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 respiratory distress syndrome (ARDS) is on volume-controlled ventilation
with a plateau pressure of 32 cm H2O and a PaO2/FiO2 ratio of 150. The nurse notes a sudden
drop in oxygen saturation and an increase in peak inspiratory pressure to 45 cm H2O, while
plateau pressure remains at 32 cm H2O. Which complication should the nurse suspect?
A. Pneumothorax
B. Mainstem bronchus intubation
C. Pulmonary embolism
D. Mucus plugging
Answer: D
Rationale: In ARDS, a sudden increase in peak pressure with unchanged plateau pressure suggests
increased airway resistance, commonly due to mucus plugging or bronchospasm. Pneumothorax would
increase both peak and plateau pressures. Mainstem intubation would cause a sudden drop in SpO2 but
not necessarily a pressure change pattern. Pulmonary embolism typically doesn't cause acute pressure
changes.
2. A patient with decompensated heart failure is receiving intravenous furosemide 80 mg twice
daily. The nurse reviews the latest lab results: serum potassium 3.1 mEq/L, creatinine 1.8 mg/dL
(baseline 1.0), and BUN 45 mg/dL. Which intervention is most appropriate?
A. Hold furosemide and administer potassium chloride 40 mEq IV over 1 hour
B. Administer furosemide as prescribed and give potassium chloride 40 mEq PO
C. Hold furosemide and notify the provider of the potassium and creatinine levels
D. Administer furosemide and repeat labs in 4 hours
Answer: C
Rationale: The patient has hypokalemia (K+ 3.1) and acute kidney injury (creatinine rise from 1.0 to 1.8).
Furosemide can worsen hypokalemia and renal function. The safest action is to hold the diuretic and
notify the provider for possible dose adjustment or alternative therapy. Rapid IV potassium replacement
is dangerous without continuous monitoring; oral potassium may be insufficient. Administering
furosemide could exacerbate hypokalemia and renal injury.
3. A patient with cirrhosis and ascites is admitted with altered mental status. Vital signs: BP 90/60,
HR 110, temp 38.5°C. Labs: ammonia 120 mcg/dL, INR 2.5, bilirubin 4.2 mg/dL. The nurse
prepares to administer lactulose. Which assessment finding indicates a therapeutic response?
Page 1
,A. Serum ammonia decreased to 80 mcg/dL
B. Patient has 2-3 soft stools per day
C. Patient's mental status returns to baseline
D. Bowel sounds become hyperactive
Answer: C
Rationale: Lactulose therapy for hepatic encephalopathy aims to reduce ammonia absorption and
improve mental status. While ammonia levels and stool frequency are monitored, the most critical
indicator of therapeutic effectiveness is improvement in the patient's neurologic status. Normalizing
stool frequency (2-3 soft stools) is a goal, but mental status improvement is the primary outcome.
Hyperactive bowel sounds are not a direct measure of encephalopathy resolution.
4. A patient with type 2 diabetes is started on metformin 500 mg twice daily. Three days later, the
patient develops abdominal discomfort, nausea, and diarrhea. The patient's eGFR is 55
mL/min/1.73 m². What is the nurse's best action?
A. Discontinue metformin and notify the provider immediately
B. Administer metformin with meals to reduce GI upset
C. Switch to metformin extended-release formulation
D. Hold metformin and obtain a lactic acid level
Answer: B
Rationale: GI side effects are common when initiating metformin and often subside with time.
Administering with meals can minimize these symptoms. The eGFR of 55 is above the threshold for
contraindication (usually <30). Discontinuation is not warranted. Switching to extended-release may
help but is not the first step. Lactic acidosis is rare and unlikely without other risk factors; checking
lactic acid is not indicated based solely on GI symptoms.
5. A patient with septic shock is receiving norepinephrine at 12 mcg/min and vasopressin at 0.04
units/min. The mean arterial pressure (MAP) is 58 mm Hg. The nurse anticipates which immediate
intervention?
A. Increase norepinephrine to 15 mcg/min
B. Administer a 500 mL bolus of normal saline
C. Start an infusion of dobutamine at 5 mcg/kg/min
D. Administer hydrocortisone 50 mg IV every 6 hours
Answer: B
Rationale: In septic shock with a MAP <65 despite vasopressors, the Surviving Sepsis Campaign
guidelines recommend fluid resuscitation as the first step, provided there is no evidence of fluid
overload. Increasing vasopressors without addressing hypovolemia may not be effective. Dobutamine is
used for myocardial dysfunction, not as first-line for hypotension. Hydrocortisone is considered if
vasopressor-dependent despite adequate fluids.
6. A patient with acute pancreatitis has a nasogastric tube to low intermittent suction. The nurse
notes that the patient's serum calcium is 7.2 mg/dL (ionized calcium 0.9 mmol/L). Which
assessment finding is most concerning?
A. Positive Chvostek sign
Page 2
,B. Prolonged QT interval on ECG
C. Muscle cramps in the calves
D. Numbness and tingling around the mouth
Answer: B
Rationale: Hypocalcemia in pancreatitis can lead to life-threatening cardiac arrhythmias. A prolonged
QT interval indicates a risk for torsades de pointes and requires immediate intervention. Chvostek sign,
muscle cramps, and perioral paresthesias are signs of hypocalcemia but are less immediately dangerous
than cardiac effects. The nurse should prioritize ECG monitoring and notify the provider for calcium
replacement.
7. A nurse is caring for a patient with a deep vein thrombosis (DVT) in the left lower extremity.
The patient is receiving a continuous heparin infusion. The aPTT is 90 seconds (therapeutic range
60-80). What action should the nurse take?
A. Increase the heparin infusion rate by 2 units/kg/hr
B. Decrease the heparin infusion rate per protocol
C. Stop the heparin infusion and administer protamine sulfate
D. Continue the current infusion rate and recheck aPTT in 6 hours
Answer: B
Rationale: An aPTT of 90 seconds is above the therapeutic range (supratherapeutic), indicating
increased bleeding risk. Per standard heparin protocols, the infusion rate should be decreased.
Increasing the rate would worsen the situation. Protamine sulfate is reserved for major bleeding or
emergency reversal, not for asymptomatic supratherapeutic aPTT. Continuing the same rate does not
address the elevated aPTT.
8. A patient with chronic kidney disease (CKD) stage 4 (eGFR 25 mL/min/1.73 m²) is prescribed
lisinopril 10 mg daily for hypertension. Which laboratory value requires the most immediate
attention?
A. Serum potassium 5.6 mEq/L
B. Serum creatinine 3.0 mg/dL (baseline 2.8)
C. Blood urea nitrogen 60 mg/dL
D. Hemoglobin 10.5 g/dL
Answer: A
Rationale: ACE inhibitors like lisinopril can cause hyperkalemia, especially in CKD. A potassium of 5.6
mEq/L is dangerously high and poses risk of cardiac arrhythmias. This requires immediate intervention
(e.g., hold lisinopril, administer potassium-binding resin). The creatinine increase is mild and expected
with ACE inhibitors. BUN elevation is common in CKD. Anemia is expected and not immediately
dangerous.
9. A patient with a traumatic brain injury (TBI) has an intracranial pressure (ICP) monitor
showing sustained ICP of 28 mm Hg for 10 minutes. The nurse intervenes by elevating the head of
bed to 30 degrees and administering mannitol 0.5 g/kg IV. Which additional action should the
nurse take?
Page 3
, A. Hyperventilate the patient to a PaCO2 of 25 mm Hg
B. Administer fentanyl 50 mcg IV for pain
C. Perform a neurological assessment every 15 minutes
D. Place the patient in a flat, supine position
Answer: B
Rationale: Elevated ICP can be exacerbated by pain and agitation. Administering an analgesic like
fentanyl can help reduce ICP by decreasing metabolic demand and sympathetic response.
Hyperventilation to PaCO2 <30 is not recommended due to risk of cerebral ischemia. Neurological
assessment is important but does not directly lower ICP. Flat supine position would increase ICP.
10. A patient with acute myeloid leukemia (AML) is receiving high-dose cytarabine. The nurse
monitors for signs of cerebellar toxicity. Which assessment finding is most indicative of this
adverse effect?
A. Nystagmus and dysmetria
B. Peripheral neuropathy in the feet
C. Slurred speech and confusion
D. Hearing loss and tinnitus
Answer: A
Rationale: High-dose cytarabine can cause cerebellar toxicity, characterized by nystagmus, dysmetria
(incoordination), ataxia, and dysarthria. Peripheral neuropathy is more common with vinca alkaloids.
Slurred speech and confusion are non-specific. Hearing loss is associated with platinum-based drugs.
Early recognition of cerebellar signs is critical to prevent irreversible damage.
11. A patient with chronic kidney disease (stage 4) is prescribed a medication that is primarily
excreted renally. The nurse reviews the medication list and notes that the patient is also taking an
ACE inhibitor and a loop diuretic. Which pharmacokinetic parameter is most likely altered in this
patient, necessitating a dosage adjustment of the renally excreted drug?
A. Increased volume of distribution due to fluid overload
B. Decreased hepatic metabolism due to uremic toxins
C. Reduced glomerular filtration rate leading to prolonged half-life
D. Enhanced bioavailability due to decreased first-pass effect
Answer: C
Rationale: In chronic kidney disease, reduced GFR decreases renal clearance, prolonging drug half-life.
Dosage adjustment is needed for renally excreted drugs to avoid toxicity. Volume of distribution changes
are less predictable, and hepatic metabolism is not the primary concern here.
12. A nurse is evaluating a patient's laboratory results and notes a serum potassium level of 5.8
mEq/L. The patient is receiving spironolactone and has a history of heart failure. Which of the
following electrocardiogram (ECG) findings is most consistent with this electrolyte imbalance?
A. Prolonged PR interval and peaked T waves
B. ST segment depression and U waves
C. Widened QRS complex and prolonged QT interval
D. Flattened T waves and prominent U waves
Page 4
Latest Versions) with Solutions Newest Complete
Questions And Correct Detailed Answers| Already
Graded A+
1. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled ventilation
with a plateau pressure of 32 cm H2O and a PaO2/FiO2 ratio of 150. The nurse notes a sudden
drop in oxygen saturation and an increase in peak inspiratory pressure to 45 cm H2O, while
plateau pressure remains at 32 cm H2O. Which complication should the nurse suspect?
A. Pneumothorax
B. Mainstem bronchus intubation
C. Pulmonary embolism
D. Mucus plugging
Answer: D
Rationale: In ARDS, a sudden increase in peak pressure with unchanged plateau pressure suggests
increased airway resistance, commonly due to mucus plugging or bronchospasm. Pneumothorax would
increase both peak and plateau pressures. Mainstem intubation would cause a sudden drop in SpO2 but
not necessarily a pressure change pattern. Pulmonary embolism typically doesn't cause acute pressure
changes.
2. A patient with decompensated heart failure is receiving intravenous furosemide 80 mg twice
daily. The nurse reviews the latest lab results: serum potassium 3.1 mEq/L, creatinine 1.8 mg/dL
(baseline 1.0), and BUN 45 mg/dL. Which intervention is most appropriate?
A. Hold furosemide and administer potassium chloride 40 mEq IV over 1 hour
B. Administer furosemide as prescribed and give potassium chloride 40 mEq PO
C. Hold furosemide and notify the provider of the potassium and creatinine levels
D. Administer furosemide and repeat labs in 4 hours
Answer: C
Rationale: The patient has hypokalemia (K+ 3.1) and acute kidney injury (creatinine rise from 1.0 to 1.8).
Furosemide can worsen hypokalemia and renal function. The safest action is to hold the diuretic and
notify the provider for possible dose adjustment or alternative therapy. Rapid IV potassium replacement
is dangerous without continuous monitoring; oral potassium may be insufficient. Administering
furosemide could exacerbate hypokalemia and renal injury.
3. A patient with cirrhosis and ascites is admitted with altered mental status. Vital signs: BP 90/60,
HR 110, temp 38.5°C. Labs: ammonia 120 mcg/dL, INR 2.5, bilirubin 4.2 mg/dL. The nurse
prepares to administer lactulose. Which assessment finding indicates a therapeutic response?
Page 1
,A. Serum ammonia decreased to 80 mcg/dL
B. Patient has 2-3 soft stools per day
C. Patient's mental status returns to baseline
D. Bowel sounds become hyperactive
Answer: C
Rationale: Lactulose therapy for hepatic encephalopathy aims to reduce ammonia absorption and
improve mental status. While ammonia levels and stool frequency are monitored, the most critical
indicator of therapeutic effectiveness is improvement in the patient's neurologic status. Normalizing
stool frequency (2-3 soft stools) is a goal, but mental status improvement is the primary outcome.
Hyperactive bowel sounds are not a direct measure of encephalopathy resolution.
4. A patient with type 2 diabetes is started on metformin 500 mg twice daily. Three days later, the
patient develops abdominal discomfort, nausea, and diarrhea. The patient's eGFR is 55
mL/min/1.73 m². What is the nurse's best action?
A. Discontinue metformin and notify the provider immediately
B. Administer metformin with meals to reduce GI upset
C. Switch to metformin extended-release formulation
D. Hold metformin and obtain a lactic acid level
Answer: B
Rationale: GI side effects are common when initiating metformin and often subside with time.
Administering with meals can minimize these symptoms. The eGFR of 55 is above the threshold for
contraindication (usually <30). Discontinuation is not warranted. Switching to extended-release may
help but is not the first step. Lactic acidosis is rare and unlikely without other risk factors; checking
lactic acid is not indicated based solely on GI symptoms.
5. A patient with septic shock is receiving norepinephrine at 12 mcg/min and vasopressin at 0.04
units/min. The mean arterial pressure (MAP) is 58 mm Hg. The nurse anticipates which immediate
intervention?
A. Increase norepinephrine to 15 mcg/min
B. Administer a 500 mL bolus of normal saline
C. Start an infusion of dobutamine at 5 mcg/kg/min
D. Administer hydrocortisone 50 mg IV every 6 hours
Answer: B
Rationale: In septic shock with a MAP <65 despite vasopressors, the Surviving Sepsis Campaign
guidelines recommend fluid resuscitation as the first step, provided there is no evidence of fluid
overload. Increasing vasopressors without addressing hypovolemia may not be effective. Dobutamine is
used for myocardial dysfunction, not as first-line for hypotension. Hydrocortisone is considered if
vasopressor-dependent despite adequate fluids.
6. A patient with acute pancreatitis has a nasogastric tube to low intermittent suction. The nurse
notes that the patient's serum calcium is 7.2 mg/dL (ionized calcium 0.9 mmol/L). Which
assessment finding is most concerning?
A. Positive Chvostek sign
Page 2
,B. Prolonged QT interval on ECG
C. Muscle cramps in the calves
D. Numbness and tingling around the mouth
Answer: B
Rationale: Hypocalcemia in pancreatitis can lead to life-threatening cardiac arrhythmias. A prolonged
QT interval indicates a risk for torsades de pointes and requires immediate intervention. Chvostek sign,
muscle cramps, and perioral paresthesias are signs of hypocalcemia but are less immediately dangerous
than cardiac effects. The nurse should prioritize ECG monitoring and notify the provider for calcium
replacement.
7. A nurse is caring for a patient with a deep vein thrombosis (DVT) in the left lower extremity.
The patient is receiving a continuous heparin infusion. The aPTT is 90 seconds (therapeutic range
60-80). What action should the nurse take?
A. Increase the heparin infusion rate by 2 units/kg/hr
B. Decrease the heparin infusion rate per protocol
C. Stop the heparin infusion and administer protamine sulfate
D. Continue the current infusion rate and recheck aPTT in 6 hours
Answer: B
Rationale: An aPTT of 90 seconds is above the therapeutic range (supratherapeutic), indicating
increased bleeding risk. Per standard heparin protocols, the infusion rate should be decreased.
Increasing the rate would worsen the situation. Protamine sulfate is reserved for major bleeding or
emergency reversal, not for asymptomatic supratherapeutic aPTT. Continuing the same rate does not
address the elevated aPTT.
8. A patient with chronic kidney disease (CKD) stage 4 (eGFR 25 mL/min/1.73 m²) is prescribed
lisinopril 10 mg daily for hypertension. Which laboratory value requires the most immediate
attention?
A. Serum potassium 5.6 mEq/L
B. Serum creatinine 3.0 mg/dL (baseline 2.8)
C. Blood urea nitrogen 60 mg/dL
D. Hemoglobin 10.5 g/dL
Answer: A
Rationale: ACE inhibitors like lisinopril can cause hyperkalemia, especially in CKD. A potassium of 5.6
mEq/L is dangerously high and poses risk of cardiac arrhythmias. This requires immediate intervention
(e.g., hold lisinopril, administer potassium-binding resin). The creatinine increase is mild and expected
with ACE inhibitors. BUN elevation is common in CKD. Anemia is expected and not immediately
dangerous.
9. A patient with a traumatic brain injury (TBI) has an intracranial pressure (ICP) monitor
showing sustained ICP of 28 mm Hg for 10 minutes. The nurse intervenes by elevating the head of
bed to 30 degrees and administering mannitol 0.5 g/kg IV. Which additional action should the
nurse take?
Page 3
, A. Hyperventilate the patient to a PaCO2 of 25 mm Hg
B. Administer fentanyl 50 mcg IV for pain
C. Perform a neurological assessment every 15 minutes
D. Place the patient in a flat, supine position
Answer: B
Rationale: Elevated ICP can be exacerbated by pain and agitation. Administering an analgesic like
fentanyl can help reduce ICP by decreasing metabolic demand and sympathetic response.
Hyperventilation to PaCO2 <30 is not recommended due to risk of cerebral ischemia. Neurological
assessment is important but does not directly lower ICP. Flat supine position would increase ICP.
10. A patient with acute myeloid leukemia (AML) is receiving high-dose cytarabine. The nurse
monitors for signs of cerebellar toxicity. Which assessment finding is most indicative of this
adverse effect?
A. Nystagmus and dysmetria
B. Peripheral neuropathy in the feet
C. Slurred speech and confusion
D. Hearing loss and tinnitus
Answer: A
Rationale: High-dose cytarabine can cause cerebellar toxicity, characterized by nystagmus, dysmetria
(incoordination), ataxia, and dysarthria. Peripheral neuropathy is more common with vinca alkaloids.
Slurred speech and confusion are non-specific. Hearing loss is associated with platinum-based drugs.
Early recognition of cerebellar signs is critical to prevent irreversible damage.
11. A patient with chronic kidney disease (stage 4) is prescribed a medication that is primarily
excreted renally. The nurse reviews the medication list and notes that the patient is also taking an
ACE inhibitor and a loop diuretic. Which pharmacokinetic parameter is most likely altered in this
patient, necessitating a dosage adjustment of the renally excreted drug?
A. Increased volume of distribution due to fluid overload
B. Decreased hepatic metabolism due to uremic toxins
C. Reduced glomerular filtration rate leading to prolonged half-life
D. Enhanced bioavailability due to decreased first-pass effect
Answer: C
Rationale: In chronic kidney disease, reduced GFR decreases renal clearance, prolonging drug half-life.
Dosage adjustment is needed for renally excreted drugs to avoid toxicity. Volume of distribution changes
are less predictable, and hepatic metabolism is not the primary concern here.
12. A nurse is evaluating a patient's laboratory results and notes a serum potassium level of 5.8
mEq/L. The patient is receiving spironolactone and has a history of heart failure. Which of the
following electrocardiogram (ECG) findings is most consistent with this electrolyte imbalance?
A. Prolonged PR interval and peaked T waves
B. ST segment depression and U waves
C. Widened QRS complex and prolonged QT interval
D. Flattened T waves and prominent U waves
Page 4
