NUR 355 Final Exam: Acute & Chronic Health Disruptions
In Adults I V2 - Arizona College Updated and Latest
Questions and Correct Answers with Rationale
1. A patient with chronic kidney disease (CKD) presents with a potassium level of 6.2 mEq/L. Which EKG
finding should the nurse prioritize for reporting?
A. Prominent U waves
B. Tall, peaked T waves
C. Shortened PR interval
D. ST segment depression
Ans: B
Explanation: Hyperkalemia is a critical electrolyte imbalance that can lead to fatal cardiac arrhythmias
in patients with renal failure. Peaked T waves are the earliest electrocardiographic sign of elevated
potassium levels affecting myocardial repolarization. While other electrolyte imbalances cause U waves
or ST changes, peaked T waves specifically signal the need for immediate intervention. The nurse must
monitor for progression to a widened QRS complex or sinus arrest. Timely administration of calcium
gluconate or insulin can stabilize the cardiac membrane and lower potassium levels.
2. A patient is admitted with an acute exacerbation of COPD. Which oxygen delivery method is most
appropriate to prevent suppression of the hypoxic drive while maintaining oxygenation?
A. Non-rebreather mask at 15 L/min
B. Simple face mask at 10 L/min
C. Venturi mask at 24% to 28% FiO2
D. Nasal cannula at 6 L/min
,Ans: C
Explanation: The Venturi mask provides a precise concentration of oxygen, which is essential for
patients with chronic CO2 retention. In COPD, excessive oxygen can decrease the respiratory drive
because the body becomes dependent on low oxygen levels to stimulate breathing. A non-rebreather or
high-flow nasal cannula might provide too much oxygen, leading to respiratory depression. Using the
Venturi mask allows the clinician to titrate FiO2 accurately to reach the target saturation of 88-92%.
Constant monitoring of arterial blood gases is necessary to ensure the patient is not retaining additional
carbon dioxide.
3. Which clinical manifestation is a hallmark sign of Left-Sided Heart Failure?
A. Jugular venous distension (JVD)
B. Peripheral dependent edema
C. Hepatomegaly and ascites
D. Crackles in the lung bases
Ans: D
Explanation: Left-sided heart failure causes blood to back up into the pulmonary circulation, leading to
pulmonary congestion. Crackles or rales upon auscultation indicate fluid leaking into the alveoli due to
increased hydrostatic pressure. JVD and peripheral edema are classic signs of right-sided heart failure
where blood backs up into the systemic venous system. Assessing breath sounds is the priority for
detecting the progression of left-sided failure and potential pulmonary edema. Improving cardiac output
with diuretics and ACE inhibitors helps reduce these respiratory symptoms.
4. A nurse is caring for a patient with Type 1 Diabetes who is found unconscious and diaphoretic. What is
the priority nursing action?
A. Administer 15g of simple carbohydrates orally
, B. Check the patient’s blood glucose level
C. Administer glucagon 1 mg IM or SC
D. Call the healthcare provider immediately
Ans: C
Explanation: Severe hypoglycemia in an unconscious patient requires immediate administration of
glucagon or IV dextrose to raise blood sugar. Oral carbohydrates are contraindicated because an
unconscious patient cannot swallow safely and is at risk for aspiration. While checking blood glucose is
important, the clinical presentation of diaphoresis and unconsciousness warrants emergency treatment.
Glucagon works by stimulating the liver to release stored glucose into the bloodstream. Once the patient
regains consciousness, a snack with complex carbs and protein should be provided to maintain stability.
5. Which arterial blood gas (ABG) result reflects uncompensated metabolic acidosis?
A. pH 7.30, PaCO2 40, HCO3 18
B. pH 7.48, PaCO2 30, HCO3 22
C. pH 7.35, PaCO2 48, HCO3 28
D. pH 7.25, PaCO2 55, HCO3 24
Ans: A
Explanation: A pH below 7.35 indicates acidosis, and a low bicarbonate (HCO3) level suggests a
metabolic origin. In this case, the PaCO2 is within the normal range, meaning the lungs have not yet
started to compensate by blowing off CO2. Option D represents respiratory acidosis, while option B
represents respiratory alkalosis. Identifying the type of acid-base imbalance is critical for determining
the underlying cause, such as diabetic ketoacidosis or renal failure. Nursing care focuses on treating the
source of the metabolic disturbance while monitoring respiratory status.
In Adults I V2 - Arizona College Updated and Latest
Questions and Correct Answers with Rationale
1. A patient with chronic kidney disease (CKD) presents with a potassium level of 6.2 mEq/L. Which EKG
finding should the nurse prioritize for reporting?
A. Prominent U waves
B. Tall, peaked T waves
C. Shortened PR interval
D. ST segment depression
Ans: B
Explanation: Hyperkalemia is a critical electrolyte imbalance that can lead to fatal cardiac arrhythmias
in patients with renal failure. Peaked T waves are the earliest electrocardiographic sign of elevated
potassium levels affecting myocardial repolarization. While other electrolyte imbalances cause U waves
or ST changes, peaked T waves specifically signal the need for immediate intervention. The nurse must
monitor for progression to a widened QRS complex or sinus arrest. Timely administration of calcium
gluconate or insulin can stabilize the cardiac membrane and lower potassium levels.
2. A patient is admitted with an acute exacerbation of COPD. Which oxygen delivery method is most
appropriate to prevent suppression of the hypoxic drive while maintaining oxygenation?
A. Non-rebreather mask at 15 L/min
B. Simple face mask at 10 L/min
C. Venturi mask at 24% to 28% FiO2
D. Nasal cannula at 6 L/min
,Ans: C
Explanation: The Venturi mask provides a precise concentration of oxygen, which is essential for
patients with chronic CO2 retention. In COPD, excessive oxygen can decrease the respiratory drive
because the body becomes dependent on low oxygen levels to stimulate breathing. A non-rebreather or
high-flow nasal cannula might provide too much oxygen, leading to respiratory depression. Using the
Venturi mask allows the clinician to titrate FiO2 accurately to reach the target saturation of 88-92%.
Constant monitoring of arterial blood gases is necessary to ensure the patient is not retaining additional
carbon dioxide.
3. Which clinical manifestation is a hallmark sign of Left-Sided Heart Failure?
A. Jugular venous distension (JVD)
B. Peripheral dependent edema
C. Hepatomegaly and ascites
D. Crackles in the lung bases
Ans: D
Explanation: Left-sided heart failure causes blood to back up into the pulmonary circulation, leading to
pulmonary congestion. Crackles or rales upon auscultation indicate fluid leaking into the alveoli due to
increased hydrostatic pressure. JVD and peripheral edema are classic signs of right-sided heart failure
where blood backs up into the systemic venous system. Assessing breath sounds is the priority for
detecting the progression of left-sided failure and potential pulmonary edema. Improving cardiac output
with diuretics and ACE inhibitors helps reduce these respiratory symptoms.
4. A nurse is caring for a patient with Type 1 Diabetes who is found unconscious and diaphoretic. What is
the priority nursing action?
A. Administer 15g of simple carbohydrates orally
, B. Check the patient’s blood glucose level
C. Administer glucagon 1 mg IM or SC
D. Call the healthcare provider immediately
Ans: C
Explanation: Severe hypoglycemia in an unconscious patient requires immediate administration of
glucagon or IV dextrose to raise blood sugar. Oral carbohydrates are contraindicated because an
unconscious patient cannot swallow safely and is at risk for aspiration. While checking blood glucose is
important, the clinical presentation of diaphoresis and unconsciousness warrants emergency treatment.
Glucagon works by stimulating the liver to release stored glucose into the bloodstream. Once the patient
regains consciousness, a snack with complex carbs and protein should be provided to maintain stability.
5. Which arterial blood gas (ABG) result reflects uncompensated metabolic acidosis?
A. pH 7.30, PaCO2 40, HCO3 18
B. pH 7.48, PaCO2 30, HCO3 22
C. pH 7.35, PaCO2 48, HCO3 28
D. pH 7.25, PaCO2 55, HCO3 24
Ans: A
Explanation: A pH below 7.35 indicates acidosis, and a low bicarbonate (HCO3) level suggests a
metabolic origin. In this case, the PaCO2 is within the normal range, meaning the lungs have not yet
started to compensate by blowing off CO2. Option D represents respiratory acidosis, while option B
represents respiratory alkalosis. Identifying the type of acid-base imbalance is critical for determining
the underlying cause, such as diabetic ketoacidosis or renal failure. Nursing care focuses on treating the
source of the metabolic disturbance while monitoring respiratory status.
