,NSG3850/NSG 3850 Exam 4 | Advanced Pathophysiology |
Galen College | Q & A | 2026/2027 Edition (PDF)
1. A client with heart failure has crackles in all lung fields, jugular venous distention, and 3+ pitting
edema. Which medication should the nurse expect to administer first?
A) Digoxin
B) Furosemide
C) Enalapril
D) Carvedilol
Correct Answer: Furosemide
Expert Rationale: Furosemide (loop diuretic) reduces preload by promoting diuresis, relieving pulmonary
congestion. The client shows signs of fluid overload; diuretics are the first-line treatment for acute
exacerbation of heart failure. Digoxin, enalapril, and carvedilol are important but not the immediate
priority for acute fluid overload.
2. A client is prescribed digoxin. Which finding indicates digoxin toxicity?
A) Heart rate 62 bpm
B) Anorexia and nausea
C) Weight gain
D) Increased urine output
Correct Answer: Anorexia and nausea
Expert Rationale: Anorexia, nausea, and vomiting are early signs of digoxin toxicity. Other signs include
visual disturbances (yellow-green halos), bradycardia, and cardiac arrhythmias. A heart rate of 62 is
within normal limits, weight gain suggests fluid retention, and increased urine output is a desired effect
of diuretics.
3. Which instruction should the nurse include when teaching a client about a transdermal nitroglycerin
patch?
,A) "Apply the patch to the same site every day."
B) "Remove the patch at night for 8-12 hours."
C) "Apply the patch to a hairy area for better adhesion."
D) "Leave the patch on continuously for 72 hours."
Correct Answer: "Remove the patch at night for 8-12 hours."
Expert Rationale: Nitroglycerin patches should be removed at night for 8-12 hours to prevent tolerance.
The site should be rotated to prevent skin irritation, and patches should be applied to clean, dry, hairless
skin.
4. Which clinical manifestation should the nurse anticipate in a client with chronic kidney disease and a
serum potassium level of 6.8 mEq/L?
A) Hypoactive deep tendon reflexes
B) Muscle weakness and cardiac dysrhythmias
C) Tetany and positive Chvostek's sign
D) Bone pain and pathological fractures
Correct Answer: Muscle weakness and cardiac dysrhythmias
Expert Rationale: A potassium level of 6.8 mEq/L indicates severe hyperkalemia. Elevated extracellular
potassium alters the resting membrane potential, progressing to muscle weakness, flaccid paralysis, and
life-threatening cardiac dysrhythmias. Tetany and Chvostek's sign are associated with hypocalcemia.
5. A client with chronic kidney disease is at risk for which acid-base imbalance?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
, Correct Answer: Metabolic acidosis
Expert Rationale: Chronic kidney disease causes metabolic acidosis due to impaired excretion of
hydrogen ions and decreased bicarbonate reabsorption. The kidneys are unable to excrete the daily acid
load, leading to a progressive acidosis.
6. A client with end-stage renal disease is receiving hemodialysis. Which complication should the nurse
monitor for during the procedure?
A) Hypertension
B) Hyperthermia
C) Hypotension
D) Tachycardia
Correct Answer: Hypotension
Expert Rationale: Hypotension is a common complication during hemodialysis due to rapid fluid removal
and shifts in osmotic pressure. Clients should be monitored for dizziness, nausea, and cramping.
7. A client with chronic kidney disease is at increased risk for anemia due to which mechanism?
A) Increased iron absorption
B) Decreased production of erythropoietin
C) Increased red blood cell destruction
D) Vitamin B12 deficiency
Correct Answer: Decreased production of erythropoietin
Expert Rationale: Patients with CKD are at increased risk for anemia due to decreased production of
erythropoietin by the damaged kidneys. Erythropoietin is needed for bone marrow production of RBCs.
8. A client with cirrhosis develops acute-onset confusion, asterixis, and a serum ammonia level of 120
mcg/dL. Which medication should the nurse anticipate administering?
Galen College | Q & A | 2026/2027 Edition (PDF)
1. A client with heart failure has crackles in all lung fields, jugular venous distention, and 3+ pitting
edema. Which medication should the nurse expect to administer first?
A) Digoxin
B) Furosemide
C) Enalapril
D) Carvedilol
Correct Answer: Furosemide
Expert Rationale: Furosemide (loop diuretic) reduces preload by promoting diuresis, relieving pulmonary
congestion. The client shows signs of fluid overload; diuretics are the first-line treatment for acute
exacerbation of heart failure. Digoxin, enalapril, and carvedilol are important but not the immediate
priority for acute fluid overload.
2. A client is prescribed digoxin. Which finding indicates digoxin toxicity?
A) Heart rate 62 bpm
B) Anorexia and nausea
C) Weight gain
D) Increased urine output
Correct Answer: Anorexia and nausea
Expert Rationale: Anorexia, nausea, and vomiting are early signs of digoxin toxicity. Other signs include
visual disturbances (yellow-green halos), bradycardia, and cardiac arrhythmias. A heart rate of 62 is
within normal limits, weight gain suggests fluid retention, and increased urine output is a desired effect
of diuretics.
3. Which instruction should the nurse include when teaching a client about a transdermal nitroglycerin
patch?
,A) "Apply the patch to the same site every day."
B) "Remove the patch at night for 8-12 hours."
C) "Apply the patch to a hairy area for better adhesion."
D) "Leave the patch on continuously for 72 hours."
Correct Answer: "Remove the patch at night for 8-12 hours."
Expert Rationale: Nitroglycerin patches should be removed at night for 8-12 hours to prevent tolerance.
The site should be rotated to prevent skin irritation, and patches should be applied to clean, dry, hairless
skin.
4. Which clinical manifestation should the nurse anticipate in a client with chronic kidney disease and a
serum potassium level of 6.8 mEq/L?
A) Hypoactive deep tendon reflexes
B) Muscle weakness and cardiac dysrhythmias
C) Tetany and positive Chvostek's sign
D) Bone pain and pathological fractures
Correct Answer: Muscle weakness and cardiac dysrhythmias
Expert Rationale: A potassium level of 6.8 mEq/L indicates severe hyperkalemia. Elevated extracellular
potassium alters the resting membrane potential, progressing to muscle weakness, flaccid paralysis, and
life-threatening cardiac dysrhythmias. Tetany and Chvostek's sign are associated with hypocalcemia.
5. A client with chronic kidney disease is at risk for which acid-base imbalance?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
, Correct Answer: Metabolic acidosis
Expert Rationale: Chronic kidney disease causes metabolic acidosis due to impaired excretion of
hydrogen ions and decreased bicarbonate reabsorption. The kidneys are unable to excrete the daily acid
load, leading to a progressive acidosis.
6. A client with end-stage renal disease is receiving hemodialysis. Which complication should the nurse
monitor for during the procedure?
A) Hypertension
B) Hyperthermia
C) Hypotension
D) Tachycardia
Correct Answer: Hypotension
Expert Rationale: Hypotension is a common complication during hemodialysis due to rapid fluid removal
and shifts in osmotic pressure. Clients should be monitored for dizziness, nausea, and cramping.
7. A client with chronic kidney disease is at increased risk for anemia due to which mechanism?
A) Increased iron absorption
B) Decreased production of erythropoietin
C) Increased red blood cell destruction
D) Vitamin B12 deficiency
Correct Answer: Decreased production of erythropoietin
Expert Rationale: Patients with CKD are at increased risk for anemia due to decreased production of
erythropoietin by the damaged kidneys. Erythropoietin is needed for bone marrow production of RBCs.
8. A client with cirrhosis develops acute-onset confusion, asterixis, and a serum ammonia level of 120
mcg/dL. Which medication should the nurse anticipate administering?
