NU180 | NU180 Nursing and Healthcare II | NCLEX
Style Exam 1 v2 | Questions with Correct Answers
and Expert Explanation for Each Question | Galen
1. A nurse is assessing a patient with a fluid volume deficit. Which clinical
manifestation should the nurse expect to find?
A. Distended neck veins
B. Increased blood pressure
C. Crackles in the lungs
D. Orthostatic hypotension
Correct Answer: D
Expert Explanation: Fluid volume deficit, or hypovolemia, leads to a decrease in
circulating blood volume. This often manifests as orthostatic hypotension and a
rapid, weak pulse as the body attempts to compensate. Other findings include poor
skin turgor and dry mucous membranes.
2. A patient is diagnosed with hyperkalemia. Which of the following ECG changes
should the nurse monitor for most closely?
A. Shortened PR interval
B. Prominent U waves
C. ST-segment depression
,D. Tall, peaked T waves
Correct Answer: D
Expert Explanation: Hyperkalemia significantly affects cardiac electrical
conduction and can lead to life-threatening arrhythmias. Tall, peaked T waves are a
classic early sign of high potassium levels on an EKG. If left untreated, this can
progress to a widened QRS complex and cardiac arrest.
3. The nurse is caring for a patient scheduled for surgery and notices the patient does
not understand the risks of the procedure. What is the nurse’s priority action?
A. Explain the risks and benefits to the patient
B. Notify the surgeon that the patient needs further explanation
C. Ask the patient’s family to explain the procedure
D. Proceed with getting the consent form signed
Correct Answer: B
Expert Explanation: The nurse’s role in informed consent is to witness the
patient’s signature and ensure the patient is competent. It is the surgeon’s legal
responsibility to explain the risks, benefits, and alternatives of the surgery. If the
patient expresses a lack of understanding, the nurse must advocate for the patient
by calling the surgeon back to provide clarification.
,4. A postoperative patient is being monitored for signs of a deep vein thrombosis
(DVT). Which finding is most indicative of this complication?
A. Bilateral pitting edema in the lower extremities
B. Cool, pale skin on the left calf
C. Absent pedal pulses in both feet
D. Unilateral warmth and redness in the calf area
Correct Answer: D
Expert Explanation: DVT typically presents as unilateral swelling, warmth, and
redness in the affected extremity. While bilateral edema may indicate heart failure
or fluid overload, a localized clot causes focal inflammation. The nurse should
immediately report these findings and prevent the patient from massaging the area
to avoid embolization.
5. Which ABG result is consistent with a patient experiencing a panic attack and
hyperventilating?
A. pH 7.32, PaCO2 50, HCO3 24
B. pH 7.30, PaCO2 35, HCO3 18
C. pH 7.48, PaCO2 30, HCO3 23
D. pH 7.50, PaCO2 40, HCO3 32
, Correct Answer: C
Expert Explanation: Hyperventilation causes the excessive ‘blowing off’ of carbon
dioxide, leading to respiratory alkalosis. A pH greater than 7.45 and a PaCO2 less
than 35 mmHg characterize this state. The nurse should encourage the patient to
breathe slowly or use a paper bag to re-breathe CO2.
6. A patient with a history of chronic alcoholism is at risk for which electrolyte
imbalance?
A. Hypermagnesemia
B. Hypercalcemia
C. Hypomagnesemia
D. Hypernatremia
Correct Answer: C
Expert Explanation: Chronic alcohol use often leads to poor dietary intake and
increased renal excretion of magnesium. Hypomagnesemia can cause
neuromuscular irritability, such as tremors and hyperactive reflexes. It is important
to monitor these patients for cardiac arrhythmias and seizures.
7. The nurse is evaluating a patient’s understanding of a low-sodium diet. Which food
choice by the patient indicates a need for further teaching?
A. Fresh grilled chicken breast
Style Exam 1 v2 | Questions with Correct Answers
and Expert Explanation for Each Question | Galen
1. A nurse is assessing a patient with a fluid volume deficit. Which clinical
manifestation should the nurse expect to find?
A. Distended neck veins
B. Increased blood pressure
C. Crackles in the lungs
D. Orthostatic hypotension
Correct Answer: D
Expert Explanation: Fluid volume deficit, or hypovolemia, leads to a decrease in
circulating blood volume. This often manifests as orthostatic hypotension and a
rapid, weak pulse as the body attempts to compensate. Other findings include poor
skin turgor and dry mucous membranes.
2. A patient is diagnosed with hyperkalemia. Which of the following ECG changes
should the nurse monitor for most closely?
A. Shortened PR interval
B. Prominent U waves
C. ST-segment depression
,D. Tall, peaked T waves
Correct Answer: D
Expert Explanation: Hyperkalemia significantly affects cardiac electrical
conduction and can lead to life-threatening arrhythmias. Tall, peaked T waves are a
classic early sign of high potassium levels on an EKG. If left untreated, this can
progress to a widened QRS complex and cardiac arrest.
3. The nurse is caring for a patient scheduled for surgery and notices the patient does
not understand the risks of the procedure. What is the nurse’s priority action?
A. Explain the risks and benefits to the patient
B. Notify the surgeon that the patient needs further explanation
C. Ask the patient’s family to explain the procedure
D. Proceed with getting the consent form signed
Correct Answer: B
Expert Explanation: The nurse’s role in informed consent is to witness the
patient’s signature and ensure the patient is competent. It is the surgeon’s legal
responsibility to explain the risks, benefits, and alternatives of the surgery. If the
patient expresses a lack of understanding, the nurse must advocate for the patient
by calling the surgeon back to provide clarification.
,4. A postoperative patient is being monitored for signs of a deep vein thrombosis
(DVT). Which finding is most indicative of this complication?
A. Bilateral pitting edema in the lower extremities
B. Cool, pale skin on the left calf
C. Absent pedal pulses in both feet
D. Unilateral warmth and redness in the calf area
Correct Answer: D
Expert Explanation: DVT typically presents as unilateral swelling, warmth, and
redness in the affected extremity. While bilateral edema may indicate heart failure
or fluid overload, a localized clot causes focal inflammation. The nurse should
immediately report these findings and prevent the patient from massaging the area
to avoid embolization.
5. Which ABG result is consistent with a patient experiencing a panic attack and
hyperventilating?
A. pH 7.32, PaCO2 50, HCO3 24
B. pH 7.30, PaCO2 35, HCO3 18
C. pH 7.48, PaCO2 30, HCO3 23
D. pH 7.50, PaCO2 40, HCO3 32
, Correct Answer: C
Expert Explanation: Hyperventilation causes the excessive ‘blowing off’ of carbon
dioxide, leading to respiratory alkalosis. A pH greater than 7.45 and a PaCO2 less
than 35 mmHg characterize this state. The nurse should encourage the patient to
breathe slowly or use a paper bag to re-breathe CO2.
6. A patient with a history of chronic alcoholism is at risk for which electrolyte
imbalance?
A. Hypermagnesemia
B. Hypercalcemia
C. Hypomagnesemia
D. Hypernatremia
Correct Answer: C
Expert Explanation: Chronic alcohol use often leads to poor dietary intake and
increased renal excretion of magnesium. Hypomagnesemia can cause
neuromuscular irritability, such as tremors and hyperactive reflexes. It is important
to monitor these patients for cardiac arrhythmias and seizures.
7. The nurse is evaluating a patient’s understanding of a low-sodium diet. Which food
choice by the patient indicates a need for further teaching?
A. Fresh grilled chicken breast