Complete NSG 3800 Exam 1 study guide for
2026–2027 Includes exam-style questions,
answers, and detailed rationales
A client with acute upper gastrointestinal bleeding presents with melena and hemoglobin of 7.8
g/dL. The priority nursing intervention is:
A) Administer oral proton pump inhibitor
B) Establish two large-bore intravenous lines and prepare for blood transfusion
C) Encourage the client to drink clear liquids
D) Place the client in a flat supine position
Correct Answer: B) Establish two large-bore intravenous lines and prepare for blood transfusion
Rationale: Acute upper GI bleeding can rapidly lead to hypovolemic shock. With melena and
low hemoglobin, the immediate priority is circulatory support through secure large-bore IV
access for rapid volume resuscitation and possible transfusion of packed red blood cells. Oral
medications are withheld until bleeding is stabilized and endoscopy can be performed. Clear
liquids are contraindicated during active bleeding. Flat positioning does not improve perfusion
and may increase risk of aspiration. Nurses also initiate intravenous proton pump inhibitors,
monitor vital signs frequently, and prepare the client for urgent endoscopy.
Which electrocardiogram change is most characteristic of hyperkalemia?
A) Prolonged QT interval
B) Peaked T waves and widened QRS complex
C) Prominent U waves with ST depression
D) Normal sinus rhythm with no changes
Correct Answer: B) Peaked T waves and widened QRS complex
Rationale: Elevated serum potassium alters cardiac cell membrane potential, causing early
peaked T waves followed by widening of the QRS complex, loss of P waves, and eventual
progression to ventricular dysrhythmias or asystole. Prolonged QT interval is seen in
hypocalcemia. U waves and ST depression are classic for hypokalemia. In clients with renal
impairment or acute kidney injury, nurses monitor telemetry continuously, restrict dietary
potassium, and prepare emergency treatments including intravenous calcium gluconate for
Page 1 of 74
,cardiac membrane stabilization, insulin with glucose to shift potassium intracellularly, and
consideration of dialysis if levels remain critically high.
A client with chronic obstructive pulmonary disease is at risk for developing cor pulmonale. The
nurse expects to observe:
A) Jugular venous distention and bilateral lower extremity edema
B) Improved exercise tolerance and clear lung sounds
C) Significant weight loss over a short period
D) Bounding peripheral pulses
Correct Answer: A) Jugular venous distention and bilateral lower extremity edema
Rationale: Long-standing hypoxemia in COPD leads to pulmonary vasoconstriction and
pulmonary hypertension, which eventually causes right ventricular hypertrophy and right-sided
heart failure known as cor pulmonale. Systemic venous congestion manifests as jugular venous
distention, peripheral edema, and hepatomegaly. Improved exercise tolerance would suggest
better disease control. Weight loss is common in advanced emphysema but is not a sign of cor
pulmonale. Nursing interventions focus on optimizing oxygenation (target SpO2 88-92%),
diuretics for fluid overload, and treating the underlying lung disease to reduce pulmonary
pressures.
The nurse is teaching a client newly diagnosed with iron deficiency anemia. The correct
instruction is:
A) Take iron supplements with milk to reduce gastrointestinal upset
B) Take iron with orange juice on an empty stomach
C) It is abnormal to have dark stools while taking iron
D) Avoid foods high in vitamin C while on iron therapy
Correct Answer: B) Take iron with orange juice on an empty stomach
Rationale: Ascorbic acid (vitamin C) enhances absorption of non-heme iron by keeping it in the
reduced ferrous form. Taking the supplement on an empty stomach maximizes bioavailability,
although gastrointestinal side effects are common. Dairy products and antacids containing
calcium inhibit iron absorption. Dark, tarry stools are an expected harmless side effect of oral
iron. Nurses advise clients to use stool softeners if constipation occurs and to report severe
abdominal pain or bright red blood in stools, which may indicate gastrointestinal bleeding.
Page 2 of 74
,A client with hypothyroidism is started on levothyroxine. The nurse explains that full therapeutic
effects typically occur in:
A) 24 to 48 hours
B) 1 to 2 weeks
C) 4 to 6 weeks
D) 3 months or longer
Correct Answer: C) 4 to 6 weeks
Rationale: Levothyroxine has a long half-life of approximately 7 days. Serum levels and
metabolic effects stabilize gradually, with noticeable improvement in energy and other
symptoms often beginning in 1–2 weeks but full therapeutic response and TSH normalization
usually requiring 4–6 weeks. Dosage adjustments are based on TSH levels drawn after this
period. Nurses instruct clients to take the medication consistently on an empty stomach in the
morning, separated by at least four hours from calcium, iron, or antacids, and to continue therapy
lifelong with regular laboratory monitoring.
A client with Addison’s disease is admitted with vomiting and diarrhea. The nurse recognizes the
greatest risk is:
A) Hyperglycemic crisis
B) Acute adrenal insufficiency (Addisonian crisis)
C) Thyroid storm
D) Hypertensive emergency
Correct Answer: B) Acute adrenal insufficiency (Addisonian crisis)
Rationale: Addison’s disease involves inadequate cortisol and aldosterone production. During
acute illness with fluid loss, the body cannot increase cortisol output, leading to profound
hypotension, severe hyponatremia, hyperkalemia, hypoglycemia, and shock. Immediate
treatment includes intravenous hydrocortisone, normal saline, and glucose. Nurses teach clients
“sick day rules” (doubling or tripling glucocorticoid dose during illness), the importance of
wearing a medical alert bracelet, and carrying emergency injectable hydrocortisone at all times.
A client with chronic pancreatitis complains of frequent bulky, greasy, foul-smelling stools. This
symptom is primarily caused by:
A) Increased bile acid production
Page 3 of 74
, B) Insufficient pancreatic lipase secretion leading to fat malabsorption
C) Excessive gastric acid secretion
D) Vitamin B12 deficiency
Correct Answer: B) Insufficient pancreatic lipase secretion leading to fat malabsorption
Rationale: Chronic inflammation and fibrosis damage pancreatic acinar cells, reducing secretion
of digestive enzymes, particularly lipase. Undigested fat results in steatorrhea (bulky, greasy,
floating stools) and malabsorption of fat-soluble vitamins. Management includes a low-fat diet
and pancreatic enzyme replacement taken with every meal and snack. Nurses teach proper
enzyme administration, monitor nutritional status, and watch for deficiencies in vitamins A, D,
E, and K.
A client is admitted during an acute sickle cell crisis with severe pain. Priority nursing
interventions include:
A) Administering high-flow oxygen to all clients
B) Providing aggressive intravenous hydration and adequate opioid analgesia
C) Applying ice packs directly to painful joints
D) Encouraging immediate ambulation
Correct Answer: B) Providing aggressive intravenous hydration and adequate opioid analgesia
Rationale: Vaso-occlusion occurs when deoxygenated hemoglobin S causes red blood cells to
sickle and obstruct small vessels, producing tissue ischemia and severe pain. Intravenous
hydration reduces blood viscosity and promotes flow through vessels. Opioids are necessary for
control of ischemic pain, often via patient-controlled analgesia. Oxygen is indicated only if
hypoxemia is documented. Cold applications cause vasoconstriction and may worsen ischemia;
warmth is preferred. Bed rest is recommended during the acute phase to decrease oxygen
demand.
A client newly started on propylthiouracil for hyperthyroidism should immediately report:
A) A weight gain of 4 pounds in one week
B) Sore throat or fever
C) Increased appetite
D) Feeling warmer than usual
Page 4 of 74
2026–2027 Includes exam-style questions,
answers, and detailed rationales
A client with acute upper gastrointestinal bleeding presents with melena and hemoglobin of 7.8
g/dL. The priority nursing intervention is:
A) Administer oral proton pump inhibitor
B) Establish two large-bore intravenous lines and prepare for blood transfusion
C) Encourage the client to drink clear liquids
D) Place the client in a flat supine position
Correct Answer: B) Establish two large-bore intravenous lines and prepare for blood transfusion
Rationale: Acute upper GI bleeding can rapidly lead to hypovolemic shock. With melena and
low hemoglobin, the immediate priority is circulatory support through secure large-bore IV
access for rapid volume resuscitation and possible transfusion of packed red blood cells. Oral
medications are withheld until bleeding is stabilized and endoscopy can be performed. Clear
liquids are contraindicated during active bleeding. Flat positioning does not improve perfusion
and may increase risk of aspiration. Nurses also initiate intravenous proton pump inhibitors,
monitor vital signs frequently, and prepare the client for urgent endoscopy.
Which electrocardiogram change is most characteristic of hyperkalemia?
A) Prolonged QT interval
B) Peaked T waves and widened QRS complex
C) Prominent U waves with ST depression
D) Normal sinus rhythm with no changes
Correct Answer: B) Peaked T waves and widened QRS complex
Rationale: Elevated serum potassium alters cardiac cell membrane potential, causing early
peaked T waves followed by widening of the QRS complex, loss of P waves, and eventual
progression to ventricular dysrhythmias or asystole. Prolonged QT interval is seen in
hypocalcemia. U waves and ST depression are classic for hypokalemia. In clients with renal
impairment or acute kidney injury, nurses monitor telemetry continuously, restrict dietary
potassium, and prepare emergency treatments including intravenous calcium gluconate for
Page 1 of 74
,cardiac membrane stabilization, insulin with glucose to shift potassium intracellularly, and
consideration of dialysis if levels remain critically high.
A client with chronic obstructive pulmonary disease is at risk for developing cor pulmonale. The
nurse expects to observe:
A) Jugular venous distention and bilateral lower extremity edema
B) Improved exercise tolerance and clear lung sounds
C) Significant weight loss over a short period
D) Bounding peripheral pulses
Correct Answer: A) Jugular venous distention and bilateral lower extremity edema
Rationale: Long-standing hypoxemia in COPD leads to pulmonary vasoconstriction and
pulmonary hypertension, which eventually causes right ventricular hypertrophy and right-sided
heart failure known as cor pulmonale. Systemic venous congestion manifests as jugular venous
distention, peripheral edema, and hepatomegaly. Improved exercise tolerance would suggest
better disease control. Weight loss is common in advanced emphysema but is not a sign of cor
pulmonale. Nursing interventions focus on optimizing oxygenation (target SpO2 88-92%),
diuretics for fluid overload, and treating the underlying lung disease to reduce pulmonary
pressures.
The nurse is teaching a client newly diagnosed with iron deficiency anemia. The correct
instruction is:
A) Take iron supplements with milk to reduce gastrointestinal upset
B) Take iron with orange juice on an empty stomach
C) It is abnormal to have dark stools while taking iron
D) Avoid foods high in vitamin C while on iron therapy
Correct Answer: B) Take iron with orange juice on an empty stomach
Rationale: Ascorbic acid (vitamin C) enhances absorption of non-heme iron by keeping it in the
reduced ferrous form. Taking the supplement on an empty stomach maximizes bioavailability,
although gastrointestinal side effects are common. Dairy products and antacids containing
calcium inhibit iron absorption. Dark, tarry stools are an expected harmless side effect of oral
iron. Nurses advise clients to use stool softeners if constipation occurs and to report severe
abdominal pain or bright red blood in stools, which may indicate gastrointestinal bleeding.
Page 2 of 74
,A client with hypothyroidism is started on levothyroxine. The nurse explains that full therapeutic
effects typically occur in:
A) 24 to 48 hours
B) 1 to 2 weeks
C) 4 to 6 weeks
D) 3 months or longer
Correct Answer: C) 4 to 6 weeks
Rationale: Levothyroxine has a long half-life of approximately 7 days. Serum levels and
metabolic effects stabilize gradually, with noticeable improvement in energy and other
symptoms often beginning in 1–2 weeks but full therapeutic response and TSH normalization
usually requiring 4–6 weeks. Dosage adjustments are based on TSH levels drawn after this
period. Nurses instruct clients to take the medication consistently on an empty stomach in the
morning, separated by at least four hours from calcium, iron, or antacids, and to continue therapy
lifelong with regular laboratory monitoring.
A client with Addison’s disease is admitted with vomiting and diarrhea. The nurse recognizes the
greatest risk is:
A) Hyperglycemic crisis
B) Acute adrenal insufficiency (Addisonian crisis)
C) Thyroid storm
D) Hypertensive emergency
Correct Answer: B) Acute adrenal insufficiency (Addisonian crisis)
Rationale: Addison’s disease involves inadequate cortisol and aldosterone production. During
acute illness with fluid loss, the body cannot increase cortisol output, leading to profound
hypotension, severe hyponatremia, hyperkalemia, hypoglycemia, and shock. Immediate
treatment includes intravenous hydrocortisone, normal saline, and glucose. Nurses teach clients
“sick day rules” (doubling or tripling glucocorticoid dose during illness), the importance of
wearing a medical alert bracelet, and carrying emergency injectable hydrocortisone at all times.
A client with chronic pancreatitis complains of frequent bulky, greasy, foul-smelling stools. This
symptom is primarily caused by:
A) Increased bile acid production
Page 3 of 74
, B) Insufficient pancreatic lipase secretion leading to fat malabsorption
C) Excessive gastric acid secretion
D) Vitamin B12 deficiency
Correct Answer: B) Insufficient pancreatic lipase secretion leading to fat malabsorption
Rationale: Chronic inflammation and fibrosis damage pancreatic acinar cells, reducing secretion
of digestive enzymes, particularly lipase. Undigested fat results in steatorrhea (bulky, greasy,
floating stools) and malabsorption of fat-soluble vitamins. Management includes a low-fat diet
and pancreatic enzyme replacement taken with every meal and snack. Nurses teach proper
enzyme administration, monitor nutritional status, and watch for deficiencies in vitamins A, D,
E, and K.
A client is admitted during an acute sickle cell crisis with severe pain. Priority nursing
interventions include:
A) Administering high-flow oxygen to all clients
B) Providing aggressive intravenous hydration and adequate opioid analgesia
C) Applying ice packs directly to painful joints
D) Encouraging immediate ambulation
Correct Answer: B) Providing aggressive intravenous hydration and adequate opioid analgesia
Rationale: Vaso-occlusion occurs when deoxygenated hemoglobin S causes red blood cells to
sickle and obstruct small vessels, producing tissue ischemia and severe pain. Intravenous
hydration reduces blood viscosity and promotes flow through vessels. Opioids are necessary for
control of ischemic pain, often via patient-controlled analgesia. Oxygen is indicated only if
hypoxemia is documented. Cold applications cause vasoconstriction and may worsen ischemia;
warmth is preferred. Bed rest is recommended during the acute phase to decrease oxygen
demand.
A client newly started on propylthiouracil for hyperthyroidism should immediately report:
A) A weight gain of 4 pounds in one week
B) Sore throat or fever
C) Increased appetite
D) Feeling warmer than usual
Page 4 of 74
