NURS 280 Final Exam – Practice Questions with
Complete Rationales (Pathophysiology &
Med‑Surg Review)
Pathophysiology & Fluids (1–5)
1. A patient with dehydration has a serum sodium of 152 mEq/L. Which
nursing intervention is most appropriate?
A. Restrict fluids
B. Administer hypotonic IV solutions as ordered and monitor neurologic
status
C. Increase sodium in diet
D. Administer diuretics
Explanation: Hypernatremia in dehydration is treated by carefully replacing free
water (often hypotonic fluids) while monitoring for cerebral edema; restricting
fluids would worsen the problem.
2. Which finding is most concerning in a patient with hypokalemia?
A. Complaints of mild nausea
B. Presence of arrhythmias and flattened T waves on ECG
C. Slight edema in ankles
D. Increased urine output
Explanation: Potassium is critical for cardiac conduction; hypokalemia often
causes ECG changes and dangerous arrhythmias, which are priority concerns.
, 3. A patient’s ABG: pH 7.28, PaCO₂ 60 mm Hg, HCO₃⁻ 25 mEq/L. How should
this be interpreted?
A. Metabolic acidosis
B. Uncompensated respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Explanation: Low pH indicates acidosis, elevated PaCO₂ points to a respiratory
cause, and normal bicarbonate shows there is not yet metabolic compensation.
4. Which manifestation is expected in systemic inflammatory response (acute
inflammation)?
A. Local warmth only
B. Fever, tachycardia, and elevated WBC count
C. Bradycardia and hypothermia
D. Decreased WBC count
Explanation: In systemic inflammation, cytokines trigger fever, increased heart
rate, and leukocytosis.
5. A patient receiving isotonic saline for hypovolemia suddenly develops
crackles and shortness of breath. What is the priority action?
A. Encourage fluids
B. Slow or stop the infusion as ordered and assess for fluid overload
C. Increase infusion rate
D. Give more salt
Explanation: New crackles and dyspnea suggest possible fluid overload; the nurse
must first stop or reduce the infusion and reassess, then notify the provider.
, Sample Respiratory & FC (6–10)
6. A COPD patient’s baseline is SpO₂ 92% on 2 L/min O₂ via nasal cannula.
Today, SpO₂ is 86%, with increased work of breathing. Priority action?
A. Turn oxygen off
B. Assess respiratory status thoroughly and consider increasing oxygen
per order/protocol while notifying provider
C. Encourage deep breaths but no O₂ changes
D. Give extra diuretics
Explanation: COPD patients can still require more oxygen; airway and breathing
come first, so assessment plus cautious adjustment and provider notification are
appropriate.
7. Which assessment best differentiates asthma from COPD?
A. Chronic cough only
B. Reversible airway obstruction with triggers such as allergens or exercise
C. Smoking history
D. Sputum color
Explanation: Asthma is characterized by reversible, often episodic obstruction;
COPD is typically progressive and less reversible.
8. A postoperative patient reports sudden pleuritic chest pain and shortness
of breath. Which finding would most strongly suggest pulmonary
embolism?
A. Slow heart rate
Complete Rationales (Pathophysiology &
Med‑Surg Review)
Pathophysiology & Fluids (1–5)
1. A patient with dehydration has a serum sodium of 152 mEq/L. Which
nursing intervention is most appropriate?
A. Restrict fluids
B. Administer hypotonic IV solutions as ordered and monitor neurologic
status
C. Increase sodium in diet
D. Administer diuretics
Explanation: Hypernatremia in dehydration is treated by carefully replacing free
water (often hypotonic fluids) while monitoring for cerebral edema; restricting
fluids would worsen the problem.
2. Which finding is most concerning in a patient with hypokalemia?
A. Complaints of mild nausea
B. Presence of arrhythmias and flattened T waves on ECG
C. Slight edema in ankles
D. Increased urine output
Explanation: Potassium is critical for cardiac conduction; hypokalemia often
causes ECG changes and dangerous arrhythmias, which are priority concerns.
, 3. A patient’s ABG: pH 7.28, PaCO₂ 60 mm Hg, HCO₃⁻ 25 mEq/L. How should
this be interpreted?
A. Metabolic acidosis
B. Uncompensated respiratory acidosis
C. Metabolic alkalosis
D. Respiratory alkalosis
Explanation: Low pH indicates acidosis, elevated PaCO₂ points to a respiratory
cause, and normal bicarbonate shows there is not yet metabolic compensation.
4. Which manifestation is expected in systemic inflammatory response (acute
inflammation)?
A. Local warmth only
B. Fever, tachycardia, and elevated WBC count
C. Bradycardia and hypothermia
D. Decreased WBC count
Explanation: In systemic inflammation, cytokines trigger fever, increased heart
rate, and leukocytosis.
5. A patient receiving isotonic saline for hypovolemia suddenly develops
crackles and shortness of breath. What is the priority action?
A. Encourage fluids
B. Slow or stop the infusion as ordered and assess for fluid overload
C. Increase infusion rate
D. Give more salt
Explanation: New crackles and dyspnea suggest possible fluid overload; the nurse
must first stop or reduce the infusion and reassess, then notify the provider.
, Sample Respiratory & FC (6–10)
6. A COPD patient’s baseline is SpO₂ 92% on 2 L/min O₂ via nasal cannula.
Today, SpO₂ is 86%, with increased work of breathing. Priority action?
A. Turn oxygen off
B. Assess respiratory status thoroughly and consider increasing oxygen
per order/protocol while notifying provider
C. Encourage deep breaths but no O₂ changes
D. Give extra diuretics
Explanation: COPD patients can still require more oxygen; airway and breathing
come first, so assessment plus cautious adjustment and provider notification are
appropriate.
7. Which assessment best differentiates asthma from COPD?
A. Chronic cough only
B. Reversible airway obstruction with triggers such as allergens or exercise
C. Smoking history
D. Sputum color
Explanation: Asthma is characterized by reversible, often episodic obstruction;
COPD is typically progressive and less reversible.
8. A postoperative patient reports sudden pleuritic chest pain and shortness
of breath. Which finding would most strongly suggest pulmonary
embolism?
A. Slow heart rate
