NURS 481 | NURS481 Exam 2: Advanced Med Surg -
WCU Updated and Latest Questions and Correct
Answers with Rationale
1. A patient with septic shock has a blood pressure of 82/46 mmHg and a heart rate of 124
bpm after receiving 3 liters of normal saline. Which medication should the nurse expect the
healthcare provider to order first?
A. Vasopressin
B. Dopamine
C. Norepinephrine
D. Atropine
Correct Answer: C
Rationale: Norepinephrine is the first-line vasopressor used to treat hypotension in septic
shock after fluid resuscitation has failed. It primarily stimulates alpha receptors to cause
vasoconstriction and increase systemic vascular resistance. The nurse must monitor the
patient’s mean arterial pressure to ensure it stays above 65 mmHg. This medication is
preferred because it has fewer tachycardic side effects compared to dopamine. Maintaining
organ perfusion is the priority goal in managing distributive shock states.
2. A patient is admitted with Diabetic Ketoacidosis (DKA) and a blood glucose of 550 mg/dL.
Before starting an intravenous regular insulin infusion, which laboratory value is most critical
for the nurse to review?
A. Serum Sodium
B. Hemoglobin A1C
C. Blood Urea Nitrogen (BUN)
D. Serum Potassium
Correct Answer: D
Rationale: Insulin administration causes potassium to shift from the extracellular fluid
into the intracellular space. If a patient is hypokalemic when insulin starts, the serum
potassium levels can drop to dangerous levels. The nurse must ensure the potassium is at
least 3.3 mEq/L before starting the drip. Potassium replacement often happens
concurrently with insulin to prevent cardiac dysrhythmias. Monitoring electrolyte balance
is a cornerstone of safe DKA management in the acute phase.
,3. A patient with Acute Respiratory Distress Syndrome (ARDS) is being mechanically
ventilated. Which setting change would the nurse expect to implement to improve
oxygenation by keeping the alveoli open at the end of expiration?
A. Increase the Tidal Volume
B. Increase the Positive End-Expiratory Pressure (PEEP)
C. Decrease the Fraction of Inspired Oxygen (FiO2)
D. Increase the Inspiratory Flow Rate
Correct Answer: B
Rationale: PEEP provides pressure at the end of expiration to prevent alveolar collapse
and improve gas exchange. In ARDS, high levels of PEEP are often required to recruit
collapsed alveoli and improve oxygenation. The nurse must monitor for complications such
as barotrauma or decreased cardiac output when PEEP is high. Tidal volumes are usually
kept low in ARDS to prevent ventilator-induced lung injury. This strategy helps maximize
the surface area available for oxygen diffusion across the capillary membrane.
4. A patient with a suspected Pulmonary Embolism (PE) presents with sudden onset shortness
of breath and chest pain. What is the priority nursing intervention while awaiting diagnostic
testing?
A. Place the patient in a prone position
B. Start a bolus of intravenous Heparin
C. Administer high-flow oxygen via non-rebreather mask
D. Encourage the patient to ambulate to improve circulation
Correct Answer: C
Rationale: Immediate administration of oxygen is critical to manage the hypoxemia
associated with a pulmonary embolism. The nurse should maintain the patient on bed rest
to prevent further mobilization of a potential deep vein thrombosis. Oxygen therapy helps
alleviate respiratory distress and supports myocardial demand during a stressful event.
Diagnostic tests like CT pulmonary angiography are necessary to confirm the diagnosis and
guide further treatment. Careful monitoring of oxygen saturation and respiratory effort is
essential for patient safety.
5. Which clinical finding should the nurse prioritize as an early indicator of cardiogenic shock
in a patient who recently suffered an acute myocardial infarction?
A. Severe peripheral edema
B. Bradycardia and hypertension
C. Elevated white blood cell count
D. Decreased urine output and cool extremities
, Correct Answer: D
Rationale: Cardiogenic shock occurs when the heart fails to pump effectively, leading to
reduced tissue perfusion. Early signs include manifestations of poor systemic perfusion like
cool skin and oliguria. Unlike septic shock, cardiogenic shock typically presents with a low
cardiac index and high filling pressures. The nurse must identify these signs quickly to
prevent multi-organ dysfunction syndrome. Monitoring cardiac output and ensuring
adequate blood pressure are primary nursing goals in this emergency.
6. A patient is admitted with a Hyperosmolar Hyperglycemic State (HHS). Which clinical
characteristic distinguishes HHS from Diabetic Ketoacidosis (DKA)?
A. The absence of significant ketosis
B. A blood glucose level typically below 300 mg/dL
C. The presence of significant metabolic acidosis
D. Rapid onset of symptoms over a few hours
Correct Answer: A
Rationale: HHS is characterized by extreme hyperglycemia without the significant ketosis
or acidosis seen in DKA. Because some insulin is still present in HHS, it is usually enough to
prevent the breakdown of fats into ketones. Patients with HHS often have higher blood
glucose levels and more severe dehydration than those with DKA. The onset of HHS is
typically gradual, occurring over several days or weeks. Treatment focuses on aggressive
fluid resuscitation and managing glucose levels slowly to avoid cerebral edema.
7. The nurse is caring for a patient on a mechanical ventilator who is exhibiting ‘fighting the
ventilator’ (asynchrony). What should be the nurse’s first action?
A. Increase the sedation dose immediately
B. Assess the patient for hypoxia and check tube patency
C. Manually ventilate the patient with a bag-valve mask
D. Call the physician to change the ventilator mode
Correct Answer: B
Rationale: Before increasing sedation or calling for help, the nurse must assess the patient
to find the underlying cause of distress. Potential issues include a kinked tube, secretions,
or a change in the patient’s respiratory status. Assessing for hypoxia ensures that the
patient is receiving adequate oxygenation during the period of asynchrony. Suctioning
should be performed if secretions are obstructing the airway and causing high-pressure
alarms. Patient safety depends on systematic troubleshooting of both the patient and the
equipment.
WCU Updated and Latest Questions and Correct
Answers with Rationale
1. A patient with septic shock has a blood pressure of 82/46 mmHg and a heart rate of 124
bpm after receiving 3 liters of normal saline. Which medication should the nurse expect the
healthcare provider to order first?
A. Vasopressin
B. Dopamine
C. Norepinephrine
D. Atropine
Correct Answer: C
Rationale: Norepinephrine is the first-line vasopressor used to treat hypotension in septic
shock after fluid resuscitation has failed. It primarily stimulates alpha receptors to cause
vasoconstriction and increase systemic vascular resistance. The nurse must monitor the
patient’s mean arterial pressure to ensure it stays above 65 mmHg. This medication is
preferred because it has fewer tachycardic side effects compared to dopamine. Maintaining
organ perfusion is the priority goal in managing distributive shock states.
2. A patient is admitted with Diabetic Ketoacidosis (DKA) and a blood glucose of 550 mg/dL.
Before starting an intravenous regular insulin infusion, which laboratory value is most critical
for the nurse to review?
A. Serum Sodium
B. Hemoglobin A1C
C. Blood Urea Nitrogen (BUN)
D. Serum Potassium
Correct Answer: D
Rationale: Insulin administration causes potassium to shift from the extracellular fluid
into the intracellular space. If a patient is hypokalemic when insulin starts, the serum
potassium levels can drop to dangerous levels. The nurse must ensure the potassium is at
least 3.3 mEq/L before starting the drip. Potassium replacement often happens
concurrently with insulin to prevent cardiac dysrhythmias. Monitoring electrolyte balance
is a cornerstone of safe DKA management in the acute phase.
,3. A patient with Acute Respiratory Distress Syndrome (ARDS) is being mechanically
ventilated. Which setting change would the nurse expect to implement to improve
oxygenation by keeping the alveoli open at the end of expiration?
A. Increase the Tidal Volume
B. Increase the Positive End-Expiratory Pressure (PEEP)
C. Decrease the Fraction of Inspired Oxygen (FiO2)
D. Increase the Inspiratory Flow Rate
Correct Answer: B
Rationale: PEEP provides pressure at the end of expiration to prevent alveolar collapse
and improve gas exchange. In ARDS, high levels of PEEP are often required to recruit
collapsed alveoli and improve oxygenation. The nurse must monitor for complications such
as barotrauma or decreased cardiac output when PEEP is high. Tidal volumes are usually
kept low in ARDS to prevent ventilator-induced lung injury. This strategy helps maximize
the surface area available for oxygen diffusion across the capillary membrane.
4. A patient with a suspected Pulmonary Embolism (PE) presents with sudden onset shortness
of breath and chest pain. What is the priority nursing intervention while awaiting diagnostic
testing?
A. Place the patient in a prone position
B. Start a bolus of intravenous Heparin
C. Administer high-flow oxygen via non-rebreather mask
D. Encourage the patient to ambulate to improve circulation
Correct Answer: C
Rationale: Immediate administration of oxygen is critical to manage the hypoxemia
associated with a pulmonary embolism. The nurse should maintain the patient on bed rest
to prevent further mobilization of a potential deep vein thrombosis. Oxygen therapy helps
alleviate respiratory distress and supports myocardial demand during a stressful event.
Diagnostic tests like CT pulmonary angiography are necessary to confirm the diagnosis and
guide further treatment. Careful monitoring of oxygen saturation and respiratory effort is
essential for patient safety.
5. Which clinical finding should the nurse prioritize as an early indicator of cardiogenic shock
in a patient who recently suffered an acute myocardial infarction?
A. Severe peripheral edema
B. Bradycardia and hypertension
C. Elevated white blood cell count
D. Decreased urine output and cool extremities
, Correct Answer: D
Rationale: Cardiogenic shock occurs when the heart fails to pump effectively, leading to
reduced tissue perfusion. Early signs include manifestations of poor systemic perfusion like
cool skin and oliguria. Unlike septic shock, cardiogenic shock typically presents with a low
cardiac index and high filling pressures. The nurse must identify these signs quickly to
prevent multi-organ dysfunction syndrome. Monitoring cardiac output and ensuring
adequate blood pressure are primary nursing goals in this emergency.
6. A patient is admitted with a Hyperosmolar Hyperglycemic State (HHS). Which clinical
characteristic distinguishes HHS from Diabetic Ketoacidosis (DKA)?
A. The absence of significant ketosis
B. A blood glucose level typically below 300 mg/dL
C. The presence of significant metabolic acidosis
D. Rapid onset of symptoms over a few hours
Correct Answer: A
Rationale: HHS is characterized by extreme hyperglycemia without the significant ketosis
or acidosis seen in DKA. Because some insulin is still present in HHS, it is usually enough to
prevent the breakdown of fats into ketones. Patients with HHS often have higher blood
glucose levels and more severe dehydration than those with DKA. The onset of HHS is
typically gradual, occurring over several days or weeks. Treatment focuses on aggressive
fluid resuscitation and managing glucose levels slowly to avoid cerebral edema.
7. The nurse is caring for a patient on a mechanical ventilator who is exhibiting ‘fighting the
ventilator’ (asynchrony). What should be the nurse’s first action?
A. Increase the sedation dose immediately
B. Assess the patient for hypoxia and check tube patency
C. Manually ventilate the patient with a bag-valve mask
D. Call the physician to change the ventilator mode
Correct Answer: B
Rationale: Before increasing sedation or calling for help, the nurse must assess the patient
to find the underlying cause of distress. Potential issues include a kinked tube, secretions,
or a change in the patient’s respiratory status. Assessing for hypoxia ensures that the
patient is receiving adequate oxygenation during the period of asynchrony. Suctioning
should be performed if secretions are obstructing the airway and causing high-pressure
alarms. Patient safety depends on systematic troubleshooting of both the patient and the
equipment.
