ADN Exam 4: Advanced Med-Surg, ICU & Leadership 2026/2027
UPDATE
1. A nurse is caring for a patient on mechanical ventilation when the high-
pressure alarm sounds. Which action should the nurse perform first?
A. Check for a disconnection in the ventilator circuit
B. Call the respiratory therapist to recalibrate the machine
C. Assess the patient for a possible cuff leak
D. Auscultate breath sounds and check for the need to suction
Answer: D
Rationale: High-pressure alarms are triggered by increased resistance, such as secretions,
biting the tube, or kinks. Suctioning or checking for tube obstruction is the priority.
2. A patient with 40% Total Body Surface Area (TBSA) burns weighs 70 kg. Using
the Parkland Formula (4mL/kg/%TBSA), how much fluid should be administered
in the first 8 hours?
A. 4,200 mL
B. 2,800 mL
C. 11,200 mL
D. 5,600 mL
Answer: D
Rationale: Total = 4 x 70 x 40 = 11,200 mL. Half of the total (5,600 mL) is given in the first
8 hours.
,3. The nurse is prioritizing care for four patients. Which patient should the nurse
assess first?
A. A patient with a chest tube who has 50 mL of drainage in the last hour
B. A patient with heart failure and 2+ pitting edema in the lower extremities
C. A patient with COPD who has an oxygen saturation of 91% on 2L NC
D. A patient 2 hours post-op abdominal surgery with a BP of 88/54 mmHg
Answer: D
Rationale: Hypotension (88/54) post-operatively may indicate hemorrhage or shock and
requires immediate intervention.
4. A nurse is delegating tasks to an Unlicensed Assistive Personnel (UAP). Which
task is appropriate to delegate?
A. Assessing the lung sounds of a patient with pneumonia
B. Feeding a patient with a high risk of aspiration
C. Assisting a stable patient with a bedside commode
D. Performing a simple dressing change on a stable surgical wound
Answer: C
Rationale: UAPs can assist with ADLs and mobility for stable patients. Assessments and
complex procedures are the RN’s responsibility.
5. Which hemodynamic finding is most characteristic of hypovolemic shock?
A. Increased Central Venous Pressure (CVP)
B. Increased Pulmonary Artery Wedge Pressure (PAWP)
C. Decreased Systemic Vascular Resistance (SVR)
D. Decreased Cardiac Output (CO) and decreased CVP
Answer: D
Rationale: Hypovolemic shock is characterized by low volume, leading to low CVP and low
cardiac output.
, 6. A patient in the ICU is diagnosed with Septic Shock. Which of the following is
the priority intervention?
A. Initiating physical therapy to prevent muscle atrophy
B. Obtaining a dietary consult for nutritional support
C. Administering broad-spectrum antibiotics within 1 hour
D. Administering oral antihypertensives
Answer: C
Rationale: Early administration of antibiotics is critical in septic shock to treat the
underlying infection.
7. A patient presents with a pH of 7.30, PaCO2 of 52, and HCO3 of 24. How does
the nurse interpret these ABGs?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Respiratory Acidosis
D. Metabolic Alkalosis
Answer: C
Rationale: The pH is low (acidosis) and the PaCO2 is high (respiratory cause), indicating
respiratory acidosis.
8. A nurse is caring for a patient with increased intracranial pressure (ICP).
Which position is most appropriate?
A. Trendelenburg position
B. Head of bed elevated at 30 to 45 degrees
C. Supine with legs elevated
D. Prone position
Answer: B
Rationale: Elevating the HOB to 30-45 degrees promotes venous drainage from the head,
helping to lower ICP.
UPDATE
1. A nurse is caring for a patient on mechanical ventilation when the high-
pressure alarm sounds. Which action should the nurse perform first?
A. Check for a disconnection in the ventilator circuit
B. Call the respiratory therapist to recalibrate the machine
C. Assess the patient for a possible cuff leak
D. Auscultate breath sounds and check for the need to suction
Answer: D
Rationale: High-pressure alarms are triggered by increased resistance, such as secretions,
biting the tube, or kinks. Suctioning or checking for tube obstruction is the priority.
2. A patient with 40% Total Body Surface Area (TBSA) burns weighs 70 kg. Using
the Parkland Formula (4mL/kg/%TBSA), how much fluid should be administered
in the first 8 hours?
A. 4,200 mL
B. 2,800 mL
C. 11,200 mL
D. 5,600 mL
Answer: D
Rationale: Total = 4 x 70 x 40 = 11,200 mL. Half of the total (5,600 mL) is given in the first
8 hours.
,3. The nurse is prioritizing care for four patients. Which patient should the nurse
assess first?
A. A patient with a chest tube who has 50 mL of drainage in the last hour
B. A patient with heart failure and 2+ pitting edema in the lower extremities
C. A patient with COPD who has an oxygen saturation of 91% on 2L NC
D. A patient 2 hours post-op abdominal surgery with a BP of 88/54 mmHg
Answer: D
Rationale: Hypotension (88/54) post-operatively may indicate hemorrhage or shock and
requires immediate intervention.
4. A nurse is delegating tasks to an Unlicensed Assistive Personnel (UAP). Which
task is appropriate to delegate?
A. Assessing the lung sounds of a patient with pneumonia
B. Feeding a patient with a high risk of aspiration
C. Assisting a stable patient with a bedside commode
D. Performing a simple dressing change on a stable surgical wound
Answer: C
Rationale: UAPs can assist with ADLs and mobility for stable patients. Assessments and
complex procedures are the RN’s responsibility.
5. Which hemodynamic finding is most characteristic of hypovolemic shock?
A. Increased Central Venous Pressure (CVP)
B. Increased Pulmonary Artery Wedge Pressure (PAWP)
C. Decreased Systemic Vascular Resistance (SVR)
D. Decreased Cardiac Output (CO) and decreased CVP
Answer: D
Rationale: Hypovolemic shock is characterized by low volume, leading to low CVP and low
cardiac output.
, 6. A patient in the ICU is diagnosed with Septic Shock. Which of the following is
the priority intervention?
A. Initiating physical therapy to prevent muscle atrophy
B. Obtaining a dietary consult for nutritional support
C. Administering broad-spectrum antibiotics within 1 hour
D. Administering oral antihypertensives
Answer: C
Rationale: Early administration of antibiotics is critical in septic shock to treat the
underlying infection.
7. A patient presents with a pH of 7.30, PaCO2 of 52, and HCO3 of 24. How does
the nurse interpret these ABGs?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Respiratory Acidosis
D. Metabolic Alkalosis
Answer: C
Rationale: The pH is low (acidosis) and the PaCO2 is high (respiratory cause), indicating
respiratory acidosis.
8. A nurse is caring for a patient with increased intracranial pressure (ICP).
Which position is most appropriate?
A. Trendelenburg position
B. Head of bed elevated at 30 to 45 degrees
C. Supine with legs elevated
D. Prone position
Answer: B
Rationale: Elevating the HOB to 30-45 degrees promotes venous drainage from the head,
helping to lower ICP.
