NUR 254 Exam 3 Practice Questions (Galen
College of Nursing) | High-Yield Med-Surg Review
with Answers & Rationales | Instant Pdf
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1. Hyperkalemia Emergency Prioritization
A 68-year-old patient with chronic kidney disease has a serum potassium level of 6.7 mEq/L and
is reporting muscle weakness and palpitations. Which nursing action should be performed first?
A. Administer sodium polystyrene sulfonate orally as prescribed
B. Place the patient on continuous cardiac monitoring immediately
C. Encourage the patient to consume foods high in potassium
D. Prepare the patient for discharge with dietary education
✔ Answer: B
Expert Rationale:
A potassium level above 6.5 mEq/L is a medical emergency because it can quickly lead to fatal
ventricular dysrhythmias and cardiac arrest. The first priority is cardiac monitoring to
detect ECG changes such as peaked T waves, widened QRS complexes, or sine-wave patterns.
Medication administration comes after stabilization and monitoring is initiated.
2. Left-Sided Heart Failure Manifestation
A patient diagnosed with chronic heart failure is admitted with increasing shortness of breath,
productive cough with frothy sputum, and crackles heard on lung auscultation. Which condition
does this most likely indicate?
A. Right-sided heart failure with systemic fluid overload
B. Acute left-sided heart failure with pulmonary congestion
C. Stable compensated heart failure without complications
D. Chronic renal failure causing fluid retention symptoms
✔ Answer: B
,Expert Rationale:
Left-sided heart failure leads to pulmonary congestion because the left ventricle cannot
effectively pump blood into systemic circulation. This causes fluid to back up into the lungs,
resulting in crackles, dyspnea, and frothy sputum. Right-sided heart failure primarily causes
peripheral edema and jugular venous distention, not pulmonary symptoms.
3. Hypoglycemia Immediate Intervention
A hospitalized diabetic patient suddenly becomes confused, sweaty, shaky, and irritable while
awaiting breakfast delivery. What is the nurse’s first appropriate action in this situation?
A. Administer prescribed rapid-acting insulin immediately
B. Check the patient’s blood glucose level without delay
C. Provide 15 grams of fast-acting oral carbohydrates immediately
D. Notify the healthcare provider before taking any action
✔ Answer: B
Expert Rationale:
Although symptoms strongly suggest hypoglycemia, the nurse must first confirm the blood
glucose level to ensure appropriate treatment. Acting without verification could worsen the
condition if the cause is not hypoglycemia. Once confirmed, fast-acting carbohydrates are
administered immediately if the patient is conscious and able to swallow.
4. Oxygen Delivery Device Selection
A patient in acute respiratory distress with severe hypoxemia requires the highest possible
oxygen concentration in an emergency situation. Which device should the nurse prepare to use?
A. Nasal cannula delivering low-flow oxygen therapy
B. Venturi mask providing controlled oxygen concentrations
C. Simple face mask with moderate oxygen delivery capacity
D. Non-rebreather mask with reservoir bag and high-flow oxygen
✔ Answer: D
Expert Rationale:
A non-rebreather mask delivers the highest oxygen concentration, typically up to 95%
, FiO₂, making it the preferred device for severe hypoxia or respiratory distress. It allows rapid
oxygen delivery in emergencies such as trauma, shock, or severe COPD exacerbation.
5. ABG Interpretation in Respiratory Disorders
A patient with a history of COPD presents with arterial blood gas results showing pH 7.31,
PaCO₂ 58 mmHg, and HCO₃ 28 mEq/L. What acid-base imbalance is most consistent with these
findings?
A. Metabolic alkalosis with compensation
B. Respiratory alkalosis due to hyperventilation
C. Respiratory acidosis with partial metabolic compensation
D. Metabolic acidosis without respiratory involvement
✔ Answer: C
Expert Rationale:
The low pH indicates acidosis, while elevated PaCO₂ confirms a respiratory origin due to
hypoventilation commonly seen in COPD. The elevated bicarbonate suggests the kidneys are
attempting to compensate, indicating partial metabolic compensation for chronic respiratory
acidosis.
6. Acute Kidney Injury Laboratory Concern
A postoperative patient is suspected of developing acute kidney injury. Which laboratory value
should the nurse recognize as the most concerning and indicative of worsening renal function?
A. Blood urea nitrogen (BUN) of 10 mg/dL
B. Serum creatinine level of 3.8 mg/dL
C. Potassium level of 4.2 mEq/L
D. Sodium level of 138 mEq/L
✔ Answer: B
Expert Rationale:
An elevated serum creatinine level indicates significant reduction in glomerular filtration rate
and worsening kidney function. Creatinine is a more specific indicator of renal impairment
than BUN. Normal electrolyte values do not indicate acute kidney injury severity.
College of Nursing) | High-Yield Med-Surg Review
with Answers & Rationales | Instant Pdf
Download
1. Hyperkalemia Emergency Prioritization
A 68-year-old patient with chronic kidney disease has a serum potassium level of 6.7 mEq/L and
is reporting muscle weakness and palpitations. Which nursing action should be performed first?
A. Administer sodium polystyrene sulfonate orally as prescribed
B. Place the patient on continuous cardiac monitoring immediately
C. Encourage the patient to consume foods high in potassium
D. Prepare the patient for discharge with dietary education
✔ Answer: B
Expert Rationale:
A potassium level above 6.5 mEq/L is a medical emergency because it can quickly lead to fatal
ventricular dysrhythmias and cardiac arrest. The first priority is cardiac monitoring to
detect ECG changes such as peaked T waves, widened QRS complexes, or sine-wave patterns.
Medication administration comes after stabilization and monitoring is initiated.
2. Left-Sided Heart Failure Manifestation
A patient diagnosed with chronic heart failure is admitted with increasing shortness of breath,
productive cough with frothy sputum, and crackles heard on lung auscultation. Which condition
does this most likely indicate?
A. Right-sided heart failure with systemic fluid overload
B. Acute left-sided heart failure with pulmonary congestion
C. Stable compensated heart failure without complications
D. Chronic renal failure causing fluid retention symptoms
✔ Answer: B
,Expert Rationale:
Left-sided heart failure leads to pulmonary congestion because the left ventricle cannot
effectively pump blood into systemic circulation. This causes fluid to back up into the lungs,
resulting in crackles, dyspnea, and frothy sputum. Right-sided heart failure primarily causes
peripheral edema and jugular venous distention, not pulmonary symptoms.
3. Hypoglycemia Immediate Intervention
A hospitalized diabetic patient suddenly becomes confused, sweaty, shaky, and irritable while
awaiting breakfast delivery. What is the nurse’s first appropriate action in this situation?
A. Administer prescribed rapid-acting insulin immediately
B. Check the patient’s blood glucose level without delay
C. Provide 15 grams of fast-acting oral carbohydrates immediately
D. Notify the healthcare provider before taking any action
✔ Answer: B
Expert Rationale:
Although symptoms strongly suggest hypoglycemia, the nurse must first confirm the blood
glucose level to ensure appropriate treatment. Acting without verification could worsen the
condition if the cause is not hypoglycemia. Once confirmed, fast-acting carbohydrates are
administered immediately if the patient is conscious and able to swallow.
4. Oxygen Delivery Device Selection
A patient in acute respiratory distress with severe hypoxemia requires the highest possible
oxygen concentration in an emergency situation. Which device should the nurse prepare to use?
A. Nasal cannula delivering low-flow oxygen therapy
B. Venturi mask providing controlled oxygen concentrations
C. Simple face mask with moderate oxygen delivery capacity
D. Non-rebreather mask with reservoir bag and high-flow oxygen
✔ Answer: D
Expert Rationale:
A non-rebreather mask delivers the highest oxygen concentration, typically up to 95%
, FiO₂, making it the preferred device for severe hypoxia or respiratory distress. It allows rapid
oxygen delivery in emergencies such as trauma, shock, or severe COPD exacerbation.
5. ABG Interpretation in Respiratory Disorders
A patient with a history of COPD presents with arterial blood gas results showing pH 7.31,
PaCO₂ 58 mmHg, and HCO₃ 28 mEq/L. What acid-base imbalance is most consistent with these
findings?
A. Metabolic alkalosis with compensation
B. Respiratory alkalosis due to hyperventilation
C. Respiratory acidosis with partial metabolic compensation
D. Metabolic acidosis without respiratory involvement
✔ Answer: C
Expert Rationale:
The low pH indicates acidosis, while elevated PaCO₂ confirms a respiratory origin due to
hypoventilation commonly seen in COPD. The elevated bicarbonate suggests the kidneys are
attempting to compensate, indicating partial metabolic compensation for chronic respiratory
acidosis.
6. Acute Kidney Injury Laboratory Concern
A postoperative patient is suspected of developing acute kidney injury. Which laboratory value
should the nurse recognize as the most concerning and indicative of worsening renal function?
A. Blood urea nitrogen (BUN) of 10 mg/dL
B. Serum creatinine level of 3.8 mg/dL
C. Potassium level of 4.2 mEq/L
D. Sodium level of 138 mEq/L
✔ Answer: B
Expert Rationale:
An elevated serum creatinine level indicates significant reduction in glomerular filtration rate
and worsening kidney function. Creatinine is a more specific indicator of renal impairment
than BUN. Normal electrolyte values do not indicate acute kidney injury severity.
