NURS 201 Medical-Surgical Nursing Exam 3 Comprehensive Study
Guide 2026 |WCU
1. A patient with chronic kidney disease (CKD) has a serum potassium level of
6.8 mEq/L. Which of the following orders should the nurse implement first?
A. Administer intravenous calcium gluconate
B. Administer oral sodium polystyrene sulfonate (Kayexalate)
C. Prepare the patient for urgent hemodialysis
D. Check the patient’s heart rate and rhythm
Answer: A
Rationale: In severe hyperkalemia, intravenous calcium gluconate is administered first to
stabilize the myocardial cell membrane and prevent life-threatening arrhythmias, even
though it doesn’t lower the potassium itself.
2. Which clinical manifestation is a hallmark sign of the ‘diuretic phase’ of acute
kidney injury (AKI)?
A. Serum creatinine and BUN levels continue to rise sharply
B. Metabolic acidosis and hypervolemia
C. Daily urine output of 1 to 3 liters, potentially up to 5 liters
D. Sudden onset of anuria and flank pain
Answer: C
Rationale: The diuretic phase of AKI is characterized by high urine output (1-5L/day)
because the kidneys can excrete waste but cannot yet concentrate urine, leading to
potential dehydration and electrolyte loss.
,3. A patient presents with arterial blood gas (ABG) results: pH 7.28, PaCO2 55
mmHg, and HCO3- 26 mEq/L. How should the nurse interpret these results?
A. Respiratory alkalosis, fully compensated
B. Metabolic acidosis, partially compensated
C. Respiratory acidosis, uncompensated
D. Metabolic alkalosis, uncompensated
Answer: C
Rationale: The pH is low (<7.35), indicating acidosis. The PaCO2 is high (>45 mmHg),
matching the acidic pH, indicating a respiratory cause. The HCO3- is normal (22-26),
meaning no compensation has occurred yet.
4. When caring for a patient with liver cirrhosis and ascites, which assessment
finding is most critical to report to the healthcare provider?
A. Presence of spider angiomas on the chest
B. An abdominal girth increase of 1 cm since yesterday
C. Weight gain of 2 pounds in 24 hours
D. New onset of confusion and flapping hand tremors (asterixis)
Answer: D
Rationale: Confusion and asterixis are signs of hepatic encephalopathy due to ammonia
buildup, a serious complication of cirrhosis requiring immediate intervention like lactulose
administration.
5. A nurse is preparing to administer a blood transfusion. Which action is the
priority to ensure patient safety?
A. Using a 22-gauge peripheral IV catheter for rapid infusion
B. Warming the blood to room temperature for 1 hour before hanging
C. Verifying the patient’s identity and blood product with another RN
D. Infusing the blood over 6 hours to prevent fluid overload
Answer: C
, Rationale: Proper identification of the patient and the blood product by two qualified
professionals is the most critical step to prevent hemolytic transfusion reactions. Blood
should not be out of refrigeration for more than 4 hours.
6. Which laboratory value is most indicative of acute pancreatitis?
A. Decreased serum calcium
B. Elevated serum albumin
C. Decreased white blood cell count
D. Elevated serum amylase and lipase
Answer: D
Rationale: Amylase and lipase are digestive enzymes released into the bloodstream when
the pancreas is inflamed. Lipase is more specific to the pancreas and stays elevated longer
than amylase.
7. A patient with a suspected deep vein thrombosis (DVT) is prescribed heparin.
Which lab test should the nurse monitor to evaluate the effectiveness of the
therapy?
A. Prothrombin Time (PT)
B. International Normalized Ratio (INR)
C. Activated Partial Thromboplastin Time (aPTT)
D. Platelet count
Answer: C
Rationale: aPTT is used to monitor the therapeutic effect of unfractionated heparin. PT
and INR are used to monitor warfarin (Coumadin).
Guide 2026 |WCU
1. A patient with chronic kidney disease (CKD) has a serum potassium level of
6.8 mEq/L. Which of the following orders should the nurse implement first?
A. Administer intravenous calcium gluconate
B. Administer oral sodium polystyrene sulfonate (Kayexalate)
C. Prepare the patient for urgent hemodialysis
D. Check the patient’s heart rate and rhythm
Answer: A
Rationale: In severe hyperkalemia, intravenous calcium gluconate is administered first to
stabilize the myocardial cell membrane and prevent life-threatening arrhythmias, even
though it doesn’t lower the potassium itself.
2. Which clinical manifestation is a hallmark sign of the ‘diuretic phase’ of acute
kidney injury (AKI)?
A. Serum creatinine and BUN levels continue to rise sharply
B. Metabolic acidosis and hypervolemia
C. Daily urine output of 1 to 3 liters, potentially up to 5 liters
D. Sudden onset of anuria and flank pain
Answer: C
Rationale: The diuretic phase of AKI is characterized by high urine output (1-5L/day)
because the kidneys can excrete waste but cannot yet concentrate urine, leading to
potential dehydration and electrolyte loss.
,3. A patient presents with arterial blood gas (ABG) results: pH 7.28, PaCO2 55
mmHg, and HCO3- 26 mEq/L. How should the nurse interpret these results?
A. Respiratory alkalosis, fully compensated
B. Metabolic acidosis, partially compensated
C. Respiratory acidosis, uncompensated
D. Metabolic alkalosis, uncompensated
Answer: C
Rationale: The pH is low (<7.35), indicating acidosis. The PaCO2 is high (>45 mmHg),
matching the acidic pH, indicating a respiratory cause. The HCO3- is normal (22-26),
meaning no compensation has occurred yet.
4. When caring for a patient with liver cirrhosis and ascites, which assessment
finding is most critical to report to the healthcare provider?
A. Presence of spider angiomas on the chest
B. An abdominal girth increase of 1 cm since yesterday
C. Weight gain of 2 pounds in 24 hours
D. New onset of confusion and flapping hand tremors (asterixis)
Answer: D
Rationale: Confusion and asterixis are signs of hepatic encephalopathy due to ammonia
buildup, a serious complication of cirrhosis requiring immediate intervention like lactulose
administration.
5. A nurse is preparing to administer a blood transfusion. Which action is the
priority to ensure patient safety?
A. Using a 22-gauge peripheral IV catheter for rapid infusion
B. Warming the blood to room temperature for 1 hour before hanging
C. Verifying the patient’s identity and blood product with another RN
D. Infusing the blood over 6 hours to prevent fluid overload
Answer: C
, Rationale: Proper identification of the patient and the blood product by two qualified
professionals is the most critical step to prevent hemolytic transfusion reactions. Blood
should not be out of refrigeration for more than 4 hours.
6. Which laboratory value is most indicative of acute pancreatitis?
A. Decreased serum calcium
B. Elevated serum albumin
C. Decreased white blood cell count
D. Elevated serum amylase and lipase
Answer: D
Rationale: Amylase and lipase are digestive enzymes released into the bloodstream when
the pancreas is inflamed. Lipase is more specific to the pancreas and stays elevated longer
than amylase.
7. A patient with a suspected deep vein thrombosis (DVT) is prescribed heparin.
Which lab test should the nurse monitor to evaluate the effectiveness of the
therapy?
A. Prothrombin Time (PT)
B. International Normalized Ratio (INR)
C. Activated Partial Thromboplastin Time (aPTT)
D. Platelet count
Answer: C
Rationale: aPTT is used to monitor the therapeutic effect of unfractionated heparin. PT
and INR are used to monitor warfarin (Coumadin).
