NUR 355 Exam 3: Acute & Chronic Health Disruptions In
Adults I V3 - Arizona College Updated and Latest Questions
and Correct Answers with Rationale
1. A patient with chronic obstructive pulmonary disease (COPD) presents with a pH of 7.31, PaCO2 of 52
mmHg, and HCO3 of 26 mEq/L. Which acid-base imbalance does this indicate?
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Respiratory Alkalosis
D. Metabolic Alkalosis
Ans: A
Explanation: Arterial blood gas analysis is essential for identifying the underlying cause of respiratory
distress in patients with chronic lung disease. In this scenario, the pH level below 7.35 indicates an acidic
state within the bloodstream. The elevated PaCO2 confirms that the lungs are failing to effectively
eliminate carbon dioxide. Bicarbonate remains within normal limits, suggesting that renal compensation
has not yet fully occurred. This clinical profile is classic for respiratory acidosis frequently seen in acute
exacerbations of COPD.
2. When caring for a patient in Diabetic Ketoacidosis (DKA), which intravenous fluid should the nurse
anticipate administering first?
A. 0.45% Normal Saline
B. 5% Dextrose in Water
C. 0.9% Normal Saline
D. 3% Hypertonic Saline
,Ans: C
Explanation: The initial management of DKA focuses on restoring intravascular volume and correcting
dehydration caused by osmotic diuresis. An isotonic solution like 0.9% Normal Saline is the preferred
choice for rapid volume expansion. Stabilizing the patient’s blood pressure and ensuring adequate renal
perfusion are the immediate priorities before addressing electrolyte shifts. Once blood glucose levels
drop to a certain threshold, the nurse may switch to a dextrose-containing fluid to prevent hypoglycemia.
Continuous monitoring of intake and output is critical during this intensive rehydration phase.
3. A client is diagnosed with left-sided heart failure. Which assessment finding should the nurse prioritize as
a sign of pulmonary congestion?
A. Peripheral edema in the lower extremities
B. Hepatosplenomegaly
C. Jugular venous distention (JVD)
D. Crackles heard upon auscultation of the lungs
Ans: D
Explanation: Left-sided heart failure primarily affects the pulmonary system as the heart fails to pump
blood efficiently into systemic circulation. This results in a backup of fluid into the lungs, leading to
symptoms like dyspnea and orthopnea. Hearing crackles or rales during lung auscultation is a hallmark
sign of fluid accumulation in the alveoli. Other symptoms like peripheral edema and JVD are more
characteristic of right-sided heart failure. Nurses must assess lung sounds frequently to evaluate the
effectiveness of diuretic therapy.
4. A patient taking an ACE inhibitor for hypertension develops a dry, persistent cough. What is the most
likely physiological cause of this side effect?
A. Fluid overload causing pulmonary edema
, B. Direct irritation of the bronchial mucosa
C. Accumulation of bradykinin in the lungs
D. A secondary bacterial respiratory infection
Ans: C
Explanation: Angiotensin-converting enzyme (ACE) inhibitors are effective at lowering blood pressure
but are known for causing a dry cough. This phenomenon occurs because the medication inhibits the
breakdown of bradykinin, a potent inflammatory mediator. Increased levels of bradykinin in the
respiratory tract stimulate sensory nerves, triggering the cough reflex. While the cough is not harmful, it
often leads to patient non-compliance with the medication regimen. If the symptom becomes intolerable,
the healthcare provider may switch the patient to an Angiotensin II Receptor Blocker (ARB).
5. During an acute asthma attack, which medication should the nurse administer immediately to provide
rapid relief of bronchospasm?
A. Albuterol (short-acting beta-agonist)
B. Salmeterol (long-acting beta-agonist)
C. Fluticasone (inhaled corticosteroid)
D. Montelukast (leukotriene modifier)
E. none
Ans: A
Explanation: Albuterol serves as a rescue inhaler because it works quickly to relax the smooth muscles
surrounding the airways. During an acute exacerbation, the goal is to open the bronchioles immediately
to improve airflow and oxygenation. Long-acting agonists and corticosteroids are intended for
maintenance therapy and do not act fast enough for emergency use. The nurse must assess the patient’s
Adults I V3 - Arizona College Updated and Latest Questions
and Correct Answers with Rationale
1. A patient with chronic obstructive pulmonary disease (COPD) presents with a pH of 7.31, PaCO2 of 52
mmHg, and HCO3 of 26 mEq/L. Which acid-base imbalance does this indicate?
A. Respiratory Acidosis
B. Metabolic Acidosis
C. Respiratory Alkalosis
D. Metabolic Alkalosis
Ans: A
Explanation: Arterial blood gas analysis is essential for identifying the underlying cause of respiratory
distress in patients with chronic lung disease. In this scenario, the pH level below 7.35 indicates an acidic
state within the bloodstream. The elevated PaCO2 confirms that the lungs are failing to effectively
eliminate carbon dioxide. Bicarbonate remains within normal limits, suggesting that renal compensation
has not yet fully occurred. This clinical profile is classic for respiratory acidosis frequently seen in acute
exacerbations of COPD.
2. When caring for a patient in Diabetic Ketoacidosis (DKA), which intravenous fluid should the nurse
anticipate administering first?
A. 0.45% Normal Saline
B. 5% Dextrose in Water
C. 0.9% Normal Saline
D. 3% Hypertonic Saline
,Ans: C
Explanation: The initial management of DKA focuses on restoring intravascular volume and correcting
dehydration caused by osmotic diuresis. An isotonic solution like 0.9% Normal Saline is the preferred
choice for rapid volume expansion. Stabilizing the patient’s blood pressure and ensuring adequate renal
perfusion are the immediate priorities before addressing electrolyte shifts. Once blood glucose levels
drop to a certain threshold, the nurse may switch to a dextrose-containing fluid to prevent hypoglycemia.
Continuous monitoring of intake and output is critical during this intensive rehydration phase.
3. A client is diagnosed with left-sided heart failure. Which assessment finding should the nurse prioritize as
a sign of pulmonary congestion?
A. Peripheral edema in the lower extremities
B. Hepatosplenomegaly
C. Jugular venous distention (JVD)
D. Crackles heard upon auscultation of the lungs
Ans: D
Explanation: Left-sided heart failure primarily affects the pulmonary system as the heart fails to pump
blood efficiently into systemic circulation. This results in a backup of fluid into the lungs, leading to
symptoms like dyspnea and orthopnea. Hearing crackles or rales during lung auscultation is a hallmark
sign of fluid accumulation in the alveoli. Other symptoms like peripheral edema and JVD are more
characteristic of right-sided heart failure. Nurses must assess lung sounds frequently to evaluate the
effectiveness of diuretic therapy.
4. A patient taking an ACE inhibitor for hypertension develops a dry, persistent cough. What is the most
likely physiological cause of this side effect?
A. Fluid overload causing pulmonary edema
, B. Direct irritation of the bronchial mucosa
C. Accumulation of bradykinin in the lungs
D. A secondary bacterial respiratory infection
Ans: C
Explanation: Angiotensin-converting enzyme (ACE) inhibitors are effective at lowering blood pressure
but are known for causing a dry cough. This phenomenon occurs because the medication inhibits the
breakdown of bradykinin, a potent inflammatory mediator. Increased levels of bradykinin in the
respiratory tract stimulate sensory nerves, triggering the cough reflex. While the cough is not harmful, it
often leads to patient non-compliance with the medication regimen. If the symptom becomes intolerable,
the healthcare provider may switch the patient to an Angiotensin II Receptor Blocker (ARB).
5. During an acute asthma attack, which medication should the nurse administer immediately to provide
rapid relief of bronchospasm?
A. Albuterol (short-acting beta-agonist)
B. Salmeterol (long-acting beta-agonist)
C. Fluticasone (inhaled corticosteroid)
D. Montelukast (leukotriene modifier)
E. none
Ans: A
Explanation: Albuterol serves as a rescue inhaler because it works quickly to relax the smooth muscles
surrounding the airways. During an acute exacerbation, the goal is to open the bronchioles immediately
to improve airflow and oxygenation. Long-acting agonists and corticosteroids are intended for
maintenance therapy and do not act fast enough for emergency use. The nurse must assess the patient’s
