NUR 283 COMPREHENSIVE II
EXAMINATION QUESTIONS AND
ANSWERS
1. A client with a history of heart failure presents with a potassium level of 6.4 mEq/L and
peaked T-waves on the ECG. Which medication should the nurse expect to administer first to
protect the myocardium?
A. Sodium polystyrene sulfonate
B. Regular insulin and D50W
C. Calcium gluconate
D. Furosemide
Answer: C
Conceptual Explanation: Calcium gluconate is administered first in severe hyperkalemia
to stabilize the myocardial cell membrane and prevent life-threatening arrhythmias,
although it does not lower the potassium level itself.
,2. A nurse is caring for a client with preeclampsia receiving magnesium sulfate. The nurse
notes absent deep tendon reflexes (DTRs) and a respiratory rate of 10 breaths/min. What is
the priority action?
A. Stop the magnesium sulfate infusion
B. Administer calcium gluconate IV
C. Decrease the infusion rate by half
D. Notify the provider immediately
Answer: A
Conceptual Explanation: The client is showing signs of magnesium toxicity (absent DTRs,
respiratory depression). The first action is to stop the infusion to prevent further toxicity,
then administer the antagonist calcium gluconate.
3. A client is admitted with Diabetic Ketoacidosis (DKA). The nurse notes a blood glucose of
580 mg/dL and serum potassium of 3.2 mEq/L. Which provider order should the nurse
implement first?
A. Start an IV infusion of Regular Insulin at 0.1 units/kg/hr
B. Administer a 1 L bolus of 0.9% Normal Saline
C. Add 20 mEq of Potassium Chloride to the IV fluids
D. Check the urine for ketones
Answer: B
, Conceptual Explanation: In DKA, rehydration is the priority to restore circulatory volume.
While insulin is needed, it will drive potassium into cells; since the potassium is already
low, fluid resuscitation occurs first while monitoring electrolytes.
4. A nurse on a psychiatric unit is caring for a client with bipolar disorder taking Lithium. The
client reports blurred vision, coarse hand tremors, and severe diarrhea. The nurse should
suspect a serum lithium level of:
A. 0.8 mEq/L
B. 2.5 mEq/L
C. 1.4 mEq/L
D. 1.2 mEq/L
Answer: B
Conceptual Explanation: Symptoms like blurred vision, coarse tremors, and severe GI
upset indicate severe lithium toxicity, typically occurring at levels above 2.0-2.5 mEq/L.
5. Which assessment finding in a client with a chest tube requires immediate intervention by
the nurse?
A. Intermittent bubbling in the water seal chamber during coughing
B. Continuous bubbling in the water seal chamber
C. Tidaling in the water seal chamber with respiration
D. Drainage of 50 mL of serosanguinous fluid over 2 hours
EXAMINATION QUESTIONS AND
ANSWERS
1. A client with a history of heart failure presents with a potassium level of 6.4 mEq/L and
peaked T-waves on the ECG. Which medication should the nurse expect to administer first to
protect the myocardium?
A. Sodium polystyrene sulfonate
B. Regular insulin and D50W
C. Calcium gluconate
D. Furosemide
Answer: C
Conceptual Explanation: Calcium gluconate is administered first in severe hyperkalemia
to stabilize the myocardial cell membrane and prevent life-threatening arrhythmias,
although it does not lower the potassium level itself.
,2. A nurse is caring for a client with preeclampsia receiving magnesium sulfate. The nurse
notes absent deep tendon reflexes (DTRs) and a respiratory rate of 10 breaths/min. What is
the priority action?
A. Stop the magnesium sulfate infusion
B. Administer calcium gluconate IV
C. Decrease the infusion rate by half
D. Notify the provider immediately
Answer: A
Conceptual Explanation: The client is showing signs of magnesium toxicity (absent DTRs,
respiratory depression). The first action is to stop the infusion to prevent further toxicity,
then administer the antagonist calcium gluconate.
3. A client is admitted with Diabetic Ketoacidosis (DKA). The nurse notes a blood glucose of
580 mg/dL and serum potassium of 3.2 mEq/L. Which provider order should the nurse
implement first?
A. Start an IV infusion of Regular Insulin at 0.1 units/kg/hr
B. Administer a 1 L bolus of 0.9% Normal Saline
C. Add 20 mEq of Potassium Chloride to the IV fluids
D. Check the urine for ketones
Answer: B
, Conceptual Explanation: In DKA, rehydration is the priority to restore circulatory volume.
While insulin is needed, it will drive potassium into cells; since the potassium is already
low, fluid resuscitation occurs first while monitoring electrolytes.
4. A nurse on a psychiatric unit is caring for a client with bipolar disorder taking Lithium. The
client reports blurred vision, coarse hand tremors, and severe diarrhea. The nurse should
suspect a serum lithium level of:
A. 0.8 mEq/L
B. 2.5 mEq/L
C. 1.4 mEq/L
D. 1.2 mEq/L
Answer: B
Conceptual Explanation: Symptoms like blurred vision, coarse tremors, and severe GI
upset indicate severe lithium toxicity, typically occurring at levels above 2.0-2.5 mEq/L.
5. Which assessment finding in a client with a chest tube requires immediate intervention by
the nurse?
A. Intermittent bubbling in the water seal chamber during coughing
B. Continuous bubbling in the water seal chamber
C. Tidaling in the water seal chamber with respiration
D. Drainage of 50 mL of serosanguinous fluid over 2 hours
