MIDTERM (Blueprint)

Question 1

Which of the following best describes the pathophysiologic difference between unstable angina and STEMI?
A. STEMI involves only partial occlusion of the coronary artery.
B. Unstable angina is associated with myocardial necrosis.
C. STEMI involves complete coronary artery occlusion leading to myocardial infarction.
D. Unstable angina shows ST elevation on ECG.

Answer 1

Correct Answer: C. STEMI involves complete coronary artery occlusion leading to myocardial infarction.
Rationale: STEMI is due to a complete blockage, causing irreversible myocardial damage, while unstable angina involves transient or partial blockage without permanent damage.

Question 2

What characterizes NSTEMI in comparison to unstable angina?
A. NSTEMI causes ST elevation.
B. NSTEMI involves myocardial necrosis, confirmed by elevated cardiac biomarkers.
C. Unstable angina presents with elevated troponin levels.
D. NSTEMI is less serious than unstable angina.

Answer 2

Correct Answer: B. NSTEMI involves myocardial necrosis, confirmed by elevated cardiac biomarkers.
Rationale: NSTEMI shows no ST elevation but includes positive cardiac biomarkers, indicating myocardial damage.

Question 3

Which of the following symptoms is most commonly associated with acute coronary syndrome?
A. Chest pain or pressure not relieved by rest or nitroglycerin
B. Intermittent palpitations without chest pain
C. Sudden onset of high fever
D. Pain only during physical exertion

Answer 3

Correct Answer: A. Chest pain or pressure not relieved by rest or nitroglycerin
Rationale: Persistent chest pain unrelieved by rest is a hallmark sign of ACS and must be evaluated immediately.

Question 4

In women and older adults, which atypical symptom may indicate ACS?
A. Unilateral leg pain
B. Unexplained fatigue or shortness of breath
C. Productive cough
D. Blurred vision

Answer 4

Correct Answer: B. Unexplained fatigue or shortness of breath
Rationale: Women and elderly patients may present with atypical signs such as fatigue or dyspnea rather than classic chest pain.

Question 5

Which ECG finding is most indicative of a STEMI?
A. T wave inversion
B. ST depression
C. ST segment elevation in contiguous leads
D. Normal sinus rhythm with PVCs

Answer 5

Correct Answer: C. ST segment elevation in contiguous leads
Rationale: ST elevation in two or more contiguous leads suggests a STEMI, requiring urgent reperfusion therapy.

Question 6

Which ECG change is most often associated with unstable angina?
A. Peaked T waves
B. Prolonged QT interval
C. ST segment depression or T wave inversion
D. Pathologic Q waves

Answer 6

Correct Answer: C. ST segment depression or T wave inversion
Rationale: These changes indicate myocardial ischemia without infarction, common in unstable angina.

Question 7

Which medication is given immediately to prevent platelet aggregation in ACS?
A. Heparin
B. Aspirin
C. Furosemide
D. Amiodarone

Answer 7

Correct Answer: B. Aspirin
Rationale: Aspirin is administered promptly in suspected ACS to reduce platelet aggregation and limit clot progression.

Question 8

What is the primary goal of reperfusion therapy in STEMI?
A. Relieve chest pain
B. Lower blood pressure
C. Restore blood flow to the myocardium
D. Decrease heart rate

Answer 8

Correct Answer: C. Restore blood flow to the myocardium
Rationale: Rapid reperfusion, either by PCI or fibrinolytics, is critical to reduce myocardial damage.

Question 9

Which of the following is a major complication following a myocardial infarction?
A. Hypokalemia
B. Pneumothorax
C. Cardiogenic shock
D. Pulmonary embolism

Answer 9

Correct Answer: C. Cardiogenic shock
Rationale: Cardiogenic shock is a serious complication of MI caused by decreased cardiac output due to myocardial damage.

Question 10

What dysrhythmia is commonly associated with inferior wall MI?
A. Atrial fibrillation
B. Ventricular fibrillation
C. Bradycardia or heart block
D. Supraventricular tachycardia

Answer 10

Correct Answer: C. Bradycardia or heart block
Rationale: Inferior MI often affects the AV node, increasing the risk of bradyarrhythmias or heart block.

Question 11

What is the nurse’s immediate action for a patient with suspected MI?
A. Apply oxygen and obtain ECG
B. Administer insulin
C. Begin CPR
D. Insert urinary catheter

Answer 11

Correct Answer: A. Apply oxygen and obtain ECG
Rationale: Oxygen supports myocardial perfusion and ECG confirms diagnosis—both are initial priorities.

Question 12

What is a key nursing responsibility when administering nitroglycerin for chest pain?
A. Monitor blood glucose
B. Monitor blood pressure closely
C. Check reflexes
D. Assess pupil response

Answer 12

Correct Answer: B. Monitor blood pressure closely
Rationale: Nitroglycerin can cause hypotension; BP must be monitored to prevent adverse effects.

Question 13

Which of the following best distinguishes a hypertensive emergency from a hypertensive urgency?
A. Blood pressure greater than 160/100 mmHg
B. Presence of chest pain
C. Systolic BP greater than 180 mmHg
D. Evidence of acute target organ damage

Answer 13

Correct Answer: D. Evidence of acute target organ damage
Rationale: Hypertensive emergency is defined by severely elevated BP with signs of organ damage (e.g., encephalopathy, renal failure, MI). Urgency lacks organ damage.

Question 14

A patient presents with BP 220/130 mmHg but no symptoms. What is the appropriate classification?
A. Normal hypertension
B. Hypertensive urgency
C. Hypertensive emergency
D. Orthostatic hypotension

Answer 14

Correct Answer: B. Hypertensive urgency
Rationale: High BP without symptoms or end-organ damage is hypertensive urgency and requires gradual reduction over 24–48 hours.

Question 15

Which symptom in a hypertensive patient suggests possible end-organ damage?
A. Dizziness
B. Mild headache
C. Tingling in fingers
D. Sudden change in vision or mental status

Answer 15

Correct Answer: D. Sudden change in vision or mental status
Rationale: Neurologic changes indicate potential cerebral involvement, requiring emergency intervention.

Question 16

A patient in hypertensive crisis develops chest pain and ECG changes. Which complication should be suspected?
A. Asthma exacerbation
B. Myocardial infarction
C. Pulmonary edema
D. GERD

Answer 16

Correct Answer: B. Myocardial infarction
Rationale: Severe hypertension can lead to cardiac ischemia or infarction, often shown by chest pain and ECG changes.

Question 17

Which IV medication is most commonly used in hypertensive emergency for rapid BP reduction?
A. Nitroprusside
B. Digoxin
C. Lorazepam
D. Furosemide

Answer 17

Correct Answer: A. Nitroprusside
Rationale: Nitroprusside is a potent vasodilator that works quickly and is often titrated in ICU settings for BP control.

Question 18

What is a key nursing consideration when administering IV labetalol for hypertensive emergency?
A. Administer with food
B. Monitor heart rate and blood pressure frequently
C. Restrict fluid intake
D. Administer diuretics first

Answer 18

Correct Answer: B. Monitor heart rate and blood pressure frequently
Rationale: Labetalol can lower both heart rate and BP; frequent monitoring is essential to avoid hypotension or bradycardia.

Question 19

What should the nurse include in teaching to prevent recurrent hypertensive crisis?
A. Take medications only when BP is elevated
B. Use salt liberally to balance medication effects
C. Take prescribed antihypertensives daily, even when feeling well
D. Stop medications if side effects occur

Answer 19

Correct Answer: C. Take prescribed antihypertensives daily, even when feeling well
Rationale: Adherence to antihypertensive medication is crucial for long-term control, even if the patient is asymptomatic.

Question 20

Which lifestyle change should be emphasized for hypertensive crisis prevention?
A. Eating a high-protein diet
B. Limiting sodium intake
C. Avoiding all carbohydrates
D. Increasing saturated fats

Answer 20

Correct Answer: B. Limiting sodium intake
Rationale: A low-sodium diet helps reduce blood pressure and is a key part of managing chronic hypertension.

Question 21

Which of the following is a major risk factor for the development of an abdominal aortic aneurysm (AAA)?
A. Female gender
B. Low cholesterol
C. Smoking history
D. Daily aspirin use

Answer 21

Correct Answer: C. Smoking history
Rationale: Smoking is the strongest modifiable risk factor for AAA due to its impact on vascular integrity.

Question 22

Which patient should be screened for an abdominal aortic aneurysm according to USPSTF guidelines?
A. A 40-year-old female with diabetes
B. A 55-year-old nonsmoking male
C. A 65-year-old male with a history of smoking
D. A 75-year-old female with osteoporosis

Answer 22

Correct Answer: C. A 65-year-old male with a history of smoking
Rationale: Men aged 65–75 with a history of smoking should undergo a one-time ultrasound screening for AAA.

Question 23

Which symptom is most commonly associated with a thoracic aortic aneurysm?
A. Chest or back pain
B. Right lower quadrant tenderness
C. Epigastric burning
D. Left arm weakness

Answer 23

Correct Answer: A. Chest or back pain
Rationale: Thoracic aneurysms may compress adjacent structures, leading to chest or back discomfort.

Question 24

A patient with an abdominal aortic aneurysm (AAA) may report which symptom?
A. Difficulty swallowing
B. Pulsatile abdominal mass with pain
C. Night sweats
D. Shoulder stiffness

Answer 24

Correct Answer: B. Pulsatile abdominal mass with pain
Rationale: A pulsatile mass in the abdomen, often with a sense of fullness or pain, is a classic sign of AAA.

Question 25

Which symptom may indicate a rupturing abdominal aortic aneurysm? A. Sudden severe abdominal or back pain with hypotension B. Nausea and vomiting C. Cough with blood D. Tachypnea and fever

Answer 25

Correct Answer: A. Sudden severe abdominal or back pain with hypotension Rationale: Rupture of an AAA can cause internal bleeding, hypotension, and a high risk of death without emergency surgery.

Question 26

Which finding requires immediate surgical consultation in a patient with known AAA? A. Decreased appetite B. New onset severe back pain C. Constipation D. Bradycardia

Answer 26

Correct Answer: B. New onset severe back pain Rationale: Back or flank pain in a patient with AAA may signal expansion or impending rupture and warrants immediate evaluation.

Question 27

After AAA surgical repair, which nursing assessment is the priority? A. Bowel sounds B. Peripheral pulses and limb perfusion C. Capillary refill D. Cranial nerve function

Answer 27

Correct Answer: B. Peripheral pulses and limb perfusion Rationale: Checking for adequate circulation is essential post-op, especially to assess for graft patency or limb ischemia.

Question 28

What is a critical complication to monitor after open AAA repair? A. Sinus bradycardia B. Graft occlusion or leakage C. Liver failure D. Allergic reaction

Answer 28

Correct Answer: B. Graft occlusion or leakage Rationale: Post-op patients must be closely monitored for signs of bleeding or graft failure, which may require re-intervention.

Question 29

A patient with an acute aortic dissection most likely reports which symptom? A. Gradual onset of left-sided chest pain B. Sudden, tearing chest or back pain C. Dull lower abdominal pain D. Substernal chest pressure relieved by rest

Answer 29

Correct Answer: B. Sudden, tearing chest or back pain Rationale: Aortic dissection typically presents with abrupt, severe, tearing pain, often radiating to the back or abdomen.

Question 30

What assessment finding supports a diagnosis of aortic dissection? A. Narrow pulse pressure B. Bradycardia and wheezing C. Blood pressure difference between arms D. Flushed skin and fever

Answer 30

Correct Answer: C. Blood pressure difference between arms Rationale: Discrepancy in BP between arms can indicate disrupted blood flow from dissection and requires immediate evaluation.

Question 31

What finding most strongly suggests aortic rupture in a patient with known dissection? A. Wheezing and cough B. Decreased oxygen saturation C. Rapid drop in blood pressure and loss of consciousness D. Intermittent nausea

Answer 31

Correct Answer: C. Rapid drop in blood pressure and loss of consciousness Rationale: These signs suggest massive internal bleeding from rupture, often fatal without rapid surgical intervention.

Question 31

Which of the following is a sign of hemodynamic instability in aortic dissection? A. Normal pulse and stable BP B. Hypotension and altered mental status C. Urinary retention D. Hypothermia

Answer 31

Correct Answer: B. Hypotension and altered mental status Rationale: These signs indicate decreased perfusion and may signal rupture, a surgical emergency.

Question 32

Which drug class is typically first-line to reduce shear stress in aortic dissection? A. Diuretics B. Beta blockers (e.g., esmolol) C. ACE inhibitors D. Calcium channel blockers

Answer 32

Correct Answer: B. Beta blockers (e.g., esmolol) Rationale: Beta blockers reduce heart rate and blood pressure, limiting aortic wall stress and preventing progression of the dissection.

Question 33

Why is IV antihypertensive therapy essential in aortic dissection? A. To raise perfusion to distal organs B. To prevent extension or rupture of the dissection C. To avoid tachycardia D. To increase renal output

Answer 33

Correct Answer: B. To prevent extension or rupture of the dissection Rationale: Tight BP control reduces stress on the aortic wall and decreases the risk of further tearing or rupture.

Question 34

Which post-op complication is most concerning after aortic dissection repair? A. Decreased urine output B. Mild incisional pain C. Drowsiness after anesthesia D. Slightly elevated WBC

Answer 34

Correct Answer: A. Decreased urine output Rationale: This may indicate renal hypoperfusion or graft issues, both of which require prompt intervention.

Question 35

Which nursing intervention is most appropriate post-op for aortic repair? A. Elevate legs above heart B. Maintain tight blood pressure control C. Increase fluid intake rapidly D. Begin ambulation immediately

Answer 35

Correct Answer: B. Maintain tight blood pressure control Rationale: Maintaining a stable and low BP is crucial to avoid stress on the surgical repair and reduce re-dissection risk.

Question 36

Which ABG finding indicates hypoxemic respiratory failure? A. PaCO₂ > 50 mmHg with pH < 7.30 B. PaO₂ < 60 mmHg on ≥60% FiO₂ C. HCO₃⁻ < 22 mEq/L D. PaO₂ > 80 mmHg on room air

Answer 36

Correct Answer: B. PaO₂ < 60 mmHg on ≥60% FiO₂ Rationale: Hypoxemic failure is defined by a low arterial oxygen level despite receiving supplemental oxygen.

Question 37

Which of the following is characteristic of hypercapnic respiratory failure? A. Normal PaCO₂ B. Elevated PaCO₂ with acidemia (pH < 7.35) C. High PaO₂ D. PaCO₂ < 35 mmHg

Answer 37

Correct Answer: B. Elevated PaCO₂ with acidemia (pH < 7.35) Rationale: Hypercapnic failure results from impaired CO₂ removal, leading to respiratory acidosis.

Question 38

Which clinical sign is commonly seen in acute respiratory failure? A. Bradycardia B. Dyspnea and use of accessory muscles C. Clear breath sounds D. Decreased respiratory rate

Answer 38

Correct Answer: B. Dyspnea and use of accessory muscles Rationale: Signs of respiratory distress include increased work of breathing, visible effort, and tachypnea.

Question 39

A patient in acute respiratory failure may also present with which neurologic symptom? A. Dilated pupils B. Restlessness or confusion C. Visual hallucinations D. Hyperreflexia

Answer 39

Correct Answer: B. Restlessness or confusion Rationale: Hypoxemia can cause altered mental status due to poor oxygenation of the brain.

Question 40

Which ABG result suggests respiratory acidosis due to hypoventilation? A. pH 7.45, PaCO₂ 35 B. pH 7.28, PaCO₂ 55 C. pH 7.52, PaCO₂ 28 D. pH 7.38, PaCO₂ 40

Answer 40

Correct Answer: B. pH 7.28, PaCO₂ 55 Rationale: A low pH and high CO₂ indicates respiratory acidosis, common in hypoventilation-related ARF.

Question 41

Which oxygen therapy is most appropriate for a patient with severe hypoxemia and intact mental status? A. Room air B. Nasal cannula at 2 L/min C. Non-rebreather mask at 15 L/min D. Ventilator with high PEEP

Answer 41

Correct Answer: C. Non-rebreather mask at 15 L/min Rationale: A non-rebreather delivers high-concentration oxygen and is suitable for conscious patients with critical hypoxemia.

Question 42

Which patient is the best candidate for noninvasive ventilation (NIV)? A. Apneic patient with GCS of 5 B. Hemodynamically unstable patient C. Alert COPD patient with elevated PaCO₂ D. Patient with facial trauma

Answer 42

Correct Answer: C. Alert COPD patient with elevated PaCO₂ Rationale: NIV is effective for conscious, cooperative patients with hypercapnia, especially in COPD exacerbations.

Question 43

What is the primary nursing goal during mechanical ventilation for ARF? A. Increase sedation B. Promote adequate gas exchange and monitor ABGs C. Encourage high fluid intake D. Perform oral care once per shift

Answer 43

Correct Answer: B. Promote adequate gas exchange and monitor ABGs Rationale: Ventilator settings are titrated to improve oxygenation and ventilation, so frequent ABG checks are essential.

Question 44

What is the nurse’s priority intervention for a patient with ARF experiencing severe dyspnea and anxiety? A. Administer sedatives without monitoring B. Reassure the patient and optimize oxygenation C. Limit communication D. Delay oxygen until ABGs are obtained

Answer 44

Correct Answer: B. Reassure the patient and optimize oxygenation Rationale: Dyspnea and anxiety feed into each other. Calm reassurance and oxygen are critical first steps.

Question 45

Which nursing action is appropriate to reduce anxiety in a ventilated patient with ARF? A. Increase TV and PEEP B. Maintain communication and provide sedation as needed C. Turn off alarms to reduce noise D. Administer diuretics for comfort

Answer 45

Correct Answer: B. Maintain communication and provide sedation as needed Rationale: Ensuring patient comfort and reducing anxiety improves compliance with ventilation and overall outcomes.

Question 46

What defines refractory hypoxemia in ARDS? A. PaO₂ improves with high-flow nasal cannula B. Severe hypoxemia unresponsive to oxygen therapy C. Increased PaCO₂ with normal PaO₂ D. Rapid normalization of SpO₂ with low FiO₂

Answer 46

Correct Answer: B. Severe hypoxemia unresponsive to oxygen therapy Rationale: Refractory hypoxemia is the hallmark of ARDS, even with 100% oxygen due to shunting and poor diffusion.

Question 46

During which phase of ARDS does alveolar-capillary membrane damage lead to noncardiogenic pulmonary edema? A. Proliferative B. Injury (exudative) C. Fibrotic D. Chronic

Answer 46

Correct Answer: B. Injury (exudative) Rationale: In this initial phase, increased permeability leads to fluid leaking into alveoli, impairing gas exchange.

Question 46

Why is refractory hypoxemia dangerous in ARDS? A. It reduces carbon dioxide clearance B. It results in inadequate tissue oxygenation despite interventions C. It improves with diuretics D. It signifies mild disease

Answer 46

Correct Answer: B. It results in inadequate tissue oxygenation despite interventions Rationale: Tissues remain hypoxic despite high FiO₂, increasing the risk for multisystem organ failure.

Question 47

What is the main characteristic of the fibrotic phase of ARDS? A. Minimal lung damage B. Capillary congestion C. Decreased lung compliance due to scar tissue D. Reversible lung inflammation

Answer 47

Correct Answer: C. Decreased lung compliance due to scar tissue Rationale: The fibrotic phase involves permanent fibrosis, leading to stiff, noncompliant lungs and chronic hypoxia.

Question 48

Which diagnostic test is most helpful in identifying ARDS? A. Brain MRI B. Chest X-ray showing bilateral infiltrates C. Echocardiogram D. ECG

Answer 48

Correct Answer: B. Chest X-ray showing bilateral infiltrates Rationale: ARDS typically shows diffuse, bilateral infiltrates ("white-out lungs") without cardiac cause.

Question 48

What distinguishes ARDS from cardiogenic pulmonary edema? A. Absence of left atrial hypertension or heart failure B. Elevated BNP C. Enlarged heart silhouette on CXR D. Positive troponins

Answer 48

Correct Answer: A. Absence of left atrial hypertension or heart failure Rationale: ARDS is noncardiogenic, and pulmonary capillary wedge pressure is typically normal or low.

Question 49

What ventilator strategy is preferred in ARDS? A. High tidal volume, low PEEP B. Low tidal volume, moderate PEEP C. High FiO₂, low respiratory rate D. Intermittent positive pressure only

Answer 49

Correct Answer: B. Low tidal volume, moderate PEEP Rationale: Lung-protective ventilation uses low tidal volumes to avoid barotrauma and high PEEP to keep alveoli open.

Question 50

Why is high PEEP used in patients with ARDS? A. Decreases blood pressure B. Prevents alveolar collapse and improves oxygenation C. Reduces cardiac output D. Enhances diuresis

Answer 50

Correct Answer: B. Prevents alveolar collapse and improves oxygenation Rationale: PEEP helps recruit collapsed alveoli, which improves oxygen exchange and reduces hypoxemia.

Question 51

Why is prone positioning used in severe ARDS? A. Increases ICP B. Improves patient comfort C. Enhances oxygenation by improving ventilation-perfusion matching D. Makes suctioning easier

Answer 51

Correct Answer: C. Enhances oxygenation by improving ventilation-perfusion matching Rationale: Proning redistributes blood flow and opens up dorsal lung regions, improving gas exchange.

Question 52

Which of the following is a nursing priority during prone positioning? A. Increase IV fluids B. Apply cooling blankets C. Protect pressure points and secure airway D. Encourage food intake

Answer 52

Correct Answer: C. Protect pressure points and secure airway Rationale: Proning increases risk for pressure ulcers and airway dislodgment, so careful monitoring is essential.

Question 52

Which assessment tool is used to monitor sedation levels? A. GCS B. Richmond Agitation-Sedation Scale (RASS) C. NIH Stroke Scale D. Braden Scale

Answer 52

Correct Answer: B. Richmond Agitation-Sedation Scale (RASS) Rationale: RASS is commonly used to titrate sedation and assess agitation or unresponsiveness in ICU patients.

Question 53

What is the goal of sedation in mechanically ventilated ARDS patients? A. Keep the patient unresponsive B. Promote synchrony with the ventilator and reduce oxygen demand C. Reduce BP D. Decrease heart rate

Answer 53

Correct Answer: B. Promote synchrony with the ventilator and reduce oxygen demand Rationale: Sedation prevents agitation and improves ventilator compliance, reducing oxygen consumption.

Question 54

Which fluid management strategy is preferred in ARDS? A. Aggressive fluid resuscitation B. Conservative fluid management C. Unlimited oral fluids D. Hypotonic saline boluses

Answer 54

Correct Answer: B. Conservative fluid management Rationale: Limiting fluids prevents worsening pulmonary edema and maintains better oxygenation in ARDS.

Question 55

Why is early enteral nutrition preferred in ARDS patients? A. It improves renal perfusion B. It preserves gut integrity and reduces infection risk C. It promotes respiratory muscle fatigue D. It lowers oxygen demand

Answer 55

Correct Answer: B. It preserves gut integrity and reduces infection risk Rationale: Enteral feeding supports immune function and reduces translocation of bacteria from the gut.

Question 56

Which condition most commonly causes prerenal acute kidney injury? A. Hypovolemia from blood loss B. Acute tubular necrosis C. Ureteral obstruction D. Bladder infection

Answer 56

Correct Answer: A. Hypovolemia from blood loss Rationale: Prerenal AKI is caused by decreased perfusion to the kidneys, often due to dehydration or blood loss.

Question 57

Which of the following best describes postrenal AKI? A. Caused by glomerular inflammation B. Obstruction of urine flow, such as from BPH or kidney stones C. Results from nephrotoxic drugs D. Is triggered by sepsis

Answer 57

Correct Answer: B. Obstruction of urine flow, such as from BPH or kidney stones Rationale: Postrenal AKI results from any blockage that prevents urine outflow, leading to increased pressure and kidney damage.

Question 58

Which lab result is most indicative of worsening acute kidney injury? A. Elevated hemoglobin B. Rising serum creatinine and BUN C. Decreased white blood cell count D. Low sodium

Answer 58

Correct Answer: B. Rising serum creatinine and BUN Rationale: Creatinine and BUN are key markers of kidney function. Their elevation suggests impaired filtration.

Question 59

A patient has a GFR of 18 mL/min. What does this indicate? A. Normal kidney function B. Severe kidney impairment C. Early stage AKI D. Fluid overload

Answer 59

Correct Answer: B. Severe kidney impairment Rationale: A GFR below 60 mL/min suggests kidney disease; less than 30 is considered severe and may require dialysis.

Question 60

Which clinical finding is typical of the oliguric phase of AKI? A. Polyuria B. Urine output <400 mL/day C. Low BUN and creatinine D. Dehydration

Answer 60

Correct Answer: B. Urine output <400 mL/day Rationale: The oliguric phase is marked by reduced urine output and fluid retention due to impaired kidney filtration.

Question 61

What complication is most likely during the diuretic phase of AKI? A. Hyperkalemia B. Hypovolemia and electrolyte imbalances C. Anemia D. Respiratory depression

Answer 61

Correct Answer: B. Hypovolemia and electrolyte imbalances Rationale: As urine output increases rapidly, the patient can become dehydrated and lose vital electrolytes.

Question 62

When is continuous renal replacement therapy (CRRT) preferred over hemodialysis (HD)? A. In hemodynamically unstable patients B. In patients with hypotension and asthma C. For chronic outpatient dialysis D. In children only

Answer 62

Correct Answer: A. In hemodynamically unstable patients Rationale: CRRT is slower and gentler, making it ideal for ICU patients who can't tolerate rapid fluid shifts from HD.

Question 62

Which condition would indicate the need for urgent dialysis in AKI? A. Low BUN B. Hypokalemia C. Severe metabolic acidosis with hyperkalemia D. Increased hematocrit

Answer 62

Correct Answer: C. Severe metabolic acidosis with hyperkalemia Rationale: Life-threatening electrolyte imbalances and acid-base disturbances are classic indications for emergency dialysis.

Question 63

Which parameter is most important to monitor in a patient with AKI? A. Heart murmur B. Daily weights and urine output C. Reflexes D. Pupillary reaction

Answer 63

Correct Answer: B. Daily weights and urine output Rationale: These indicators help monitor fluid balance and kidney function in real time.

Question 64

What is a key nursing action to prevent further kidney damage in AKI? A. Encourage high-protein diet B. Administer nephrotoxic drugs C. Avoid NSAIDs and nephrotoxic agents D. Restrict all fluids completely

Answer 64

Correct Answer: C. Avoid NSAIDs and nephrotoxic agents Rationale: NSAIDs and some antibiotics can worsen kidney damage and should be avoided or used with caution.

Question 65

What is the underlying pathophysiologic cause of DKA? A. Overhydration B. Absolute insulin deficiency leading to fat breakdown and ketone production C. Excessive insulin use D. Hyperthyroidism

Answer 65

Correct Answer: B. Absolute insulin deficiency leading to fat breakdown and ketone production Rationale: Without insulin, glucose can’t be used, so the body breaks down fat for fuel, producing ketones and causing acidosis.

Question 66

Which of the following best describes the acid-base imbalance in DKA? A. Respiratory alkalosis B. Metabolic acidosis due to accumulation of ketone bodies C. Metabolic alkalosis D. Respiratory acidosis

Answer 66

Correct Answer: B. Metabolic acidosis due to accumulation of ketone bodies Rationale: DKA leads to an accumulation of acidic ketones, resulting in a decreased pH and bicarbonate.

Question 67

Which classic triad of symptoms is associated with diabetic ketoacidosis? A. Fatigue, bradycardia, seizures B. Polyuria, polydipsia, polyphagia C. Nausea, vomiting, fever D. Weakness, chills, chest pain

Answer 67

Correct Answer: B. Polyuria, polydipsia, polyphagia Rationale: These three "polys" are hallmark signs of hyperglycemia and dehydration in DKA.

Question 68

Which physical finding is often noted in a patient with DKA? A. Shallow breathing and cyanosis B. Hypertension and flushed skin C. Kussmaul respirations and fruity breath odor D. Dilated pupils and increased reflexes

Answer 68

Correct Answer: C. Kussmaul respirations and fruity breath odor Rationale: Deep, rapid breathing is the body’s attempt to compensate for metabolic acidosis; fruity breath comes from acetone.

Question 69

Which ABG result is most consistent with DKA? A. pH 7.42, HCO₃⁻ 24 B. pH 7.20, HCO₃⁻ 12 C. pH 7.52, HCO₃⁻ 30 D. pH 7.40, PaCO₂ 35

Answer 69

Correct Answer: B. pH 7.20, HCO₃⁻ 12 Rationale: A low pH and low bicarbonate reflect metabolic acidosis, typical in DKA.

Question 70

What is the expected respiratory compensation pattern in DKA? A. Apnea B. Hyperventilation (Kussmaul breathing) C. Hypoventilation D. Cheyne-Stokes respirations

Answer 70

Correct Answer: B. Hyperventilation (Kussmaul breathing) Rationale: The body tries to "blow off" CO₂ to compensate for the acidotic state, resulting in deep, rapid breaths.

Question 71

What is the first priority in treating a patient with DKA? A. Administer sodium bicarbonate B. Give insulin immediately C. Start IV fluids for volume resuscitation D. Administer oxygen

Answer 71

Correct Answer: C. Start IV fluids for volume resuscitation Rationale: Fluid replacement is crucial to restore perfusion and prevent shock before initiating insulin therapy.

Question 72

What is a nursing priority during insulin therapy for DKA? A. Monitor for hypothermia B. Monitor potassium levels closely C. Restrict fluids D. Increase dietary sugar intake

Answer 72

Correct Answer: B. Monitor potassium levels closely Rationale: Insulin drives potassium into cells, which can cause hypokalemia and lead to arrhythmias if not monitored.

Question 73

Which of the following situations can trigger a thyroid storm in a patient with hyperthyroidism? A. Starting beta blockers B. Infection or trauma C. Use of antithyroid medications D. Low iodine diet

Answer 73

Correct Answer: B. Infection or trauma Rationale: Acute stressors like infection, trauma, or surgery can precipitate thyroid storm by increasing thyroid hormone activity.

Question 74

What medication, if abruptly stopped, may trigger a thyroid storm? A. Acetaminophen B. Propylthiouracil (PTU) C. Metformin D. Furosemide

Answer 74

Correct Answer: B. Propylthiouracil (PTU) Rationale: Sudden discontinuation of antithyroid medications can cause a surge in thyroid hormone, leading to a crisis.

Question 75

Which of the following is a hallmark sign of thyroid storm? A. Bradycardia B. Constipation C. Hyperthermia and tachycardia D. Hypoglycemia

Answer 75

Correct Answer: C. Hyperthermia and tachycardia Rationale: Excess thyroid hormone causes increased metabolism, leading to dangerously high fever and heart rate.

Question 76

A nurse suspects thyroid storm in a patient with known hyperthyroidism. Which symptom would confirm this? A. Decreased deep tendon reflexes B. Agitation, confusion, and severe hypertension C. Cold intolerance D. Weight gain

Answer 76

Correct Answer: B. Agitation, confusion, and severe hypertension Rationale: CNS changes, high BP, and altered LOC are signs of severe thyrotoxicosis and CNS overstimulation.

Question 77

Which medication is used to block the effects of circulating thyroid hormone in thyroid storm? A. Methimazole B. Beta blockers like propranolol C. Digoxin D. Lisinopril

Answer 77

Correct Answer: B. Beta blockers like propranolol Rationale: Beta blockers help manage tachycardia, anxiety, and tremors by blocking the sympathetic effects of thyroid hormone.

Question 78

What is the role of iodine in managing thyroid storm? A. Stimulates T3 production B. Inhibits synthesis and release of thyroid hormones C. Lowers potassium D. Increases thyroid receptor sensitivity

Answer 78

Correct Answer: B. Inhibits synthesis and release of thyroid hormones Rationale: Iodine, when given after antithyroid drugs, reduces hormone release and is part of the acute treatment protocol.

Question 79

Which nursing intervention is a priority in thyroid storm management? A. Maintain a quiet, cool environment to reduce stimulation B. Administer a high-iodine diet C. Encourage ambulation D. Promote fluid restriction

Answer 79

Correct Answer: A. Maintain a quiet, cool environment to reduce stimulation Rationale: Excess stimulation can worsen symptoms; calm, controlled surroundings help reduce sympathetic activation.

Question 80

In addition to medication, what supportive care should the nurse provide for a patient in thyroid storm? A. High-sodium fluids B. Antipyretics and cooling measures for fever control C. Insulin to reduce hormone levels D. Encourage warm blankets

Answer 80

Correct Answer: B. Antipyretics and cooling measures for fever control Rationale: Fever in thyroid storm can become life-threatening; external cooling and antipyretics are essential for stabilizing temperature.

Question 81

Which of the following is a common trigger for myxedema coma in a patient with hypothyroidism? A. Excess thyroid hormone intake B. Cold exposure or infection C. High-protein diet D. Hyperglycemia

Answer 81

Correct Answer: B. Cold exposure or infection Rationale: Myxedema coma can be precipitated by stressors such as infection, surgery, cold, or sedative use in a hypothyroid patient.

Question 82

Which medication class should be avoided in patients with severe hypothyroidism to prevent triggering myxedema coma? A. Antihistamines B. Sedatives or opioids C. Beta blockers D. Diuretics

Answer 82

Correct Answer: B. Sedatives or opioids Rationale: These depress respiratory drive and can precipitate coma in patients with untreated or severe hypothyroidism.

Question 83

What is a hallmark clinical finding in a patient with myxedema coma? A. Hypertension and hyperactivity B. Hypothermia, bradycardia, and altered mental status C. Sweating and tremors D. Hyperventilation

Answer 83

Correct Answer: B. Hypothermia, bradycardia, and altered mental status Rationale: Myxedema coma presents as a life-threatening slowing of all systems, including low temperature, HR, and mental status.

Question 84

Which symptom would differentiate myxedema coma from general hypothyroidism? A. Fatigue and weight gain B. Cold intolerance C. Unresponsiveness and respiratory failure D. Dry skin and constipation

Answer 84

Correct Answer: C. Unresponsiveness and respiratory failure Rationale: Coma and hypoventilation are severe features that distinguish myxedema coma from typical hypothyroidism.

Question 85

What is the first-line treatment for myxedema coma? A. Oral levothyroxine B. IV thyroid hormone replacement (levothyroxine) C. Beta blockers D. High-dose corticosteroids only

Answer 85

Correct Answer: B. IV thyroid hormone replacement (levothyroxine) Rationale: IV levothyroxine is necessary due to poor GI absorption and urgency in correcting hormone deficiency.

Question 86

Which nursing intervention is most critical in the initial management of a patient with myxedema coma? A. Maintain airway and assist with ventilation B. Administer diuretics to remove excess fluid C. Promote early ambulation D. Initiate enteral nutrition immediately

Answer 86

Correct Answer: A. Maintain airway and assist with ventilation Rationale: Respiratory depression is common in myxedema coma, making airway protection and oxygenation top priorities.

Question 87

Which lab pattern is most consistent with primary hypothyroidism? A. ↓TSH, ↓T3, ↓T4 B. ↑TSH, ↓T3, ↓T4 C. ↑TSH, ↑T3, ↑T4 D. ↓TSH, ↑T3, ↑T4

Answer 87

Answer: B. ↑TSH, ↓T3, ↓T4 Rationale: In primary hypothyroidism, the thyroid fails to produce enough hormone, so the pituitary increases TSH to compensate.

Question 88

Which lab findings indicate overt hyperthyroidism? A. ↑TSH, ↓T4 B. ↓TSH, ↑T4 and/or ↑T3 C. Normal TSH, ↑T4 D. ↓TSH, ↓T4

Answer 88

Answer: B. ↓TSH, ↑T4 and/or ↑T3 Rationale: In hyperthyroidism, high circulating T3/T4 suppresses TSH through negative feedback.