NSG 3850 Exam 2 Review 2026 Update –
Complete Solutions & Rationales
Final Study Tips for NSG 3850 Exam 2:
1. Fluid & Electrolytes: Know normal ranges, signs of imbalance, and ECG changes
(peaked T waves = hyperkalemia, flattened T waves/U waves = hypokalemia).
2. Oxygenation: Master ABG interpretation, oxygen delivery devices (non-rebreather,
Venturi, nasal cannula), and chest tube management.
3. Cardiovascular: Know signs of right vs. left heart failure, DVT/PE, hypertension
management, and anticoagulation monitoring (aPTT for heparin, INR for warfarin).
4. Neurological: Understand stroke assessment (FAST), seizure precautions, Parkinson's
disease, multiple sclerosis, and increased ICP signs (Cushing's triad).
5. Gastrointestinal: Know NG tube placement verification (pH <5), ostomy care (stoma
should be red/moist), and dietary restrictions (low-fiber for diverticulitis, low-protein for
liver disease).
6. Endocrine: Master insulin types (onset, peak, duration), DKA vs. HHS, and diabetes sick
day rules.
7. Renal: Understand CKD stages, dialysis complications, and electrolyte management
(potassium, phosphorus).
8. Perioperative: Know DVT prophylaxis, PCA pump safety, incentive spirometry, and signs
of infection.
9. Pain & End-of-Life: Understand pain assessment (PQRST, FLACC), PCA safety,
morphine use in palliative care, and advance directives.
10. Safety: Apply RACE for fire, PASS for extinguisher, fall precautions, and seizure
precautions.
Good luck on your NSG 3850 Exam 2!
Section 1: Fluid & Electrolyte Balance (Questions 1–30)
1. A patient with heart failure is prescribed furosemide (Lasix). Which
electrolyte imbalance is the patient at highest risk for developing?
,A) Hyperkalemia
B) Hypokalemia
C) Hyponatremia
D) Hypercalcemia
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting in the
distal tubule. Hypokalemia (low potassium) increases the risk of cardiac
arrhythmias, especially in patients taking digoxin.
2. A patient's serum potassium level is 6.2 mEq/L (normal 3.5-5.0). Which
ECG change would the nurse expect to see?
A) Flattened T waves
B) Prominent U waves
C) Peaked T waves
D) Prolonged QT interval
Answer: C
Rationale: Hyperkalemia causes peaked (tented) T waves, widened QRS, and
prolonged PR interval. Hypokalemia causes flattened T waves and prominent
U waves.
3. A patient with chronic kidney disease has a serum potassium of 6.5
mEq/L. Which intervention should the nurse implement first?
A) Administer oral potassium supplements
B) Prepare for hemodialysis
C) Administer IV calcium gluconate as ordered
D) Encourage potassium-rich foods
Answer: C
Rationale: IV calcium gluconate stabilizes the cardiac membrane and is given
first in severe hyperkalemia to prevent cardiac arrhythmias. Insulin/glucose,
albuterol, and kayexalate may follow.
,4. A patient's serum sodium level is 125 mEq/L (normal 135-145). The patient
is confused and has a history of heart failure. Which intervention is most
appropriate?
A) Administer hypertonic saline as ordered
B) Restrict fluid intake as ordered
C) Encourage increased oral fluids
D) Administer sodium tablets
Answer: B
*Rationale: In heart failure, hyponatremia is often dilutional (excess water
relative to sodium). Fluid restriction (e.g., 1-1.5 L/day) is first-line treatment.
Hypertonic saline is rarely used.*
5. A patient with diabetic ketoacidosis (DKA) has an arterial blood gas (ABG)
result of pH 7.25, PaCO2 30, HCO3 14. This indicates:
A) Respiratory acidosis
B) Metabolic acidosis
C) Respiratory alkalosis
D) Metabolic alkalosis
Answer: B
Rationale: DKA causes metabolic acidosis (low pH, low HCO3). The low
PaCO2 indicates compensatory respiratory alkalosis (hyperventilation). The
primary disorder is metabolic acidosis.
6. A patient with COPD has an ABG result of pH 7.35, PaCO2 65, HCO3 36.
This indicates:
A) Acute respiratory acidosis
B) Chronic compensated respiratory acidosis
C) Metabolic alkalosis
D) Respiratory alkalosis
, Answer: B
*Rationale: Chronic respiratory acidosis (elevated PaCO2) with metabolic
compensation (elevated HCO3) and near-normal pH indicates chronic
compensated respiratory acidosis, expected in advanced COPD.*
7. A patient has a serum calcium level of 7.5 mg/dL (normal 8.5-10.2). Which
finding would the nurse expect?
A) Positive Chvostek's sign
B) Decreased deep tendon reflexes
C) Hypertension
D) Constipation
Answer: A
Rationale: Hypocalcemia causes neuromuscular irritability, including
positive Chvostek's sign (facial twitching with tap over facial nerve) and
Trousseau's sign (carpal spasm with BP cuff inflation).
8. The nurse is monitoring a patient receiving IV fluids after surgery. Which
finding indicates possible fluid overload?
A) Decreased blood pressure
B) Crackles in the lung bases
C) Increased urine specific gravity
D) Dry mucous membranes
Answer: B
Rationale: Crackles (rales) in the lung bases indicate pulmonary congestion
from fluid overload. Other signs include hypertension, distended neck veins,
peripheral edema, and weight gain.
9. A patient has a serum magnesium level of 1.2 mg/dL (normal 1.7-2.2).
Which finding would the nurse expect?
Complete Solutions & Rationales
Final Study Tips for NSG 3850 Exam 2:
1. Fluid & Electrolytes: Know normal ranges, signs of imbalance, and ECG changes
(peaked T waves = hyperkalemia, flattened T waves/U waves = hypokalemia).
2. Oxygenation: Master ABG interpretation, oxygen delivery devices (non-rebreather,
Venturi, nasal cannula), and chest tube management.
3. Cardiovascular: Know signs of right vs. left heart failure, DVT/PE, hypertension
management, and anticoagulation monitoring (aPTT for heparin, INR for warfarin).
4. Neurological: Understand stroke assessment (FAST), seizure precautions, Parkinson's
disease, multiple sclerosis, and increased ICP signs (Cushing's triad).
5. Gastrointestinal: Know NG tube placement verification (pH <5), ostomy care (stoma
should be red/moist), and dietary restrictions (low-fiber for diverticulitis, low-protein for
liver disease).
6. Endocrine: Master insulin types (onset, peak, duration), DKA vs. HHS, and diabetes sick
day rules.
7. Renal: Understand CKD stages, dialysis complications, and electrolyte management
(potassium, phosphorus).
8. Perioperative: Know DVT prophylaxis, PCA pump safety, incentive spirometry, and signs
of infection.
9. Pain & End-of-Life: Understand pain assessment (PQRST, FLACC), PCA safety,
morphine use in palliative care, and advance directives.
10. Safety: Apply RACE for fire, PASS for extinguisher, fall precautions, and seizure
precautions.
Good luck on your NSG 3850 Exam 2!
Section 1: Fluid & Electrolyte Balance (Questions 1–30)
1. A patient with heart failure is prescribed furosemide (Lasix). Which
electrolyte imbalance is the patient at highest risk for developing?
,A) Hyperkalemia
B) Hypokalemia
C) Hyponatremia
D) Hypercalcemia
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting in the
distal tubule. Hypokalemia (low potassium) increases the risk of cardiac
arrhythmias, especially in patients taking digoxin.
2. A patient's serum potassium level is 6.2 mEq/L (normal 3.5-5.0). Which
ECG change would the nurse expect to see?
A) Flattened T waves
B) Prominent U waves
C) Peaked T waves
D) Prolonged QT interval
Answer: C
Rationale: Hyperkalemia causes peaked (tented) T waves, widened QRS, and
prolonged PR interval. Hypokalemia causes flattened T waves and prominent
U waves.
3. A patient with chronic kidney disease has a serum potassium of 6.5
mEq/L. Which intervention should the nurse implement first?
A) Administer oral potassium supplements
B) Prepare for hemodialysis
C) Administer IV calcium gluconate as ordered
D) Encourage potassium-rich foods
Answer: C
Rationale: IV calcium gluconate stabilizes the cardiac membrane and is given
first in severe hyperkalemia to prevent cardiac arrhythmias. Insulin/glucose,
albuterol, and kayexalate may follow.
,4. A patient's serum sodium level is 125 mEq/L (normal 135-145). The patient
is confused and has a history of heart failure. Which intervention is most
appropriate?
A) Administer hypertonic saline as ordered
B) Restrict fluid intake as ordered
C) Encourage increased oral fluids
D) Administer sodium tablets
Answer: B
*Rationale: In heart failure, hyponatremia is often dilutional (excess water
relative to sodium). Fluid restriction (e.g., 1-1.5 L/day) is first-line treatment.
Hypertonic saline is rarely used.*
5. A patient with diabetic ketoacidosis (DKA) has an arterial blood gas (ABG)
result of pH 7.25, PaCO2 30, HCO3 14. This indicates:
A) Respiratory acidosis
B) Metabolic acidosis
C) Respiratory alkalosis
D) Metabolic alkalosis
Answer: B
Rationale: DKA causes metabolic acidosis (low pH, low HCO3). The low
PaCO2 indicates compensatory respiratory alkalosis (hyperventilation). The
primary disorder is metabolic acidosis.
6. A patient with COPD has an ABG result of pH 7.35, PaCO2 65, HCO3 36.
This indicates:
A) Acute respiratory acidosis
B) Chronic compensated respiratory acidosis
C) Metabolic alkalosis
D) Respiratory alkalosis
, Answer: B
*Rationale: Chronic respiratory acidosis (elevated PaCO2) with metabolic
compensation (elevated HCO3) and near-normal pH indicates chronic
compensated respiratory acidosis, expected in advanced COPD.*
7. A patient has a serum calcium level of 7.5 mg/dL (normal 8.5-10.2). Which
finding would the nurse expect?
A) Positive Chvostek's sign
B) Decreased deep tendon reflexes
C) Hypertension
D) Constipation
Answer: A
Rationale: Hypocalcemia causes neuromuscular irritability, including
positive Chvostek's sign (facial twitching with tap over facial nerve) and
Trousseau's sign (carpal spasm with BP cuff inflation).
8. The nurse is monitoring a patient receiving IV fluids after surgery. Which
finding indicates possible fluid overload?
A) Decreased blood pressure
B) Crackles in the lung bases
C) Increased urine specific gravity
D) Dry mucous membranes
Answer: B
Rationale: Crackles (rales) in the lung bases indicate pulmonary congestion
from fluid overload. Other signs include hypertension, distended neck veins,
peripheral edema, and weight gain.
9. A patient has a serum magnesium level of 1.2 mg/dL (normal 1.7-2.2).
Which finding would the nurse expect?
