
1. A patient with septic shock has a mean arterial pressure (MAP) of 58 mmHg despite
aggressive fluid resuscitation. Which medication should the nurse anticipate administering
next?
A. Nitroglycerin
B. Norepinephrine
C. Furosemide
D. Atropine
Correct Answer: B
Rationale: Septic shock requires vasopressors when fluid resuscitation fails to maintain
adequate perfusion. Norepinephrine is the first-line vasopressor used to increase systemic
vascular resistance and blood pressure. Nitroglycerin would further lower blood pressure
due to its vasodilatory effects. Furosemide is contraindicated as it would deplete volume in
a patient already lacking effective circulating volume. The goal is to maintain a MAP of at
least 65 mmHg to ensure vital organ perfusion.
2. Which clinical manifestation is most indicative of the ‘progressive stage’ of shock?
A. Mild anxiety and restlessness
B. Cold, clammy skin and metabolic acidosis
C. Normal blood pressure with narrowed pulse pressure
D. Slightly increased heart rate and respiratory rate
Correct Answer: B
Rationale: The progressive stage of shock involves a significant drop in compensatory
mechanisms. During this stage, blood is shunted away from the periphery to protect core
organs, causing cold skin. Metabolic acidosis occurs because cells switch to anaerobic
metabolism as oxygen delivery fails. While anxiety occurs early, clinical deterioration
becomes more obvious in this middle stage. Failure to intervene during this stage often
leads to irreversible organ damage and death.
3. A patient is admitted with Acute Respiratory Distress Syndrome (ARDS). The nurse notes
the patient’s PaO2/FiO2 ratio is 150. How should the nurse interpret this finding?
A. The patient has moderate ARDS
B. The patient has mild ARDS
,C. The patient has severe ARDS
D. The patient is within normal limits
Correct Answer: A
Rationale: ARDS severity is classified using the Berlin definition based on the P/F ratio. A
ratio between 200 and 300 signifies mild ARDS, while 100 to 200 signifies moderate ARDS.
Since the patient’s ratio is 150, they fall into the moderate category. Severe ARDS is defined
as a ratio of less than 100. This calculation helps clinicians determine the necessary level of
mechanical ventilation support.
4. A patient with a head injury exhibits a widened pulse pressure, bradycardia, and irregular
respirations. Which action should the nurse take first?
A. Prepare for immediate intubation and sedation
B. Notify the provider and prepare for ICP monitoring
C. Administer a bolus of isotonic saline
D. Place the patient in a Trendelenburg position
Correct Answer: B
Rationale: These three symptoms are known as Cushing’s Triad, indicating a late sign of
increased intracranial pressure (ICP). This is a medical emergency that requires immediate
notification of the surgical or medical team. Rapid intervention is needed to prevent brain
stem herniation and permanent neurological damage. Isotonic saline is helpful for BP but
does not address the underlying ICP issue. Elevating the head of the bed, not
Trendelenburg, is appropriate for managing ICP.
5. When managing a patient with Acute Kidney Injury (AKI) in the oliguric phase, which lab
abnormality is the nurse most likely to find?
A. Hypokalemia
B. Hyperkalemia
C. Hypercalcemia
D. Metabolic alkalosis
Correct Answer: B
Rationale: In the oliguric phase of AKI, the kidneys are unable to excrete waste products
effectively. Potassium levels rise because the kidneys are the primary route for potassium
excretion. Hyperkalemia is a dangerous complication that can lead to life-threatening
cardiac dysrhythmias. Patients also typically exhibit metabolic acidosis due to the inability
to excrete hydrogen ions. Monitoring the ECG and serum electrolyte levels is a priority
nursing intervention.
, 6. A patient with 40% total body surface area (TBSA) burns is in the emergent phase. Which
electrolyte imbalance is typical during this period?
A. Hypernatremia and hypokalemia
B. Hyponatremia and hyperkalemia
C. Hypocalcemia and hypernatremia
D. Hypermagnesemia and hypokalemia
Correct Answer: B
Rationale: During the emergent phase of a burn, massive fluid shifts and cell destruction
occur. Potassium is released from damaged cells into the extracellular fluid, causing
hyperkalemia. Sodium moves from the intravascular space into the interstitial space with
fluid, resulting in hyponatremia. This period lasts for the first 24 to 48 hours until capillary
integrity is restored. Frequent lab monitoring and fluid resuscitation are essential to
prevent cardiovascular collapse.
7. A patient is diagnosed with Disseminated Intravascular Coagulation (DIC). Which
laboratory result supports this diagnosis?
A. Increased fibrinogen levels
B. Decreased D-dimer levels
C. Increased platelet count
D. Increased Prothrombin Time (PT)
Correct Answer: D
Rationale: DIC is characterized by systemic activation of blood coagulation, leading to the
consumption of clotting factors. As clotting factors and platelets are used up, coagulation
times like PT and PTT become prolonged. D-dimer levels will be increased as the body tries
to break down the widespread clots. Fibrinogen levels will decrease because it is being
consumed during the clotting process. These results reflect a paradox of simultaneous
excessive clotting and high risk for bleeding.
8. A patient with Diabetic Ketoacidosis (DKA) has a blood glucose of 550 mg/dL and a serum
potassium of 3.3 mEq/L. Which order should the nurse implement first?
A. Start an insulin drip at 0.1 units/kg/hr
B. Administer 40 mEq of Potassium Chloride IV
C. Administer 10 units of regular insulin IV bolus
D. Give 500 mL of 5% Dextrose
Correct Answer: B
WCU Updated and Latest Questions and Correct
Answers with Rationale
1. A patient with septic shock has a mean arterial pressure (MAP) of 58 mmHg despite
aggressive fluid resuscitation. Which medication should the nurse anticipate administering
next?
A. Nitroglycerin
B. Norepinephrine
C. Furosemide
D. Atropine
Correct Answer: B
Rationale: Septic shock requires vasopressors when fluid resuscitation fails to maintain
adequate perfusion. Norepinephrine is the first-line vasopressor used to increase systemic
vascular resistance and blood pressure. Nitroglycerin would further lower blood pressure
due to its vasodilatory effects. Furosemide is contraindicated as it would deplete volume in
a patient already lacking effective circulating volume. The goal is to maintain a MAP of at
least 65 mmHg to ensure vital organ perfusion.
2. Which clinical manifestation is most indicative of the ‘progressive stage’ of shock?
A. Mild anxiety and restlessness
B. Cold, clammy skin and metabolic acidosis
C. Normal blood pressure with narrowed pulse pressure
D. Slightly increased heart rate and respiratory rate
Correct Answer: B
Rationale: The progressive stage of shock involves a significant drop in compensatory
mechanisms. During this stage, blood is shunted away from the periphery to protect core
organs, causing cold skin. Metabolic acidosis occurs because cells switch to anaerobic
metabolism as oxygen delivery fails. While anxiety occurs early, clinical deterioration
becomes more obvious in this middle stage. Failure to intervene during this stage often
leads to irreversible organ damage and death.
3. A patient is admitted with Acute Respiratory Distress Syndrome (ARDS). The nurse notes
the patient’s PaO2/FiO2 ratio is 150. How should the nurse interpret this finding?
A. The patient has moderate ARDS
B. The patient has mild ARDS
,C. The patient has severe ARDS
D. The patient is within normal limits
Correct Answer: A
Rationale: ARDS severity is classified using the Berlin definition based on the P/F ratio. A
ratio between 200 and 300 signifies mild ARDS, while 100 to 200 signifies moderate ARDS.
Since the patient’s ratio is 150, they fall into the moderate category. Severe ARDS is defined
as a ratio of less than 100. This calculation helps clinicians determine the necessary level of
mechanical ventilation support.
4. A patient with a head injury exhibits a widened pulse pressure, bradycardia, and irregular
respirations. Which action should the nurse take first?
A. Prepare for immediate intubation and sedation
B. Notify the provider and prepare for ICP monitoring
C. Administer a bolus of isotonic saline
D. Place the patient in a Trendelenburg position
Correct Answer: B
Rationale: These three symptoms are known as Cushing’s Triad, indicating a late sign of
increased intracranial pressure (ICP). This is a medical emergency that requires immediate
notification of the surgical or medical team. Rapid intervention is needed to prevent brain
stem herniation and permanent neurological damage. Isotonic saline is helpful for BP but
does not address the underlying ICP issue. Elevating the head of the bed, not
Trendelenburg, is appropriate for managing ICP.
5. When managing a patient with Acute Kidney Injury (AKI) in the oliguric phase, which lab
abnormality is the nurse most likely to find?
A. Hypokalemia
B. Hyperkalemia
C. Hypercalcemia
D. Metabolic alkalosis
Correct Answer: B
Rationale: In the oliguric phase of AKI, the kidneys are unable to excrete waste products
effectively. Potassium levels rise because the kidneys are the primary route for potassium
excretion. Hyperkalemia is a dangerous complication that can lead to life-threatening
cardiac dysrhythmias. Patients also typically exhibit metabolic acidosis due to the inability
to excrete hydrogen ions. Monitoring the ECG and serum electrolyte levels is a priority
nursing intervention.
, 6. A patient with 40% total body surface area (TBSA) burns is in the emergent phase. Which
electrolyte imbalance is typical during this period?
A. Hypernatremia and hypokalemia
B. Hyponatremia and hyperkalemia
C. Hypocalcemia and hypernatremia
D. Hypermagnesemia and hypokalemia
Correct Answer: B
Rationale: During the emergent phase of a burn, massive fluid shifts and cell destruction
occur. Potassium is released from damaged cells into the extracellular fluid, causing
hyperkalemia. Sodium moves from the intravascular space into the interstitial space with
fluid, resulting in hyponatremia. This period lasts for the first 24 to 48 hours until capillary
integrity is restored. Frequent lab monitoring and fluid resuscitation are essential to
prevent cardiovascular collapse.
7. A patient is diagnosed with Disseminated Intravascular Coagulation (DIC). Which
laboratory result supports this diagnosis?
A. Increased fibrinogen levels
B. Decreased D-dimer levels
C. Increased platelet count
D. Increased Prothrombin Time (PT)
Correct Answer: D
Rationale: DIC is characterized by systemic activation of blood coagulation, leading to the
consumption of clotting factors. As clotting factors and platelets are used up, coagulation
times like PT and PTT become prolonged. D-dimer levels will be increased as the body tries
to break down the widespread clots. Fibrinogen levels will decrease because it is being
consumed during the clotting process. These results reflect a paradox of simultaneous
excessive clotting and high risk for bleeding.
8. A patient with Diabetic Ketoacidosis (DKA) has a blood glucose of 550 mg/dL and a serum
potassium of 3.3 mEq/L. Which order should the nurse implement first?
A. Start an insulin drip at 0.1 units/kg/hr
B. Administer 40 mEq of Potassium Chloride IV
C. Administer 10 units of regular insulin IV bolus
D. Give 500 mL of 5% Dextrose
Correct Answer: B
