NRSG 2350 EXAM 2 TEST BANK
INTEGRATED PATHOPHYSIOLOGY AND
PHARMACOLOGY PREMIUM 200-
QUESTION STUDY GUIDE WITH
RATIONALES GRADED A+
This comprehensive 200-question test bank delivers high-yield, NCLEX-style
application queries explicitly tailored for the NRSG 2350 Exam 2 curriculum. Each
question features an italicized correct answer paired with a bold-italicized critical
thinking rationale to guarantee a premium, self-contained study experience.
Perfect for nursing students seeking immediate conceptual mastery of advanced
fluid/electrolytes, multi-system shock, hematology/oncology emergencies, and
psychopharmacology protocols.
Module 1: Advanced Fluid, Electrolyte, and Acid-Base Imbalances
1. A patient with severe chronic obstructive pulmonary disease (COPD) presents
with a pH of 7.28, PaCO2 of 54 mmHg, and HCO3 of 25 mEq/L. Which acid-base
imbalance is present?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
Answer: C) Respiratory acidosis
Rationale: The low pH (<7.35) indicates acidosis, and the elevated PaCO2
(>45 mmHg) confirms a respiratory origin. The normal HCO3 shows that
renal compensation has not yet occurred or is incomplete.
2. A client is admitted with a serum sodium level of 118 mEq/L. Which nursing
intervention is the highest priority?
A) Encourage oral fluid intake of water.
B) Administer 3% hypertonic saline slowly via an infusion pump.
, C) Administer subcutaneous insulin.
D) Implement a low-sodium diet.
Answer: B) Administer 3% hypertonic saline slowly via an infusion pump.
Rationale: Severe hyponatremia (<120 mEq/L) puts the patient at extreme
risk for cerebral edema and seizures. Hypertonic saline must be
administered cautiously and slowly via an infusion pump to prevent central
pontine myelinolysis.
3. Which electrocardiogram (ECG) change should the nurse closely monitor for in a
patient with a serum potassium level of 6.2 mEq/L?
A) Prominent U waves
B) Prolonged QT interval
C) Tall, peaked T waves
D) ST-segment depression
Answer: C) Tall, peaked T waves
Rationale: Hyperkalemia (>5.0 mEq/L) causes characteristic ECG changes,
beginning with tall, peaked T waves, followed by prolonged PR intervals
and widened QRS complexes, which can progress to ventricular fibrillation.
4. A nurse evaluates a patient's laboratory values and notes a serum calcium level
of 7.1 mg/dL. Which clinical manifestation should the nurse expect to find?
A) Negative Chvostek's sign
B) Hyperreflexia and cramping
C) Constipation and lethargy
D) Hypoactive bowel sounds
Answer: B) Hyperreflexia and cramping
Rationale: Hypocalcemia (<8.5 mg/dL) increases neuromuscular excitability,
leading to tingling, muscle cramping, hyperreflexia, a positive Chvostek's
sign, and Trousseau's sign.
5. A patient with prolonged nasogastric (NG) suctioning is at risk for developing
which acid-base imbalance?
A) Respiratory acidosis
B) Respiratory alkalosis
C) Metabolic acidosis
D) Metabolic alkalosis
Answer: D) Metabolic alkalosis
Rationale: Nasogastric suctioning removes highly acidic gastric secretions
(hydrochloric acid), leading to a relative excess of bicarbonate ions in the
extracellular fluid and causing metabolic alkalosis.
,6. Which intravenous fluid is considered hypotonic and used to treat intracellular
dehydration?
A) 0.9% Normal Saline
B) Lactated Ringer's
C) 0.45% Normal Saline
D) 5% Dextrose in 0.9% Normal Saline
Answer: C) 0.45% Normal Saline
Rationale: 0.45% Normal Saline has an osmolality lower than plasma,
causing fluid to shift out of the intravascular space and into the cells to
correct cellular dehydration.
7. A patient with advanced chronic kidney disease presents with a serum
magnesium level of 3.4 mEq/L. Which assessment finding requires immediate
intervention?
A) Hyperactive deep tendon reflexes
B) Diminished or absent deep tendon reflexes
C) Tachycardia
D) Hypertension
Answer: B) Diminished or absent deep tendon reflexes
Rationale: Hypermagnesemia (>2.5 mEq/L) exerts a central nervous system
depressant effect, characteristically presenting with bradycardia,
hypotension, and diminished or completely absent deep tendon reflexes.
8. Which compensatory mechanism will the body initiate during a state of metabolic
acidosis?
A) Kidneys excrete more bicarbonate ions.
B) Hypoventilation to retain carbon dioxide.
C) Kussmaul respirations to blow off carbon dioxide.
D) Lungs retain oxygen to decrease blood pH.
Answer: C) Kussmaul respirations to blow off carbon dioxide.
Rationale: In metabolic acidosis, the respiratory system compensates by
increasing the rate and depth of breathing (Kussmaul respirations) to
eliminate carbon dioxide (an acid), thereby raising the blood pH back
toward normal.
9. A patient is prescribed intravenous potassium chloride (KCl) for hypokalemia.
What is the maximum safe infusion rate for a peripheral IV line?
A) 10 mEq/hour
B) 20 mEq/hour
C) 30 mEq/hour
D) 40 mEq/hour
Answer: A) 10 mEq/hour
, Rationale: To avoid local vein irritation, chemical phlebitis, and dangerous
cardiac arrhythmias, intravenous potassium should never exceed 10
mEq/hour when administered through a peripheral line.
10. A patient has a phosphorus level of 1.8 mg/dL. The nurse understands that this
condition is most commonly associated with which chronic issue?
A) Chronic alcoholism
B) Hypoparathyroidism
C) Renal failure
D) Vitamin D toxicity
Answer: A) Chronic alcoholism
Rationale: Hypophosphatemia (<2.5 mg/dL) is frequently observed in
chronic alcoholism due to malnutrition, poor dietary intake, and alcohol-
induced renal wasting of phosphorus.
Module 2: Advanced Cardiovascular Nursing & Hemodynamics
11. A nurse is caring for a patient with a pulmonary artery catheter. The patient's
central venous pressure (CVP) reading is 12 mmHg. How should the nurse
interpret this finding?
A) Hypovolemia
B) Fluid volume overload
C) Normal fluid status
D) Cardiogenic shock
Answer: B) Fluid volume overload
Rationale: Normal central venous pressure ranges from 2 to 6 mmHg. An
elevated CVP (>6 mmHg) indicates increased systemic venous volume,
right ventricular preload, or fluid volume overload.
12. A patient with acute myocardial infarction develops cardiogenic shock. Which
hemodynamic parameters would the nurse expect to see?
A) Increased Cardiac Output (CO) and decreased Pulmonary Artery Wedge
Pressure (PAWP)
B) Decreased CO and increased PAWP
C) Decreased CO and decreased Systemic Vascular Resistance (SVR)
D) Increased CO and increased SVR
Answer: B) Decreased CO and increased PAWP
Rationale: In cardiogenic shock, mechanical pump failure causes a severe
drop in Cardiac Output (CO). Blood backs up into the pulmonary
vasculature, resulting in an elevated Pulmonary Artery Wedge Pressure
(PAWP).
INTEGRATED PATHOPHYSIOLOGY AND
PHARMACOLOGY PREMIUM 200-
QUESTION STUDY GUIDE WITH
RATIONALES GRADED A+
This comprehensive 200-question test bank delivers high-yield, NCLEX-style
application queries explicitly tailored for the NRSG 2350 Exam 2 curriculum. Each
question features an italicized correct answer paired with a bold-italicized critical
thinking rationale to guarantee a premium, self-contained study experience.
Perfect for nursing students seeking immediate conceptual mastery of advanced
fluid/electrolytes, multi-system shock, hematology/oncology emergencies, and
psychopharmacology protocols.
Module 1: Advanced Fluid, Electrolyte, and Acid-Base Imbalances
1. A patient with severe chronic obstructive pulmonary disease (COPD) presents
with a pH of 7.28, PaCO2 of 54 mmHg, and HCO3 of 25 mEq/L. Which acid-base
imbalance is present?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
Answer: C) Respiratory acidosis
Rationale: The low pH (<7.35) indicates acidosis, and the elevated PaCO2
(>45 mmHg) confirms a respiratory origin. The normal HCO3 shows that
renal compensation has not yet occurred or is incomplete.
2. A client is admitted with a serum sodium level of 118 mEq/L. Which nursing
intervention is the highest priority?
A) Encourage oral fluid intake of water.
B) Administer 3% hypertonic saline slowly via an infusion pump.
, C) Administer subcutaneous insulin.
D) Implement a low-sodium diet.
Answer: B) Administer 3% hypertonic saline slowly via an infusion pump.
Rationale: Severe hyponatremia (<120 mEq/L) puts the patient at extreme
risk for cerebral edema and seizures. Hypertonic saline must be
administered cautiously and slowly via an infusion pump to prevent central
pontine myelinolysis.
3. Which electrocardiogram (ECG) change should the nurse closely monitor for in a
patient with a serum potassium level of 6.2 mEq/L?
A) Prominent U waves
B) Prolonged QT interval
C) Tall, peaked T waves
D) ST-segment depression
Answer: C) Tall, peaked T waves
Rationale: Hyperkalemia (>5.0 mEq/L) causes characteristic ECG changes,
beginning with tall, peaked T waves, followed by prolonged PR intervals
and widened QRS complexes, which can progress to ventricular fibrillation.
4. A nurse evaluates a patient's laboratory values and notes a serum calcium level
of 7.1 mg/dL. Which clinical manifestation should the nurse expect to find?
A) Negative Chvostek's sign
B) Hyperreflexia and cramping
C) Constipation and lethargy
D) Hypoactive bowel sounds
Answer: B) Hyperreflexia and cramping
Rationale: Hypocalcemia (<8.5 mg/dL) increases neuromuscular excitability,
leading to tingling, muscle cramping, hyperreflexia, a positive Chvostek's
sign, and Trousseau's sign.
5. A patient with prolonged nasogastric (NG) suctioning is at risk for developing
which acid-base imbalance?
A) Respiratory acidosis
B) Respiratory alkalosis
C) Metabolic acidosis
D) Metabolic alkalosis
Answer: D) Metabolic alkalosis
Rationale: Nasogastric suctioning removes highly acidic gastric secretions
(hydrochloric acid), leading to a relative excess of bicarbonate ions in the
extracellular fluid and causing metabolic alkalosis.
,6. Which intravenous fluid is considered hypotonic and used to treat intracellular
dehydration?
A) 0.9% Normal Saline
B) Lactated Ringer's
C) 0.45% Normal Saline
D) 5% Dextrose in 0.9% Normal Saline
Answer: C) 0.45% Normal Saline
Rationale: 0.45% Normal Saline has an osmolality lower than plasma,
causing fluid to shift out of the intravascular space and into the cells to
correct cellular dehydration.
7. A patient with advanced chronic kidney disease presents with a serum
magnesium level of 3.4 mEq/L. Which assessment finding requires immediate
intervention?
A) Hyperactive deep tendon reflexes
B) Diminished or absent deep tendon reflexes
C) Tachycardia
D) Hypertension
Answer: B) Diminished or absent deep tendon reflexes
Rationale: Hypermagnesemia (>2.5 mEq/L) exerts a central nervous system
depressant effect, characteristically presenting with bradycardia,
hypotension, and diminished or completely absent deep tendon reflexes.
8. Which compensatory mechanism will the body initiate during a state of metabolic
acidosis?
A) Kidneys excrete more bicarbonate ions.
B) Hypoventilation to retain carbon dioxide.
C) Kussmaul respirations to blow off carbon dioxide.
D) Lungs retain oxygen to decrease blood pH.
Answer: C) Kussmaul respirations to blow off carbon dioxide.
Rationale: In metabolic acidosis, the respiratory system compensates by
increasing the rate and depth of breathing (Kussmaul respirations) to
eliminate carbon dioxide (an acid), thereby raising the blood pH back
toward normal.
9. A patient is prescribed intravenous potassium chloride (KCl) for hypokalemia.
What is the maximum safe infusion rate for a peripheral IV line?
A) 10 mEq/hour
B) 20 mEq/hour
C) 30 mEq/hour
D) 40 mEq/hour
Answer: A) 10 mEq/hour
, Rationale: To avoid local vein irritation, chemical phlebitis, and dangerous
cardiac arrhythmias, intravenous potassium should never exceed 10
mEq/hour when administered through a peripheral line.
10. A patient has a phosphorus level of 1.8 mg/dL. The nurse understands that this
condition is most commonly associated with which chronic issue?
A) Chronic alcoholism
B) Hypoparathyroidism
C) Renal failure
D) Vitamin D toxicity
Answer: A) Chronic alcoholism
Rationale: Hypophosphatemia (<2.5 mg/dL) is frequently observed in
chronic alcoholism due to malnutrition, poor dietary intake, and alcohol-
induced renal wasting of phosphorus.
Module 2: Advanced Cardiovascular Nursing & Hemodynamics
11. A nurse is caring for a patient with a pulmonary artery catheter. The patient's
central venous pressure (CVP) reading is 12 mmHg. How should the nurse
interpret this finding?
A) Hypovolemia
B) Fluid volume overload
C) Normal fluid status
D) Cardiogenic shock
Answer: B) Fluid volume overload
Rationale: Normal central venous pressure ranges from 2 to 6 mmHg. An
elevated CVP (>6 mmHg) indicates increased systemic venous volume,
right ventricular preload, or fluid volume overload.
12. A patient with acute myocardial infarction develops cardiogenic shock. Which
hemodynamic parameters would the nurse expect to see?
A) Increased Cardiac Output (CO) and decreased Pulmonary Artery Wedge
Pressure (PAWP)
B) Decreased CO and increased PAWP
C) Decreased CO and decreased Systemic Vascular Resistance (SVR)
D) Increased CO and increased SVR
Answer: B) Decreased CO and increased PAWP
Rationale: In cardiogenic shock, mechanical pump failure causes a severe
drop in Cardiac Output (CO). Blood backs up into the pulmonary
vasculature, resulting in an elevated Pulmonary Artery Wedge Pressure
(PAWP).
