NURS 307 FINAL EXAM STUDY GUIDE
QUESTIONS AND VERIFIED ANSWERS |
100% CORRECT | GRADE A+
1. A patient with a history of heart failure presents with a pH of 7.32, PaCO2 of 50 mmHg, and
HCO3- of 26 mEq/L. Which acid-base imbalance is occurring?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Acidosis
D. Respiratory Alkalosis
Answer: C
Conceptual Explanation: The pH is below 7.35, indicating acidosis. The PaCO2 is elevated
above 45 mmHg, which matches the direction of the pH change (acidic), while the
bicarbonate is within normal limits. This indicates a primary respiratory cause.
2. Which clinical manifestation is a hallmark sign of Autonomic Dysreflexia in a patient with a
T6 spinal cord injury?
A. Tachycardia and hypotension
B. Profuse sweating below the level of injury
C. Sudden significant hypertension and bradycardia
,D. Severe hypotension and tachypnea
Answer: C
Conceptual Explanation: Autonomic dysreflexia is a medical emergency characterized by
a sudden, massive sympathetic discharge resulting in severe hypertension and a
compensatory parasympathetic response causing bradycardia and flushing above the level
of injury.
3. A patient is receiving a continuous heparin infusion for a pulmonary embolism. The nurse
notes the aPTT is 105 seconds (Control: 25-35). What is the priority nursing action?
A. Decrease the infusion rate per protocol
B. Continue the infusion and recheck in 4 hours
C. Stop the infusion and prepare protamine sulfate
D. Increase the infusion rate to reach therapeutic range
Answer: C
Conceptual Explanation: An aPTT of 105 seconds is significantly above the therapeutic
range (usually 1.5-2.5 times the control). Because of the high risk for spontaneous bleeding,
the infusion must be stopped and the antidote, protamine sulfate, may be needed.
4. A patient with Type 1 Diabetes Mellitus presents to the ED with Kussmaul respirations and
a fruity breath odor. Which lab result is most expected?
A. Serum glucose of 180 mg/dL
, B. Serum bicarbonate of 28 mEq/L
C. Negative urine ketones
D. Arterial pH of 7.15
Answer: D
Conceptual Explanation: These are classic signs of Diabetic Ketoacidosis (DKA). DKA is
characterized by metabolic acidosis (pH < 7.35), hyperglycemia, and the presence of
ketones. Kussmaul respirations are a compensatory mechanism to blow off CO2.
5. When assessing a patient with suspected Cushing’s Syndrome, which physical finding is the
nurse most likely to observe?
A. Truncal obesity and moon face
B. Bronze skin pigmentation
C. Hypotension and weight loss
D. Hyperkalemia and hypoglycemia
Answer: A
Conceptual Explanation: Cushing’s Syndrome results from excessive cortisol. Clinical
features include truncal obesity, moon face, buffalo hump, and purple striae. Hypotension
and bronze skin are associated with Addison’s disease.
QUESTIONS AND VERIFIED ANSWERS |
100% CORRECT | GRADE A+
1. A patient with a history of heart failure presents with a pH of 7.32, PaCO2 of 50 mmHg, and
HCO3- of 26 mEq/L. Which acid-base imbalance is occurring?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Acidosis
D. Respiratory Alkalosis
Answer: C
Conceptual Explanation: The pH is below 7.35, indicating acidosis. The PaCO2 is elevated
above 45 mmHg, which matches the direction of the pH change (acidic), while the
bicarbonate is within normal limits. This indicates a primary respiratory cause.
2. Which clinical manifestation is a hallmark sign of Autonomic Dysreflexia in a patient with a
T6 spinal cord injury?
A. Tachycardia and hypotension
B. Profuse sweating below the level of injury
C. Sudden significant hypertension and bradycardia
,D. Severe hypotension and tachypnea
Answer: C
Conceptual Explanation: Autonomic dysreflexia is a medical emergency characterized by
a sudden, massive sympathetic discharge resulting in severe hypertension and a
compensatory parasympathetic response causing bradycardia and flushing above the level
of injury.
3. A patient is receiving a continuous heparin infusion for a pulmonary embolism. The nurse
notes the aPTT is 105 seconds (Control: 25-35). What is the priority nursing action?
A. Decrease the infusion rate per protocol
B. Continue the infusion and recheck in 4 hours
C. Stop the infusion and prepare protamine sulfate
D. Increase the infusion rate to reach therapeutic range
Answer: C
Conceptual Explanation: An aPTT of 105 seconds is significantly above the therapeutic
range (usually 1.5-2.5 times the control). Because of the high risk for spontaneous bleeding,
the infusion must be stopped and the antidote, protamine sulfate, may be needed.
4. A patient with Type 1 Diabetes Mellitus presents to the ED with Kussmaul respirations and
a fruity breath odor. Which lab result is most expected?
A. Serum glucose of 180 mg/dL
, B. Serum bicarbonate of 28 mEq/L
C. Negative urine ketones
D. Arterial pH of 7.15
Answer: D
Conceptual Explanation: These are classic signs of Diabetic Ketoacidosis (DKA). DKA is
characterized by metabolic acidosis (pH < 7.35), hyperglycemia, and the presence of
ketones. Kussmaul respirations are a compensatory mechanism to blow off CO2.
5. When assessing a patient with suspected Cushing’s Syndrome, which physical finding is the
nurse most likely to observe?
A. Truncal obesity and moon face
B. Bronze skin pigmentation
C. Hypotension and weight loss
D. Hyperkalemia and hypoglycemia
Answer: A
Conceptual Explanation: Cushing’s Syndrome results from excessive cortisol. Clinical
features include truncal obesity, moon face, buffalo hump, and purple striae. Hypotension
and bronze skin are associated with Addison’s disease.
