NUR 2804C GIDDENS MODULE EXAM– QUESTIONS AND
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1. A nurse is assessing a patient admitted with newly diagnosed type 2 diabetes mellitus.
Which pathophysiological mechanism should the nurse understand is primarily responsible
for this condition?
A. Autoimmune destruction of pancreatic beta cells leading to absolute insulin deficiency
B. Insulin resistance coupled with a progressive secretory defect in pancreatic beta cells
C. Ectopic deposition of glycogen within skeletal muscle fibers causing receptor blockade
D. Hypersecretion of glucagon by alpha cells leading to peripheral glucose utilization failure
ANSWER: B. Insulin resistance coupled with a progressive secretory defect in pancreatic
beta cells
Type 2 diabetes mellitus is characterized primarily by peripheral insulin resistance paired with
beta cell dysfunction, whereas autoimmune destruction defines type 1 diabetes. Glycogen
deposition and hyperglucagonemia do not serve as primary causal mechanisms.
2. A patient with chronic kidney disease presents with fatigue, pallor, and generalized
weakness. Laboratory results indicate a hemoglobin level of 8.8 g/dL. Which physiological
factor accounts for this clinical finding?
A. Decreased production of erythropoietin by the failing kidneys
B. Accelerated destruction of erythrocytes within the splenic reticuloendothelial system
C. Dietary malabsorption of vitamin B12 secondary to uremic enteropathy
D. Chronic intravascular hemolysis caused by high-pressure glomerular microcirculation
ANSWER: A. Decreased production of erythropoietin by the failing kidneys
The kidneys produce erythropoietin, the primary hormone stimulating bone marrow
erythropoiesis. Chronic renal failure impairs this synthesis, resulting in normocytic
normochromic anemia. Splenic destruction, B12 malabsorption, and hemolysis are not the
primary drivers.
,3. An adult patient is admitted to the emergency department following a severe motor
vehicle crash. Assessment reveals cold, clammy skin, tachycardia, tachypnea, and a blood
pressure of 82/50 mmHg. Which compensatory mechanism is activated immediately to
maintain organ perfusion?
A. Stimulation of the parasympathetic nervous system to slow metabolic demand
B. Activation of the sympathetic nervous system causing vasoconstriction and increased heart
rate
C. Suppression of antidiuretic hormone release to facilitate renal excretion of free water
D. Vasodilation of the mesenteric vascular bed to redirect blood flow to vital organs
ANSWER: B. Activation of the sympathetic nervous system causing vasoconstriction and
increased heart rate
Acute hypovolemic shock triggers baroreceptor reflexes, prompting immediate sympathetic
nervous system activation. This increases heart rate, myocardial contractility, and systemic
vascular resistance to preserve perfusion. Parasympathetic stimulation and vasodilation would
worsen shock.
4. A nurse is caring for a patient receiving intravenous potassium chloride for severe
hypokalemia. During the infusion, the patient reports a burning sensation along the vein,
and the surrounding tissue appears slightly blanched. What is the immediate priority
action for the nurse?
A. Slow the infusion rate by half and apply a warm compress to the site
B. Stop the infusion immediately and assess the intravenous access site for infiltration
C. Administer a sublingual anti-inflammatory agent and continue monitoring the infusion
D. Flush the line with 10 mL of normal saline to clear the medication into the vessel
ANSWER: B. Stop the infusion immediately and assess the intravenous access site for
infiltration
Potassium chloride is a potent vesicant and irritant to peripheral vascular walls. Burning and
blanching indicate possible infiltration or extravasation, which can cause severe tissue
necrosis. The infusion must be stopped instantly to prevent injury.
5. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted
with acute respiratory distress. Arterial blood gas results show pH 7.31, PaCO2 60 mmHg,
HCO3 28 mEq/L, and PaO2 55 mmHg. How should the nurse interpret these findings?
,A. Metabolic acidosis with respiratory compensation
B. Respiratory alkalosis with metabolic compensation
C. Uncompensated metabolic alkalosis
D. Respiratory acidosis with partial metabolic compensation
ANSWER: D. Respiratory acidosis with partial metabolic compensation
An acidic pH combined with an elevated PaCO2 indicates a primary respiratory acidosis. The
elevated bicarbonate level represents renal compensation, making this a partially compensated
state. The low PaO2 confirms concurrent hypoxemia.
6. A nurse is developing a care plan for an elderly patient immobile following orthopedic
surgery. Which intervention is most critical for preventing deep vein thrombosis (DVT)?
A. Applying warm moist heat to the lower extremities every four hours
B. Administering prescribed prophylactic anticoagulation and encouraging early ambulation
C. Positioning a knee gatch pillow under the knees to relieve popliteal pressure
D. Massaging the lower calves vigorously twice per shift to stimulate venous return
ANSWER: B. Administering prescribed prophylactic anticoagulation and encouraging early
ambulation
Virchow's triad—venous stasis, endothelial injury, and hypercoagulability—places immobile
surgical patients at high risk for DVT. Prophylactic anticoagulation and early ambulation
directly mitigate stasis. Massage and knee gatch pillows are contraindicated due to the risk of
dislodging clots.
7. A patient is prescribed a new antihypertensive medication, lisinopril. During discharge
education, which common adverse effect should the nurse instruct the patient to report?
A. Persistent dry, hacking cough
B. Visual disturbances such as halos around lights
C. Uncontrolled tremors of the upper extremities
D. Significant hair thinning and scalp tenderness
ANSWER: A. Persistent dry, hacking cough
, ACE inhibitors like lisinopril commonly cause a persistent, dry, nonproductive cough due to
the accumulation of bradykinin in the pulmonary tree. This is a well-documented side effect
that frequently necessitates medication switching.
8. A nurse is caring for a client experiencing an acute panic attack. The client is
hyperventilating and expresses a feeling of impending doom. Which arterial blood gas
abnormality is expected in this acute situation?
A. Decreased pH, elevated PaCO2
B. Elevated pH, decreased PaCO2
C. Decreased pH, decreased HCO3
D. Elevated pH, elevated HCO3
ANSWER: B. Elevated pH, decreased PaCO2
Acute hyperventilation causes excessive elimination of carbon dioxide, reducing PaCO2
(hypocapnia). This shifts the carbonic acid equilibrium, raising blood pH and resulting in
acute respiratory alkalosis.
9. A patient is admitted to the telemetry unit with a diagnosis of heart failure exacerbation.
Which assessment finding is most indicative of left ventricular failure?
A. Bilateral lower extremity pitting edema and jugular venous distention
B. Hepatomegaly and a positive hepatojugular reflux sign
C. Fine crackles in bilateral lung bases and an S3 heart sound
D. Unexplained weight gain of two kilograms over a 48-hour period
ANSWER: C. Fine crackles in bilateral lung bases and an S3 heart sound
Left ventricular failure causes blood to back up into the pulmonary circulation, leading to
increased hydrostatic pressure, pulmonary congestion (crackles), and ventricular gallops (S3).
Edema, JVD, and hepatomegaly are signs of right ventricular failure.
10. A patient scheduled for an open cholecystectomy expresses anxiety regarding
postoperative pain management. What is the most effective initial nursing intervention?
A. Reassure the patient that pain is temporary and completely manageable with modern drugs
B. Assess the patient's past experiences with pain and preferences for pain management
strategies
ANSWERS | VERIFIED AND WELL DETAILED ANSWERS PLUS
RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE |
EXAM PREP | STUDY GUIDE | PRACTICE TEST| DOWNLOAD
INSTANT PDF
1. A nurse is assessing a patient admitted with newly diagnosed type 2 diabetes mellitus.
Which pathophysiological mechanism should the nurse understand is primarily responsible
for this condition?
A. Autoimmune destruction of pancreatic beta cells leading to absolute insulin deficiency
B. Insulin resistance coupled with a progressive secretory defect in pancreatic beta cells
C. Ectopic deposition of glycogen within skeletal muscle fibers causing receptor blockade
D. Hypersecretion of glucagon by alpha cells leading to peripheral glucose utilization failure
ANSWER: B. Insulin resistance coupled with a progressive secretory defect in pancreatic
beta cells
Type 2 diabetes mellitus is characterized primarily by peripheral insulin resistance paired with
beta cell dysfunction, whereas autoimmune destruction defines type 1 diabetes. Glycogen
deposition and hyperglucagonemia do not serve as primary causal mechanisms.
2. A patient with chronic kidney disease presents with fatigue, pallor, and generalized
weakness. Laboratory results indicate a hemoglobin level of 8.8 g/dL. Which physiological
factor accounts for this clinical finding?
A. Decreased production of erythropoietin by the failing kidneys
B. Accelerated destruction of erythrocytes within the splenic reticuloendothelial system
C. Dietary malabsorption of vitamin B12 secondary to uremic enteropathy
D. Chronic intravascular hemolysis caused by high-pressure glomerular microcirculation
ANSWER: A. Decreased production of erythropoietin by the failing kidneys
The kidneys produce erythropoietin, the primary hormone stimulating bone marrow
erythropoiesis. Chronic renal failure impairs this synthesis, resulting in normocytic
normochromic anemia. Splenic destruction, B12 malabsorption, and hemolysis are not the
primary drivers.
,3. An adult patient is admitted to the emergency department following a severe motor
vehicle crash. Assessment reveals cold, clammy skin, tachycardia, tachypnea, and a blood
pressure of 82/50 mmHg. Which compensatory mechanism is activated immediately to
maintain organ perfusion?
A. Stimulation of the parasympathetic nervous system to slow metabolic demand
B. Activation of the sympathetic nervous system causing vasoconstriction and increased heart
rate
C. Suppression of antidiuretic hormone release to facilitate renal excretion of free water
D. Vasodilation of the mesenteric vascular bed to redirect blood flow to vital organs
ANSWER: B. Activation of the sympathetic nervous system causing vasoconstriction and
increased heart rate
Acute hypovolemic shock triggers baroreceptor reflexes, prompting immediate sympathetic
nervous system activation. This increases heart rate, myocardial contractility, and systemic
vascular resistance to preserve perfusion. Parasympathetic stimulation and vasodilation would
worsen shock.
4. A nurse is caring for a patient receiving intravenous potassium chloride for severe
hypokalemia. During the infusion, the patient reports a burning sensation along the vein,
and the surrounding tissue appears slightly blanched. What is the immediate priority
action for the nurse?
A. Slow the infusion rate by half and apply a warm compress to the site
B. Stop the infusion immediately and assess the intravenous access site for infiltration
C. Administer a sublingual anti-inflammatory agent and continue monitoring the infusion
D. Flush the line with 10 mL of normal saline to clear the medication into the vessel
ANSWER: B. Stop the infusion immediately and assess the intravenous access site for
infiltration
Potassium chloride is a potent vesicant and irritant to peripheral vascular walls. Burning and
blanching indicate possible infiltration or extravasation, which can cause severe tissue
necrosis. The infusion must be stopped instantly to prevent injury.
5. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted
with acute respiratory distress. Arterial blood gas results show pH 7.31, PaCO2 60 mmHg,
HCO3 28 mEq/L, and PaO2 55 mmHg. How should the nurse interpret these findings?
,A. Metabolic acidosis with respiratory compensation
B. Respiratory alkalosis with metabolic compensation
C. Uncompensated metabolic alkalosis
D. Respiratory acidosis with partial metabolic compensation
ANSWER: D. Respiratory acidosis with partial metabolic compensation
An acidic pH combined with an elevated PaCO2 indicates a primary respiratory acidosis. The
elevated bicarbonate level represents renal compensation, making this a partially compensated
state. The low PaO2 confirms concurrent hypoxemia.
6. A nurse is developing a care plan for an elderly patient immobile following orthopedic
surgery. Which intervention is most critical for preventing deep vein thrombosis (DVT)?
A. Applying warm moist heat to the lower extremities every four hours
B. Administering prescribed prophylactic anticoagulation and encouraging early ambulation
C. Positioning a knee gatch pillow under the knees to relieve popliteal pressure
D. Massaging the lower calves vigorously twice per shift to stimulate venous return
ANSWER: B. Administering prescribed prophylactic anticoagulation and encouraging early
ambulation
Virchow's triad—venous stasis, endothelial injury, and hypercoagulability—places immobile
surgical patients at high risk for DVT. Prophylactic anticoagulation and early ambulation
directly mitigate stasis. Massage and knee gatch pillows are contraindicated due to the risk of
dislodging clots.
7. A patient is prescribed a new antihypertensive medication, lisinopril. During discharge
education, which common adverse effect should the nurse instruct the patient to report?
A. Persistent dry, hacking cough
B. Visual disturbances such as halos around lights
C. Uncontrolled tremors of the upper extremities
D. Significant hair thinning and scalp tenderness
ANSWER: A. Persistent dry, hacking cough
, ACE inhibitors like lisinopril commonly cause a persistent, dry, nonproductive cough due to
the accumulation of bradykinin in the pulmonary tree. This is a well-documented side effect
that frequently necessitates medication switching.
8. A nurse is caring for a client experiencing an acute panic attack. The client is
hyperventilating and expresses a feeling of impending doom. Which arterial blood gas
abnormality is expected in this acute situation?
A. Decreased pH, elevated PaCO2
B. Elevated pH, decreased PaCO2
C. Decreased pH, decreased HCO3
D. Elevated pH, elevated HCO3
ANSWER: B. Elevated pH, decreased PaCO2
Acute hyperventilation causes excessive elimination of carbon dioxide, reducing PaCO2
(hypocapnia). This shifts the carbonic acid equilibrium, raising blood pH and resulting in
acute respiratory alkalosis.
9. A patient is admitted to the telemetry unit with a diagnosis of heart failure exacerbation.
Which assessment finding is most indicative of left ventricular failure?
A. Bilateral lower extremity pitting edema and jugular venous distention
B. Hepatomegaly and a positive hepatojugular reflux sign
C. Fine crackles in bilateral lung bases and an S3 heart sound
D. Unexplained weight gain of two kilograms over a 48-hour period
ANSWER: C. Fine crackles in bilateral lung bases and an S3 heart sound
Left ventricular failure causes blood to back up into the pulmonary circulation, leading to
increased hydrostatic pressure, pulmonary congestion (crackles), and ventricular gallops (S3).
Edema, JVD, and hepatomegaly are signs of right ventricular failure.
10. A patient scheduled for an open cholecystectomy expresses anxiety regarding
postoperative pain management. What is the most effective initial nursing intervention?
A. Reassure the patient that pain is temporary and completely manageable with modern drugs
B. Assess the patient's past experiences with pain and preferences for pain management
strategies
