NR 324 Adult Health I (Med-Surg 1) Final
NEWEST 2026/2027 ACTUAL EXAM TEST
BANK 250 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
(VERIFIED ANSWERS) |ALREADY GRADED
A+||NEWEST VERSION
Question 1
A nurse is caring for a 64-year-old client admitted with acute kidney injury secondary to
dehydration. The client’s morning laboratory results and assessment findings are as follows:
potassium 6.6 mEq/L, creatinine 2.3 mg/dL, urine output 20 mL/hr over the past 3 hours, blood
pressure 148/88 mmHg, and ECG showing peaked T waves. Which findings require immediate
intervention? (Select all that apply)
A. Potassium 6.6 mEq/L
B. Urine output 20 mL/hr
C. Creatinine 2.3 mg/dL
D. Peaked T waves on ECG
E. Blood pressure 148/88 mmHg
Correct Answers: A, D
Expert Rationale: Severe hyperkalemia (potassium 6.6 mEq/L) is a critical, life-threatening
electrolyte imbalance due to its direct impact on cardiac conduction. The presence of peaked T
waves on ECG confirms that the elevated potassium is already affecting cardiac electrical
activity, placing the client at high risk for fatal dysrhythmias such as ventricular tachycardia or
fibrillation. These findings require immediate treatment, including calcium gluconate for cardiac
stabilization and interventions to lower potassium levels. Reduced urine output and elevated
creatinine are expected findings in acute kidney injury and reflect renal impairment rather than
immediate instability. Elevated blood pressure is also common but not emergent compared to
cardiac risk.
,DIF: Analysis REF: Renal Disorders / Electrolyte Imbalances OBJ: Recognize life-threatening
electrolyte disturbances TOP: Nursing Process: Analysis
Question 2
A nurse is caring for a 58-year-old client with a history of chronic alcohol use disorder who is
admitted with worsening abdominal distention, jaundice, and confusion. Laboratory results
reveal elevated ammonia levels, prolonged PT/INR, and low albumin. The provider prescribes
multiple medications, including lactulose, spironolactone, and a reduced dose of morphine for
pain management.
Which of the following findings best explains the need for reducing the client’s morphine
dosage?
A. Increased renal clearance due to diuretic therapy
B. Impaired hepatic metabolism leading to drug accumulation
C. Decreased intestinal absorption from ascites
D. Increased protein binding due to hypoalbuminemia
Correct Answer: B
Expert Rationale: Cirrhosis is a chronic liver condition that significantly reduces hepatic
metabolism and drug clearance. Since the liver is responsible for biotransformation of most
medications, impaired liver function leads to drug accumulation and increased risk of toxicity. As
a result, patients with cirrhosis often require lower doses of many drugs to achieve therapeutic
effects safely. Infection does not generally impair drug metabolism, although it may temporarily
affect pharmacokinetics in some cases. Diabetes primarily affects glucose regulation and does
not typically require dose reductions for most medications. Colitis affects intestinal absorption
but does not consistently impact overall drug metabolism to the extent that dose reduction is
broadly required.
DIF: Application REF: Pharmacology / Hepatic Function and Drug Metabolism OBJ: Identify
conditions requiring reduced drug dosing due to impaired metabolism TOP: Pharmacokinetics /
Nursing Process: Planning
Question 3
A nurse is caring for a client with acute pancreatitis who reports severe epigastric pain radiating
to the back. The client’s laboratory results show elevated serum amylase and lipase. The
provider prescribes NPO status, IV fluids, and opioid analgesics.
,Which of the following findings indicates a potential complication requiring immediate
intervention?
A. Blood glucose level of 180 mg/dL
B. Calcium level of 7.2 mg/dL
C. White blood cell count of 14,000/mm³
D. Heart rate of 102/min
Correct Answer: B
Expert Rationale: Acute pancreatitis can lead to hypocalcemia due to fat necrosis, where
calcium binds to fatty acids in the inflamed pancreas. A calcium level of 7.2 mg/dL is critically
low and can result in tetany, seizures, or cardiac dysrhythmias, requiring immediate
intervention. Mild hyperglycemia, leukocytosis, and slight tachycardia are common
inflammatory responses and not immediately life-threatening.
DIF: Application REF: Gastrointestinal / Pancreatitis Complications OBJ: Recognize critical
electrolyte imbalances TOP: Nursing Process: Assessment
Question 4
A nurse is caring for a client with chronic kidney disease (CKD) stage 5 who is scheduled for
hemodialysis. The client’s lab results include potassium 6.3 mEq/L, creatinine 7.8 mg/dL, and
BUN 68 mg/dL.
Which of the following ECG changes should the nurse anticipate?
A. U waves and flattened T waves
B. Peaked T waves and widened QRS complexes
C. ST-segment depression
D. Shortened PR interval
Correct Answer: B
Expert Rationale: Hyperkalemia, a common complication in advanced CKD, affects cardiac
conduction and can lead to life-threatening arrhythmias. Classic ECG findings include tall,
peaked T waves and widening of the QRS complex. Hypokalemia causes U waves and flattened T
waves. ST depression and PR changes are not hallmark signs of hyperkalemia.
DIF: Application REF: Renal / Electrolyte Imbalance OBJ: Identify ECG changes associated with
hyperkalemia TOP: Nursing Process: Assessment
Question 5
, A nurse is caring for a postoperative client who develops sudden confusion, restlessness, and
attempts to remove IV lines. The client has a history of chronic alcohol use and reports the last
drink was 24 hours ago.
Which of the following medications should the nurse anticipate administering?
A. Haloperidol
B. Lorazepam
C. Morphine
D. Propranolol
Correct Answer: B
Expert Rationale: The client is exhibiting signs of acute alcohol withdrawal, which can progress
to delirium tremens. Benzodiazepines, such as lorazepam, are the first-line treatment because
they enhance GABA activity, reducing CNS hyperexcitability and preventing seizures.
Antipsychotics may be used adjunctively but do not prevent withdrawal complications. Opioids
and beta-blockers do not address the underlying pathophysiology of alcohol withdrawal.
DIF: Application REF: Neurological / Substance Withdrawal OBJ: Manage acute alcohol
withdrawal safely TOP: Nursing Process: Implementation
Question 6
A nurse is caring for a 72-year-old client with heart failure who presents with worsening
dyspnea, orthopnea, and bilateral crackles. The client’s medications include furosemide,
lisinopril, and digoxin. Laboratory results show potassium 2.9 mEq/L and digoxin level 1.9
ng/mL.
Which of the following findings requires immediate nursing intervention?
A. Digoxin level within therapeutic range
B. Hypokalemia increasing risk of digoxin toxicity
C. Presence of bilateral crackles
D. Orthopnea when lying flat
Correct Answer: B
Expert Rationale: Hypokalemia significantly increases the risk of digoxin toxicity because
potassium and digoxin compete for the same binding sites in the myocardium. A potassium
level of 2.9 mEq/L is critically low and predisposes the client to life-threatening arrhythmias.
Although the digoxin level appears within or near the upper therapeutic range, toxicity can still
NEWEST 2026/2027 ACTUAL EXAM TEST
BANK 250 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
(VERIFIED ANSWERS) |ALREADY GRADED
A+||NEWEST VERSION
Question 1
A nurse is caring for a 64-year-old client admitted with acute kidney injury secondary to
dehydration. The client’s morning laboratory results and assessment findings are as follows:
potassium 6.6 mEq/L, creatinine 2.3 mg/dL, urine output 20 mL/hr over the past 3 hours, blood
pressure 148/88 mmHg, and ECG showing peaked T waves. Which findings require immediate
intervention? (Select all that apply)
A. Potassium 6.6 mEq/L
B. Urine output 20 mL/hr
C. Creatinine 2.3 mg/dL
D. Peaked T waves on ECG
E. Blood pressure 148/88 mmHg
Correct Answers: A, D
Expert Rationale: Severe hyperkalemia (potassium 6.6 mEq/L) is a critical, life-threatening
electrolyte imbalance due to its direct impact on cardiac conduction. The presence of peaked T
waves on ECG confirms that the elevated potassium is already affecting cardiac electrical
activity, placing the client at high risk for fatal dysrhythmias such as ventricular tachycardia or
fibrillation. These findings require immediate treatment, including calcium gluconate for cardiac
stabilization and interventions to lower potassium levels. Reduced urine output and elevated
creatinine are expected findings in acute kidney injury and reflect renal impairment rather than
immediate instability. Elevated blood pressure is also common but not emergent compared to
cardiac risk.
,DIF: Analysis REF: Renal Disorders / Electrolyte Imbalances OBJ: Recognize life-threatening
electrolyte disturbances TOP: Nursing Process: Analysis
Question 2
A nurse is caring for a 58-year-old client with a history of chronic alcohol use disorder who is
admitted with worsening abdominal distention, jaundice, and confusion. Laboratory results
reveal elevated ammonia levels, prolonged PT/INR, and low albumin. The provider prescribes
multiple medications, including lactulose, spironolactone, and a reduced dose of morphine for
pain management.
Which of the following findings best explains the need for reducing the client’s morphine
dosage?
A. Increased renal clearance due to diuretic therapy
B. Impaired hepatic metabolism leading to drug accumulation
C. Decreased intestinal absorption from ascites
D. Increased protein binding due to hypoalbuminemia
Correct Answer: B
Expert Rationale: Cirrhosis is a chronic liver condition that significantly reduces hepatic
metabolism and drug clearance. Since the liver is responsible for biotransformation of most
medications, impaired liver function leads to drug accumulation and increased risk of toxicity. As
a result, patients with cirrhosis often require lower doses of many drugs to achieve therapeutic
effects safely. Infection does not generally impair drug metabolism, although it may temporarily
affect pharmacokinetics in some cases. Diabetes primarily affects glucose regulation and does
not typically require dose reductions for most medications. Colitis affects intestinal absorption
but does not consistently impact overall drug metabolism to the extent that dose reduction is
broadly required.
DIF: Application REF: Pharmacology / Hepatic Function and Drug Metabolism OBJ: Identify
conditions requiring reduced drug dosing due to impaired metabolism TOP: Pharmacokinetics /
Nursing Process: Planning
Question 3
A nurse is caring for a client with acute pancreatitis who reports severe epigastric pain radiating
to the back. The client’s laboratory results show elevated serum amylase and lipase. The
provider prescribes NPO status, IV fluids, and opioid analgesics.
,Which of the following findings indicates a potential complication requiring immediate
intervention?
A. Blood glucose level of 180 mg/dL
B. Calcium level of 7.2 mg/dL
C. White blood cell count of 14,000/mm³
D. Heart rate of 102/min
Correct Answer: B
Expert Rationale: Acute pancreatitis can lead to hypocalcemia due to fat necrosis, where
calcium binds to fatty acids in the inflamed pancreas. A calcium level of 7.2 mg/dL is critically
low and can result in tetany, seizures, or cardiac dysrhythmias, requiring immediate
intervention. Mild hyperglycemia, leukocytosis, and slight tachycardia are common
inflammatory responses and not immediately life-threatening.
DIF: Application REF: Gastrointestinal / Pancreatitis Complications OBJ: Recognize critical
electrolyte imbalances TOP: Nursing Process: Assessment
Question 4
A nurse is caring for a client with chronic kidney disease (CKD) stage 5 who is scheduled for
hemodialysis. The client’s lab results include potassium 6.3 mEq/L, creatinine 7.8 mg/dL, and
BUN 68 mg/dL.
Which of the following ECG changes should the nurse anticipate?
A. U waves and flattened T waves
B. Peaked T waves and widened QRS complexes
C. ST-segment depression
D. Shortened PR interval
Correct Answer: B
Expert Rationale: Hyperkalemia, a common complication in advanced CKD, affects cardiac
conduction and can lead to life-threatening arrhythmias. Classic ECG findings include tall,
peaked T waves and widening of the QRS complex. Hypokalemia causes U waves and flattened T
waves. ST depression and PR changes are not hallmark signs of hyperkalemia.
DIF: Application REF: Renal / Electrolyte Imbalance OBJ: Identify ECG changes associated with
hyperkalemia TOP: Nursing Process: Assessment
Question 5
, A nurse is caring for a postoperative client who develops sudden confusion, restlessness, and
attempts to remove IV lines. The client has a history of chronic alcohol use and reports the last
drink was 24 hours ago.
Which of the following medications should the nurse anticipate administering?
A. Haloperidol
B. Lorazepam
C. Morphine
D. Propranolol
Correct Answer: B
Expert Rationale: The client is exhibiting signs of acute alcohol withdrawal, which can progress
to delirium tremens. Benzodiazepines, such as lorazepam, are the first-line treatment because
they enhance GABA activity, reducing CNS hyperexcitability and preventing seizures.
Antipsychotics may be used adjunctively but do not prevent withdrawal complications. Opioids
and beta-blockers do not address the underlying pathophysiology of alcohol withdrawal.
DIF: Application REF: Neurological / Substance Withdrawal OBJ: Manage acute alcohol
withdrawal safely TOP: Nursing Process: Implementation
Question 6
A nurse is caring for a 72-year-old client with heart failure who presents with worsening
dyspnea, orthopnea, and bilateral crackles. The client’s medications include furosemide,
lisinopril, and digoxin. Laboratory results show potassium 2.9 mEq/L and digoxin level 1.9
ng/mL.
Which of the following findings requires immediate nursing intervention?
A. Digoxin level within therapeutic range
B. Hypokalemia increasing risk of digoxin toxicity
C. Presence of bilateral crackles
D. Orthopnea when lying flat
Correct Answer: B
Expert Rationale: Hypokalemia significantly increases the risk of digoxin toxicity because
potassium and digoxin compete for the same binding sites in the myocardium. A potassium
level of 2.9 mEq/L is critically low and predisposes the client to life-threatening arrhythmias.
Although the digoxin level appears within or near the upper therapeutic range, toxicity can still
