NSG 3250 Exam 2 Complete Test Bank | Real
Practice Questions & Detailed Rationales
Topic: Fluid & Electrolyte Balance
1. A client with congestive heart failure is prescribed furosemide (Lasix). Which of
the following laboratory values should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Answer: B. Serum potassium
Rationale: Furosemide is a loop diuretic that inhibits the reabsorption of sodium and
chloride in the ascending limb of the loop of Henle, which also leads to significant
potassium wasting. Hypokalemia is a common and potentially dangerous adverse effect
that can lead to cardiac arrhythmias. While sodium, calcium, and magnesium can be
affected, potassium imbalance is the most critical and frequent concern with loop
diuretics.
,2. A nurse is assessing a client who has hyponatremia. Which of the following
findings should the nurse expect?
A. Hyperactive reflexes
B. Increased thirst
C. Dry mucous membranes
D. Muscle weakness
Answer: D. Muscle weakness
Rationale: Hyponatremia (low serum sodium) leads to cellular swelling as water moves
into the cells. In the neurological and muscular systems, this manifests as confusion,
lethargy, muscle weakness, and cramps. Hyperactive reflexes, increased thirst, and dry
mucous membranes are classic signs of hypernatremia, not hyponatremia.
3. A client's arterial blood gas (ABG) results are: pH 7.32, PaCO2 50 mmHg, and
HCO3- 24 mEq/L. The nurse correctly interprets these values as indicating which of
the following acid-base imbalances?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Answer: C. Respiratory acidosis
Rationale: The pH is below the normal range (7.35-7.45), indicating acidosis. The PaCO2 is
above the normal range (35-45 mmHg), indicating a respiratory cause. Because the
HCO3- is within the normal range (22-26 mEq/L), the body has not yet compensated.
Therefore, this is an uncompensated respiratory acidosis. This is seen in conditions that
impair ventilation, such as COPD or airway obstruction.
,4. A client is receiving a blood transfusion. Fifteen minutes after the start of the
transfusion, the client reports chills, low back pain, and nausea. What is the nurse's
priority action?
A. Administer an antihistamine as prescribed.
B. Slow the infusion rate and monitor vital signs.
C. Stop the transfusion and maintain the IV line with normal saline.
D. Obtain a urine sample to assess for hematuria.
Answer: C. Stop the transfusion and maintain the IV line with normal saline.
Rationale: The client is exhibiting classic signs of a hemolytic transfusion reaction (chills,
low back pain, nausea). The priority is to immediately stop the transfusion to prevent
further infusion of the incompatible blood. The IV line must be kept open with normal
saline to maintain venous access for emergency medications if needed. The other actions
may be implemented later but are not the priority.
Topic: Pain Management
5. A nurse is planning care for a client with chronic cancer pain. The nurse
understands that which of the following principles is most important for effective
pain management?
A. Administering pain medication on an "as needed" (PRN) schedule.
B. Administering pain medication around the clock (ATC).
C. Using the lowest possible dose of medication to avoid addiction.
D. Encouraging the client to wait as long as possible between doses.
, Answer: B. Administering pain medication around the clock (ATC).
Rationale: For chronic pain, especially cancer pain, a scheduled, around-the-clock (ATC)
regimen is the most effective approach. This maintains a steady serum level of the
analgesic, preventing the recurrence of severe pain. A PRN schedule leads to peaks and
troughs in pain control, which is less effective for chronic conditions. Concerns about
addiction should not interfere with adequate pain management.
6. A client is prescribed hydromorphone (Dilaudid) for severe postoperative pain.
Which of the following assessment findings would indicate a potential adverse
effect requiring immediate intervention?
A. A respiratory rate of 10 breaths per minute.
B. A blood pressure of 110/70 mmHg.
C. A heart rate of 90 beats per minute.
D. A pain rating of 3 on a 0-10 scale.
Answer: A. A respiratory rate of 10 breaths per minute.
Rationale: Hydromorphone is a potent opioid agonist that can cause significant respiratory
depression by depressing the brainstem's respiratory center. A respiratory rate of 10
breaths/min is below the normal range (12-20) and signals a serious adverse effect. The
nurse's priority would be to stimulate the client and potentially administer naloxone
(Narcan).
7. A client is receiving morphine sulfate via a patient-controlled analgesia (PCA)
pump. The client's spouse expresses concern that the client might become
addicted to the medication. What is the nurse's best response?
Practice Questions & Detailed Rationales
Topic: Fluid & Electrolyte Balance
1. A client with congestive heart failure is prescribed furosemide (Lasix). Which of
the following laboratory values should the nurse monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Answer: B. Serum potassium
Rationale: Furosemide is a loop diuretic that inhibits the reabsorption of sodium and
chloride in the ascending limb of the loop of Henle, which also leads to significant
potassium wasting. Hypokalemia is a common and potentially dangerous adverse effect
that can lead to cardiac arrhythmias. While sodium, calcium, and magnesium can be
affected, potassium imbalance is the most critical and frequent concern with loop
diuretics.
,2. A nurse is assessing a client who has hyponatremia. Which of the following
findings should the nurse expect?
A. Hyperactive reflexes
B. Increased thirst
C. Dry mucous membranes
D. Muscle weakness
Answer: D. Muscle weakness
Rationale: Hyponatremia (low serum sodium) leads to cellular swelling as water moves
into the cells. In the neurological and muscular systems, this manifests as confusion,
lethargy, muscle weakness, and cramps. Hyperactive reflexes, increased thirst, and dry
mucous membranes are classic signs of hypernatremia, not hyponatremia.
3. A client's arterial blood gas (ABG) results are: pH 7.32, PaCO2 50 mmHg, and
HCO3- 24 mEq/L. The nurse correctly interprets these values as indicating which of
the following acid-base imbalances?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Answer: C. Respiratory acidosis
Rationale: The pH is below the normal range (7.35-7.45), indicating acidosis. The PaCO2 is
above the normal range (35-45 mmHg), indicating a respiratory cause. Because the
HCO3- is within the normal range (22-26 mEq/L), the body has not yet compensated.
Therefore, this is an uncompensated respiratory acidosis. This is seen in conditions that
impair ventilation, such as COPD or airway obstruction.
,4. A client is receiving a blood transfusion. Fifteen minutes after the start of the
transfusion, the client reports chills, low back pain, and nausea. What is the nurse's
priority action?
A. Administer an antihistamine as prescribed.
B. Slow the infusion rate and monitor vital signs.
C. Stop the transfusion and maintain the IV line with normal saline.
D. Obtain a urine sample to assess for hematuria.
Answer: C. Stop the transfusion and maintain the IV line with normal saline.
Rationale: The client is exhibiting classic signs of a hemolytic transfusion reaction (chills,
low back pain, nausea). The priority is to immediately stop the transfusion to prevent
further infusion of the incompatible blood. The IV line must be kept open with normal
saline to maintain venous access for emergency medications if needed. The other actions
may be implemented later but are not the priority.
Topic: Pain Management
5. A nurse is planning care for a client with chronic cancer pain. The nurse
understands that which of the following principles is most important for effective
pain management?
A. Administering pain medication on an "as needed" (PRN) schedule.
B. Administering pain medication around the clock (ATC).
C. Using the lowest possible dose of medication to avoid addiction.
D. Encouraging the client to wait as long as possible between doses.
, Answer: B. Administering pain medication around the clock (ATC).
Rationale: For chronic pain, especially cancer pain, a scheduled, around-the-clock (ATC)
regimen is the most effective approach. This maintains a steady serum level of the
analgesic, preventing the recurrence of severe pain. A PRN schedule leads to peaks and
troughs in pain control, which is less effective for chronic conditions. Concerns about
addiction should not interfere with adequate pain management.
6. A client is prescribed hydromorphone (Dilaudid) for severe postoperative pain.
Which of the following assessment findings would indicate a potential adverse
effect requiring immediate intervention?
A. A respiratory rate of 10 breaths per minute.
B. A blood pressure of 110/70 mmHg.
C. A heart rate of 90 beats per minute.
D. A pain rating of 3 on a 0-10 scale.
Answer: A. A respiratory rate of 10 breaths per minute.
Rationale: Hydromorphone is a potent opioid agonist that can cause significant respiratory
depression by depressing the brainstem's respiratory center. A respiratory rate of 10
breaths/min is below the normal range (12-20) and signals a serious adverse effect. The
nurse's priority would be to stimulate the client and potentially administer naloxone
(Narcan).
7. A client is receiving morphine sulfate via a patient-controlled analgesia (PCA)
pump. The client's spouse expresses concern that the client might become
addicted to the medication. What is the nurse's best response?
