, Question 1
A patient with acute decompensated heart failure is prescribed IV furosemide.
Which assessment finding best indicates a therapeutic response to the
medication?
A. Serum potassium increase from 3.2 to 4.0 mEq/L
B. Urine output of 50 mL/hr with decreased dyspnea
C. Blood pressure decrease from 140/90 to 110/70 mm Hg
D. Weight loss of 0.5 kg over 24 hours
Correct Answer: B - Urine output of 50 mL/hr with decreased
dyspnea
RATIONALE
Furosemide is a loop diuretic; therapeutic response is increased
diuresis and relief of pulmonary congestion. Option A indicates
correction of hypokalemia, but not directly therapeutic diuresis.
Option C may indicate hypotension, an adverse effect. Option D is
insignificant weight loss; expected is 0.5-1 kg/day.
Question 2
Which pathophysiological mechanism best explains the development of
metabolic alkalosis in a patient with prolonged nasogastric suctioning?
A. Increased renal excretion of bicarbonate
B. Loss of hydrogen ions and chloride
C. Hyperventilation-induced carbon dioxide loss
D. Excessive aldosterone secretion
Correct Answer: B - Loss of hydrogen ions and chloride
RATIONALE
Gastric suction removes HCl, leading to loss of H+ and Cl-, causing
hypochloremic metabolic alkalosis. Option A would worsen alkalosis.
Option C causes respiratory alkalosis. Option D causes metabolic
alkalosis but not from suctioning.
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, Question 3
A nurse is calculating the dose of IV morphine for a patient with severe pain.
The order is for 2 mg IV every 4 hours PRN. The vial contains 10 mg/mL.
How many mL will the nurse administer per dose?
A. 0.2 mL
B. 0.5 mL
C. 1 mL
D. 2 mL
Correct Answer: A - 0.2 mL
RATIONALE
Desired dose 2 mg divided by concentration 10 mg/mL equals 0.2 mL.
Options B, C, and D represent miscalculations.
Question 4
A patient with type 1 diabetes is admitted with DKA. Which laboratory finding
would the nurse expect to see as a compensatory mechanism?
A. pH 7.50, PaCO2 30 mm Hg
B. pH 7.30, PaCO2 30 mm Hg
C. pH 7.30, PaCO2 50 mm Hg
D. pH 7.50, PaCO2 50 mm Hg
Correct Answer: B - pH 7.30, PaCO2 30 mm Hg
RATIONALE
DKA causes metabolic acidosis (low pH, low HCO3). Respiratory
compensation is hyperventilation (Kussmaul respirations) to blow off
CO2, resulting in low PaCO2. Option A is alkalosis. Option C is
respiratory acidosis. Option D is metabolic alkalosis with respiratory
compensation.
Page 3
, Question 5
A patient is receiving a blood transfusion and develops fever, chills, and flank
pain. Which action should the nurse take first?
A. Administer acetaminophen
B. Stop the transfusion and maintain IV access
C. Slow the transfusion rate
D. Obtain a urine sample
Correct Answer: B - Stop the transfusion and maintain IV access
RATIONALE
These symptoms suggest an acute hemolytic transfusion reaction. The
priority is to stop the transfusion immediately and keep the IV line
patent with normal saline. Acetaminophen is for febrile non-hemolytic
reactions. Slowing the rate is unsafe. Urine sample is secondary.
Question 6
Which assessment finding is most concerning in a patient receiving a
continuous IV infusion of potassium chloride?
A. Urine output of 30 mL/hr
B. Serum potassium of 5.0 mEq/L
C. Complaint of burning at IV site
D. Presence of U wave on ECG
Correct Answer: C - Complaint of burning at IV site
RATIONALE
Burning at the IV site indicates phlebitis or infiltration, which can lead
to tissue necrosis; the infusion must be stopped. Urine output of 30
mL/hr is adequate (minimum 30 mL/hr). Potassium 5.0 is within
normal range. U waves indicate hypokalemia, not a complication of
infusion.
Page 4
A patient with acute decompensated heart failure is prescribed IV furosemide.
Which assessment finding best indicates a therapeutic response to the
medication?
A. Serum potassium increase from 3.2 to 4.0 mEq/L
B. Urine output of 50 mL/hr with decreased dyspnea
C. Blood pressure decrease from 140/90 to 110/70 mm Hg
D. Weight loss of 0.5 kg over 24 hours
Correct Answer: B - Urine output of 50 mL/hr with decreased
dyspnea
RATIONALE
Furosemide is a loop diuretic; therapeutic response is increased
diuresis and relief of pulmonary congestion. Option A indicates
correction of hypokalemia, but not directly therapeutic diuresis.
Option C may indicate hypotension, an adverse effect. Option D is
insignificant weight loss; expected is 0.5-1 kg/day.
Question 2
Which pathophysiological mechanism best explains the development of
metabolic alkalosis in a patient with prolonged nasogastric suctioning?
A. Increased renal excretion of bicarbonate
B. Loss of hydrogen ions and chloride
C. Hyperventilation-induced carbon dioxide loss
D. Excessive aldosterone secretion
Correct Answer: B - Loss of hydrogen ions and chloride
RATIONALE
Gastric suction removes HCl, leading to loss of H+ and Cl-, causing
hypochloremic metabolic alkalosis. Option A would worsen alkalosis.
Option C causes respiratory alkalosis. Option D causes metabolic
alkalosis but not from suctioning.
Page 2
, Question 3
A nurse is calculating the dose of IV morphine for a patient with severe pain.
The order is for 2 mg IV every 4 hours PRN. The vial contains 10 mg/mL.
How many mL will the nurse administer per dose?
A. 0.2 mL
B. 0.5 mL
C. 1 mL
D. 2 mL
Correct Answer: A - 0.2 mL
RATIONALE
Desired dose 2 mg divided by concentration 10 mg/mL equals 0.2 mL.
Options B, C, and D represent miscalculations.
Question 4
A patient with type 1 diabetes is admitted with DKA. Which laboratory finding
would the nurse expect to see as a compensatory mechanism?
A. pH 7.50, PaCO2 30 mm Hg
B. pH 7.30, PaCO2 30 mm Hg
C. pH 7.30, PaCO2 50 mm Hg
D. pH 7.50, PaCO2 50 mm Hg
Correct Answer: B - pH 7.30, PaCO2 30 mm Hg
RATIONALE
DKA causes metabolic acidosis (low pH, low HCO3). Respiratory
compensation is hyperventilation (Kussmaul respirations) to blow off
CO2, resulting in low PaCO2. Option A is alkalosis. Option C is
respiratory acidosis. Option D is metabolic alkalosis with respiratory
compensation.
Page 3
, Question 5
A patient is receiving a blood transfusion and develops fever, chills, and flank
pain. Which action should the nurse take first?
A. Administer acetaminophen
B. Stop the transfusion and maintain IV access
C. Slow the transfusion rate
D. Obtain a urine sample
Correct Answer: B - Stop the transfusion and maintain IV access
RATIONALE
These symptoms suggest an acute hemolytic transfusion reaction. The
priority is to stop the transfusion immediately and keep the IV line
patent with normal saline. Acetaminophen is for febrile non-hemolytic
reactions. Slowing the rate is unsafe. Urine sample is secondary.
Question 6
Which assessment finding is most concerning in a patient receiving a
continuous IV infusion of potassium chloride?
A. Urine output of 30 mL/hr
B. Serum potassium of 5.0 mEq/L
C. Complaint of burning at IV site
D. Presence of U wave on ECG
Correct Answer: C - Complaint of burning at IV site
RATIONALE
Burning at the IV site indicates phlebitis or infiltration, which can lead
to tissue necrosis; the infusion must be stopped. Urine output of 30
mL/hr is adequate (minimum 30 mL/hr). Potassium 5.0 is within
normal range. U waves indicate hypokalemia, not a complication of
infusion.
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