Chamberlain Adult
Health / Medical-
Surgical Nursing
Exam Overview
Sample Exam Questions with Rationales
Fluid, Electrolyte & Acid-Base Balance
1. A patient is admitted with severe dehydration. Which assessment finding would
the nurse expect?
A. Bounding pulse
B. Jugular vein distention
C. Orthostatic hypotension
D. Crackles in lung bases
Rationale: Dehydration causes hypovolemia, leading to orthostatic hypotension.
Bounding pulse, jugular vein distention, and crackles indicate fluid overload .
2. A patient has a serum potassium level of 6.8 mEq/L. Which ECG change would
the nurse expect?
,A. Flattened T waves
B. Peaked T waves
C. Prolonged QT interval
D. Prominent U waves
Rationale: Hyperkalemia causes peaked (tented) T waves. Flattened T waves and
prominent U waves are associated with hypokalemia .
3. A patient with hyperkalemia is prescribed IV calcium gluconate. The nurse
understands that this medication works by:
A. Lowering serum potassium levels
B. Antagonizing the cardiac effects of hyperkalemia
C. Increasing potassium excretion
D. Shifting potassium into cells
Rationale: Calcium stabilizes cardiac membranes but does not lower potassium levels.
Insulin/glucose and albuterol shift potassium into cells .
4. A patient has an ABG result: pH 7.32, PaCO₂ 48, HCO₃ 24. The nurse interprets
this as:
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Rationale: Low pH with elevated PaCO₂ indicates respiratory acidosis. The HCO₃ is
normal, indicating no metabolic compensation .
5. A client with fluid volume excess has crackles in the lung bases and 3+ pitting
edema. Which of the following is a priority nursing intervention?
,A. Administer a diuretic as prescribed
B. Restrict oral fluids
C. Elevate the head of the bed
D. All of the above
Rationale: Fluid volume excess requires multiple interventions: diuretics to remove
excess fluid, fluid restriction to prevent further overload, and elevating the head of the
bed to improve breathing and reduce pulmonary congestion .
Cardiovascular Disorders
6. A nurse is caring for a client who suddenly develops crushing chest pain
radiating to the left arm. Which action should the nurse take first?
A. Obtain a dietary history
B. Assess pain characteristics and activate appropriate cardiac protocols
C. Encourage ambulation
D. Schedule discharge teaching
Rationale: Chest pain radiating to the arm may indicate myocardial ischemia or
infarction and requires immediate assessment and intervention .
7. A client with heart failure develops sudden shortness of breath and pink frothy
sputum. Which complication should the nurse suspect?
A. Stable angina
B. Deep vein thrombosis
C. Acute pulmonary edema
D. Gastroenteritis
Rationale: Pink frothy sputum and severe dyspnea are classic signs of pulmonary
edema .
, 8. A client with heart failure gains 2.5 kg (5.5 lb) in two days. Which action should
the nurse take?
A. Document the finding as normal
B. Notify the provider immediately
C. Restrict all fluids
D. Encourage increased oral intake
Rationale: A weight gain of 2.5 kg in two days indicates fluid retention and worsening
heart failure, requiring immediate provider notification .
Respiratory Disorders
9. A client with COPD develops increasing confusion and drowsiness. Which
condition should the nurse suspect?
A. Hypocapnia
B. Carbon dioxide retention
C. Hyperthyroidism
D. Hypoglycemia
Rationale: COPD clients can develop hypercapnia (elevated CO₂), leading to altered
mental status. This is a sign of respiratory failure .
10. Which assessment finding is most concerning in a client with asthma?
A. Mild wheezing
B. Respiratory rate of 22/min
C. Diminished breath sounds during severe distress
D. Occasional cough
Rationale: Diminished breath sounds can indicate critically reduced airflow and
impending respiratory failure, requiring immediate intervention .
Health / Medical-
Surgical Nursing
Exam Overview
Sample Exam Questions with Rationales
Fluid, Electrolyte & Acid-Base Balance
1. A patient is admitted with severe dehydration. Which assessment finding would
the nurse expect?
A. Bounding pulse
B. Jugular vein distention
C. Orthostatic hypotension
D. Crackles in lung bases
Rationale: Dehydration causes hypovolemia, leading to orthostatic hypotension.
Bounding pulse, jugular vein distention, and crackles indicate fluid overload .
2. A patient has a serum potassium level of 6.8 mEq/L. Which ECG change would
the nurse expect?
,A. Flattened T waves
B. Peaked T waves
C. Prolonged QT interval
D. Prominent U waves
Rationale: Hyperkalemia causes peaked (tented) T waves. Flattened T waves and
prominent U waves are associated with hypokalemia .
3. A patient with hyperkalemia is prescribed IV calcium gluconate. The nurse
understands that this medication works by:
A. Lowering serum potassium levels
B. Antagonizing the cardiac effects of hyperkalemia
C. Increasing potassium excretion
D. Shifting potassium into cells
Rationale: Calcium stabilizes cardiac membranes but does not lower potassium levels.
Insulin/glucose and albuterol shift potassium into cells .
4. A patient has an ABG result: pH 7.32, PaCO₂ 48, HCO₃ 24. The nurse interprets
this as:
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Rationale: Low pH with elevated PaCO₂ indicates respiratory acidosis. The HCO₃ is
normal, indicating no metabolic compensation .
5. A client with fluid volume excess has crackles in the lung bases and 3+ pitting
edema. Which of the following is a priority nursing intervention?
,A. Administer a diuretic as prescribed
B. Restrict oral fluids
C. Elevate the head of the bed
D. All of the above
Rationale: Fluid volume excess requires multiple interventions: diuretics to remove
excess fluid, fluid restriction to prevent further overload, and elevating the head of the
bed to improve breathing and reduce pulmonary congestion .
Cardiovascular Disorders
6. A nurse is caring for a client who suddenly develops crushing chest pain
radiating to the left arm. Which action should the nurse take first?
A. Obtain a dietary history
B. Assess pain characteristics and activate appropriate cardiac protocols
C. Encourage ambulation
D. Schedule discharge teaching
Rationale: Chest pain radiating to the arm may indicate myocardial ischemia or
infarction and requires immediate assessment and intervention .
7. A client with heart failure develops sudden shortness of breath and pink frothy
sputum. Which complication should the nurse suspect?
A. Stable angina
B. Deep vein thrombosis
C. Acute pulmonary edema
D. Gastroenteritis
Rationale: Pink frothy sputum and severe dyspnea are classic signs of pulmonary
edema .
, 8. A client with heart failure gains 2.5 kg (5.5 lb) in two days. Which action should
the nurse take?
A. Document the finding as normal
B. Notify the provider immediately
C. Restrict all fluids
D. Encourage increased oral intake
Rationale: A weight gain of 2.5 kg in two days indicates fluid retention and worsening
heart failure, requiring immediate provider notification .
Respiratory Disorders
9. A client with COPD develops increasing confusion and drowsiness. Which
condition should the nurse suspect?
A. Hypocapnia
B. Carbon dioxide retention
C. Hyperthyroidism
D. Hypoglycemia
Rationale: COPD clients can develop hypercapnia (elevated CO₂), leading to altered
mental status. This is a sign of respiratory failure .
10. Which assessment finding is most concerning in a client with asthma?
A. Mild wheezing
B. Respiratory rate of 22/min
C. Diminished breath sounds during severe distress
D. Occasional cough
Rationale: Diminished breath sounds can indicate critically reduced airflow and
impending respiratory failure, requiring immediate intervention .
