NSG 3250 Exam 2 | ACTUAL QUESTIONS AND
ANSWERS | WITH VERIFIED RATIONALES | 2026/27 |
DIGITAL DOWNLOAD PDF
1. A patient has a serum sodium level of 118 mEq/L. Which assessment finding
is most critical to report immediately?
a) Dry mucous membranes
b) Weak peripheral pulses
c) Change in level of consciousness
d) 2+ pitting edema in lower extremities
Rationale: Severe hyponatremia (↓Na) causes cerebral edema and neurological
changes such as confusion, seizures, or coma. LOC change is a medical
emergency.
2. A patient with heart failure has daily weights. Which finding indicates
worsening fluid volume excess?
a) Weight gain of 1 kg over 2 days
b) Weight gain of 2 kg in 24 hours
c) Weight loss of 0.5 kg overnight
d) Stable weight for 3 days
Rationale: Rapid weight gain (1–2 kg in 24 hours) reflects significant fluid retention in
heart failure. A 2 kg gain in 24 hours is a sign of decompensation.
3. Which intravenous fluid is isotonic and used to expand intravascular
volume?
a) 0.45% sodium chloride
b) 0.9% sodium chloride
c) 3% sodium chloride
d) 5% dextrose in water (D5W) after infusion
,Rationale: 0.9% NaCl (normal saline) remains isotonic and expands ECF without
shifting fluid between compartments. D5W becomes hypotonic after glucose
metabolism.
4. A patient’s ABG results: pH 7.31, PaCO₂ 49 mm Hg, HCO₃ 24 mEq/L. What is
the primary acid-base disorder?
a) Respiratory acidosis
b) Metabolic acidosis
c) Respiratory alkalosis
d) Metabolic alkalosis
Rationale: pH ↓ (acidosis) + PaCO₂ ↑ (respiratory cause). HCO₃ normal → no
metabolic compensation yet = acute respiratory acidosis.
5. The nurse is administering a blood transfusion. Which sign indicates a
possible hemolytic reaction?
a) Urticaria and itching
b) Temperature 100.2°F (37.9°C)
c) Low back pain and dark urine
d) Tachycardia that resolves with slowing the infusion
Rationale: Hemolytic reaction (ABO incompatibility) causes intravascular hemolysis
→ low back pain, hemoglobinuria (dark urine), hypotension, and fever.
6. A patient on total parenteral nutrition (TPN) has a blood glucose level of 320
mg/dL. What is the priority action?
a) Stop the TPN immediately
b) Check the infusion rate and notify the provider
c) Add insulin to the TPN bag at the bedside
d) Decrease TPN rate by half
Rationale: Hyperglycemia from TPN is common; do NOT abruptly stop TPN (risk
hypoglycemia). Adjust rate or add insulin per protocol and notify provider.
7. Which electrolyte imbalance is most concerning in a patient receiving
furosemide?
, a) Hypernatremia
b) Hypokalemia
c) Hypercalcemia
d) Hypermagnesemia
Rationale: Loop diuretics cause renal potassium wasting. Hypokalemia increases
arrhythmia risk, especially in cardiac patients.
8. A postoperative patient’s wound has separated edges with visible bowel
loops. What is the nurse’s priority action?
a) Push the bowel back gently
b) Place the patient in high Fowler’s position
c) Cover with sterile moist saline gauze
d) Irrigate with hydrogen peroxide
Rationale: This is wound dehiscence with evisceration. Cover with sterile saline-
moistened dressing to keep tissue moist, then notify surgeon. NEVER reinsert
organs.
9. Which laboratory finding indicates a need to hold digoxin?
a) Sodium 135 mEq/L
b) Potassium 3.1 mEq/L
c) Calcium 9.2 mg/dL
d) Magnesium 2.0 mg/dL
*Rationale: Hypokalemia increases digoxin toxicity risk, leading to dysrhythmias.
Hold dose and notify provider if K⁺ < 3.5 mEq/L.*
10. A patient with metabolic alkalosis is likely to exhibit which compensatory
breathing pattern?
a) Kussmaul respirations
b) Hypoventilation
c) Tachypnea
d) Cheyne-Stokes
ANSWERS | WITH VERIFIED RATIONALES | 2026/27 |
DIGITAL DOWNLOAD PDF
1. A patient has a serum sodium level of 118 mEq/L. Which assessment finding
is most critical to report immediately?
a) Dry mucous membranes
b) Weak peripheral pulses
c) Change in level of consciousness
d) 2+ pitting edema in lower extremities
Rationale: Severe hyponatremia (↓Na) causes cerebral edema and neurological
changes such as confusion, seizures, or coma. LOC change is a medical
emergency.
2. A patient with heart failure has daily weights. Which finding indicates
worsening fluid volume excess?
a) Weight gain of 1 kg over 2 days
b) Weight gain of 2 kg in 24 hours
c) Weight loss of 0.5 kg overnight
d) Stable weight for 3 days
Rationale: Rapid weight gain (1–2 kg in 24 hours) reflects significant fluid retention in
heart failure. A 2 kg gain in 24 hours is a sign of decompensation.
3. Which intravenous fluid is isotonic and used to expand intravascular
volume?
a) 0.45% sodium chloride
b) 0.9% sodium chloride
c) 3% sodium chloride
d) 5% dextrose in water (D5W) after infusion
,Rationale: 0.9% NaCl (normal saline) remains isotonic and expands ECF without
shifting fluid between compartments. D5W becomes hypotonic after glucose
metabolism.
4. A patient’s ABG results: pH 7.31, PaCO₂ 49 mm Hg, HCO₃ 24 mEq/L. What is
the primary acid-base disorder?
a) Respiratory acidosis
b) Metabolic acidosis
c) Respiratory alkalosis
d) Metabolic alkalosis
Rationale: pH ↓ (acidosis) + PaCO₂ ↑ (respiratory cause). HCO₃ normal → no
metabolic compensation yet = acute respiratory acidosis.
5. The nurse is administering a blood transfusion. Which sign indicates a
possible hemolytic reaction?
a) Urticaria and itching
b) Temperature 100.2°F (37.9°C)
c) Low back pain and dark urine
d) Tachycardia that resolves with slowing the infusion
Rationale: Hemolytic reaction (ABO incompatibility) causes intravascular hemolysis
→ low back pain, hemoglobinuria (dark urine), hypotension, and fever.
6. A patient on total parenteral nutrition (TPN) has a blood glucose level of 320
mg/dL. What is the priority action?
a) Stop the TPN immediately
b) Check the infusion rate and notify the provider
c) Add insulin to the TPN bag at the bedside
d) Decrease TPN rate by half
Rationale: Hyperglycemia from TPN is common; do NOT abruptly stop TPN (risk
hypoglycemia). Adjust rate or add insulin per protocol and notify provider.
7. Which electrolyte imbalance is most concerning in a patient receiving
furosemide?
, a) Hypernatremia
b) Hypokalemia
c) Hypercalcemia
d) Hypermagnesemia
Rationale: Loop diuretics cause renal potassium wasting. Hypokalemia increases
arrhythmia risk, especially in cardiac patients.
8. A postoperative patient’s wound has separated edges with visible bowel
loops. What is the nurse’s priority action?
a) Push the bowel back gently
b) Place the patient in high Fowler’s position
c) Cover with sterile moist saline gauze
d) Irrigate with hydrogen peroxide
Rationale: This is wound dehiscence with evisceration. Cover with sterile saline-
moistened dressing to keep tissue moist, then notify surgeon. NEVER reinsert
organs.
9. Which laboratory finding indicates a need to hold digoxin?
a) Sodium 135 mEq/L
b) Potassium 3.1 mEq/L
c) Calcium 9.2 mg/dL
d) Magnesium 2.0 mg/dL
*Rationale: Hypokalemia increases digoxin toxicity risk, leading to dysrhythmias.
Hold dose and notify provider if K⁺ < 3.5 mEq/L.*
10. A patient with metabolic alkalosis is likely to exhibit which compensatory
breathing pattern?
a) Kussmaul respirations
b) Hypoventilation
c) Tachypnea
d) Cheyne-Stokes
