NRSG 2350 EXAM 3 STUDY GUIDE 2026
COMPLETE QUESTIONS WITH CORRECT
DETAILED ANSWERS || 100% GUARANTEED
PASS LATEST VERSION
1. A patient with end-stage renal disease on hemodialysis presents with confusion, muscle
twitching, and a serum phosphate level of 7.2 mg/dL. The nurse reviews the medication
administration record. Which prescription should the nurse question?
A. Calcium acetate 1334 mg orally three times daily with meals
B. Sevelamer carbonate 800 mg orally three times daily with meals
C. Cinacalcet 30 mg orally once daily
D. Calcium carbonate 500 mg orally three times daily between meals
Answer: D
Rationale: Calcium carbonate given between meals increases calcium absorption without binding
phosphate, worsening hyperphosphatemia and risking vascular calcification. Calcium acetate and
sevelamer carbonate are phosphate binders given with meals. Cinacalcet lowers PTH but does not
directly address phosphate.
2. A patient receiving a continuous intravenous infusion of heparin for acute coronary syndrome
has an activated partial thromboplastin time (aPTT) of 120 seconds (therapeutic range 60-80
seconds). The nurse notes the patient has dark urine and flank pain. What is the priority nursing
action?
A. Administer protamine sulfate as prescribed
B. Stop the heparin infusion and notify the provider
C. Increase the rate of IV fluids to maintain urine output
D. Obtain a stat hemoglobin and hematocrit
Answer: B
Rationale: The supratherapeutic aPTT and symptoms (dark urine, flank pain) suggest heparin-induced
bleeding (e.g., retroperitoneal hemorrhage). Priority is to stop the infusion and notify the provider.
Protamine may be indicated but is not the first action; assessment and discontinuation come first.
3. A patient with type 2 diabetes mellitus is admitted for uncontrolled hyperglycemia (blood
glucose 450 mg/dL) and is started on an insulin drip. The nurse reviews the orders: 0.9% sodium
chloride at 250 mL/hr, regular insulin 0.1 units/kg/hr, and potassium chloride 20 mEq/L once
potassium is <5.0 mEq/L. Which assessment finding indicates that the current management plan
may need modification?
A. Serum potassium of 4.8 mEq/L
Page 1
,B. Urine output of 40 mL over the past hour
C. Serum osmolality of 310 mOsm/kg
D. Bicarbonate level of 18 mEq/L
Answer: D
Rationale: A bicarbonate of 18 mEq/L indicates metabolic acidosis, suggesting possible diabetic
ketoacidosis (DKA) rather than hyperglycemic hyperosmolar state (HHS). The management for DKA
includes bicarbonate if pH <7.0, but the question is about modification: if DKA is present, the insulin
drip protocol may need adjustment (e.g., higher dose) and closer monitoring. Potassium of 4.8 is within
range to add KCl. Urine output is adequate. Osmolality is consistent with HHS.
4. A patient with a history of hypertension and heart failure with reduced ejection fraction
(HFrEF) is prescribed lisinopril, carvedilol, furosemide, and spironolactone. Which laboratory
value is most critical to monitor in the first week of therapy?
A. Serum potassium
B. Blood urea nitrogen
C. Serum sodium
D. Serum creatinine
Answer: A
Rationale: Combination of ACE inhibitor (lisinopril) and aldosterone antagonist (spironolactone)
significantly increases risk of hyperkalemia. Carvedilol and furosemide do not directly affect potassium
as much. While renal function (creatinine) is important, hyperkalemia is the most immediately
dangerous and common in this combination.
5. A patient with schizophrenia is started on clozapine. The nurse should educate the patient about
the need for regular monitoring of which parameter to prevent a life-threatening adverse effect?
A. White blood cell count with differential
B. Liver function tests
C. Serum prolactin level
D. Electrocardiogram
Answer: A
Rationale: Clozapine carries a risk of agranulocytosis, a severe drop in neutrophil count, requiring
regular WBC monitoring. Liver function, prolactin, and ECG are relevant for other antipsychotics (e.g.,
haloperidol, risperidone) but not the priority for clozapine.
6. A pregnant patient at 28 weeks gestation presents with a blood pressure of 160/105 mmHg, 3+
proteinuria, and a headache. The provider orders magnesium sulfate 4 g IV bolus followed by 2
g/hr. The nurse understands that the purpose of magnesium sulfate in this scenario is primarily to:
A. Lower the blood pressure to a safe range
B. Prevent seizures in the setting of severe preeclampsia
C. Induce diuresis to reduce edema
D. Promote fetal lung maturity
Answer: B
Page 2
,Rationale: Magnesium sulfate is the drug of choice for seizure prophylaxis in severe preeclampsia/eclampsia. It does not
significantly lower blood pressure (antihypertensives like labetalol are used); it does not induce diuresis; fetal lung maturity
is promoted by corticosteroids like betamethasone.
7. A patient with major depressive disorder has been on phenelzine (MAOI) for 6 weeks. The
patient reports improvement but complains of insomnia. The provider considers adding a second
medication. Which of the following would be safest to prescribe?
A. Trazodone
B. Meperidine
C. Dextromethorphan
D. Bupropion
Answer: A
Rationale: Trazodone is a sedating antidepressant with low risk of serotonin syndrome when combined
with MAOIs (though caution still needed). Meperidine and dextromethorphan are contraindicated with
MAOIs due to risk of serotonin syndrome. Bupropion is not typically used for insomnia and has its own
risks, but the safest among these for sleep is trazodone.
8. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
acute respiratory failure. Arterial blood gas results: pH 7.28, PaCO2 65 mm Hg, PaO2 55 mm Hg,
HCO3- 26 mEq/L. The nurse anticipates which intervention as the priority?
A. Administer sodium bicarbonate intravenously
B. Initiate noninvasive positive pressure ventilation (NIPPV)
C. Increase the fraction of inspired oxygen to 100%
D. Administer albuterol nebulizer treatment
Answer: B
Rationale: The ABG shows acute-on-chronic respiratory acidosis (pH <7.35, PaCO2 >45, HCO3-
normal). The priority is to improve ventilation. NIPPV (BiPAP) is first-line for acute hypercapnic
respiratory failure in COPD. Sodium bicarbonate is not indicated as acidosis is respiratory. High-flow
oxygen may worsen hypercapnia by blunting hypoxic drive. Albuterol may help but is not the priority.
9. A patient with cirrhosis and ascites is prescribed spironolactone 100 mg daily. The nurse notes
the patient has a serum sodium of 128 mEq/L and potassium of 5.6 mEq/L. Which action should
the nurse take?
A. Administer the spironolactone as ordered
B. Hold the spironolactone and notify the provider
C. Administer sodium chloride tablets to correct hyponatremia
D. Give the spironolactone and monitor urine output
Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic. In the setting of hyperkalemia (5.6 mEq/L), it
should be held to prevent life-threatening arrhythmias. Hyponatremia in cirrhosis is often dilutional and
not treated with sodium tablets unless severe and symptomatic. The provider needs to adjust therapy.
Page 3
, 10. A patient with acute pancreatitis is receiving total parenteral nutrition (TPN). Which
laboratory value indicates that the TPN formulation may need adjustment?
A. Serum glucose of 180 mg/dL
B. Serum triglycerides of 450 mg/dL
C. Serum calcium of 8.5 mg/dL
D. Serum albumin of 3.0 g/dL
Answer: B
Rationale: Hypertriglyceridemia (>400 mg/dL) can exacerbate pancreatitis and indicates the lipid
component of TPN should be reduced or held. Glucose of 180 is acceptable (goal <200). Calcium and
albumin are low but not directly related to TPN adjustment; they may need supplementation but are not
the priority.
11. A patient with chronic kidney disease (stage 4) is admitted with hyperkalemia (K+ 6.8 mEq/L).
The ECG shows peaked T waves. Which intervention should be implemented first?
A. Administer sodium polystyrene sulfonate (Kayexalate) orally
B. Administer calcium gluconate intravenously
C. Administer insulin and dextrose intravenously
D. Prepare the patient for emergency hemodialysis
Answer: B
Rationale: Calcium gluconate is given first to stabilize the cardiac membrane and prevent arrhythmias.
Kayexalate works slowly, insulin/dextrose shifts potassium into cells but takes 30-60 minutes, and
dialysis is definitive but not immediately available. Calcium gluconate provides immediate cardiac
protection.
12. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled ventilation
with FiO2 0.6, PEEP 10 cm H2O, tidal volume 6 mL/kg, and plateau pressure 28 cm H2O. The
ABG shows pH 7.25, PaCO2 55 mm Hg, PaO2 65 mm Hg. Which change should the nurse
anticipate?
A. Increase tidal volume to 8 mL/kg
B. Increase PEEP to 15 cm H2O
C. Increase FiO2 to 0.8
D. Increase respiratory rate to 20 breaths/min
Answer: D
Rationale: The primary issue is hypercapnia (PaCO2 55) causing respiratory acidosis. Increasing the
respiratory rate will increase minute ventilation and lower PaCO2. Increasing tidal volume risks
barotrauma (plateau pressure already 28). Increasing PEEP or FiO2 addresses oxygenation but not the
acidosis.
13. A patient receiving total parenteral nutrition (TPN) via a peripherally inserted central catheter
(PICC) develops fever, chills, and glucose in the urine. Which action is most appropriate?
A. Decrease the TPN infusion rate and check blood glucose
B. Discontinue the TPN and send the catheter tip for culture
Page 4
COMPLETE QUESTIONS WITH CORRECT
DETAILED ANSWERS || 100% GUARANTEED
PASS LATEST VERSION
1. A patient with end-stage renal disease on hemodialysis presents with confusion, muscle
twitching, and a serum phosphate level of 7.2 mg/dL. The nurse reviews the medication
administration record. Which prescription should the nurse question?
A. Calcium acetate 1334 mg orally three times daily with meals
B. Sevelamer carbonate 800 mg orally three times daily with meals
C. Cinacalcet 30 mg orally once daily
D. Calcium carbonate 500 mg orally three times daily between meals
Answer: D
Rationale: Calcium carbonate given between meals increases calcium absorption without binding
phosphate, worsening hyperphosphatemia and risking vascular calcification. Calcium acetate and
sevelamer carbonate are phosphate binders given with meals. Cinacalcet lowers PTH but does not
directly address phosphate.
2. A patient receiving a continuous intravenous infusion of heparin for acute coronary syndrome
has an activated partial thromboplastin time (aPTT) of 120 seconds (therapeutic range 60-80
seconds). The nurse notes the patient has dark urine and flank pain. What is the priority nursing
action?
A. Administer protamine sulfate as prescribed
B. Stop the heparin infusion and notify the provider
C. Increase the rate of IV fluids to maintain urine output
D. Obtain a stat hemoglobin and hematocrit
Answer: B
Rationale: The supratherapeutic aPTT and symptoms (dark urine, flank pain) suggest heparin-induced
bleeding (e.g., retroperitoneal hemorrhage). Priority is to stop the infusion and notify the provider.
Protamine may be indicated but is not the first action; assessment and discontinuation come first.
3. A patient with type 2 diabetes mellitus is admitted for uncontrolled hyperglycemia (blood
glucose 450 mg/dL) and is started on an insulin drip. The nurse reviews the orders: 0.9% sodium
chloride at 250 mL/hr, regular insulin 0.1 units/kg/hr, and potassium chloride 20 mEq/L once
potassium is <5.0 mEq/L. Which assessment finding indicates that the current management plan
may need modification?
A. Serum potassium of 4.8 mEq/L
Page 1
,B. Urine output of 40 mL over the past hour
C. Serum osmolality of 310 mOsm/kg
D. Bicarbonate level of 18 mEq/L
Answer: D
Rationale: A bicarbonate of 18 mEq/L indicates metabolic acidosis, suggesting possible diabetic
ketoacidosis (DKA) rather than hyperglycemic hyperosmolar state (HHS). The management for DKA
includes bicarbonate if pH <7.0, but the question is about modification: if DKA is present, the insulin
drip protocol may need adjustment (e.g., higher dose) and closer monitoring. Potassium of 4.8 is within
range to add KCl. Urine output is adequate. Osmolality is consistent with HHS.
4. A patient with a history of hypertension and heart failure with reduced ejection fraction
(HFrEF) is prescribed lisinopril, carvedilol, furosemide, and spironolactone. Which laboratory
value is most critical to monitor in the first week of therapy?
A. Serum potassium
B. Blood urea nitrogen
C. Serum sodium
D. Serum creatinine
Answer: A
Rationale: Combination of ACE inhibitor (lisinopril) and aldosterone antagonist (spironolactone)
significantly increases risk of hyperkalemia. Carvedilol and furosemide do not directly affect potassium
as much. While renal function (creatinine) is important, hyperkalemia is the most immediately
dangerous and common in this combination.
5. A patient with schizophrenia is started on clozapine. The nurse should educate the patient about
the need for regular monitoring of which parameter to prevent a life-threatening adverse effect?
A. White blood cell count with differential
B. Liver function tests
C. Serum prolactin level
D. Electrocardiogram
Answer: A
Rationale: Clozapine carries a risk of agranulocytosis, a severe drop in neutrophil count, requiring
regular WBC monitoring. Liver function, prolactin, and ECG are relevant for other antipsychotics (e.g.,
haloperidol, risperidone) but not the priority for clozapine.
6. A pregnant patient at 28 weeks gestation presents with a blood pressure of 160/105 mmHg, 3+
proteinuria, and a headache. The provider orders magnesium sulfate 4 g IV bolus followed by 2
g/hr. The nurse understands that the purpose of magnesium sulfate in this scenario is primarily to:
A. Lower the blood pressure to a safe range
B. Prevent seizures in the setting of severe preeclampsia
C. Induce diuresis to reduce edema
D. Promote fetal lung maturity
Answer: B
Page 2
,Rationale: Magnesium sulfate is the drug of choice for seizure prophylaxis in severe preeclampsia/eclampsia. It does not
significantly lower blood pressure (antihypertensives like labetalol are used); it does not induce diuresis; fetal lung maturity
is promoted by corticosteroids like betamethasone.
7. A patient with major depressive disorder has been on phenelzine (MAOI) for 6 weeks. The
patient reports improvement but complains of insomnia. The provider considers adding a second
medication. Which of the following would be safest to prescribe?
A. Trazodone
B. Meperidine
C. Dextromethorphan
D. Bupropion
Answer: A
Rationale: Trazodone is a sedating antidepressant with low risk of serotonin syndrome when combined
with MAOIs (though caution still needed). Meperidine and dextromethorphan are contraindicated with
MAOIs due to risk of serotonin syndrome. Bupropion is not typically used for insomnia and has its own
risks, but the safest among these for sleep is trazodone.
8. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
acute respiratory failure. Arterial blood gas results: pH 7.28, PaCO2 65 mm Hg, PaO2 55 mm Hg,
HCO3- 26 mEq/L. The nurse anticipates which intervention as the priority?
A. Administer sodium bicarbonate intravenously
B. Initiate noninvasive positive pressure ventilation (NIPPV)
C. Increase the fraction of inspired oxygen to 100%
D. Administer albuterol nebulizer treatment
Answer: B
Rationale: The ABG shows acute-on-chronic respiratory acidosis (pH <7.35, PaCO2 >45, HCO3-
normal). The priority is to improve ventilation. NIPPV (BiPAP) is first-line for acute hypercapnic
respiratory failure in COPD. Sodium bicarbonate is not indicated as acidosis is respiratory. High-flow
oxygen may worsen hypercapnia by blunting hypoxic drive. Albuterol may help but is not the priority.
9. A patient with cirrhosis and ascites is prescribed spironolactone 100 mg daily. The nurse notes
the patient has a serum sodium of 128 mEq/L and potassium of 5.6 mEq/L. Which action should
the nurse take?
A. Administer the spironolactone as ordered
B. Hold the spironolactone and notify the provider
C. Administer sodium chloride tablets to correct hyponatremia
D. Give the spironolactone and monitor urine output
Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic. In the setting of hyperkalemia (5.6 mEq/L), it
should be held to prevent life-threatening arrhythmias. Hyponatremia in cirrhosis is often dilutional and
not treated with sodium tablets unless severe and symptomatic. The provider needs to adjust therapy.
Page 3
, 10. A patient with acute pancreatitis is receiving total parenteral nutrition (TPN). Which
laboratory value indicates that the TPN formulation may need adjustment?
A. Serum glucose of 180 mg/dL
B. Serum triglycerides of 450 mg/dL
C. Serum calcium of 8.5 mg/dL
D. Serum albumin of 3.0 g/dL
Answer: B
Rationale: Hypertriglyceridemia (>400 mg/dL) can exacerbate pancreatitis and indicates the lipid
component of TPN should be reduced or held. Glucose of 180 is acceptable (goal <200). Calcium and
albumin are low but not directly related to TPN adjustment; they may need supplementation but are not
the priority.
11. A patient with chronic kidney disease (stage 4) is admitted with hyperkalemia (K+ 6.8 mEq/L).
The ECG shows peaked T waves. Which intervention should be implemented first?
A. Administer sodium polystyrene sulfonate (Kayexalate) orally
B. Administer calcium gluconate intravenously
C. Administer insulin and dextrose intravenously
D. Prepare the patient for emergency hemodialysis
Answer: B
Rationale: Calcium gluconate is given first to stabilize the cardiac membrane and prevent arrhythmias.
Kayexalate works slowly, insulin/dextrose shifts potassium into cells but takes 30-60 minutes, and
dialysis is definitive but not immediately available. Calcium gluconate provides immediate cardiac
protection.
12. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled ventilation
with FiO2 0.6, PEEP 10 cm H2O, tidal volume 6 mL/kg, and plateau pressure 28 cm H2O. The
ABG shows pH 7.25, PaCO2 55 mm Hg, PaO2 65 mm Hg. Which change should the nurse
anticipate?
A. Increase tidal volume to 8 mL/kg
B. Increase PEEP to 15 cm H2O
C. Increase FiO2 to 0.8
D. Increase respiratory rate to 20 breaths/min
Answer: D
Rationale: The primary issue is hypercapnia (PaCO2 55) causing respiratory acidosis. Increasing the
respiratory rate will increase minute ventilation and lower PaCO2. Increasing tidal volume risks
barotrauma (plateau pressure already 28). Increasing PEEP or FiO2 addresses oxygenation but not the
acidosis.
13. A patient receiving total parenteral nutrition (TPN) via a peripherally inserted central catheter
(PICC) develops fever, chills, and glucose in the urine. Which action is most appropriate?
A. Decrease the TPN infusion rate and check blood glucose
B. Discontinue the TPN and send the catheter tip for culture
Page 4
