NR-324 – Adult Health I Introduces nursing care for
adult patients experiencing common acute and chronic
conditions across multiple healthcare settings.
Question 1
A patient with COPD has an SpO₂ of 88% on room air. The nurse applies 2 L/min
oxygen via nasal cannula. Thirty minutes later, the patient becomes lethargic and
their respiratory rate drops from 22 to 10 breaths/min. What is the priority nursing
action?
A) Increase oxygen to 4 L/min
B) Prepare for possible intubation and hypoventilation support
C) Administer naloxone
D) Check blood glucose
Rationale: COPD patients may retain CO₂ and rely on hypoxic drive. Excess
oxygen can reduce respiratory drive, causing hypercapnia and respiratory acidosis.
This patient is showing signs of CO₂ narcosis (lethargy, hypoventilation).
Decreasing oxygen and supporting ventilation is needed; intubation may be
required.
Question 2
A patient is admitted with exacerbation of heart failure. Which assessment finding
best indicates improvement in fluid status?
A) Blood pressure 150/90 mmHg
B) Daily weight decrease of 2 kg in 24 hours
C) Jugular venous distension at 45 degrees
D) +3 pitting edema in lower extremities
Rationale: Daily weight is the most reliable indicator of fluid volume status. A
loss of 1 kg ≈ 1 L of fluid. A 2 kg loss in 24 hours reflects effective diuresis. JVD
and edema indicate persistent overload.
Question 3
,A patient with acute pancreatitis reports severe abdominal pain radiating to the
back, nausea, and vomiting. Which laboratory finding is most consistent with this
diagnosis?
A) Elevated troponin I
B) Serum lipase 600 U/L (normal <60)
C) Decreased serum calcium
D) Elevated BUN
Rationale: Lipase is highly specific for pancreatitis, remains elevated longer than
amylase. Hypocalcemia (from saponification) may occur but is not diagnostic.
Troponin indicates cardiac injury.
Question 4
A patient post–myocardial infarction is started on metoprolol. What is the most
important therapeutic effect of this medication in this patient?
A) Increased cardiac contractility
B) Reduced myocardial oxygen demand
C) Vasodilation of coronary arteries
D) Thrombolysis of occluded vessels
Rationale: Metoprolol (beta-1 blocker) reduces heart rate and contractility,
decreasing myocardial oxygen demand, which prevents reinfarction and reduces
mortality post-MI. It does not vasodilate or lyse clots.
Question 5
A nurse is caring for a patient with diabetic ketoacidosis (DKA). Which finding
indicates that treatment with IV insulin is effective?
A) Serum potassium increases from 4.0 to 4.5 mEq/L
B) Anion gap decreases from 24 to 12
C) Blood glucose normalizes to 110 mg/dL
D) Urine ketones become large
Rationale: DKA improves when anion gap closes (normal ~8–12), indicating
resolution of metabolic acidosis. Glucose may still be elevated; insulin is continued
until gap closes and pH normalizes.
, Question 6
A patient with cirrhosis develops asterixis (liver flap). What is the priority nursing
intervention?
A) Administer lactulose
B) Assess for precipitating factors of hepatic encephalopathy
C) Restrict dietary protein
D) Prepare for paracentesis
Rationale: Asterixis indicates hepatic encephalopathy. First step is identifying
triggers (bleeding, infection, electrolyte imbalance, constipation, high protein
load). Lactulose is treatment, but assessment precedes intervention.
Question 7
A patient with chronic kidney disease (CKD) stage 4 has a hemoglobin of 8.2
g/dL. Which prescribed medication addresses the underlying cause?
A) Ferrous sulfate
B) Epoetin alfa
C) Folic acid
D) Vitamin B12
Rationale: Anemia in CKD is due to decreased erythropoietin production by
kidneys. Epoetin alfa (erythropoiesis-stimulating agent) replaces erythropoietin.
Iron is adjunct if iron deficiency exists.
Question 8
A patient with pneumonia has the following ABG: pH 7.30, PaCO₂ 55 mm Hg,
HCO₃ 24 mEq/L. Which condition do these values indicate?
A) Metabolic acidosis
B) Acute respiratory acidosis
C) Metabolic alkalosis
D) Compensated respiratory acidosis
adult patients experiencing common acute and chronic
conditions across multiple healthcare settings.
Question 1
A patient with COPD has an SpO₂ of 88% on room air. The nurse applies 2 L/min
oxygen via nasal cannula. Thirty minutes later, the patient becomes lethargic and
their respiratory rate drops from 22 to 10 breaths/min. What is the priority nursing
action?
A) Increase oxygen to 4 L/min
B) Prepare for possible intubation and hypoventilation support
C) Administer naloxone
D) Check blood glucose
Rationale: COPD patients may retain CO₂ and rely on hypoxic drive. Excess
oxygen can reduce respiratory drive, causing hypercapnia and respiratory acidosis.
This patient is showing signs of CO₂ narcosis (lethargy, hypoventilation).
Decreasing oxygen and supporting ventilation is needed; intubation may be
required.
Question 2
A patient is admitted with exacerbation of heart failure. Which assessment finding
best indicates improvement in fluid status?
A) Blood pressure 150/90 mmHg
B) Daily weight decrease of 2 kg in 24 hours
C) Jugular venous distension at 45 degrees
D) +3 pitting edema in lower extremities
Rationale: Daily weight is the most reliable indicator of fluid volume status. A
loss of 1 kg ≈ 1 L of fluid. A 2 kg loss in 24 hours reflects effective diuresis. JVD
and edema indicate persistent overload.
Question 3
,A patient with acute pancreatitis reports severe abdominal pain radiating to the
back, nausea, and vomiting. Which laboratory finding is most consistent with this
diagnosis?
A) Elevated troponin I
B) Serum lipase 600 U/L (normal <60)
C) Decreased serum calcium
D) Elevated BUN
Rationale: Lipase is highly specific for pancreatitis, remains elevated longer than
amylase. Hypocalcemia (from saponification) may occur but is not diagnostic.
Troponin indicates cardiac injury.
Question 4
A patient post–myocardial infarction is started on metoprolol. What is the most
important therapeutic effect of this medication in this patient?
A) Increased cardiac contractility
B) Reduced myocardial oxygen demand
C) Vasodilation of coronary arteries
D) Thrombolysis of occluded vessels
Rationale: Metoprolol (beta-1 blocker) reduces heart rate and contractility,
decreasing myocardial oxygen demand, which prevents reinfarction and reduces
mortality post-MI. It does not vasodilate or lyse clots.
Question 5
A nurse is caring for a patient with diabetic ketoacidosis (DKA). Which finding
indicates that treatment with IV insulin is effective?
A) Serum potassium increases from 4.0 to 4.5 mEq/L
B) Anion gap decreases from 24 to 12
C) Blood glucose normalizes to 110 mg/dL
D) Urine ketones become large
Rationale: DKA improves when anion gap closes (normal ~8–12), indicating
resolution of metabolic acidosis. Glucose may still be elevated; insulin is continued
until gap closes and pH normalizes.
, Question 6
A patient with cirrhosis develops asterixis (liver flap). What is the priority nursing
intervention?
A) Administer lactulose
B) Assess for precipitating factors of hepatic encephalopathy
C) Restrict dietary protein
D) Prepare for paracentesis
Rationale: Asterixis indicates hepatic encephalopathy. First step is identifying
triggers (bleeding, infection, electrolyte imbalance, constipation, high protein
load). Lactulose is treatment, but assessment precedes intervention.
Question 7
A patient with chronic kidney disease (CKD) stage 4 has a hemoglobin of 8.2
g/dL. Which prescribed medication addresses the underlying cause?
A) Ferrous sulfate
B) Epoetin alfa
C) Folic acid
D) Vitamin B12
Rationale: Anemia in CKD is due to decreased erythropoietin production by
kidneys. Epoetin alfa (erythropoiesis-stimulating agent) replaces erythropoietin.
Iron is adjunct if iron deficiency exists.
Question 8
A patient with pneumonia has the following ABG: pH 7.30, PaCO₂ 55 mm Hg,
HCO₃ 24 mEq/L. Which condition do these values indicate?
A) Metabolic acidosis
B) Acute respiratory acidosis
C) Metabolic alkalosis
D) Compensated respiratory acidosis
