NUR176/NUR 176 Exam 1 V3 | Concepts of
Adult Health Nursing for the Practical
Nurse I Q&A with Rationale | Hondros
College of Nursing
1. A nurse is caring for a patient with severe dehydration. Which clinical manifestation should
the nurse expect to find during the assessment?
A. Bounding peripheral pulses
B. Increased skin turgor
C. Decreased urine output with high specific gravity
D. Distended neck veins
Correct Answer: C
Rationale: Decreased urine output occurs as the kidneys attempt to conserve water in
response to a fluid volume deficit. High specific gravity indicates that the urine is highly
concentrated with solutes. This is a compensatory mechanism triggered by antidiuretic
hormone (ADH) to maintain circulating volume.
2. Which electrolyte imbalance is most commonly associated with the development of
Chvostek’s and Trousseau’s signs?
A. Hypomagnesemia
B. Hyperkalemia
,C. Hyponatremia
D. Hypocalcemia
Correct Answer: D
Rationale: Hypocalcemia increases neuromuscular excitability, leading to tetany and
twitching. Chvostek’s sign is elicited by tapping the facial nerve, while Trousseau’s sign is
observed as carpal spasm when a blood pressure cuff is inflated. These clinical signs are
critical indicators for the nurse to monitor to prevent seizures or laryngeal spasms.
3. A patient’s arterial blood gas (ABG) results are pH 7.30, PaCO2 52 mmHg, and HCO3 24
mEq/L. The nurse interprets these results as which of the following?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Alkalosis
D. Respiratory Acidosis
Correct Answer: D
Rationale: A pH below 7.35 indicates acidosis, and a PaCO2 above 45 mmHg indicates a
respiratory cause. Since the bicarbonate (HCO3) level is within the normal range of 22-26
mEq/L, the condition is uncompensated. This state is often seen in patients with
hypoventilation or chronic obstructive pulmonary disease (COPD).
, 4. During the preoperative assessment, the patient informs the nurse they are allergic to
bananas and avocados. What is the nurse’s priority action?
A. Document the allergy in the dietary section only.
B. Ask the patient if they like strawberries.
C. Administer an antihistamine immediately.
D. Notify the surgical team of a potential latex allergy.
Correct Answer: D
Rationale: Cross-sensitivity exists between certain foods, such as bananas, avocados, and
chestnuts, and latex. Identifying this risk is crucial to prevent intraoperative anaphylaxis.
The nurse must communicate this finding to the entire surgical team to ensure a latex-free
environment is maintained.
5. A postoperative patient has not voided for 8 hours following surgery. Which is the nurse’s
first intervention?
A. Insert an indwelling urinary catheter.
B. Increase the rate of IV fluids.
C. Perform a bladder scan at the bedside.
D. Administer a diuretic as ordered.
Correct Answer: C
Adult Health Nursing for the Practical
Nurse I Q&A with Rationale | Hondros
College of Nursing
1. A nurse is caring for a patient with severe dehydration. Which clinical manifestation should
the nurse expect to find during the assessment?
A. Bounding peripheral pulses
B. Increased skin turgor
C. Decreased urine output with high specific gravity
D. Distended neck veins
Correct Answer: C
Rationale: Decreased urine output occurs as the kidneys attempt to conserve water in
response to a fluid volume deficit. High specific gravity indicates that the urine is highly
concentrated with solutes. This is a compensatory mechanism triggered by antidiuretic
hormone (ADH) to maintain circulating volume.
2. Which electrolyte imbalance is most commonly associated with the development of
Chvostek’s and Trousseau’s signs?
A. Hypomagnesemia
B. Hyperkalemia
,C. Hyponatremia
D. Hypocalcemia
Correct Answer: D
Rationale: Hypocalcemia increases neuromuscular excitability, leading to tetany and
twitching. Chvostek’s sign is elicited by tapping the facial nerve, while Trousseau’s sign is
observed as carpal spasm when a blood pressure cuff is inflated. These clinical signs are
critical indicators for the nurse to monitor to prevent seizures or laryngeal spasms.
3. A patient’s arterial blood gas (ABG) results are pH 7.30, PaCO2 52 mmHg, and HCO3 24
mEq/L. The nurse interprets these results as which of the following?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Alkalosis
D. Respiratory Acidosis
Correct Answer: D
Rationale: A pH below 7.35 indicates acidosis, and a PaCO2 above 45 mmHg indicates a
respiratory cause. Since the bicarbonate (HCO3) level is within the normal range of 22-26
mEq/L, the condition is uncompensated. This state is often seen in patients with
hypoventilation or chronic obstructive pulmonary disease (COPD).
, 4. During the preoperative assessment, the patient informs the nurse they are allergic to
bananas and avocados. What is the nurse’s priority action?
A. Document the allergy in the dietary section only.
B. Ask the patient if they like strawberries.
C. Administer an antihistamine immediately.
D. Notify the surgical team of a potential latex allergy.
Correct Answer: D
Rationale: Cross-sensitivity exists between certain foods, such as bananas, avocados, and
chestnuts, and latex. Identifying this risk is crucial to prevent intraoperative anaphylaxis.
The nurse must communicate this finding to the entire surgical team to ensure a latex-free
environment is maintained.
5. A postoperative patient has not voided for 8 hours following surgery. Which is the nurse’s
first intervention?
A. Insert an indwelling urinary catheter.
B. Increase the rate of IV fluids.
C. Perform a bladder scan at the bedside.
D. Administer a diuretic as ordered.
Correct Answer: C
