, Question 1
A patient with heart failure is prescribed furosemide 40 mg IV push. Which
assessment finding most urgently requires holding the dose and notifying the
provider?
A. Serum potassium 3.1 mEq/L
B. Serum sodium 134 mEq/L
C. Urine output 60 mL/hr
D. Blood pressure 118/72 mm Hg
Correct Answer: A - Serum potassium 3.1 mEq/L
RATIONALE
Loop diuretics like furosemide cause potassium loss; a potassium of
3.1 mEq/L is dangerously low and increases risk of dysrhythmias.
Sodium 134 is mildly low but not an immediate hold. Urine output
and blood pressure are acceptable.
Question 2
Which arterial blood gas value indicates uncompensated respiratory alkalosis?
A. pH 7.48, PaCO2 30 mm Hg, HCO3- 24 mEq/L
B. pH 7.32, PaCO2 50 mm Hg, HCO3- 26 mEq/L
C. pH 7.30, PaCO2 34 mm Hg, HCO3- 18 mEq/L
D. pH 7.44, PaCO2 42 mm Hg, HCO3- 28 mEq/L
Correct Answer: A - pH 7.48, PaCO2 30 mm Hg, HCO3- 24
mEq/L
RATIONALE
Uncompensated respiratory alkalosis shows elevated pH, low PaCO2,
and normal HCO3-. Option A matches this. B is respiratory acidosis,
C is metabolic acidosis, D is metabolic alkalosis.
Page 2
, Question 3
A patient returns from surgery with a Jackson-Pratt drain. Which finding
requires immediate intervention?
A. Serosanguineous drainage of 50 mL in 8 hours
B. Drain tubing coiled below the insertion site
C. Drain bulb fully compressed and secured
D. Sudden cessation of drainage with abdominal distention
Correct Answer: D - Sudden cessation of drainage with
abdominal distention
RATIONALE
Sudden cessation of drainage with distention may indicate drain
obstruction or bleeding, requiring immediate assessment. A is
expected. B and C are correct drain management.
Question 4
Which ECG change is most characteristic of hyperkalemia?
A. Prolonged QT interval
B. Prominent U waves
C. Peaked T waves and widened QRS
D. ST elevation in contiguous leads
Correct Answer: C - Peaked T waves and widened QRS
RATIONALE
Hyperkalemia causes tall, peaked T waves, widened QRS, and
flattened P waves. Prolonged QT and U waves are seen in
hypokalemia. ST elevation indicates myocardial injury.
Question 5
A patient with type 1 diabetes has a blood glucose of 520 mg/dL, pH 7.22, and
positive serum ketones. Which prescription is the priority?
Page 3
A patient with heart failure is prescribed furosemide 40 mg IV push. Which
assessment finding most urgently requires holding the dose and notifying the
provider?
A. Serum potassium 3.1 mEq/L
B. Serum sodium 134 mEq/L
C. Urine output 60 mL/hr
D. Blood pressure 118/72 mm Hg
Correct Answer: A - Serum potassium 3.1 mEq/L
RATIONALE
Loop diuretics like furosemide cause potassium loss; a potassium of
3.1 mEq/L is dangerously low and increases risk of dysrhythmias.
Sodium 134 is mildly low but not an immediate hold. Urine output
and blood pressure are acceptable.
Question 2
Which arterial blood gas value indicates uncompensated respiratory alkalosis?
A. pH 7.48, PaCO2 30 mm Hg, HCO3- 24 mEq/L
B. pH 7.32, PaCO2 50 mm Hg, HCO3- 26 mEq/L
C. pH 7.30, PaCO2 34 mm Hg, HCO3- 18 mEq/L
D. pH 7.44, PaCO2 42 mm Hg, HCO3- 28 mEq/L
Correct Answer: A - pH 7.48, PaCO2 30 mm Hg, HCO3- 24
mEq/L
RATIONALE
Uncompensated respiratory alkalosis shows elevated pH, low PaCO2,
and normal HCO3-. Option A matches this. B is respiratory acidosis,
C is metabolic acidosis, D is metabolic alkalosis.
Page 2
, Question 3
A patient returns from surgery with a Jackson-Pratt drain. Which finding
requires immediate intervention?
A. Serosanguineous drainage of 50 mL in 8 hours
B. Drain tubing coiled below the insertion site
C. Drain bulb fully compressed and secured
D. Sudden cessation of drainage with abdominal distention
Correct Answer: D - Sudden cessation of drainage with
abdominal distention
RATIONALE
Sudden cessation of drainage with distention may indicate drain
obstruction or bleeding, requiring immediate assessment. A is
expected. B and C are correct drain management.
Question 4
Which ECG change is most characteristic of hyperkalemia?
A. Prolonged QT interval
B. Prominent U waves
C. Peaked T waves and widened QRS
D. ST elevation in contiguous leads
Correct Answer: C - Peaked T waves and widened QRS
RATIONALE
Hyperkalemia causes tall, peaked T waves, widened QRS, and
flattened P waves. Prolonged QT and U waves are seen in
hypokalemia. ST elevation indicates myocardial injury.
Question 5
A patient with type 1 diabetes has a blood glucose of 520 mg/dL, pH 7.22, and
positive serum ketones. Which prescription is the priority?
Page 3
