Complete NSG 3800 Exam 2 study guide for
2026-2027. Includes exam-style questions, answers,
and detailed rationales. Designed to help you pass
confidently and achieve top grades.
1. A patient with septic shock has a pulmonary artery catheter in place. The nurse notes a cardiac
index (CI) of 1.8 L/min/m², pulmonary artery wedge pressure (PAWP) of 6 mm Hg, and systemic
vascular resistance (SVR) of 800 dynes-sec-cm. Which intervention should the nurse prioritize?
A. Administer intravenous norepinephrine to increase SVR.
B. Administer a fluid bolus of 500 mL crystalloid and reassess CI.
C. Start dobutamine infusion to increase cardiac contractility.
D. Prepare for intra-aortic balloon pump insertion.
Answer: B
Rationale: The low PAWP (6 mm Hg) indicates hypovolemia, and the low CI suggests inadequate preload.
Fluid resuscitation is the priority to improve CI and perfusion. Norepinephrine may be added later if
hypotension persists, but initial hypovolemia must be corrected. Dobutamine is not first-line without
adequate preload. IABP is used for cardiogenic shock, not septic shock.
2. A patient on volume-controlled ventilation has the following alarm: high peak inspiratory
pressure (PIP) of 40 cm HO. Which action should the nurse take first?
A. Suction the endotracheal tube.
B. Check for ventilator circuit kinking or water in the tubing.
C. Increase the tidal volume setting.
D. Administer a bronchodilator as prescribed.
Answer: B
Rationale: High PIP can result from increased airway resistance or decreased lung compliance. The first
step is to rule out mechanical issues in the circuit (kinks, water) before intervening on the patient.
Suctioning or bronchodilators may be needed later if the problem is patient-related. Increasing tidal
volume would worsen PIP.
3. A patient with acute respiratory distress syndrome (ARDS) is on a lung-protective ventilation
strategy with tidal volume 6 mL/kg ideal body weight and plateau pressure 28 cm HO. Arterial
blood gas shows pH 7.30, PaCO 50 mm Hg, PaO 60 mm Hg on FiO 0.7. Which adjustment is most
appropriate?
A. Increase tidal volume to 8 mL/kg to improve ventilation.
B. Increase positive end-expiratory pressure (PEEP) to improve oxygenation.
C. Decrease FiO to 0.5 to reduce oxygen toxicity risk.
Page 1
,D. Administer sodium bicarbonate to correct acidosis.
Answer: B
Rationale: In ARDS, permissive hypercapnia is accepted; the priority is oxygenation. Increasing PEEP
recruits alveoli and improves PaO, allowing FiO reduction. Increasing tidal volume would risk
volutrauma. Decreasing FiO without improving oxygenation is unsafe. Sodium bicarbonate is not
recommended for respiratory acidosis.
4. A patient with acute kidney injury (AKI) due to sepsis has a urine output of 0.3 mL/kg/hr over 6
hours, serum creatinine 3.2 mg/dL (baseline 1.0), and BUN 60 mg/dL. Which intervention should
the nurse question?
A. Administer furosemide 40 mg IV push.
B. Hold metformin as prescribed.
C. Prepare for continuous renal replacement therapy (CRRT).
D. Administer IV contrast for a CT scan.
Answer: D
Rationale: IV contrast is nephrotoxic and contraindicated in AKI. Furosemide may be used to manage
fluid overload, but not to treat AKI itself. Metformin should be held due to risk of lactic acidosis. CRRT
is indicated for severe AKI with oliguria and rising creatinine. The nurse should question contrast
administration.
5. A patient with heart failure (HFrEF) is receiving furosemide 80 mg IV twice daily. The nurse
notes a serum potassium of 3.1 mEq/L. Which action is most appropriate?
A. Hold furosemide and administer potassium chloride 40 mEq IV.
B. Continue furosemide and monitor potassium levels.
C. Replace potassium orally and decrease furosemide dose.
D. Administer spironolactone to counteract potassium loss.
Answer: A
Rationale: Hypokalemia (3.1 mEq/L) increases risk of dysrhythmias, especially with HF. Furosemide
should be held until potassium is corrected. IV potassium replacement is urgent. Continuing furosemide
would worsen hypokalemia. Spironolactone is a potassium-sparing diuretic but not for acute correction.
Decreasing dose is insufficient.
6. A patient with chronic pain on long-term opioid therapy (morphine extended-release 60 mg
twice daily) is admitted for acute pancreatitis. The patient rates pain as 8/10. Which pain
management approach is most appropriate?
A. Administer morphine 10 mg IV every 2 hours as needed.
B. Continue basal morphine and add immediate-release morphine for breakthrough pain.
C. Switch to a non-opioid analgesic to avoid respiratory depression.
D. Hold opioids and administer ketorolac 30 mg IV.
Answer: B
Rationale: Opioid-tolerant patients require continuation of baseline therapy plus additional analgesia for
acute pain. PRN only would cause withdrawal and inadequate control. Non-opioids alone are
insufficient. Ketorolac may be used adjunctively but not as sole therapy. Basal plus breakthrough is
Page 2
,standard.
7. A patient with cirrhosis and ascites develops acute confusion, asterixis, and a serum ammonia
level of 120 mcg/dL. Which intervention should the nurse implement first?
A. Administer lactulose 30 mL orally.
B. Start a protein-restricted diet.
C. Prepare for paracentesis.
D. Administer flumazenil.
Answer: A
Rationale: The patient has hepatic encephalopathy. Lactulose reduces ammonia absorption and is
first-line treatment. Protein restriction is no longer routinely recommended; moderate protein is
preferred. Paracentesis treats ascites, not encephalopathy. Flumazenil reverses benzodiazepine
overdose, not hepatic encephalopathy.
8. A patient with diabetic ketoacidosis (DKA) has a serum glucose of 600 mg/dL, pH 7.1,
bicarbonate 10 mEq/L, and potassium 5.5 mEq/L. Which intravenous fluid should the nurse
initiate?
A. 0.9% normal saline at 15 mL/kg/hr.
B. 5% dextrose in 0.45% normal saline.
C. Lactated Ringer's solution.
D. 0.45% normal saline at 250 mL/hr.
Answer: A
Rationale: Initial fluid resuscitation in DKA is with 0.9% normal saline to restore intravascular volume.
The rate is typically 15-20 mL/kg/hr. Dextrose is added later when glucose falls below 250 mg/dL.
Lactated Ringer's may worsen acidosis. 0.45% saline is hypotonic and not first-line for shock.
9. A patient with a history of hypertension and diabetes is admitted with chest pain. ECG shows
ST-segment depression in leads V3-V5. Troponin I is elevated. The patient is scheduled for cardiac
catheterization. Which medication should the nurse question?
A. Metformin 1000 mg orally twice daily.
B. Aspirin 325 mg orally now.
C. Heparin infusion per protocol.
D. Nitroglycerin 0.4 mg sublingual every 5 minutes for pain.
Answer: A
Rationale: Metformin should be held in patients undergoing procedures with contrast due to risk of lactic
acidosis. Aspirin, heparin, and nitroglycerin are standard for acute coronary syndrome. The nurse
should question the metformin order and clarify with the provider.
10. A patient with a history of heart failure (LVEF 35%) is admitted with dyspnea, jugular venous
distention, and bilateral crackles. The nurse reviews the medication list. Which order requires
clarification?
A. Furosemide 40 mg IV twice daily.
Page 3
, B. Lisinopril 10 mg orally daily.
C. Metoprolol succinate 100 mg orally daily.
D. Ibuprofen 600 mg orally every 6 hours as needed for pain.
Answer: D
Rationale: NSAIDs like ibuprofen cause sodium and water retention, worsening heart failure. They are
contraindicated in decompensated HF. Furosemide, lisinopril, and metoprolol are standard therapies.
The nurse should clarify the ibuprofen order.
11. A 45-year-old patient with type 2 diabetes and chronic kidney disease (stage 3) is admitted with
hyperkalemia (K+ 6.2 mEq/L). ECG shows peaked T waves. Which of the following interventions
should be prioritized first?
A. Administer intravenous calcium gluconate
B. Administer nebulized albuterol
C. Administer insulin and dextrose
D. Administer oral sodium polystyrene sulfonate
Answer: A
Rationale: Intravenous calcium gluconate is the first-line intervention for life-threatening hyperkalemia
(ECG changes) as it stabilizes the cardiac membrane. Albuterol and insulin/dextrose shift potassium
intracellularly but do not stabilize the myocardium. Sodium polystyrene sulfonate is slow-acting and not
for acute management.
12. Which of the following best explains the mechanism by which loop diuretics cause ototoxicity?
A. Direct inhibition of the Na-K-2Cl cotransporter in the stria vascularis
B. Induction of hypokalemia leading to cochlear ischemia
C. Binding to the potassium channel in hair cells
D. Inhibition of carbonic anhydrase in the inner ear
Answer: A
Rationale: Loop diuretics inhibit the Na-K-2Cl cotransporter in the thick ascending limb of Henle, but
also in the stria vascularis of the inner ear, disrupting ion gradients necessary for hair cell function. This
direct effect, not hypokalemia or carbonic anhydrase inhibition, causes ototoxicity.
13. A patient with heart failure with reduced ejection fraction (HFrEF) is started on
sacubitril/valsartan. Which of the following laboratory parameters requires the most vigilant
monitoring?
A. Serum potassium and creatinine
B. Serum sodium and glucose
C. Serum magnesium and calcium
D. Serum bicarbonate and albumin
Answer: A
Rationale: Sacubitril/valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI). Neprilysin
inhibition increases natriuretic peptides, which can cause hypotension and renal impairment; the ARB
component can cause hyperkalemia and acute kidney injury. Therefore, potassium and creatinine must
be monitored closely.
Page 4
2026-2027. Includes exam-style questions, answers,
and detailed rationales. Designed to help you pass
confidently and achieve top grades.
1. A patient with septic shock has a pulmonary artery catheter in place. The nurse notes a cardiac
index (CI) of 1.8 L/min/m², pulmonary artery wedge pressure (PAWP) of 6 mm Hg, and systemic
vascular resistance (SVR) of 800 dynes-sec-cm. Which intervention should the nurse prioritize?
A. Administer intravenous norepinephrine to increase SVR.
B. Administer a fluid bolus of 500 mL crystalloid and reassess CI.
C. Start dobutamine infusion to increase cardiac contractility.
D. Prepare for intra-aortic balloon pump insertion.
Answer: B
Rationale: The low PAWP (6 mm Hg) indicates hypovolemia, and the low CI suggests inadequate preload.
Fluid resuscitation is the priority to improve CI and perfusion. Norepinephrine may be added later if
hypotension persists, but initial hypovolemia must be corrected. Dobutamine is not first-line without
adequate preload. IABP is used for cardiogenic shock, not septic shock.
2. A patient on volume-controlled ventilation has the following alarm: high peak inspiratory
pressure (PIP) of 40 cm HO. Which action should the nurse take first?
A. Suction the endotracheal tube.
B. Check for ventilator circuit kinking or water in the tubing.
C. Increase the tidal volume setting.
D. Administer a bronchodilator as prescribed.
Answer: B
Rationale: High PIP can result from increased airway resistance or decreased lung compliance. The first
step is to rule out mechanical issues in the circuit (kinks, water) before intervening on the patient.
Suctioning or bronchodilators may be needed later if the problem is patient-related. Increasing tidal
volume would worsen PIP.
3. A patient with acute respiratory distress syndrome (ARDS) is on a lung-protective ventilation
strategy with tidal volume 6 mL/kg ideal body weight and plateau pressure 28 cm HO. Arterial
blood gas shows pH 7.30, PaCO 50 mm Hg, PaO 60 mm Hg on FiO 0.7. Which adjustment is most
appropriate?
A. Increase tidal volume to 8 mL/kg to improve ventilation.
B. Increase positive end-expiratory pressure (PEEP) to improve oxygenation.
C. Decrease FiO to 0.5 to reduce oxygen toxicity risk.
Page 1
,D. Administer sodium bicarbonate to correct acidosis.
Answer: B
Rationale: In ARDS, permissive hypercapnia is accepted; the priority is oxygenation. Increasing PEEP
recruits alveoli and improves PaO, allowing FiO reduction. Increasing tidal volume would risk
volutrauma. Decreasing FiO without improving oxygenation is unsafe. Sodium bicarbonate is not
recommended for respiratory acidosis.
4. A patient with acute kidney injury (AKI) due to sepsis has a urine output of 0.3 mL/kg/hr over 6
hours, serum creatinine 3.2 mg/dL (baseline 1.0), and BUN 60 mg/dL. Which intervention should
the nurse question?
A. Administer furosemide 40 mg IV push.
B. Hold metformin as prescribed.
C. Prepare for continuous renal replacement therapy (CRRT).
D. Administer IV contrast for a CT scan.
Answer: D
Rationale: IV contrast is nephrotoxic and contraindicated in AKI. Furosemide may be used to manage
fluid overload, but not to treat AKI itself. Metformin should be held due to risk of lactic acidosis. CRRT
is indicated for severe AKI with oliguria and rising creatinine. The nurse should question contrast
administration.
5. A patient with heart failure (HFrEF) is receiving furosemide 80 mg IV twice daily. The nurse
notes a serum potassium of 3.1 mEq/L. Which action is most appropriate?
A. Hold furosemide and administer potassium chloride 40 mEq IV.
B. Continue furosemide and monitor potassium levels.
C. Replace potassium orally and decrease furosemide dose.
D. Administer spironolactone to counteract potassium loss.
Answer: A
Rationale: Hypokalemia (3.1 mEq/L) increases risk of dysrhythmias, especially with HF. Furosemide
should be held until potassium is corrected. IV potassium replacement is urgent. Continuing furosemide
would worsen hypokalemia. Spironolactone is a potassium-sparing diuretic but not for acute correction.
Decreasing dose is insufficient.
6. A patient with chronic pain on long-term opioid therapy (morphine extended-release 60 mg
twice daily) is admitted for acute pancreatitis. The patient rates pain as 8/10. Which pain
management approach is most appropriate?
A. Administer morphine 10 mg IV every 2 hours as needed.
B. Continue basal morphine and add immediate-release morphine for breakthrough pain.
C. Switch to a non-opioid analgesic to avoid respiratory depression.
D. Hold opioids and administer ketorolac 30 mg IV.
Answer: B
Rationale: Opioid-tolerant patients require continuation of baseline therapy plus additional analgesia for
acute pain. PRN only would cause withdrawal and inadequate control. Non-opioids alone are
insufficient. Ketorolac may be used adjunctively but not as sole therapy. Basal plus breakthrough is
Page 2
,standard.
7. A patient with cirrhosis and ascites develops acute confusion, asterixis, and a serum ammonia
level of 120 mcg/dL. Which intervention should the nurse implement first?
A. Administer lactulose 30 mL orally.
B. Start a protein-restricted diet.
C. Prepare for paracentesis.
D. Administer flumazenil.
Answer: A
Rationale: The patient has hepatic encephalopathy. Lactulose reduces ammonia absorption and is
first-line treatment. Protein restriction is no longer routinely recommended; moderate protein is
preferred. Paracentesis treats ascites, not encephalopathy. Flumazenil reverses benzodiazepine
overdose, not hepatic encephalopathy.
8. A patient with diabetic ketoacidosis (DKA) has a serum glucose of 600 mg/dL, pH 7.1,
bicarbonate 10 mEq/L, and potassium 5.5 mEq/L. Which intravenous fluid should the nurse
initiate?
A. 0.9% normal saline at 15 mL/kg/hr.
B. 5% dextrose in 0.45% normal saline.
C. Lactated Ringer's solution.
D. 0.45% normal saline at 250 mL/hr.
Answer: A
Rationale: Initial fluid resuscitation in DKA is with 0.9% normal saline to restore intravascular volume.
The rate is typically 15-20 mL/kg/hr. Dextrose is added later when glucose falls below 250 mg/dL.
Lactated Ringer's may worsen acidosis. 0.45% saline is hypotonic and not first-line for shock.
9. A patient with a history of hypertension and diabetes is admitted with chest pain. ECG shows
ST-segment depression in leads V3-V5. Troponin I is elevated. The patient is scheduled for cardiac
catheterization. Which medication should the nurse question?
A. Metformin 1000 mg orally twice daily.
B. Aspirin 325 mg orally now.
C. Heparin infusion per protocol.
D. Nitroglycerin 0.4 mg sublingual every 5 minutes for pain.
Answer: A
Rationale: Metformin should be held in patients undergoing procedures with contrast due to risk of lactic
acidosis. Aspirin, heparin, and nitroglycerin are standard for acute coronary syndrome. The nurse
should question the metformin order and clarify with the provider.
10. A patient with a history of heart failure (LVEF 35%) is admitted with dyspnea, jugular venous
distention, and bilateral crackles. The nurse reviews the medication list. Which order requires
clarification?
A. Furosemide 40 mg IV twice daily.
Page 3
, B. Lisinopril 10 mg orally daily.
C. Metoprolol succinate 100 mg orally daily.
D. Ibuprofen 600 mg orally every 6 hours as needed for pain.
Answer: D
Rationale: NSAIDs like ibuprofen cause sodium and water retention, worsening heart failure. They are
contraindicated in decompensated HF. Furosemide, lisinopril, and metoprolol are standard therapies.
The nurse should clarify the ibuprofen order.
11. A 45-year-old patient with type 2 diabetes and chronic kidney disease (stage 3) is admitted with
hyperkalemia (K+ 6.2 mEq/L). ECG shows peaked T waves. Which of the following interventions
should be prioritized first?
A. Administer intravenous calcium gluconate
B. Administer nebulized albuterol
C. Administer insulin and dextrose
D. Administer oral sodium polystyrene sulfonate
Answer: A
Rationale: Intravenous calcium gluconate is the first-line intervention for life-threatening hyperkalemia
(ECG changes) as it stabilizes the cardiac membrane. Albuterol and insulin/dextrose shift potassium
intracellularly but do not stabilize the myocardium. Sodium polystyrene sulfonate is slow-acting and not
for acute management.
12. Which of the following best explains the mechanism by which loop diuretics cause ototoxicity?
A. Direct inhibition of the Na-K-2Cl cotransporter in the stria vascularis
B. Induction of hypokalemia leading to cochlear ischemia
C. Binding to the potassium channel in hair cells
D. Inhibition of carbonic anhydrase in the inner ear
Answer: A
Rationale: Loop diuretics inhibit the Na-K-2Cl cotransporter in the thick ascending limb of Henle, but
also in the stria vascularis of the inner ear, disrupting ion gradients necessary for hair cell function. This
direct effect, not hypokalemia or carbonic anhydrase inhibition, causes ototoxicity.
13. A patient with heart failure with reduced ejection fraction (HFrEF) is started on
sacubitril/valsartan. Which of the following laboratory parameters requires the most vigilant
monitoring?
A. Serum potassium and creatinine
B. Serum sodium and glucose
C. Serum magnesium and calcium
D. Serum bicarbonate and albumin
Answer: A
Rationale: Sacubitril/valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI). Neprilysin
inhibition increases natriuretic peptides, which can cause hypotension and renal impairment; the ARB
component can cause hyperkalemia and acute kidney injury. Therefore, potassium and creatinine must
be monitored closely.
Page 4
