NURS 328 COMPREHENSIVE REVIEW
(EXAMS 1, 2 & FINAL) QUESTIONS AND
ANSWERS
1. A patient with a history of chronic kidney disease presents with fatigue and palpitations.
The ECG reveals tall, peaked T-waves. Which medication should the nurse anticipate
administering first to stabilize the cardiac membrane?
A. Sodium Polystyrene Sulfonate
B. Calcium Gluconate
C. Insulin and Dextrose
D. Furosemide
Answer: B
Conceptual Explanation: Calcium gluconate is administered in hyperkalemia to stabilize
the myocardial cell membrane and prevent life-threatening arrhythmias, even though it
does not lower the potassium level itself.
2. A nurse is caring for a patient who is 12 hours post-abdominal surgery. The patient
suddenly reports ‘something popped’ and the nurse observes a loop of bowel protruding
through the incision. What is the priority nursing action?
A. Attempt to push the bowel back into the abdominal cavity
,B. Place the patient in a High-Fowler’s position
C. Apply a tight abdominal binder to provide support
D. Cover the wound with sterile dressings moistened with warm sterile saline
Answer: D
Conceptual Explanation: Evisceration is a medical emergency. The nurse must cover the
protruding organs with sterile, saline-soaked dressings to keep them moist and call the
surgeon immediately. The patient should be kept in a low-Fowler’s position with knees
flexed.
3. An arterial blood gas (ABG) result shows: pH 7.30, PaCO2 52 mmHg, and HCO3 26 mEq/L.
Which condition does this reflect?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Respiratory Acidosis
D. Metabolic Alkalosis
Answer: C
Conceptual Explanation: The pH is low (<7.35), indicating acidosis. The PaCO2 is high
(>45), indicating a respiratory cause. The HCO3 is within the normal range, indicating no
compensation yet.
, 4. A patient with Type 1 Diabetes is admitted with a blood glucose of 600 mg/dL and positive
ketones in the urine. Which acid-base imbalance is most likely present?
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Answer: C
Conceptual Explanation: Diabetic Ketoacidosis (DKA) leads to the accumulation of
ketones, which are acidic, resulting in metabolic acidosis characterized by a low pH and low
bicarbonate.
5. Which clinical manifestation should a nurse monitor for as the earliest sign of increased
intracranial pressure (ICP) in a patient with a head injury?
A. Cushing’s Triad
B. Dilated and fixed pupils
C. Decerebrate posturing
D. Decreased level of consciousness (LOC)
Answer: D
Conceptual Explanation: Changes in level of consciousness are the earliest and most
sensitive indicators of increasing ICP. Cushing’s triad and posturing are late signs.
(EXAMS 1, 2 & FINAL) QUESTIONS AND
ANSWERS
1. A patient with a history of chronic kidney disease presents with fatigue and palpitations.
The ECG reveals tall, peaked T-waves. Which medication should the nurse anticipate
administering first to stabilize the cardiac membrane?
A. Sodium Polystyrene Sulfonate
B. Calcium Gluconate
C. Insulin and Dextrose
D. Furosemide
Answer: B
Conceptual Explanation: Calcium gluconate is administered in hyperkalemia to stabilize
the myocardial cell membrane and prevent life-threatening arrhythmias, even though it
does not lower the potassium level itself.
2. A nurse is caring for a patient who is 12 hours post-abdominal surgery. The patient
suddenly reports ‘something popped’ and the nurse observes a loop of bowel protruding
through the incision. What is the priority nursing action?
A. Attempt to push the bowel back into the abdominal cavity
,B. Place the patient in a High-Fowler’s position
C. Apply a tight abdominal binder to provide support
D. Cover the wound with sterile dressings moistened with warm sterile saline
Answer: D
Conceptual Explanation: Evisceration is a medical emergency. The nurse must cover the
protruding organs with sterile, saline-soaked dressings to keep them moist and call the
surgeon immediately. The patient should be kept in a low-Fowler’s position with knees
flexed.
3. An arterial blood gas (ABG) result shows: pH 7.30, PaCO2 52 mmHg, and HCO3 26 mEq/L.
Which condition does this reflect?
A. Metabolic Acidosis
B. Respiratory Alkalosis
C. Respiratory Acidosis
D. Metabolic Alkalosis
Answer: C
Conceptual Explanation: The pH is low (<7.35), indicating acidosis. The PaCO2 is high
(>45), indicating a respiratory cause. The HCO3 is within the normal range, indicating no
compensation yet.
, 4. A patient with Type 1 Diabetes is admitted with a blood glucose of 600 mg/dL and positive
ketones in the urine. Which acid-base imbalance is most likely present?
A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Answer: C
Conceptual Explanation: Diabetic Ketoacidosis (DKA) leads to the accumulation of
ketones, which are acidic, resulting in metabolic acidosis characterized by a low pH and low
bicarbonate.
5. Which clinical manifestation should a nurse monitor for as the earliest sign of increased
intracranial pressure (ICP) in a patient with a head injury?
A. Cushing’s Triad
B. Dilated and fixed pupils
C. Decerebrate posturing
D. Decreased level of consciousness (LOC)
Answer: D
Conceptual Explanation: Changes in level of consciousness are the earliest and most
sensitive indicators of increasing ICP. Cushing’s triad and posturing are late signs.
