NUR 257 ADVANCED NURSING CARE
EXAM REVIEW QUESTIONS AND
ANSWERS WITH VERIFIED SOLUTIONS
2026/2027 UPDATE
1. A patient with a spinal cord injury at T4 reports a pounding headache and is found to have
a blood pressure of 190/100 mmHg. What is the priority nursing action?
A. Administer an ordered antihypertensive medication
B. Check the patient’s bladder for distension
C. Check the patient’s bladder for distension
D. Perform a neurological assessment
B. Place the patient in a prone position
Answer: C
Conceptual Explanation: The patient is exhibiting signs of autonomic dysreflexia. The
priority is to identify and remove the triggering stimulus, which is most commonly a
distended bladder or impacted bowel.
2. Which ABG result is consistent with a patient experiencing early-stage acute respiratory
distress syndrome (ARDS)?
A. pH 7.35, PaCO2 48, HCO3 26
,B. pH 7.40, PaCO2 40, HCO3 24
C. pH 7.28, PaCO2 55, HCO3 28
D. pH 7.48, PaCO2 30, HCO3 22
Answer: D
Conceptual Explanation: Early ARDS often presents with respiratory alkalosis due to
hyperventilation as the body attempts to compensate for hypoxemia.
3. A patient is admitted with Diabetic Ketoacidosis (DKA). Which electrolyte abnormality
should the nurse monitor most closely once insulin therapy begins?
A. Hypernatremia
B. Hypocalcemia
C. Hypermagnesemia
D. Hypokalemia
Answer: D
Conceptual Explanation: Insulin causes potassium to shift from the extracellular fluid into
the cells, which can lead to life-threatening hypokalemia.
4. A patient with liver cirrhosis presents with increased confusion and asterixis. Which
medication does the nurse anticipate administering?
A. Spironolactone
B. Lactulose
, C. Furosemide
D. Propranolol
Answer: B
Conceptual Explanation: Asterixis and confusion are signs of hepatic encephalopathy
caused by high ammonia levels. Lactulose helps excrete ammonia through the stool.
5. In a patient with Acute Kidney Injury (AKI), which phase is characterized by a daily urine
output of 400 mL or less?
A. Diuretic phase
B. Recovery phase
C. Initiation phase
D. Oliguric phase
Answer: D
Conceptual Explanation: The oliguric phase is defined by a significant decrease in urine
output, usually less than 400 mL/day, leading to fluid volume excess and electrolyte
imbalances.
6. Which clinical finding is part of Beck’s Triad, indicating cardiac tamponade?
A. Hypertension
B. Bradycardia
C. Muffled heart sounds
EXAM REVIEW QUESTIONS AND
ANSWERS WITH VERIFIED SOLUTIONS
2026/2027 UPDATE
1. A patient with a spinal cord injury at T4 reports a pounding headache and is found to have
a blood pressure of 190/100 mmHg. What is the priority nursing action?
A. Administer an ordered antihypertensive medication
B. Check the patient’s bladder for distension
C. Check the patient’s bladder for distension
D. Perform a neurological assessment
B. Place the patient in a prone position
Answer: C
Conceptual Explanation: The patient is exhibiting signs of autonomic dysreflexia. The
priority is to identify and remove the triggering stimulus, which is most commonly a
distended bladder or impacted bowel.
2. Which ABG result is consistent with a patient experiencing early-stage acute respiratory
distress syndrome (ARDS)?
A. pH 7.35, PaCO2 48, HCO3 26
,B. pH 7.40, PaCO2 40, HCO3 24
C. pH 7.28, PaCO2 55, HCO3 28
D. pH 7.48, PaCO2 30, HCO3 22
Answer: D
Conceptual Explanation: Early ARDS often presents with respiratory alkalosis due to
hyperventilation as the body attempts to compensate for hypoxemia.
3. A patient is admitted with Diabetic Ketoacidosis (DKA). Which electrolyte abnormality
should the nurse monitor most closely once insulin therapy begins?
A. Hypernatremia
B. Hypocalcemia
C. Hypermagnesemia
D. Hypokalemia
Answer: D
Conceptual Explanation: Insulin causes potassium to shift from the extracellular fluid into
the cells, which can lead to life-threatening hypokalemia.
4. A patient with liver cirrhosis presents with increased confusion and asterixis. Which
medication does the nurse anticipate administering?
A. Spironolactone
B. Lactulose
, C. Furosemide
D. Propranolol
Answer: B
Conceptual Explanation: Asterixis and confusion are signs of hepatic encephalopathy
caused by high ammonia levels. Lactulose helps excrete ammonia through the stool.
5. In a patient with Acute Kidney Injury (AKI), which phase is characterized by a daily urine
output of 400 mL or less?
A. Diuretic phase
B. Recovery phase
C. Initiation phase
D. Oliguric phase
Answer: D
Conceptual Explanation: The oliguric phase is defined by a significant decrease in urine
output, usually less than 400 mL/day, leading to fluid volume excess and electrolyte
imbalances.
6. Which clinical finding is part of Beck’s Triad, indicating cardiac tamponade?
A. Hypertension
B. Bradycardia
C. Muffled heart sounds
