NURS 120 MEDICAL-SURGICAL
NURSING EXAM 3 - ADVANCED
PRACTICE STUDY GUIDE
1. A patient with a history of heart failure presents with a potassium level of 6.2 mEq/L and
tall, peaked T waves on the ECG. Which medication should the nurse expect to administer
first to protect the myocardium?
A. Sodium polystyrene sulfonate
B. Calcium gluconate
C. Furosemide
D. Insulin and Dextrose
Answer: B
Conceptual Explanation: Calcium gluconate is administered to stabilize the myocardial
cell membrane and protect the heart from life-threatening arrhythmias associated with
hyperkalemia, though it does not lower potassium levels itself.
2. A client is diagnosed with Atrial Fibrillation with a rapid ventricular response (RVR). The
client is hemodynamically unstable with a blood pressure of 88/50 mmHg. What is the
priority intervention?
A. Synchronized cardioversion
,B. Administration of Diltiazem IV bolus
C. Immediate defibrillation at 200 Joules
D. Preparation for a permanent pacemaker
Answer: A
Conceptual Explanation: For unstable supraventricular tachyarrhythmias like AFib with
RVR, synchronized cardioversion is the treatment of choice. Defibrillation is used for
pulseless VT/VF.
3. Which arterial blood gas (ABG) result would the nurse expect in a patient experiencing a
severe exacerbation of COPD with respiratory failure?
A. pH 7.50, PaCO2 45, HCO3 34
B. pH 7.48, PaCO2 30, HCO3 22
C. pH 7.32, PaCO2 40, HCO3 18
D. pH 7.30, PaCO2 55, HCO3 28
Answer: D
Conceptual Explanation: COPD exacerbations typically lead to respiratory acidosis (low
pH, high PaCO2) with partial metabolic compensation (elevated HCO3).
4. A patient with Chronic Kidney Disease (CKD) has a phosphorus level of 5.8 mg/dL. Which
instruction should the nurse include in the teaching plan?
A. Increase intake of dairy products for calcium
, B. Take calcium carbonate with meals
C. Limit intake of green leafy vegetables
D. Restrict fluid intake to 500 mL per day
Answer: B
Conceptual Explanation: Phosphate binders like calcium carbonate must be taken with
meals to bind phosphorus in food and prevent absorption in CKD patients.
5. The nurse is caring for a patient post-thyroidectomy. The patient reports tingling in the
fingers and around the mouth. Which assessment finding should the nurse prioritize?
A. Positive Trousseau’s sign
B. Hypotension
C. Negative Chvostek’s sign
D. Bradycardia
Answer: A
Conceptual Explanation: Tingling and numbness (paresthesia) post-thyroidectomy
indicate hypocalcemia due to parathyroid damage. Trousseau’s sign is a clinical indicator of
hypocalcemia.
6. A client in DKA has a blood glucose of 250 mg/dL and the IV insulin infusion is still running.
What is the priority nursing action?
A. Discontinue the insulin infusion
NURSING EXAM 3 - ADVANCED
PRACTICE STUDY GUIDE
1. A patient with a history of heart failure presents with a potassium level of 6.2 mEq/L and
tall, peaked T waves on the ECG. Which medication should the nurse expect to administer
first to protect the myocardium?
A. Sodium polystyrene sulfonate
B. Calcium gluconate
C. Furosemide
D. Insulin and Dextrose
Answer: B
Conceptual Explanation: Calcium gluconate is administered to stabilize the myocardial
cell membrane and protect the heart from life-threatening arrhythmias associated with
hyperkalemia, though it does not lower potassium levels itself.
2. A client is diagnosed with Atrial Fibrillation with a rapid ventricular response (RVR). The
client is hemodynamically unstable with a blood pressure of 88/50 mmHg. What is the
priority intervention?
A. Synchronized cardioversion
,B. Administration of Diltiazem IV bolus
C. Immediate defibrillation at 200 Joules
D. Preparation for a permanent pacemaker
Answer: A
Conceptual Explanation: For unstable supraventricular tachyarrhythmias like AFib with
RVR, synchronized cardioversion is the treatment of choice. Defibrillation is used for
pulseless VT/VF.
3. Which arterial blood gas (ABG) result would the nurse expect in a patient experiencing a
severe exacerbation of COPD with respiratory failure?
A. pH 7.50, PaCO2 45, HCO3 34
B. pH 7.48, PaCO2 30, HCO3 22
C. pH 7.32, PaCO2 40, HCO3 18
D. pH 7.30, PaCO2 55, HCO3 28
Answer: D
Conceptual Explanation: COPD exacerbations typically lead to respiratory acidosis (low
pH, high PaCO2) with partial metabolic compensation (elevated HCO3).
4. A patient with Chronic Kidney Disease (CKD) has a phosphorus level of 5.8 mg/dL. Which
instruction should the nurse include in the teaching plan?
A. Increase intake of dairy products for calcium
, B. Take calcium carbonate with meals
C. Limit intake of green leafy vegetables
D. Restrict fluid intake to 500 mL per day
Answer: B
Conceptual Explanation: Phosphate binders like calcium carbonate must be taken with
meals to bind phosphorus in food and prevent absorption in CKD patients.
5. The nurse is caring for a patient post-thyroidectomy. The patient reports tingling in the
fingers and around the mouth. Which assessment finding should the nurse prioritize?
A. Positive Trousseau’s sign
B. Hypotension
C. Negative Chvostek’s sign
D. Bradycardia
Answer: A
Conceptual Explanation: Tingling and numbness (paresthesia) post-thyroidectomy
indicate hypocalcemia due to parathyroid damage. Trousseau’s sign is a clinical indicator of
hypocalcemia.
6. A client in DKA has a blood glucose of 250 mg/dL and the IV insulin infusion is still running.
What is the priority nursing action?
A. Discontinue the insulin infusion
