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CORE DOMAINS
Cardiovascular Nursing Management
Respiratory Care and Oxygenation
Renal and Urinary Disorders
Gastrointestinal Systems and Nutrition
Endocrine Regulation and Metabolic Health
Neurological Assessment and Interventions
Musculoskeletal Recovery and Mobility
Fluid, Electrolyte, and Acid-Base Balance
INTRODUCTION
The NSG 3000 Exam 3 assessment is designed to evaluate a candidate’s mastery of
medical-surgical nursing concepts and clinical judgment. The purpose of this exam
is to ensure that students can safely transition from theoretical knowledge to
professional practice in acute and chronic care settings. The skills assessed include
advanced physical assessment, pharmacological integration, and the prioritization
of patient care. This exam utilizes a multiple-choice and scenario-based format,
reflecting the complexity of modern healthcare environments. There is a heavy
emphasis on practical application, evidence-based interventions, and professional
decision-making to ensure optimal patient outcomes and safety.
, SECTION 1: QUESTIONS 1–35
A patient presents with a potassium level of 6.2 mEq/L. Which ECG change
should the nurse anticipate?
A. Prominent U waves
B. ST-segment depression
🔴 C. Tall, peaked T waves
D. Shortened PR interval
🔴 Explanation: Hyperkalemia (potassium > 5.0 mEq/L) causes rapid
repolarization of the ventricles, which manifests as tall, peaked T waves on an
ECG.
Which clinical manifestation is most indicative of a tension pneumothorax?
A. Productive cough with hemoptysis
🔴 B. Tracheal deviation toward the unaffected side
C. Dullness on percussion of the affected side
D. Increased breath sounds on the affected side
🔴 Explanation: A tension pneumothorax causes air to trap in the pleural space,
increasing pressure and shifting the mediastinum and trachea toward the opposite
(unaffected) side.
A nurse is caring for a patient with Chronic Obstructive Pulmonary Disease
(COPD). What is the primary stimulus for breathing in this patient population?
A. High carbon dioxide levels
B. Low blood pH
🔴 C. Low oxygen levels
,D. High bicarbonate levels
🔴 Explanation: In many chronic COPD patients, the body becomes desensitized
to high CO2 levels, shifting the respiratory drive to "hypoxic drive," where low
oxygen levels stimulate breathing.
A patient is diagnosed with acute pyelonephritis. Which symptom is a hallmark
sign of this condition?
🔴 A. Costovertebral angle (CVA) tenderness
B. Painless hematuria
C. Left lower quadrant pain
D. Absence of fever
🔴 Explanation: CVA tenderness is a classic sign of kidney inflammation or
infection, distinguishing upper UTIs like pyelonephritis from lower UTIs.
Which laboratory value is the most sensitive indicator of renal function in a patient
with acute kidney injury?
A. Blood urea nitrogen (BUN)
🔴 B. Serum creatinine
C. Serum sodium
D. Urine specific gravity
🔴 Explanation: Creatinine is a metabolic byproduct of muscle that is excreted
almost entirely by the kidneys, making it a more specific indicator of glomerular
filtration than BUN.
A patient with Type 1 Diabetes is found unconscious with a blood glucose of 45
mg/dL. What is the priority nursing action?
, A. Administer 10 units of regular insulin
B. Provide 4 ounces of orange juice orally
🔴 C. Administer Glucagon IM or SQ
D. Start an infusion of normal saline
🔴 Explanation: Since the patient is unconscious and cannot safely swallow,
Glucagon or IV Dextrose is required to rapidly raise blood glucose levels.
What is the priority assessment for a patient immediately following a
thyroidectomy?
🔴 A. Respiratory effort and airway patency
B. Ability to speak in a loud voice
C. Intake and output ratio
D. Peripheral pulse strength
🔴 Explanation: Post-thyroidectomy patients are at risk for airway obstruction due
to edema, hematoma, or laryngeal nerve damage; airway is always the priority.
A patient is receiving a blood transfusion and begins to complain of lower back
pain and chills. What is the first action the nurse should take?
A. Notify the healthcare provider
B. Check the patient's temperature
🔴 C. Stop the transfusion immediately
D. Slow the rate of the infusion
🔴 Explanation: Back pain and chills suggest a hemolytic reaction; the primary
safety intervention is to stop the infusion to prevent further exposure to the antigen.