, 1. A patient with heart failure presents with crackles in the lung bases,
jugular vein distention, and 3+ pitting edema. Which nursing diagnosis is
the priority?
• A) Impaired Gas Exchange
• B) Excess Fluid Volume
• Rationale: Crackles, JVD, and edema all indicate fluid overload. Excess Fluid
Volume is the priority because it directly contributes to impaired gas exchange.
2. A patient with COPD has an SpO2 of 88%. The nurse should first:
• A) Apply a non-rebreather mask at 15 L/min
• B) Administer oxygen via nasal cannula at 2 L/min
• *Rationale: COPD patients may rely on hypoxic drive. Start low (2 L/min) and
titrate to SpO2 88–92%.*
3. Which finding is most specific for acute pancreatitis?
• A) Elevated WBC
• B) Elevated serum lipase
• C) Elevated ALT
• D) Decreased calcium
• Rationale: Lipase is highly specific for pancreatitis; rises within 24 hours and
remains elevated longer than amylase.
4. After a thyroidectomy, the patient develops muscle twitching and a
positive Chvostek’s sign. The nurse anticipates:
• A) Hyperthyroidism
• B) Hypocalcemia
• C) Hypokalemia
• D) Hypernatremia
, • Rationale: Accidental parathyroid removal causes hypocalcemia →
neuromuscular irritability (Chvostek’s, Trousseau’s).
5. A patient with DKA has a glucose of 680 mg/dL, pH 7.10, and potassium
of 5.2 mEq/L (hemolyzed). Which action is priority?
• A) Start IV 0.9% normal saline
• B) Administer IV potassium
• C) Give sodium bicarbonate
• D) Start insulin bolus
• Rationale: Volume resuscitation with NS is first. Insulin without fluids can
worsen shock. Recheck potassium before giving.
6. Which ECG finding is consistent with hypokalemia?
• A) Tall peaked T waves
• B) U waves and flat T waves
• C) Widened QRS
• D) ST elevation
• Rationale: Hypokalemia causes U waves and flat T waves. Tall T waves suggest
hyperkalemia.
7. A patient on warfarin has an INR of 4.5 and minor gum bleeding. The
nurse should:
• A) Administer vitamin K IM
• B) Hold warfarin and notify provider
• C) Give fresh frozen plasma
• D) Continue warfarin as ordered
• Rationale: INR 4.5 with minor bleeding – hold warfarin. Vitamin K or FFP for
major bleeding or INR >10.
jugular vein distention, and 3+ pitting edema. Which nursing diagnosis is
the priority?
• A) Impaired Gas Exchange
• B) Excess Fluid Volume
• Rationale: Crackles, JVD, and edema all indicate fluid overload. Excess Fluid
Volume is the priority because it directly contributes to impaired gas exchange.
2. A patient with COPD has an SpO2 of 88%. The nurse should first:
• A) Apply a non-rebreather mask at 15 L/min
• B) Administer oxygen via nasal cannula at 2 L/min
• *Rationale: COPD patients may rely on hypoxic drive. Start low (2 L/min) and
titrate to SpO2 88–92%.*
3. Which finding is most specific for acute pancreatitis?
• A) Elevated WBC
• B) Elevated serum lipase
• C) Elevated ALT
• D) Decreased calcium
• Rationale: Lipase is highly specific for pancreatitis; rises within 24 hours and
remains elevated longer than amylase.
4. After a thyroidectomy, the patient develops muscle twitching and a
positive Chvostek’s sign. The nurse anticipates:
• A) Hyperthyroidism
• B) Hypocalcemia
• C) Hypokalemia
• D) Hypernatremia
, • Rationale: Accidental parathyroid removal causes hypocalcemia →
neuromuscular irritability (Chvostek’s, Trousseau’s).
5. A patient with DKA has a glucose of 680 mg/dL, pH 7.10, and potassium
of 5.2 mEq/L (hemolyzed). Which action is priority?
• A) Start IV 0.9% normal saline
• B) Administer IV potassium
• C) Give sodium bicarbonate
• D) Start insulin bolus
• Rationale: Volume resuscitation with NS is first. Insulin without fluids can
worsen shock. Recheck potassium before giving.
6. Which ECG finding is consistent with hypokalemia?
• A) Tall peaked T waves
• B) U waves and flat T waves
• C) Widened QRS
• D) ST elevation
• Rationale: Hypokalemia causes U waves and flat T waves. Tall T waves suggest
hyperkalemia.
7. A patient on warfarin has an INR of 4.5 and minor gum bleeding. The
nurse should:
• A) Administer vitamin K IM
• B) Hold warfarin and notify provider
• C) Give fresh frozen plasma
• D) Continue warfarin as ordered
• Rationale: INR 4.5 with minor bleeding – hold warfarin. Vitamin K or FFP for
major bleeding or INR >10.
