RNSG 2539 Nursing Care of the Childbearing Family Study
Guide, Comprehensive Maternal Newborn Nursing Exam
Review, High-Yield NCLEX Questions with Detailed
Rationales, Obstetrics and Gynecology Nursing Concepts,
and Complete RN Success Resource for Guaranteed Exam
Performance
Question 1: A patient with chronic obstructive pulmonary disease (COPD) presents with
arterial blood gas results showing pH 7.32, PaCO2 58 mmHg, HCO3- 28 mEq/L, and PaO2 65
mmHg. How should the nurse interpret these findings?
A. Uncompensated respiratory alkalosis
B. Partially compensated respiratory acidosis
C. Fully compensated metabolic acidosis
D. Uncompensated metabolic alkalosis
CORRECT ANSWER: B. Partially compensated respiratory acidosis
Rationale: The ABG results demonstrate respiratory acidosis evidenced by low pH (<7.35) and
elevated PaCO2 (>45 mmHg), consistent with CO2 retention in COPD. The elevated HCO3- (28
mEq/L) indicates renal compensation is occurring, but because the pH remains abnormal,
compensation is partial rather than complete. This pattern is characteristic of chronic
respiratory conditions where the kidneys retain bicarbonate to buffer the acidosis over time.
Question 2: Which nursing intervention is the priority for a patient experiencing metabolic
acidosis secondary to diabetic ketoacidosis?
A. Administer sodium bicarbonate IV push
B. Initiate insulin therapy per protocol
C. Provide high-flow oxygen via non-rebreather mask
D. Restrict oral fluid intake
CORRECT ANSWER: B. Initiate insulin therapy per protocol
Rationale: In diabetic ketoacidosis, metabolic acidosis results from accumulation of ketones due
to insulin deficiency. The priority intervention is insulin administration to halt ketone
production, allow glucose utilization, and correct the underlying metabolic disturbance. Sodium
bicarbonate is rarely indicated and may worsen outcomes; oxygen is not the priority unless
hypoxemia is present; and fluid restriction would exacerbate dehydration common in DKA.
Question 3: A patient receiving mechanical ventilation has ABG results: pH 7.48, PaCO2 30
mmHg, HCO3- 22 mEq/L. Which action should the nurse anticipate?
A. Increase the respiratory rate on the ventilator
B. Decrease the tidal volume settings
C. Administer IV sodium bicarbonate
D. Reduce the FiO2 concentration
CORRECT ANSWER: B. Decrease the tidal volume settings
Rationale: The ABG indicates respiratory alkalosis (elevated pH, low PaCO2) likely due to
hyperventilation from excessive ventilator settings. Decreasing tidal volume or respiratory rate
reduces alveolar ventilation, allowing PaCO2 to rise toward normal and correcting the alkalosis.
Increasing respiratory rate would worsen alkalosis; bicarbonate is not indicated for respiratory
alkalosis; and FiO2 adjustments address oxygenation, not ventilation.
,Question 4: Which clinical manifestation would the nurse expect to assess in a patient with
severe metabolic alkalosis?
A. Kussmaul respirations
B. Muscle twitching and tetany
C. Bradycardia and hypotension
D. Flushed, warm skin
CORRECT ANSWER: B. Muscle twitching and tetany
Rationale: Metabolic alkalosis increases protein binding of calcium, reducing ionized calcium
levels and causing neuromuscular irritability manifested as muscle twitching, paresthesias, and
tetany. Kussmaul respirations occur in metabolic acidosis as a compensatory mechanism;
bradycardia is not characteristic; and flushed skin is more associated with fever or vasodilation
states.
Question 5: A patient with prolonged nasogastric suctioning is at highest risk for developing
which acid-base imbalance?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
CORRECT ANSWER: D. Metabolic alkalosis
Rationale: Nasogastric suctioning removes gastric acid (hydrochloric acid), leading to loss of
hydrogen ions and chloride, which causes metabolic alkalosis. The kidneys attempt
compensation by excreting bicarbonate, but ongoing losses perpetuate the imbalance.
Respiratory imbalances relate to ventilation issues; metabolic acidosis would result from acid
accumulation or bicarbonate loss via other routes.
Question 6: When reviewing arterial blood gases, which value indicates the respiratory
component of acid-base balance?
A. pH
B. PaCO2
C. HCO3-
D. Base excess
CORRECT ANSWER: B. PaCO2
Rationale: PaCO2 reflects the respiratory component of acid-base balance because carbon
dioxide combines with water to form carbonic acid, directly influencing pH. The lungs regulate
PaCO2 through ventilation. pH indicates overall acid-base status; HCO3- represents the
metabolic (renal) component; and base excess quantifies metabolic deviation from normal.
Question 7: A patient with acute kidney injury has ABG results: pH 7.25, PaCO2 38 mmHg,
HCO3- 16 mEq/L. Which compensatory mechanism should the nurse expect?
A. Hyperventilation to decrease PaCO2
B. Hypoventilation to increase PaCO2
C. Renal excretion of bicarbonate
D. Increased reabsorption of hydrogen ions
CORRECT ANSWER: A. Hyperventilation to decrease PaCO2
,Rationale: The ABG shows metabolic acidosis (low pH, low HCO3-) with normal PaCO2,
indicating uncompensated or early compensated status. The respiratory system compensates
for metabolic acidosis by increasing ventilation (Kussmaul respirations) to blow off CO2,
lowering PaCO2 and raising pH toward normal. Renal compensation occurs more slowly and is
impaired in kidney injury.
Question 8: Which finding in a patient with respiratory acidosis requires immediate nursing
intervention?
A. PaCO2 of 50 mmHg
B. Oxygen saturation of 92% on room air
C. Confusion and lethargy
D. Bicarbonate level of 26 mEq/L
CORRECT ANSWER: C. Confusion and lethargy
Rationale: Confusion and lethargy indicate CO2 narcosis, a life-threatening complication of
severe respiratory acidosis where elevated PaCO2 depresses central nervous system function.
This requires immediate intervention such as improving ventilation. A PaCO2 of 50 mmHg is
elevated but may be chronic; oxygen saturation of 92% is acceptable; and bicarbonate of 26
mEq/L suggests compensation.
Question 9: A patient receiving loop diuretics develops muscle weakness and ECG changes.
Which acid-base imbalance should the nurse suspect?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
CORRECT ANSWER: B. Metabolic alkalosis
Rationale: Loop diuretics cause loss of potassium and chloride in urine, promoting hydrogen ion
excretion and bicarbonate retention, leading to metabolic alkalosis. Hypokalemia associated
with this imbalance causes muscle weakness and characteristic ECG changes (flattened T
waves, U waves). Metabolic acidosis would present with different electrolyte patterns and
symptoms.
Question 10: Which statement by a patient with chronic respiratory acidosis indicates
understanding of long-term management?
A. "I will limit my fluid intake to prevent fluid overload."
B. "I should use my bronchodilator before exercising."
C. "I need to breathe into a paper bag if I feel short of breath."
D. "I will take antacids daily to prevent stomach upset."
CORRECT ANSWER: B. "I should use my bronchodilator before exercising."
Rationale: Using bronchodilators prophylactically before activity helps maintain airway patency
and improve ventilation, which is essential for managing chronic respiratory acidosis in
conditions like COPD. Limiting fluids may thicken secretions; breathing into a paper bag is for
acute hyperventilation/respiratory alkalosis; and antacids could worsen metabolic alkalosis.
Question 11: A patient with disseminated intravascular coagulation (DIC) has a platelet count
of 45,000/mm³. Which nursing action is the priority?
, A. Administer aspirin for pain management
B. Apply firm pressure for 5-10 minutes after venipuncture
C. Encourage ambulation to prevent thrombus formation
D. Restrict vitamin K-containing foods
CORRECT ANSWER: B. Apply firm pressure for 5-10 minutes after venipuncture
Rationale: In DIC, thrombocytopenia increases bleeding risk. Applying prolonged pressure after
invasive procedures minimizes hemorrhage risk. Aspirin would further impair platelet function
and is contraindicated; ambulation could precipitate bleeding in thrombocytopenic patients;
and vitamin K restriction is not indicated as DIC involves consumption of clotting factors, not
vitamin K deficiency.
Question 12: Which laboratory finding is most characteristic of heparin-induced
thrombocytopenia (HIT)?
A. Platelet count decrease of 30% from baseline
B. Positive D-dimer with normal fibrinogen
C. Platelet count drop of 50% occurring 5-10 days after heparin initiation
D. Prolonged PT with normal aPTT
CORRECT ANSWER: C. Platelet count drop of 50% occurring 5-10 days after heparin initiation
Rationale: HIT typically presents with a platelet count decline of ≥50% from baseline, occurring
5-10 days after starting heparin (or sooner with prior exposure). This immune-mediated
reaction requires immediate heparin discontinuation. A 30% drop is not diagnostic; D-dimer
elevation is nonspecific; and PT/aPTT changes are not characteristic of HIT.
Question 13: A patient with idiopathic thrombocytopenic purpura (ITP) is prescribed
intravenous immunoglobulin (IVIG). What is the primary mechanism of action for this
therapy?
A. Stimulates platelet production in bone marrow
B. Blocks Fc receptors on macrophages, reducing platelet destruction
C. Provides clotting factors to enhance coagulation
D. Suppresses antibody production against platelets
CORRECT ANSWER: B. Blocks Fc receptors on macrophages, reducing platelet destruction
Rationale: IVIG works in ITP by saturating Fc receptors on reticuloendothelial macrophages,
preventing them from binding to and destroying antibody-coated platelets. This rapidly
increases platelet counts. IVIG does not directly stimulate platelet production, provide clotting
factors, or suppress antibody synthesis; corticosteroids address antibody production.
Question 14: Which assessment finding in a patient with thrombocytopenia requires
immediate notification of the healthcare provider?
A. Petechiae on the lower extremities
B. Platelet count of 75,000/mm³
C. New-onset headache and confusion
D. Mild epistaxis that resolves with pressure
CORRECT ANSWER: C. New-onset headache and confusion
Rationale: Headache and confusion in thrombocytopenia may indicate intracranial hemorrhage,
a life-threatening emergency requiring immediate intervention. Petechiae and mild epistaxis
Guide, Comprehensive Maternal Newborn Nursing Exam
Review, High-Yield NCLEX Questions with Detailed
Rationales, Obstetrics and Gynecology Nursing Concepts,
and Complete RN Success Resource for Guaranteed Exam
Performance
Question 1: A patient with chronic obstructive pulmonary disease (COPD) presents with
arterial blood gas results showing pH 7.32, PaCO2 58 mmHg, HCO3- 28 mEq/L, and PaO2 65
mmHg. How should the nurse interpret these findings?
A. Uncompensated respiratory alkalosis
B. Partially compensated respiratory acidosis
C. Fully compensated metabolic acidosis
D. Uncompensated metabolic alkalosis
CORRECT ANSWER: B. Partially compensated respiratory acidosis
Rationale: The ABG results demonstrate respiratory acidosis evidenced by low pH (<7.35) and
elevated PaCO2 (>45 mmHg), consistent with CO2 retention in COPD. The elevated HCO3- (28
mEq/L) indicates renal compensation is occurring, but because the pH remains abnormal,
compensation is partial rather than complete. This pattern is characteristic of chronic
respiratory conditions where the kidneys retain bicarbonate to buffer the acidosis over time.
Question 2: Which nursing intervention is the priority for a patient experiencing metabolic
acidosis secondary to diabetic ketoacidosis?
A. Administer sodium bicarbonate IV push
B. Initiate insulin therapy per protocol
C. Provide high-flow oxygen via non-rebreather mask
D. Restrict oral fluid intake
CORRECT ANSWER: B. Initiate insulin therapy per protocol
Rationale: In diabetic ketoacidosis, metabolic acidosis results from accumulation of ketones due
to insulin deficiency. The priority intervention is insulin administration to halt ketone
production, allow glucose utilization, and correct the underlying metabolic disturbance. Sodium
bicarbonate is rarely indicated and may worsen outcomes; oxygen is not the priority unless
hypoxemia is present; and fluid restriction would exacerbate dehydration common in DKA.
Question 3: A patient receiving mechanical ventilation has ABG results: pH 7.48, PaCO2 30
mmHg, HCO3- 22 mEq/L. Which action should the nurse anticipate?
A. Increase the respiratory rate on the ventilator
B. Decrease the tidal volume settings
C. Administer IV sodium bicarbonate
D. Reduce the FiO2 concentration
CORRECT ANSWER: B. Decrease the tidal volume settings
Rationale: The ABG indicates respiratory alkalosis (elevated pH, low PaCO2) likely due to
hyperventilation from excessive ventilator settings. Decreasing tidal volume or respiratory rate
reduces alveolar ventilation, allowing PaCO2 to rise toward normal and correcting the alkalosis.
Increasing respiratory rate would worsen alkalosis; bicarbonate is not indicated for respiratory
alkalosis; and FiO2 adjustments address oxygenation, not ventilation.
,Question 4: Which clinical manifestation would the nurse expect to assess in a patient with
severe metabolic alkalosis?
A. Kussmaul respirations
B. Muscle twitching and tetany
C. Bradycardia and hypotension
D. Flushed, warm skin
CORRECT ANSWER: B. Muscle twitching and tetany
Rationale: Metabolic alkalosis increases protein binding of calcium, reducing ionized calcium
levels and causing neuromuscular irritability manifested as muscle twitching, paresthesias, and
tetany. Kussmaul respirations occur in metabolic acidosis as a compensatory mechanism;
bradycardia is not characteristic; and flushed skin is more associated with fever or vasodilation
states.
Question 5: A patient with prolonged nasogastric suctioning is at highest risk for developing
which acid-base imbalance?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
CORRECT ANSWER: D. Metabolic alkalosis
Rationale: Nasogastric suctioning removes gastric acid (hydrochloric acid), leading to loss of
hydrogen ions and chloride, which causes metabolic alkalosis. The kidneys attempt
compensation by excreting bicarbonate, but ongoing losses perpetuate the imbalance.
Respiratory imbalances relate to ventilation issues; metabolic acidosis would result from acid
accumulation or bicarbonate loss via other routes.
Question 6: When reviewing arterial blood gases, which value indicates the respiratory
component of acid-base balance?
A. pH
B. PaCO2
C. HCO3-
D. Base excess
CORRECT ANSWER: B. PaCO2
Rationale: PaCO2 reflects the respiratory component of acid-base balance because carbon
dioxide combines with water to form carbonic acid, directly influencing pH. The lungs regulate
PaCO2 through ventilation. pH indicates overall acid-base status; HCO3- represents the
metabolic (renal) component; and base excess quantifies metabolic deviation from normal.
Question 7: A patient with acute kidney injury has ABG results: pH 7.25, PaCO2 38 mmHg,
HCO3- 16 mEq/L. Which compensatory mechanism should the nurse expect?
A. Hyperventilation to decrease PaCO2
B. Hypoventilation to increase PaCO2
C. Renal excretion of bicarbonate
D. Increased reabsorption of hydrogen ions
CORRECT ANSWER: A. Hyperventilation to decrease PaCO2
,Rationale: The ABG shows metabolic acidosis (low pH, low HCO3-) with normal PaCO2,
indicating uncompensated or early compensated status. The respiratory system compensates
for metabolic acidosis by increasing ventilation (Kussmaul respirations) to blow off CO2,
lowering PaCO2 and raising pH toward normal. Renal compensation occurs more slowly and is
impaired in kidney injury.
Question 8: Which finding in a patient with respiratory acidosis requires immediate nursing
intervention?
A. PaCO2 of 50 mmHg
B. Oxygen saturation of 92% on room air
C. Confusion and lethargy
D. Bicarbonate level of 26 mEq/L
CORRECT ANSWER: C. Confusion and lethargy
Rationale: Confusion and lethargy indicate CO2 narcosis, a life-threatening complication of
severe respiratory acidosis where elevated PaCO2 depresses central nervous system function.
This requires immediate intervention such as improving ventilation. A PaCO2 of 50 mmHg is
elevated but may be chronic; oxygen saturation of 92% is acceptable; and bicarbonate of 26
mEq/L suggests compensation.
Question 9: A patient receiving loop diuretics develops muscle weakness and ECG changes.
Which acid-base imbalance should the nurse suspect?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
CORRECT ANSWER: B. Metabolic alkalosis
Rationale: Loop diuretics cause loss of potassium and chloride in urine, promoting hydrogen ion
excretion and bicarbonate retention, leading to metabolic alkalosis. Hypokalemia associated
with this imbalance causes muscle weakness and characteristic ECG changes (flattened T
waves, U waves). Metabolic acidosis would present with different electrolyte patterns and
symptoms.
Question 10: Which statement by a patient with chronic respiratory acidosis indicates
understanding of long-term management?
A. "I will limit my fluid intake to prevent fluid overload."
B. "I should use my bronchodilator before exercising."
C. "I need to breathe into a paper bag if I feel short of breath."
D. "I will take antacids daily to prevent stomach upset."
CORRECT ANSWER: B. "I should use my bronchodilator before exercising."
Rationale: Using bronchodilators prophylactically before activity helps maintain airway patency
and improve ventilation, which is essential for managing chronic respiratory acidosis in
conditions like COPD. Limiting fluids may thicken secretions; breathing into a paper bag is for
acute hyperventilation/respiratory alkalosis; and antacids could worsen metabolic alkalosis.
Question 11: A patient with disseminated intravascular coagulation (DIC) has a platelet count
of 45,000/mm³. Which nursing action is the priority?
, A. Administer aspirin for pain management
B. Apply firm pressure for 5-10 minutes after venipuncture
C. Encourage ambulation to prevent thrombus formation
D. Restrict vitamin K-containing foods
CORRECT ANSWER: B. Apply firm pressure for 5-10 minutes after venipuncture
Rationale: In DIC, thrombocytopenia increases bleeding risk. Applying prolonged pressure after
invasive procedures minimizes hemorrhage risk. Aspirin would further impair platelet function
and is contraindicated; ambulation could precipitate bleeding in thrombocytopenic patients;
and vitamin K restriction is not indicated as DIC involves consumption of clotting factors, not
vitamin K deficiency.
Question 12: Which laboratory finding is most characteristic of heparin-induced
thrombocytopenia (HIT)?
A. Platelet count decrease of 30% from baseline
B. Positive D-dimer with normal fibrinogen
C. Platelet count drop of 50% occurring 5-10 days after heparin initiation
D. Prolonged PT with normal aPTT
CORRECT ANSWER: C. Platelet count drop of 50% occurring 5-10 days after heparin initiation
Rationale: HIT typically presents with a platelet count decline of ≥50% from baseline, occurring
5-10 days after starting heparin (or sooner with prior exposure). This immune-mediated
reaction requires immediate heparin discontinuation. A 30% drop is not diagnostic; D-dimer
elevation is nonspecific; and PT/aPTT changes are not characteristic of HIT.
Question 13: A patient with idiopathic thrombocytopenic purpura (ITP) is prescribed
intravenous immunoglobulin (IVIG). What is the primary mechanism of action for this
therapy?
A. Stimulates platelet production in bone marrow
B. Blocks Fc receptors on macrophages, reducing platelet destruction
C. Provides clotting factors to enhance coagulation
D. Suppresses antibody production against platelets
CORRECT ANSWER: B. Blocks Fc receptors on macrophages, reducing platelet destruction
Rationale: IVIG works in ITP by saturating Fc receptors on reticuloendothelial macrophages,
preventing them from binding to and destroying antibody-coated platelets. This rapidly
increases platelet counts. IVIG does not directly stimulate platelet production, provide clotting
factors, or suppress antibody synthesis; corticosteroids address antibody production.
Question 14: Which assessment finding in a patient with thrombocytopenia requires
immediate notification of the healthcare provider?
A. Petechiae on the lower extremities
B. Platelet count of 75,000/mm³
C. New-onset headache and confusion
D. Mild epistaxis that resolves with pressure
CORRECT ANSWER: C. New-onset headache and confusion
Rationale: Headache and confusion in thrombocytopenia may indicate intracranial hemorrhage,
a life-threatening emergency requiring immediate intervention. Petechiae and mild epistaxis
