,NR-325 Verified Adult Health II Exam 3 |
Chamberlain University | Q & A | 2026/2027
Edition
1. A client with acute decompensated heart failure presents with dyspnea, orthopnea, and
jugular venous distention. Which diuretic does the nurse anticipate administering to achieve
rapid venous and pulmonary vasodilation?
A) Furosemide
B) Hydrochlorothiazide
C) Spironolactone
D) Mannitol
Correct Answer: Furosemide
Rationale: Furosemide, a loop diuretic, is the first-line agent for acute decompensated heart
failure due to its rapid onset and venous vasodilating effects that reduce preload within
minutes. Hydrochlorothiazide is ineffective in renal impairment, spironolactone is too slow-
acting for acute management, and mannitol is an osmotic diuretic used for increased
intracranial pressure.
2. A client with chronic kidney disease has a serum potassium of 6.8 mEq/L and ECG showing
peaked T waves. Which immediate intervention should the nurse implement first?
A) Administer oral sodium polystyrene sulfonate
B) Prepare the client for emergent hemodialysis
,C) Administer intravenous calcium gluconate
D) Initiate a potassium-restricted diet
Correct Answer: Administer intravenous calcium gluconate
Rationale: Calcium gluconate is administered first to stabilize cardiac membranes and prevent
life-threatening dysrhythmias in severe hyperkalemia. Sodium polystyrene sulfonate and dietary
restriction are slower interventions, and hemodialysis, while definitive, requires preparation
time that delays immediate cardiac protection.
3. Which pathophysiological mechanism best explains the development of pulmonary
hypertension in a client with chronic obstructive pulmonary disease?
A) Increased pulmonary vascular resistance from chronic hypoxic vasoconstriction
B) Left ventricular failure causing backward transmission of pressure
C) Pulmonary emboli obstructing the pulmonary arterial bed
D) Autoimmune destruction of pulmonary arterial endothelium
Correct Answer: Increased pulmonary vascular resistance from chronic hypoxic vasoconstriction
Rationale: Chronic hypoxia in COPD causes sustained pulmonary arteriolar vasoconstriction,
leading to increased pulmonary vascular resistance and eventual right ventricular hypertrophy.
Left ventricular failure is not the primary mechanism in COPD, and pulmonary emboli or
autoimmune processes are not characteristic of COPD pathophysiology.
4. A client with cirrhosis develops asterixis, confusion, and a serum ammonia level of 180
mcg/dL. Which medication does the nurse expect to administer to reduce ammonia
production?
, A) Spironolactone
B) Lactulose
C) Furosemide
D) Omeprazole
Correct Answer: Lactulose
Rationale: Lactulose acidifies the colon, trapping ammonia as ammonium ion for excretion and
reducing serum ammonia levels in hepatic encephalopathy. Spironolactone and furosemide
treat ascites, and omeprazole reduces gastric acid but does not affect ammonia metabolism.
5. A client with acute pancreatitis has severe abdominal pain radiating to the back. Which
laboratory finding is most specific for the diagnosis of acute pancreatitis?
A) Elevated serum amylase
B) Elevated serum lipase
C) Elevated serum glucose
D) Elevated white blood cell count
Correct Answer: Elevated serum lipase
Rationale: Serum lipase is more specific than amylase for acute pancreatitis, as it remains
elevated longer and is not affected by salivary sources. Glucose elevation and leukocytosis are
non-specific findings that can occur in many conditions.
6. A nurse is assessing a client with suspected acute kidney injury. Which finding indicates
prerenal azotemia rather than intrarenal injury?
Chamberlain University | Q & A | 2026/2027
Edition
1. A client with acute decompensated heart failure presents with dyspnea, orthopnea, and
jugular venous distention. Which diuretic does the nurse anticipate administering to achieve
rapid venous and pulmonary vasodilation?
A) Furosemide
B) Hydrochlorothiazide
C) Spironolactone
D) Mannitol
Correct Answer: Furosemide
Rationale: Furosemide, a loop diuretic, is the first-line agent for acute decompensated heart
failure due to its rapid onset and venous vasodilating effects that reduce preload within
minutes. Hydrochlorothiazide is ineffective in renal impairment, spironolactone is too slow-
acting for acute management, and mannitol is an osmotic diuretic used for increased
intracranial pressure.
2. A client with chronic kidney disease has a serum potassium of 6.8 mEq/L and ECG showing
peaked T waves. Which immediate intervention should the nurse implement first?
A) Administer oral sodium polystyrene sulfonate
B) Prepare the client for emergent hemodialysis
,C) Administer intravenous calcium gluconate
D) Initiate a potassium-restricted diet
Correct Answer: Administer intravenous calcium gluconate
Rationale: Calcium gluconate is administered first to stabilize cardiac membranes and prevent
life-threatening dysrhythmias in severe hyperkalemia. Sodium polystyrene sulfonate and dietary
restriction are slower interventions, and hemodialysis, while definitive, requires preparation
time that delays immediate cardiac protection.
3. Which pathophysiological mechanism best explains the development of pulmonary
hypertension in a client with chronic obstructive pulmonary disease?
A) Increased pulmonary vascular resistance from chronic hypoxic vasoconstriction
B) Left ventricular failure causing backward transmission of pressure
C) Pulmonary emboli obstructing the pulmonary arterial bed
D) Autoimmune destruction of pulmonary arterial endothelium
Correct Answer: Increased pulmonary vascular resistance from chronic hypoxic vasoconstriction
Rationale: Chronic hypoxia in COPD causes sustained pulmonary arteriolar vasoconstriction,
leading to increased pulmonary vascular resistance and eventual right ventricular hypertrophy.
Left ventricular failure is not the primary mechanism in COPD, and pulmonary emboli or
autoimmune processes are not characteristic of COPD pathophysiology.
4. A client with cirrhosis develops asterixis, confusion, and a serum ammonia level of 180
mcg/dL. Which medication does the nurse expect to administer to reduce ammonia
production?
, A) Spironolactone
B) Lactulose
C) Furosemide
D) Omeprazole
Correct Answer: Lactulose
Rationale: Lactulose acidifies the colon, trapping ammonia as ammonium ion for excretion and
reducing serum ammonia levels in hepatic encephalopathy. Spironolactone and furosemide
treat ascites, and omeprazole reduces gastric acid but does not affect ammonia metabolism.
5. A client with acute pancreatitis has severe abdominal pain radiating to the back. Which
laboratory finding is most specific for the diagnosis of acute pancreatitis?
A) Elevated serum amylase
B) Elevated serum lipase
C) Elevated serum glucose
D) Elevated white blood cell count
Correct Answer: Elevated serum lipase
Rationale: Serum lipase is more specific than amylase for acute pancreatitis, as it remains
elevated longer and is not affected by salivary sources. Glucose elevation and leukocytosis are
non-specific findings that can occur in many conditions.
6. A nurse is assessing a client with suspected acute kidney injury. Which finding indicates
prerenal azotemia rather than intrarenal injury?
