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 acute decompensated heart failure is receiving intravenous furosemide at 10
mg/hour. The nurse notes a urine output of 20 mL over the past hour and the patient's blood
pressure is 88/56 mm Hg. Which action should the nurse take first?
A. Administer a 250 mL normal saline bolus over 15 minutes.
B. Hold the furosemide infusion and notify the provider.
C. Increase the furosemide infusion to 20 mg/hour.
D. Obtain a serum potassium level stat.
Answer: B
Rationale: The patient is hypotensive and oliguric despite furosemide, indicating possible hypovolemia or
worsening renal function. Continuing or increasing furosemide could exacerbate hypotension and renal
injury. Holding the infusion and notifying the provider is the safest immediate action. Saline bolus may
be considered but not without provider order; potassium level is important but not the priority.
2. A nurse is caring for a patient with a traumatic brain injury and an intracranial pressure (ICP)
monitor. The ICP is consistently 22-25 mm Hg. Which intervention has the highest priority to
reduce ICP?
A. Administer 100 mL of 3% hypertonic saline intravenously over 30 minutes.
B. Elevate the head of bed to 45 degrees and maintain midline head position.
C. Administer 50 grams of mannitol intravenously over 15 minutes.
D. Increase the ventilator rate to achieve a PaCO2 of 28 mm Hg.
Answer: B
Rationale: Elevating the head of bed to 30-45 degrees and maintaining midline head position facilitates
venous drainage and is a first-line, non-invasive intervention for elevated ICP. Hypertonic saline and
mannitol are osmotic therapies used if ICP remains elevated; however, they require provider orders and
have risks. Hyperventilation (PaCO2 < 30) is no longer recommended due to risk of cerebral ischemia.
3. A patient with chronic kidney disease stage 4 has a serum potassium of 6.2 mEq/L. The
electrocardiogram shows peaked T waves. Which medication should the nurse prepare to
administer first?
A. Sodium polystyrene sulfonate (Kayexalate) orally.
B. Intravenous calcium gluconate.
C. Intravenous regular insulin with D50W.
Page 1
,D. Intravenous sodium bicarbonate.
Answer: B
Rationale: In hyperkalemia with ECG changes (peaked T waves), the priority is to stabilize the cardiac
membrane to prevent arrhythmias. Intravenous calcium gluconate antagonizes the cardiac effects of
potassium. Insulin with dextrose and sodium bicarbonate shift potassium into cells but do not protect the
heart immediately. Kayexalate is a slow-acting removal method and not first-line in an emergency.
4. A patient receiving a continuous heparin infusion for deep vein thrombosis has an activated
partial thromboplastin time (aPTT) of 120 seconds (therapeutic range 60-80 seconds). The nurse
notes the patient has new-onset epistaxis and hematuria. What is the nurse's priority action?
A. Administer protamine sulfate per protocol.
B. Stop the heparin infusion immediately.
C. Apply pressure to the nose and monitor bleeding.
D. Draw a stat aPTT and complete blood count.
Answer: B
Rationale: The aPTT is supratherapeutic (120 seconds) and the patient has active bleeding. The
immediate priority is to stop the heparin infusion to prevent further bleeding. Protamine sulfate may be
administered but requires a provider order and is not the first action. Applying pressure and drawing
labs are important but secondary to discontinuing the anticoagulant.
5. A nurse is assessing a patient who has been on mechanical ventilation for 5 days. The patient
suddenly becomes agitated, has decreased breath sounds on the right side, and tracheal deviation
to the left. What should the nurse do first?
A. Obtain a stat chest x-ray.
B. Prepare for needle decompression at the 2nd intercostal space, midclavicular line.
C. Increase the FiO2 to 100% and call the provider.
D. Assess the patient's oxygen saturation and blood pressure.
Answer: B
Rationale: The presentation (sudden agitation, decreased breath sounds unilaterally, tracheal deviation
away from the affected side) is classic for tension pneumothorax. This is a life-threatening emergency
requiring immediate needle decompression. A chest x-ray would delay treatment; increasing FiO2 and
assessing vital signs are supportive but not the priority.
6. A patient with cirrhosis and ascites is admitted with confusion, asterixis, and a serum ammonia
level of 120 mcg/dL (normal 15-45 mcg/dL). Which intervention should the nurse question?
A. Administer lactulose 30 mL orally every 6 hours.
B. Administer a normal saline enema.
C. Insert a nasogastric tube for enteral nutrition.
D. Monitor the patient's level of consciousness hourly.
Answer: C
Rationale: The patient is experiencing hepatic encephalopathy. Nasogastric tube insertion increases the
risk of bleeding (due to coagulopathy) and may increase intracranial pressure; it is not indicated for
nutrition in this acute setting. Lactulose and enemas help reduce ammonia, and monitoring LOC is
Page 2
,essential. Enteral nutrition may be considered later but is not the priority now.
7. A patient with type 1 diabetes mellitus is admitted with diabetic ketoacidosis (DKA). Initial labs
show: pH 7.1, bicarbonate 10 mEq/L, glucose 650 mg/dL, potassium 5.8 mEq/L, and negative
troponin. The nurse starts an insulin infusion at 0.1 units/kg/hour. One hour later, the glucose is
480 mg/dL. What is the nurse's next action?
A. Continue the insulin infusion at the same rate.
B. Decrease the insulin infusion to 0.05 units/kg/hour.
C. Increase the insulin infusion to 0.2 units/kg/hour.
D. Add dextrose to the IV fluids and continue insulin.
Answer: A
Rationale: In DKA management, the goal is to decrease glucose by 50-75 mg/dL per hour. A drop from
650 to 480 mg/dL (170 mg/dL) in one hour is acceptable, though on the higher side. The insulin infusion
should be continued at the same rate until glucose reaches 250-300 mg/dL, then dextrose is added.
Decreasing or increasing the rate is not indicated. Adding dextrose now would be premature.
8. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
acute respiratory failure. Arterial blood gas results on room air: pH 7.25, PaCO2 65 mm Hg, PaO2
50 mm Hg, HCO3 28 mEq/L. Which intervention should the nurse anticipate first?
A. Initiate noninvasive positive pressure ventilation (NIPPV).
B. Administer oxygen via nasal cannula at 2 L/min.
C. Prepare for endotracheal intubation and mechanical ventilation.
D. Administer intravenous sodium bicarbonate.
Answer: A
Rationale: The ABG shows acute-on-chronic respiratory acidosis (pH 7.25, elevated PaCO2 with
compensatory HCO3). NIPPV is the first-line intervention for acute hypercapnic respiratory failure in
COPD, improving ventilation and reducing the need for intubation. Low-flow oxygen is needed but
alone will not address hypercapnia. Bicarbonate is not indicated for respiratory acidosis. Intubation is
reserved if NIPPV fails.
9. A patient is receiving a blood transfusion of packed red blood cells. Fifteen minutes into the
transfusion, the patient develops chills, lower back pain, and a temperature of 101.2°F (38.4°C).
The nurse stops the transfusion and maintains IV access with normal saline. Which action is most
important next?
A. Send the blood bag and tubing to the blood bank for analysis.
B. Administer acetaminophen 650 mg orally for fever.
C. Obtain a urine specimen to check for hemoglobinuria.
D. Document the vital signs and the patient's reaction.
Answer: A
Rationale: The symptoms suggest a febrile non-hemolytic transfusion reaction or possibly an acute
hemolytic reaction. After stopping the transfusion, the priority is to send the blood bag and tubing to the
blood bank for a clerical check and direct antiglobulin test to rule out hemolysis. Acetaminophen and
urine testing are important but secondary to the investigation. Documentation is ongoing but not the
most critical next step.
Page 3
, 10. A patient with a history of opioid use disorder is admitted for sepsis. The nurse notes the
patient's vital signs: heart rate 110, blood pressure 90/60, respiratory rate 8, oxygen saturation
90% on room air. The patient is somnolent and pupils are constricted. Which medication should
the nurse prepare to administer?
A. Naloxone 0.4 mg intravenously.
B. Flumazenil 0.2 mg intravenously.
C. Methylnaltrexone 8 mg subcutaneously.
D. Naltrexone 50 mg orally.
Answer: A
Rationale: The patient is exhibiting opioid overdose symptoms (respiratory depression, somnolence,
miosis) likely due to opioids used for pain or illicit use. Naloxone is the antidote that reverses opioid
effects. Flumazenil is for benzodiazepine overdose. Methylnaltrexone is for opioid-induced constipation.
Naltrexone is used for maintenance therapy and would not reverse acute overdose.
11. A patient presents with acute onset of confusion, tachypnea, and a serum pH of 7.28, PaCO2 30
mm Hg, and HCO3- 14 mEq/L. Which acid-base disturbance is primarily present, and what is the
most likely compensatory mechanism?
A. Metabolic acidosis with full respiratory compensation; expected PaCO2 = 1.5 × HCO3- + 8 ± 2
B. Metabolic acidosis with partial respiratory compensation; expected PaCO2 = HCO3- + 15
C. Respiratory alkalosis with metabolic compensation; expected HCO3- = 0.5 × PaCO2 + 24
D. Metabolic alkalosis with respiratory compensation; expected PaCO2 = 0.7 × HCO3- + 20
Answer: A
Rationale: The ABG shows metabolic acidosis (low pH, low HCO3-). Using Winter's formula, expected
PaCO2 = 1.5 × 14 + 8 ± 2 = 21 + 8 = 29, range 27-31; actual PaCO2 is 30, indicating appropriate
compensation. Option B uses an incorrect formula; C and D misinterpret the primary disorder.
12. In a patient with suspected sepsis, which biomarker is most specific for bacterial infection and
correlates with severity, and what is its primary limitation in clinical use?
A. Procalcitonin; limited by poor sensitivity in localized infections
B. C-reactive protein; limited by slow rise in early sepsis
C. Interleukin-6; limited by short half-life and assay variability
D. Lactate; limited by lack of specificity for infection
Answer: A
Rationale: Procalcitonin is more specific than CRP for bacterial infection and correlates with severity.
Its limitation is lower sensitivity in localized or early infections. CRP rises slowly and is nonspecific;
IL-6 has a short half-life; lactate indicates hypoperfusion but is not specific to infection.
13. A nurse is reviewing a patient's medication list and notes concurrent use of warfarin and
amiodarone. What is the primary pharmacokinetic interaction, and how should the nurse adjust
monitoring?
A. Amiodarone inhibits warfarin metabolism via CYP2C9, requiring increased INR monitoring and possible
warfarin dose reduction
Page 4
Latest Versions) with Solutions Newest Complete
Questions And Correct Detailed Answers| Already
Graded A+
1. A patient with acute decompensated heart failure is receiving intravenous furosemide at 10
mg/hour. The nurse notes a urine output of 20 mL over the past hour and the patient's blood
pressure is 88/56 mm Hg. Which action should the nurse take first?
A. Administer a 250 mL normal saline bolus over 15 minutes.
B. Hold the furosemide infusion and notify the provider.
C. Increase the furosemide infusion to 20 mg/hour.
D. Obtain a serum potassium level stat.
Answer: B
Rationale: The patient is hypotensive and oliguric despite furosemide, indicating possible hypovolemia or
worsening renal function. Continuing or increasing furosemide could exacerbate hypotension and renal
injury. Holding the infusion and notifying the provider is the safest immediate action. Saline bolus may
be considered but not without provider order; potassium level is important but not the priority.
2. A nurse is caring for a patient with a traumatic brain injury and an intracranial pressure (ICP)
monitor. The ICP is consistently 22-25 mm Hg. Which intervention has the highest priority to
reduce ICP?
A. Administer 100 mL of 3% hypertonic saline intravenously over 30 minutes.
B. Elevate the head of bed to 45 degrees and maintain midline head position.
C. Administer 50 grams of mannitol intravenously over 15 minutes.
D. Increase the ventilator rate to achieve a PaCO2 of 28 mm Hg.
Answer: B
Rationale: Elevating the head of bed to 30-45 degrees and maintaining midline head position facilitates
venous drainage and is a first-line, non-invasive intervention for elevated ICP. Hypertonic saline and
mannitol are osmotic therapies used if ICP remains elevated; however, they require provider orders and
have risks. Hyperventilation (PaCO2 < 30) is no longer recommended due to risk of cerebral ischemia.
3. A patient with chronic kidney disease stage 4 has a serum potassium of 6.2 mEq/L. The
electrocardiogram shows peaked T waves. Which medication should the nurse prepare to
administer first?
A. Sodium polystyrene sulfonate (Kayexalate) orally.
B. Intravenous calcium gluconate.
C. Intravenous regular insulin with D50W.
Page 1
,D. Intravenous sodium bicarbonate.
Answer: B
Rationale: In hyperkalemia with ECG changes (peaked T waves), the priority is to stabilize the cardiac
membrane to prevent arrhythmias. Intravenous calcium gluconate antagonizes the cardiac effects of
potassium. Insulin with dextrose and sodium bicarbonate shift potassium into cells but do not protect the
heart immediately. Kayexalate is a slow-acting removal method and not first-line in an emergency.
4. A patient receiving a continuous heparin infusion for deep vein thrombosis has an activated
partial thromboplastin time (aPTT) of 120 seconds (therapeutic range 60-80 seconds). The nurse
notes the patient has new-onset epistaxis and hematuria. What is the nurse's priority action?
A. Administer protamine sulfate per protocol.
B. Stop the heparin infusion immediately.
C. Apply pressure to the nose and monitor bleeding.
D. Draw a stat aPTT and complete blood count.
Answer: B
Rationale: The aPTT is supratherapeutic (120 seconds) and the patient has active bleeding. The
immediate priority is to stop the heparin infusion to prevent further bleeding. Protamine sulfate may be
administered but requires a provider order and is not the first action. Applying pressure and drawing
labs are important but secondary to discontinuing the anticoagulant.
5. A nurse is assessing a patient who has been on mechanical ventilation for 5 days. The patient
suddenly becomes agitated, has decreased breath sounds on the right side, and tracheal deviation
to the left. What should the nurse do first?
A. Obtain a stat chest x-ray.
B. Prepare for needle decompression at the 2nd intercostal space, midclavicular line.
C. Increase the FiO2 to 100% and call the provider.
D. Assess the patient's oxygen saturation and blood pressure.
Answer: B
Rationale: The presentation (sudden agitation, decreased breath sounds unilaterally, tracheal deviation
away from the affected side) is classic for tension pneumothorax. This is a life-threatening emergency
requiring immediate needle decompression. A chest x-ray would delay treatment; increasing FiO2 and
assessing vital signs are supportive but not the priority.
6. A patient with cirrhosis and ascites is admitted with confusion, asterixis, and a serum ammonia
level of 120 mcg/dL (normal 15-45 mcg/dL). Which intervention should the nurse question?
A. Administer lactulose 30 mL orally every 6 hours.
B. Administer a normal saline enema.
C. Insert a nasogastric tube for enteral nutrition.
D. Monitor the patient's level of consciousness hourly.
Answer: C
Rationale: The patient is experiencing hepatic encephalopathy. Nasogastric tube insertion increases the
risk of bleeding (due to coagulopathy) and may increase intracranial pressure; it is not indicated for
nutrition in this acute setting. Lactulose and enemas help reduce ammonia, and monitoring LOC is
Page 2
,essential. Enteral nutrition may be considered later but is not the priority now.
7. A patient with type 1 diabetes mellitus is admitted with diabetic ketoacidosis (DKA). Initial labs
show: pH 7.1, bicarbonate 10 mEq/L, glucose 650 mg/dL, potassium 5.8 mEq/L, and negative
troponin. The nurse starts an insulin infusion at 0.1 units/kg/hour. One hour later, the glucose is
480 mg/dL. What is the nurse's next action?
A. Continue the insulin infusion at the same rate.
B. Decrease the insulin infusion to 0.05 units/kg/hour.
C. Increase the insulin infusion to 0.2 units/kg/hour.
D. Add dextrose to the IV fluids and continue insulin.
Answer: A
Rationale: In DKA management, the goal is to decrease glucose by 50-75 mg/dL per hour. A drop from
650 to 480 mg/dL (170 mg/dL) in one hour is acceptable, though on the higher side. The insulin infusion
should be continued at the same rate until glucose reaches 250-300 mg/dL, then dextrose is added.
Decreasing or increasing the rate is not indicated. Adding dextrose now would be premature.
8. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
acute respiratory failure. Arterial blood gas results on room air: pH 7.25, PaCO2 65 mm Hg, PaO2
50 mm Hg, HCO3 28 mEq/L. Which intervention should the nurse anticipate first?
A. Initiate noninvasive positive pressure ventilation (NIPPV).
B. Administer oxygen via nasal cannula at 2 L/min.
C. Prepare for endotracheal intubation and mechanical ventilation.
D. Administer intravenous sodium bicarbonate.
Answer: A
Rationale: The ABG shows acute-on-chronic respiratory acidosis (pH 7.25, elevated PaCO2 with
compensatory HCO3). NIPPV is the first-line intervention for acute hypercapnic respiratory failure in
COPD, improving ventilation and reducing the need for intubation. Low-flow oxygen is needed but
alone will not address hypercapnia. Bicarbonate is not indicated for respiratory acidosis. Intubation is
reserved if NIPPV fails.
9. A patient is receiving a blood transfusion of packed red blood cells. Fifteen minutes into the
transfusion, the patient develops chills, lower back pain, and a temperature of 101.2°F (38.4°C).
The nurse stops the transfusion and maintains IV access with normal saline. Which action is most
important next?
A. Send the blood bag and tubing to the blood bank for analysis.
B. Administer acetaminophen 650 mg orally for fever.
C. Obtain a urine specimen to check for hemoglobinuria.
D. Document the vital signs and the patient's reaction.
Answer: A
Rationale: The symptoms suggest a febrile non-hemolytic transfusion reaction or possibly an acute
hemolytic reaction. After stopping the transfusion, the priority is to send the blood bag and tubing to the
blood bank for a clerical check and direct antiglobulin test to rule out hemolysis. Acetaminophen and
urine testing are important but secondary to the investigation. Documentation is ongoing but not the
most critical next step.
Page 3
, 10. A patient with a history of opioid use disorder is admitted for sepsis. The nurse notes the
patient's vital signs: heart rate 110, blood pressure 90/60, respiratory rate 8, oxygen saturation
90% on room air. The patient is somnolent and pupils are constricted. Which medication should
the nurse prepare to administer?
A. Naloxone 0.4 mg intravenously.
B. Flumazenil 0.2 mg intravenously.
C. Methylnaltrexone 8 mg subcutaneously.
D. Naltrexone 50 mg orally.
Answer: A
Rationale: The patient is exhibiting opioid overdose symptoms (respiratory depression, somnolence,
miosis) likely due to opioids used for pain or illicit use. Naloxone is the antidote that reverses opioid
effects. Flumazenil is for benzodiazepine overdose. Methylnaltrexone is for opioid-induced constipation.
Naltrexone is used for maintenance therapy and would not reverse acute overdose.
11. A patient presents with acute onset of confusion, tachypnea, and a serum pH of 7.28, PaCO2 30
mm Hg, and HCO3- 14 mEq/L. Which acid-base disturbance is primarily present, and what is the
most likely compensatory mechanism?
A. Metabolic acidosis with full respiratory compensation; expected PaCO2 = 1.5 × HCO3- + 8 ± 2
B. Metabolic acidosis with partial respiratory compensation; expected PaCO2 = HCO3- + 15
C. Respiratory alkalosis with metabolic compensation; expected HCO3- = 0.5 × PaCO2 + 24
D. Metabolic alkalosis with respiratory compensation; expected PaCO2 = 0.7 × HCO3- + 20
Answer: A
Rationale: The ABG shows metabolic acidosis (low pH, low HCO3-). Using Winter's formula, expected
PaCO2 = 1.5 × 14 + 8 ± 2 = 21 + 8 = 29, range 27-31; actual PaCO2 is 30, indicating appropriate
compensation. Option B uses an incorrect formula; C and D misinterpret the primary disorder.
12. In a patient with suspected sepsis, which biomarker is most specific for bacterial infection and
correlates with severity, and what is its primary limitation in clinical use?
A. Procalcitonin; limited by poor sensitivity in localized infections
B. C-reactive protein; limited by slow rise in early sepsis
C. Interleukin-6; limited by short half-life and assay variability
D. Lactate; limited by lack of specificity for infection
Answer: A
Rationale: Procalcitonin is more specific than CRP for bacterial infection and correlates with severity.
Its limitation is lower sensitivity in localized or early infections. CRP rises slowly and is nonspecific;
IL-6 has a short half-life; lactate indicates hypoperfusion but is not specific to infection.
13. A nurse is reviewing a patient's medication list and notes concurrent use of warfarin and
amiodarone. What is the primary pharmacokinetic interaction, and how should the nurse adjust
monitoring?
A. Amiodarone inhibits warfarin metabolism via CYP2C9, requiring increased INR monitoring and possible
warfarin dose reduction
Page 4
