NSG 3100 Exam and Answers Practice Questions (2
Latest Versions) with Solutions Newest Complete
Questions And Correct Detailed Answers| Already
Graded A+
1. A patient with a history of chronic heart failure is admitted with acute dyspnea and pulmonary
edema. The provider orders intravenous furosemide 80 mg now. The patient's current medications
include digoxin 0.125 mg daily, lisinopril 20 mg daily, and metoprolol succinate 50 mg daily.
Which finding requires immediate action before administering the furosemide?
A. Serum potassium level of 4.0 mEq/L
B. Blood pressure 98/62 mm Hg
C. Heart rate 58 beats per minute
D. Respiratory rate 28 breaths per minute
Answer: B
Rationale: Furosemide can cause hypotension; with a BP of 98/62, the patient is already hypotensive,
and administering furosemide could precipitate hypoperfusion. Potassium 4.0 is normal, heart rate 58 is
bradycardic but not immediately dangerous, and tachypnea is expected in pulmonary edema. The
hypotension is the most urgent concern.
2. A patient receiving a continuous infusion of heparin for deep vein thrombosis has an aPTT of
110 seconds (therapeutic range 60-80 seconds). The nurse notes the patient has new-onset
hematuria and gingival bleeding. Which intervention should the nurse prioritize?
A. Administer vitamin K intravenously
B. Stop the heparin infusion and notify the provider
C. Decrease the heparin infusion rate by 50%
D. Apply pressure to the gingiva and continue monitoring
Answer: B
Rationale: The aPTT is supratherapeutic and the patient shows signs of bleeding (hematuria, gingival
bleeding), indicating heparin overdose. The priority is to stop the infusion immediately and notify the
provider for possible protamine sulfate administration. Vitamin K reverses warfarin, not heparin.
Decreasing the rate does not address the current overdose. Application of pressure is secondary to
stopping the infusion.
3. A patient with end-stage renal disease is admitted with hyperkalemia (serum potassium 6.8
mEq/L) and ECG changes showing peaked T waves. Which of the following interventions should
the nurse implement first?
A. Administer sodium polystyrene sulfonate (Kayexalate) orally
Page 1
,B. Prepare for emergency hemodialysis
C. Administer intravenous calcium gluconate
D. Administer intravenous regular insulin with dextrose
Answer: C
Rationale: In life-threatening hyperkalemia with ECG changes, the priority is to stabilize the cardiac
membrane. IV calcium gluconate does not lower potassium but protects the heart from arrhythmias.
Insulin+dextrose shifts potassium intracellularly but takes 15-30 minutes. Kayexalate works slowly and
is not first-line in emergencies. Hemodialysis is definitive but not immediately available.
4. A patient with a history of type 2 diabetes mellitus is admitted with diabetic ketoacidosis. The
initial blood glucose is 650 mg/dL, arterial pH 7.1, bicarbonate 12 mEq/L, and serum ketones
large. The provider orders an insulin infusion at 0.1 unit/kg/hour. Two hours later, the blood
glucose is 300 mg/dL. Which action should the nurse take?
A. Continue the insulin infusion at the same rate
B. Decrease the insulin infusion to 0.05 units/kg/hour
C. Discontinue the insulin infusion and start subcutaneous insulin
D. Add dextrose to the IV fluids and continue the insulin infusion at 0.1 unit/kg/hour
Answer: D
Rationale: In DKA, insulin is needed to correct acidosis even after glucose falls. When glucose reaches
~250-300 mg/dL, dextrose is added to prevent hypoglycemia while continuing insulin to clear ketones.
Decreasing or stopping insulin risks persistent acidosis. Subcutaneous insulin is not appropriate until
the patient is stable and ketoacidosis resolved.
5. A patient is receiving a blood transfusion of packed red blood cells. Fifteen minutes after the
start, the patient develops chills, fever (temperature 38.8°C), and low back pain. The nurse
suspects a hemolytic transfusion reaction. Which action should the nurse take first?
A. Administer diphenhydramine intramuscularly
B. Slow the transfusion rate and monitor vital signs
C. Stop the transfusion immediately and maintain IV access with normal saline
D. Obtain a urine specimen to check for hemoglobinuria
Answer: C
Rationale: For suspected acute hemolytic transfusion reaction, the priority is to stop the transfusion
immediately to prevent further hemolysis. IV access is maintained with normal saline for potential
hypotension and medication administration. Antihistamines are not first-line; slowing the transfusion is
dangerous. Urine collection is done after stopping, not before.
6. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
pneumonia. Arterial blood gases on room air show: pH 7.32, PaCO2 58 mm Hg, PaO2 55 mm Hg,
HCO3- 30 mEq/L. The nurse notes that the patient has been receiving oxygen at 2 L/min via nasal
cannula. Which interpretation of the ABG is correct?
A. Uncompensated respiratory alkalosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
Page 2
,D. Metabolic alkalosis with respiratory compensation
Answer: B
Rationale: pH 7.32 indicates acidosis. PaCO2 58 is elevated, pointing to respiratory acidosis. HCO3- 30
is elevated (normal 24), indicating metabolic compensation. Since pH is still acidic, compensation is
partial. Full compensation would normalize pH. The patient has chronic CO2 retention (elevated
HCO3- from renal compensation) but acute on chronic acidosis due to pneumonia.
7. A patient with a history of hypertension and atrial fibrillation is prescribed warfarin 5 mg daily.
The INR is 2.5. The patient reports taking ibuprofen 400 mg three times daily for joint pain.
Which of the following is the most appropriate nursing action?
A. Advise the patient to continue both medications as prescribed
B. Instruct the patient to stop warfarin immediately
C. Educate the patient about the increased risk of bleeding and recommend acetaminophen instead
D. Increase the warfarin dose to maintain therapeutic INR
Answer: C
Rationale: Ibuprofen (NSAID) increases bleeding risk by inhibiting platelet function and causing GI
irritation. The correct action is to educate the patient and suggest a safer alternative like
acetaminophen. Continuing both is unsafe. Stopping warfarin increases thromboembolic risk. Increasing
warfarin is not indicated; INR is therapeutic.
8. A patient with a history of bipolar disorder is admitted for a manic episode and is started on
lithium carbonate. The nurse reviews the patient's laboratory results: serum lithium 0.6 mEq/L,
serum sodium 138 mEq/L, BUN 12 mg/dL, creatinine 0.9 mg/dL. Which of the following findings
would require the nurse to hold the next dose of lithium?
A. Serum lithium level of 0.6 mEq/L
B. Serum sodium level of 138 mEq/L
C. BUN of 12 mg/dL
D. Therapeutic lithium level is 0.8-1.2 mEq/L; the current level is subtherapeutic
Answer: D
Rationale: The therapeutic range for acute mania is 0.8-1.2 mEq/L. A level of 0.6 is subtherapeutic, so
the nurse should not hold the dose; rather, the provider may increase the dose. Sodium 138 is normal,
BUN and creatinine are normal. The correct answer is the one that indicates the level is too low, which
is not a reason to hold the dose but to adjust upward.
9. A patient with a history of chronic kidney disease stage 4 (GFR 25 mL/min) is prescribed
metformin 500 mg twice daily for type 2 diabetes. Which action should the nurse take?
A. Administer the metformin as ordered
B. Hold the metformin and notify the provider
C. Administer half the dose (250 mg) twice daily
D. Administer metformin with a high-protein meal to reduce renal workload
Answer: B
Rationale: Metformin is contraindicated in patients with GFR <30 mL/min due to risk of lactic acidosis.
Stage 4 CKD (GFR 15-29) is a contraindication. The nurse should hold the medication and notify the
Page 3
, provider for an alternative. Administering any dose is unsafe. High-protein meals do not mitigate the
risk.
10. A patient with a history of cirrhosis and ascites is admitted with hepatic encephalopathy. The
provider orders lactulose 30 mL orally every 6 hours. The nurse notes the patient has four loose
stools per day. Which assessment finding indicates that the lactulose is effective?
A. Serum ammonia level of 80 mcg/dL
B. Stool pH of 5.5
C. Two to three soft stools per day
D. Absence of asterixis
Answer: D
Rationale: Lactulose works by acidifying the colon, trapping ammonia as ammonium in stool, and
reducing serum ammonia. The goal is 2-3 soft stools per day. Absence of asterixis (liver flap) indicates
improved encephalopathy. Serum ammonia of 80 is still elevated (normal 15-45). Stool pH of 5.5 is
acidic but not a direct measure of efficacy. The patient currently has four stools, which is excessive; the
dose may need reduction.
11. A patient with a history of chronic heart failure is admitted with acute decompensation. The
nurse reviews the latest evidence-based guidelines for management. Which combination of
pharmacological interventions is most appropriate for this patient, assuming no contraindications?
A. Initiate intravenous furosemide and titrate to achieve a urine output of at least 1 mL/kg/hr; add low-dose
dopamine for renal protection.
B. Start intravenous nitroglycerin for preload reduction and consider noninvasive ventilation if respiratory
distress is present; avoid routine use of inotropes unless refractory to diuretics.
C. Administer intravenous dobutamine to improve cardiac output, and begin oral metoprolol succinate once
euvolemic.
D. Use intravenous nesiritide as first-line therapy to reduce pulmonary capillary wedge pressure, and monitor
for hypotension.
Answer: B
Rationale: Current guidelines (ACC/AHA) recommend diuretics for volume overload, vasodilators (e.g.,
nitroglycerin) for preload reduction, and noninvasive ventilation for respiratory distress. Inotropes are
reserved for refractory cases due to increased mortality. Option A is incorrect because low-dose
dopamine does not provide renal protection. Option C includes early beta-blocker use, which is
contraindicated in acute decompensation. Option D is wrong because nesiritide is not first-line and
increases hypotension risk.
12. A nurse is caring for a patient receiving a continuous infusion of unfractionated heparin for
acute pulmonary embolism. The patient's activated partial thromboplastin time (aPTT) is 45
seconds (therapeutic range 60-80 seconds). Which action should the nurse take?
A. Increase the heparin infusion rate by 2 units/kg/hr and recheck aPTT in 6 hours.
B. Administer a bolus of 5000 units of heparin and increase the infusion rate by 4 units/kg/hr.
C. Hold the heparin infusion for 1 hour, then restart at the same rate.
D. Decrease the heparin infusion rate by 2 units/kg/hr because the patient is at risk for bleeding.
Page 4
Latest Versions) with Solutions Newest Complete
Questions And Correct Detailed Answers| Already
Graded A+
1. A patient with a history of chronic heart failure is admitted with acute dyspnea and pulmonary
edema. The provider orders intravenous furosemide 80 mg now. The patient's current medications
include digoxin 0.125 mg daily, lisinopril 20 mg daily, and metoprolol succinate 50 mg daily.
Which finding requires immediate action before administering the furosemide?
A. Serum potassium level of 4.0 mEq/L
B. Blood pressure 98/62 mm Hg
C. Heart rate 58 beats per minute
D. Respiratory rate 28 breaths per minute
Answer: B
Rationale: Furosemide can cause hypotension; with a BP of 98/62, the patient is already hypotensive,
and administering furosemide could precipitate hypoperfusion. Potassium 4.0 is normal, heart rate 58 is
bradycardic but not immediately dangerous, and tachypnea is expected in pulmonary edema. The
hypotension is the most urgent concern.
2. A patient receiving a continuous infusion of heparin for deep vein thrombosis has an aPTT of
110 seconds (therapeutic range 60-80 seconds). The nurse notes the patient has new-onset
hematuria and gingival bleeding. Which intervention should the nurse prioritize?
A. Administer vitamin K intravenously
B. Stop the heparin infusion and notify the provider
C. Decrease the heparin infusion rate by 50%
D. Apply pressure to the gingiva and continue monitoring
Answer: B
Rationale: The aPTT is supratherapeutic and the patient shows signs of bleeding (hematuria, gingival
bleeding), indicating heparin overdose. The priority is to stop the infusion immediately and notify the
provider for possible protamine sulfate administration. Vitamin K reverses warfarin, not heparin.
Decreasing the rate does not address the current overdose. Application of pressure is secondary to
stopping the infusion.
3. A patient with end-stage renal disease is admitted with hyperkalemia (serum potassium 6.8
mEq/L) and ECG changes showing peaked T waves. Which of the following interventions should
the nurse implement first?
A. Administer sodium polystyrene sulfonate (Kayexalate) orally
Page 1
,B. Prepare for emergency hemodialysis
C. Administer intravenous calcium gluconate
D. Administer intravenous regular insulin with dextrose
Answer: C
Rationale: In life-threatening hyperkalemia with ECG changes, the priority is to stabilize the cardiac
membrane. IV calcium gluconate does not lower potassium but protects the heart from arrhythmias.
Insulin+dextrose shifts potassium intracellularly but takes 15-30 minutes. Kayexalate works slowly and
is not first-line in emergencies. Hemodialysis is definitive but not immediately available.
4. A patient with a history of type 2 diabetes mellitus is admitted with diabetic ketoacidosis. The
initial blood glucose is 650 mg/dL, arterial pH 7.1, bicarbonate 12 mEq/L, and serum ketones
large. The provider orders an insulin infusion at 0.1 unit/kg/hour. Two hours later, the blood
glucose is 300 mg/dL. Which action should the nurse take?
A. Continue the insulin infusion at the same rate
B. Decrease the insulin infusion to 0.05 units/kg/hour
C. Discontinue the insulin infusion and start subcutaneous insulin
D. Add dextrose to the IV fluids and continue the insulin infusion at 0.1 unit/kg/hour
Answer: D
Rationale: In DKA, insulin is needed to correct acidosis even after glucose falls. When glucose reaches
~250-300 mg/dL, dextrose is added to prevent hypoglycemia while continuing insulin to clear ketones.
Decreasing or stopping insulin risks persistent acidosis. Subcutaneous insulin is not appropriate until
the patient is stable and ketoacidosis resolved.
5. A patient is receiving a blood transfusion of packed red blood cells. Fifteen minutes after the
start, the patient develops chills, fever (temperature 38.8°C), and low back pain. The nurse
suspects a hemolytic transfusion reaction. Which action should the nurse take first?
A. Administer diphenhydramine intramuscularly
B. Slow the transfusion rate and monitor vital signs
C. Stop the transfusion immediately and maintain IV access with normal saline
D. Obtain a urine specimen to check for hemoglobinuria
Answer: C
Rationale: For suspected acute hemolytic transfusion reaction, the priority is to stop the transfusion
immediately to prevent further hemolysis. IV access is maintained with normal saline for potential
hypotension and medication administration. Antihistamines are not first-line; slowing the transfusion is
dangerous. Urine collection is done after stopping, not before.
6. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
pneumonia. Arterial blood gases on room air show: pH 7.32, PaCO2 58 mm Hg, PaO2 55 mm Hg,
HCO3- 30 mEq/L. The nurse notes that the patient has been receiving oxygen at 2 L/min via nasal
cannula. Which interpretation of the ABG is correct?
A. Uncompensated respiratory alkalosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
Page 2
,D. Metabolic alkalosis with respiratory compensation
Answer: B
Rationale: pH 7.32 indicates acidosis. PaCO2 58 is elevated, pointing to respiratory acidosis. HCO3- 30
is elevated (normal 24), indicating metabolic compensation. Since pH is still acidic, compensation is
partial. Full compensation would normalize pH. The patient has chronic CO2 retention (elevated
HCO3- from renal compensation) but acute on chronic acidosis due to pneumonia.
7. A patient with a history of hypertension and atrial fibrillation is prescribed warfarin 5 mg daily.
The INR is 2.5. The patient reports taking ibuprofen 400 mg three times daily for joint pain.
Which of the following is the most appropriate nursing action?
A. Advise the patient to continue both medications as prescribed
B. Instruct the patient to stop warfarin immediately
C. Educate the patient about the increased risk of bleeding and recommend acetaminophen instead
D. Increase the warfarin dose to maintain therapeutic INR
Answer: C
Rationale: Ibuprofen (NSAID) increases bleeding risk by inhibiting platelet function and causing GI
irritation. The correct action is to educate the patient and suggest a safer alternative like
acetaminophen. Continuing both is unsafe. Stopping warfarin increases thromboembolic risk. Increasing
warfarin is not indicated; INR is therapeutic.
8. A patient with a history of bipolar disorder is admitted for a manic episode and is started on
lithium carbonate. The nurse reviews the patient's laboratory results: serum lithium 0.6 mEq/L,
serum sodium 138 mEq/L, BUN 12 mg/dL, creatinine 0.9 mg/dL. Which of the following findings
would require the nurse to hold the next dose of lithium?
A. Serum lithium level of 0.6 mEq/L
B. Serum sodium level of 138 mEq/L
C. BUN of 12 mg/dL
D. Therapeutic lithium level is 0.8-1.2 mEq/L; the current level is subtherapeutic
Answer: D
Rationale: The therapeutic range for acute mania is 0.8-1.2 mEq/L. A level of 0.6 is subtherapeutic, so
the nurse should not hold the dose; rather, the provider may increase the dose. Sodium 138 is normal,
BUN and creatinine are normal. The correct answer is the one that indicates the level is too low, which
is not a reason to hold the dose but to adjust upward.
9. A patient with a history of chronic kidney disease stage 4 (GFR 25 mL/min) is prescribed
metformin 500 mg twice daily for type 2 diabetes. Which action should the nurse take?
A. Administer the metformin as ordered
B. Hold the metformin and notify the provider
C. Administer half the dose (250 mg) twice daily
D. Administer metformin with a high-protein meal to reduce renal workload
Answer: B
Rationale: Metformin is contraindicated in patients with GFR <30 mL/min due to risk of lactic acidosis.
Stage 4 CKD (GFR 15-29) is a contraindication. The nurse should hold the medication and notify the
Page 3
, provider for an alternative. Administering any dose is unsafe. High-protein meals do not mitigate the
risk.
10. A patient with a history of cirrhosis and ascites is admitted with hepatic encephalopathy. The
provider orders lactulose 30 mL orally every 6 hours. The nurse notes the patient has four loose
stools per day. Which assessment finding indicates that the lactulose is effective?
A. Serum ammonia level of 80 mcg/dL
B. Stool pH of 5.5
C. Two to three soft stools per day
D. Absence of asterixis
Answer: D
Rationale: Lactulose works by acidifying the colon, trapping ammonia as ammonium in stool, and
reducing serum ammonia. The goal is 2-3 soft stools per day. Absence of asterixis (liver flap) indicates
improved encephalopathy. Serum ammonia of 80 is still elevated (normal 15-45). Stool pH of 5.5 is
acidic but not a direct measure of efficacy. The patient currently has four stools, which is excessive; the
dose may need reduction.
11. A patient with a history of chronic heart failure is admitted with acute decompensation. The
nurse reviews the latest evidence-based guidelines for management. Which combination of
pharmacological interventions is most appropriate for this patient, assuming no contraindications?
A. Initiate intravenous furosemide and titrate to achieve a urine output of at least 1 mL/kg/hr; add low-dose
dopamine for renal protection.
B. Start intravenous nitroglycerin for preload reduction and consider noninvasive ventilation if respiratory
distress is present; avoid routine use of inotropes unless refractory to diuretics.
C. Administer intravenous dobutamine to improve cardiac output, and begin oral metoprolol succinate once
euvolemic.
D. Use intravenous nesiritide as first-line therapy to reduce pulmonary capillary wedge pressure, and monitor
for hypotension.
Answer: B
Rationale: Current guidelines (ACC/AHA) recommend diuretics for volume overload, vasodilators (e.g.,
nitroglycerin) for preload reduction, and noninvasive ventilation for respiratory distress. Inotropes are
reserved for refractory cases due to increased mortality. Option A is incorrect because low-dose
dopamine does not provide renal protection. Option C includes early beta-blocker use, which is
contraindicated in acute decompensation. Option D is wrong because nesiritide is not first-line and
increases hypotension risk.
12. A nurse is caring for a patient receiving a continuous infusion of unfractionated heparin for
acute pulmonary embolism. The patient's activated partial thromboplastin time (aPTT) is 45
seconds (therapeutic range 60-80 seconds). Which action should the nurse take?
A. Increase the heparin infusion rate by 2 units/kg/hr and recheck aPTT in 6 hours.
B. Administer a bolus of 5000 units of heparin and increase the infusion rate by 4 units/kg/hr.
C. Hold the heparin infusion for 1 hour, then restart at the same rate.
D. Decrease the heparin infusion rate by 2 units/kg/hr because the patient is at risk for bleeding.
Page 4
