NUR 254 EXAM 1 STUDY GUIDE ACTUAL EXAM
2026-2027 COMPLETE EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS WITH
RATIONALES (100% VERIFIED ANSWERS)
ALREADY GRADED A+ MOST RECENT!!!
Question 1
A nurse is caring for a client with chronic obstructive pulmonary disease
(COPD) who has a blood gas pH of 7.32, PaCO₂ of 58 mm Hg, and
HCO₃⁻ of 30 mEq/L. The nurse interprets these findings as:
A. Uncompensated respiratory acidosis
B. Compensated metabolic alkalosis
C. Partially compensated respiratory acidosis
D. Fully compensated metabolic acidosis
Rationale: The pH is low (acidosis) and PaCO₂ is elevated (respiratory
cause). HCO₃⁻ is elevated (compensatory metabolic alkalosis), but since
pH is still below normal, compensation is partial, not complete.
Question 2
A postoperative client reports sudden chest pain and dyspnea. Oxygen
saturation is 88%. The nurse’s priority action is to:
A. Administer PRN pain medication
B. Apply oxygen and notify the provider
,C. Encourage deep breathing and coughing
D. Ambulate the client to expand the lungs
Rationale: Sudden chest pain and desaturation post-op suggest
pulmonary embolism. Oxygen and provider notification are priority;
pain meds and ambulation could worsen the condition.
Question 3
A nurse assesses a client’s intravenous (IV) site and finds warmth,
erythema, and purulent drainage. The nurse should:
A. Continue the infusion and monitor hourly
B. Apply a warm compress
C. Discontinue the IV and culture the site
D. Increase the infusion rate to flush the line
Rationale: Signs indicate phlebitis or infection. The IV must be
discontinued, and the site cultured. Warm compresses may be used after
removal, but not as the primary action.
Question 4
A client with heart failure has crackles in the lung bases, jugular vein
distention, and peripheral edema. The priority nursing diagnosis is:
A. Risk for infection
B. Impaired gas exchange
C. Activity intolerance
D. Fluid volume excess
Rationale: Impaired gas exchange is the priority because crackles
indicate fluid in the alveoli, which threatens oxygenation. Fluid volume
excess is a related but less immediate diagnosis.
,Question 5
The nurse administers furosemide to a client with pulmonary edema.
Which assessment finding best indicates the medication is effective?
A. Blood pressure increases from 90/60 to 110/70
B. Crackles decrease to bases only
C. Urine output is 30 mL/hr
D. Heart rate decreases from 110 to 80 bpm
Rationale: Furosemide reduces preload, decreasing pulmonary
congestion. Reduction of crackles directly indicates improved gas
exchange in pulmonary edema.
Question 6
A client with diabetic ketoacidosis (DKA) has a serum potassium of 5.9
mEq/L. The nurse should first:
A. Administer insulin as ordered
B. Hold potassium supplements and check ECG
C. Give calcium gluconate IV push
D. Increase IV fluid rate
Rationale: Hyperkalemia in DKA can cause cardiac dysrhythmias.
Holding potassium and obtaining an ECG are priority before other
interventions.
Question 7
A client’s arterial blood gas shows pH 7.48, PaCO₂ 32 mm Hg, HCO₃⁻
24 mEq/L. The nurse identifies this as:
, A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Respiratory acidosis
Rationale: High pH (alkalosis), low PaCO₂ (respiratory cause), normal
HCO₃⁻ indicates acute respiratory alkalosis (hyperventilation).
Question 8
A nurse is preparing to insert a nasogastric tube. To reduce the risk of
aspiration during insertion, the nurse should:
A. Have the client lie flat
B. Place the client in high Fowler’s position
C. Lubricate the tube with mineral oil
D. Advance the tube during inspiration
Rationale: High Fowler’s position uses gravity to prevent aspiration and
allows easier passage into the esophagus.
Question 9
A client with chronic kidney disease has a hemoglobin of 8.2 g/dL. The
nurse expects which medication to be prescribed?
A. Folic acid
B. Epoetin alfa
C. Ferrous sulfate
D. Vitamin B12
Rationale: Epoetin alfa stimulates RBC production in chronic kidney
disease due to lack of endogenous erythropoietin.
2026-2027 COMPLETE EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS WITH
RATIONALES (100% VERIFIED ANSWERS)
ALREADY GRADED A+ MOST RECENT!!!
Question 1
A nurse is caring for a client with chronic obstructive pulmonary disease
(COPD) who has a blood gas pH of 7.32, PaCO₂ of 58 mm Hg, and
HCO₃⁻ of 30 mEq/L. The nurse interprets these findings as:
A. Uncompensated respiratory acidosis
B. Compensated metabolic alkalosis
C. Partially compensated respiratory acidosis
D. Fully compensated metabolic acidosis
Rationale: The pH is low (acidosis) and PaCO₂ is elevated (respiratory
cause). HCO₃⁻ is elevated (compensatory metabolic alkalosis), but since
pH is still below normal, compensation is partial, not complete.
Question 2
A postoperative client reports sudden chest pain and dyspnea. Oxygen
saturation is 88%. The nurse’s priority action is to:
A. Administer PRN pain medication
B. Apply oxygen and notify the provider
,C. Encourage deep breathing and coughing
D. Ambulate the client to expand the lungs
Rationale: Sudden chest pain and desaturation post-op suggest
pulmonary embolism. Oxygen and provider notification are priority;
pain meds and ambulation could worsen the condition.
Question 3
A nurse assesses a client’s intravenous (IV) site and finds warmth,
erythema, and purulent drainage. The nurse should:
A. Continue the infusion and monitor hourly
B. Apply a warm compress
C. Discontinue the IV and culture the site
D. Increase the infusion rate to flush the line
Rationale: Signs indicate phlebitis or infection. The IV must be
discontinued, and the site cultured. Warm compresses may be used after
removal, but not as the primary action.
Question 4
A client with heart failure has crackles in the lung bases, jugular vein
distention, and peripheral edema. The priority nursing diagnosis is:
A. Risk for infection
B. Impaired gas exchange
C. Activity intolerance
D. Fluid volume excess
Rationale: Impaired gas exchange is the priority because crackles
indicate fluid in the alveoli, which threatens oxygenation. Fluid volume
excess is a related but less immediate diagnosis.
,Question 5
The nurse administers furosemide to a client with pulmonary edema.
Which assessment finding best indicates the medication is effective?
A. Blood pressure increases from 90/60 to 110/70
B. Crackles decrease to bases only
C. Urine output is 30 mL/hr
D. Heart rate decreases from 110 to 80 bpm
Rationale: Furosemide reduces preload, decreasing pulmonary
congestion. Reduction of crackles directly indicates improved gas
exchange in pulmonary edema.
Question 6
A client with diabetic ketoacidosis (DKA) has a serum potassium of 5.9
mEq/L. The nurse should first:
A. Administer insulin as ordered
B. Hold potassium supplements and check ECG
C. Give calcium gluconate IV push
D. Increase IV fluid rate
Rationale: Hyperkalemia in DKA can cause cardiac dysrhythmias.
Holding potassium and obtaining an ECG are priority before other
interventions.
Question 7
A client’s arterial blood gas shows pH 7.48, PaCO₂ 32 mm Hg, HCO₃⁻
24 mEq/L. The nurse identifies this as:
, A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Respiratory acidosis
Rationale: High pH (alkalosis), low PaCO₂ (respiratory cause), normal
HCO₃⁻ indicates acute respiratory alkalosis (hyperventilation).
Question 8
A nurse is preparing to insert a nasogastric tube. To reduce the risk of
aspiration during insertion, the nurse should:
A. Have the client lie flat
B. Place the client in high Fowler’s position
C. Lubricate the tube with mineral oil
D. Advance the tube during inspiration
Rationale: High Fowler’s position uses gravity to prevent aspiration and
allows easier passage into the esophagus.
Question 9
A client with chronic kidney disease has a hemoglobin of 8.2 g/dL. The
nurse expects which medication to be prescribed?
A. Folic acid
B. Epoetin alfa
C. Ferrous sulfate
D. Vitamin B12
Rationale: Epoetin alfa stimulates RBC production in chronic kidney
disease due to lack of endogenous erythropoietin.
