NSG 3800 Exam 3 V3 | NSG 3800 Nursing Practice – Adult Health II |
Actual Q&A with Rationale (NSG3800 Exam 3) | Galen
1. A nurse is caring for a patient who has developed cardiac tamponade. Which of the
following findings should the nurse expect?
A. Muffled heart sounds and jugular venous distention
B. Bradycardia and hypertension
C. Widened pulse pressure and bounding pulses
D. Flattened neck veins and tachycardia
Answer: A
Rationale: Cardiac tamponade is characterized by Beck’s triad, which includes muffled
heart sounds, jugular venous distention, and hypotension. These symptoms occur because
fluid accumulates in the pericardial sac, compressing the heart and preventing adequate
filling. The nurse must monitor for these signs as they indicate a medical emergency
requiring immediate pericardiocentesis.
2. A patient is admitted with a suspected pulmonary embolism (PE). Which diagnostic test is
considered the gold standard for confirming this diagnosis?
A. Chest X-ray
B. CT Pulmonary Angiography (CTPA)
C. D-dimer assay
D. Electrocardiogram (ECG)
Answer: B
Rationale: CT Pulmonary Angiography is the preferred diagnostic tool for confirming a
pulmonary embolism because it provides high-quality visualization of the pulmonary
vasculature. While a D-dimer can rule out a PE if negative, it is not specific enough to
confirm one. The CTPA allows clinicians to identify the location and extent of the clot
quickly and accurately.
3. Which arterial blood gas (ABG) result is most consistent with a patient experiencing early-
stage respiratory failure due to hyperventilation?
A. pH 7.30, PaCO2 50, HCO3 24
B. pH 7.20, PaCO2 40, HCO3 18
C. pH 7.50, PaCO2 30, HCO3 22
D. pH 7.45, PaCO2 45, HCO3 28
,Answer: C
Rationale: Hyperventilation leads to the excessive blowing off of carbon dioxide, which
causes respiratory alkalosis. In this state, the pH rises above 7.45 and the PaCO2 drops
below 35 mmHg. The bicarbonate level initially remains normal until the kidneys begin to
compensate, which takes longer than the respiratory change.
4. A patient with Chronic Obstructive Pulmonary Disease (COPD) is prescribed oxygen at
2L/min via nasal cannula. What is the primary physiological reason for maintaining a low flow
rate in this patient?
A. To prevent oxygen toxicity in lung tissue
B. To maintain a high level of carbon dioxide for gas exchange
C. To reduce the risk of spontaneous pneumothorax
D. To avoid suppressing the hypoxic drive to breathe
Answer: D
Rationale: Patients with chronic hypercapnia often rely on low oxygen levels (hypoxic
drive) rather than high CO2 levels to stimulate breathing. If too much oxygen is
administered, their stimulus to breathe may be suppressed, leading to respiratory arrest.
Therefore, titration of oxygen must be done carefully to maintain saturations between 88-
92%.
5. The nurse is preparing to administer a bolus of IV fluid to a patient in hypovolemic shock.
Which type of fluid is most appropriate for initial volume resuscitation?
A. 0.45% Sodium Chloride
B. 5% Dextrose in Water (D5W)
C. 3% Sodium Chloride
D. 0.9% Sodium Chloride (Normal Saline)
Answer: D
Rationale: Isotonic solutions like 0.9% Sodium Chloride or Lactured Ringer’s are the
preferred choice for initial fluid resuscitation in hypovolemic shock. These fluids stay in the
intravascular space longer than hypotonic solutions, effectively increasing blood volume
and pressure. Hypotonic solutions like 0.45% saline would shift fluid into the cells,
potentially worsening hypotension.
6. A patient has just returned from a cardiac catheterization via the femoral artery. Which
nursing intervention is the highest priority?
A. Encouraging the patient to ambulate immediately
B. Restricting oral fluid intake for 24 hours
, C. Placing the patient in a high-Fowler’s position
D. Monitoring the insertion site for bleeding or hematoma
Answer: D
Rationale: After a femoral artery catheterization, the patient is at high risk for hemorrhage
or hematoma formation at the puncture site. The nurse must perform frequent
neurovascular checks and assess the site for signs of bleeding while keeping the affected
extremity straight. Early ambulation or sitting upright is contraindicated as it increases
pressure on the arterial seal.
7. In a patient with Acute Respiratory Distress Syndrome (ARDS), what is the hallmark clinical
finding despite increasing the fraction of inspired oxygen (FiO2)?
A. Refractory hypoxemia
B. Hypocapnia
C. Hyperventilation
D. Increased lung compliance
Answer: A
Rationale: Refractory hypoxemia occurs when the arterial oxygen levels remain low even
when the patient is receiving high concentrations of supplemental oxygen. This is a classic
sign of ARDS caused by significant shunting and alveolar collapse. Managing this condition
usually requires mechanical ventilation with Positive End-Expiratory Pressure (PEEP).
8. A patient with Acute Renal Failure is in the oliguric phase. Which electrolyte imbalance is
the nurse most likely to observe?
A. Hypokalemia
B. Hypercalcemia
C. Hyperkalemia
D. Hyponatremia due to polyuria
Answer: C
Rationale: During the oliguric phase of acute kidney injury, the kidneys are unable to
excrete potassium effectively, leading to hyperkalemia. This condition is dangerous
because it can cause life-threatening cardiac arrhythmias. The nurse should monitor the
ECG for peaked T-waves and other signs of electrolyte imbalance.
9. Which medication is typically administered to a patient with a potassium level of 6.5 mEq/L
to protect the heart from arrhythmias?
A. Sodium Polystyrene Sulfonate
Actual Q&A with Rationale (NSG3800 Exam 3) | Galen
1. A nurse is caring for a patient who has developed cardiac tamponade. Which of the
following findings should the nurse expect?
A. Muffled heart sounds and jugular venous distention
B. Bradycardia and hypertension
C. Widened pulse pressure and bounding pulses
D. Flattened neck veins and tachycardia
Answer: A
Rationale: Cardiac tamponade is characterized by Beck’s triad, which includes muffled
heart sounds, jugular venous distention, and hypotension. These symptoms occur because
fluid accumulates in the pericardial sac, compressing the heart and preventing adequate
filling. The nurse must monitor for these signs as they indicate a medical emergency
requiring immediate pericardiocentesis.
2. A patient is admitted with a suspected pulmonary embolism (PE). Which diagnostic test is
considered the gold standard for confirming this diagnosis?
A. Chest X-ray
B. CT Pulmonary Angiography (CTPA)
C. D-dimer assay
D. Electrocardiogram (ECG)
Answer: B
Rationale: CT Pulmonary Angiography is the preferred diagnostic tool for confirming a
pulmonary embolism because it provides high-quality visualization of the pulmonary
vasculature. While a D-dimer can rule out a PE if negative, it is not specific enough to
confirm one. The CTPA allows clinicians to identify the location and extent of the clot
quickly and accurately.
3. Which arterial blood gas (ABG) result is most consistent with a patient experiencing early-
stage respiratory failure due to hyperventilation?
A. pH 7.30, PaCO2 50, HCO3 24
B. pH 7.20, PaCO2 40, HCO3 18
C. pH 7.50, PaCO2 30, HCO3 22
D. pH 7.45, PaCO2 45, HCO3 28
,Answer: C
Rationale: Hyperventilation leads to the excessive blowing off of carbon dioxide, which
causes respiratory alkalosis. In this state, the pH rises above 7.45 and the PaCO2 drops
below 35 mmHg. The bicarbonate level initially remains normal until the kidneys begin to
compensate, which takes longer than the respiratory change.
4. A patient with Chronic Obstructive Pulmonary Disease (COPD) is prescribed oxygen at
2L/min via nasal cannula. What is the primary physiological reason for maintaining a low flow
rate in this patient?
A. To prevent oxygen toxicity in lung tissue
B. To maintain a high level of carbon dioxide for gas exchange
C. To reduce the risk of spontaneous pneumothorax
D. To avoid suppressing the hypoxic drive to breathe
Answer: D
Rationale: Patients with chronic hypercapnia often rely on low oxygen levels (hypoxic
drive) rather than high CO2 levels to stimulate breathing. If too much oxygen is
administered, their stimulus to breathe may be suppressed, leading to respiratory arrest.
Therefore, titration of oxygen must be done carefully to maintain saturations between 88-
92%.
5. The nurse is preparing to administer a bolus of IV fluid to a patient in hypovolemic shock.
Which type of fluid is most appropriate for initial volume resuscitation?
A. 0.45% Sodium Chloride
B. 5% Dextrose in Water (D5W)
C. 3% Sodium Chloride
D. 0.9% Sodium Chloride (Normal Saline)
Answer: D
Rationale: Isotonic solutions like 0.9% Sodium Chloride or Lactured Ringer’s are the
preferred choice for initial fluid resuscitation in hypovolemic shock. These fluids stay in the
intravascular space longer than hypotonic solutions, effectively increasing blood volume
and pressure. Hypotonic solutions like 0.45% saline would shift fluid into the cells,
potentially worsening hypotension.
6. A patient has just returned from a cardiac catheterization via the femoral artery. Which
nursing intervention is the highest priority?
A. Encouraging the patient to ambulate immediately
B. Restricting oral fluid intake for 24 hours
, C. Placing the patient in a high-Fowler’s position
D. Monitoring the insertion site for bleeding or hematoma
Answer: D
Rationale: After a femoral artery catheterization, the patient is at high risk for hemorrhage
or hematoma formation at the puncture site. The nurse must perform frequent
neurovascular checks and assess the site for signs of bleeding while keeping the affected
extremity straight. Early ambulation or sitting upright is contraindicated as it increases
pressure on the arterial seal.
7. In a patient with Acute Respiratory Distress Syndrome (ARDS), what is the hallmark clinical
finding despite increasing the fraction of inspired oxygen (FiO2)?
A. Refractory hypoxemia
B. Hypocapnia
C. Hyperventilation
D. Increased lung compliance
Answer: A
Rationale: Refractory hypoxemia occurs when the arterial oxygen levels remain low even
when the patient is receiving high concentrations of supplemental oxygen. This is a classic
sign of ARDS caused by significant shunting and alveolar collapse. Managing this condition
usually requires mechanical ventilation with Positive End-Expiratory Pressure (PEEP).
8. A patient with Acute Renal Failure is in the oliguric phase. Which electrolyte imbalance is
the nurse most likely to observe?
A. Hypokalemia
B. Hypercalcemia
C. Hyperkalemia
D. Hyponatremia due to polyuria
Answer: C
Rationale: During the oliguric phase of acute kidney injury, the kidneys are unable to
excrete potassium effectively, leading to hyperkalemia. This condition is dangerous
because it can cause life-threatening cardiac arrhythmias. The nurse should monitor the
ECG for peaked T-waves and other signs of electrolyte imbalance.
9. Which medication is typically administered to a patient with a potassium level of 6.5 mEq/L
to protect the heart from arrhythmias?
A. Sodium Polystyrene Sulfonate
