Complete NSG 3800 Exam 1 study guide
for 2026–2027 Includes exam-style
questions, answers, and detailed
rationales
1. A nurse is caring for a client with hyponatremia secondary to SIADH. Which finding should
the nurse expect?
A) Increased urine output with low specific gravity
B) Decreased urine output with high urine osmolality
C) Hypernatremia with thirst and dry mucous membranes
D) Weight loss and bounding pulses
Correct Answer: B) Decreased urine output with high urine osmolality
Rationale: In Syndrome of Inappropriate Antidiuretic Hormone (SIADH), excessive ADH
secretion causes the kidneys to retain water, leading to dilutional hyponatremia, concentrated
urine (high urine osmolality >100 mOsm/kg and often > serum osmolality), and oliguria. This
results in fluid volume excess with symptoms like headache, confusion, and weight gain. Option
A describes diabetes insipidus (opposite problem). Option C is consistent with
hypernatremia/dehydration, and Option D suggests fluid volume deficit. Nursing priority
includes strict I&O monitoring, fluid restriction, and hypertonic saline in severe cases to prevent
seizures or cerebral edema.
2. Which laboratory value is most important for the nurse to monitor in a client receiving
furosemide (Lasix) for heart failure?
A) Serum potassium
B) Serum sodium
C) Blood glucose
D) Serum calcium
Correct Answer: A) Serum potassium
Rationale: Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption in the
loop of Henle, causing significant potassium excretion (hypokalemia). Hypokalemia can lead to
cardiac dysrhythmias, muscle weakness, and digoxin toxicity if the client is also on digitalis.
Page 1 of 81
,While sodium and calcium can be affected, potassium is the most critical due to its direct
impact on cardiac conduction. Blood glucose is more relevant for thiazides or corticosteroids.
Nurses must monitor electrolytes frequently, supplement potassium as ordered, and teach
clients about potassium-rich foods.
3. A client with chronic obstructive pulmonary disease (COPD) is admitted with acute
exacerbation. The nurse notes pursed-lip breathing and use of accessory muscles. This is
primarily an attempt to:
A) Increase oxygen delivery to tissues
B) Prevent alveolar collapse and improve gas exchange
C) Decrease carbon dioxide retention
D) Compensate for metabolic acidosis
Correct Answer: B) Prevent alveolar collapse and improve gas exchange
Rationale: In COPD (especially emphysema), loss of elastic recoil and airway collapse occur
during expiration. Pursed-lip breathing creates positive end-expiratory pressure (PEEP), which
stents open small airways, prolongs expiration, reduces air trapping, and improves ventilation-
perfusion matching. This helps reduce dyspnea and CO₂ retention over time. Option A is more
related to supplemental oxygen. Option C is partially true but not the primary mechanism.
Option D relates to Kussmaul breathing in diabetic ketoacidosis. Nursing interventions include
positioning in high Fowler’s, teaching pursed-lip breathing, and monitoring ABGs for respiratory
acidosis.
4. Which symptom is most indicative of hypocalcemia in a postoperative client after
thyroidectomy?
A) Tetany and positive Chvostek’s sign
B) Muscle weakness and constipation
C) Bradycardia and hypotension
D) Polyuria and polydipsia
Correct Answer: A) Tetany and positive Chvostek’s sign
Rationale: Accidental removal or damage to parathyroid glands during thyroidectomy can cause
hypoparathyroidism, leading to hypocalcemia. Low calcium increases neuromuscular
excitability, causing tetany, paresthesia, muscle spasms, and positive Chvostek’s sign (facial
twitching when tapping the cheek) or Trousseau’s sign (carpopedal spasm with BP cuff). Option
B describes hypercalcemia. Option C may occur in severe cases but is not the hallmark. Option
D indicates diabetes insipidus. Immediate nursing actions include monitoring serum calcium,
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,administering IV calcium gluconate if ordered, and ensuring airway patency due to
laryngospasm risk.
5. A nurse is teaching a client with iron deficiency anemia. Which dietary instruction is most
appropriate?
A) Increase intake of dairy products with meals
B) Take iron supplements with orange juice on an empty stomach
C) Consume high-fiber foods to prevent constipation from iron
D) Avoid vitamin C while taking iron
Correct Answer: B) Take iron supplements with orange juice on an empty stomach
Rationale: Iron deficiency anemia results from inadequate iron for hemoglobin synthesis,
leading to microcytic hypochromic RBCs, fatigue, and pallor. Vitamin C (ascorbic acid) enhances
non-heme iron absorption by reducing it to a more absorbable form and countering inhibitors
like calcium or tannins. Taking iron on an empty stomach maximizes absorption, though it may
cause GI upset. Dairy (calcium) and antacids inhibit absorption (Option A and D are wrong).
High-fiber foods can bind iron, but constipation is a side effect of iron therapy, so stool
softeners are often recommended. Nurses should teach black tarry stools as normal and when
to report severe GI distress.
6. Which arterial blood gas (ABG) result is consistent with compensated respiratory acidosis in a
client with COPD?
A) pH 7.35, PaCO₂ 50 mmHg, HCO₃⁻ 28 mEq/L
B) pH 7.25, PaCO₂ 60 mmHg, HCO₃⁻ 24 mEq/L
C) pH 7.50, PaCO₂ 30 mmHg, HCO₃⁻ 22 mEq/L
D) pH 7.28, PaCO₂ 32 mmHg, HCO₃⁻ 18 mEq/L
Correct Answer: A) pH 7.35, PaCO₂ 50 mmHg, HCO₃⁻ 28 mEq/L
Rationale: Chronic COPD causes CO₂ retention (hypercapnia), leading to respiratory acidosis.
Over time, the kidneys compensate by retaining bicarbonate (HCO₃⁻), normalizing pH (7.35–
7.45) while PaCO₂ remains elevated and HCO₃⁻ is elevated. Option B is uncompensated
respiratory acidosis. Option C is compensated respiratory alkalosis. Option D is partially
compensated metabolic acidosis. In NSG 3800, nurses must interpret ABGs to guide oxygen
therapy (avoid high-flow O₂ in chronic retainers to prevent suppressing hypoxic drive) and
monitor for acute-on-chronic failure.
7. A client with hypothyroidism is started on levothyroxine. The nurse should monitor for which
expected therapeutic effect?
Page 3 of 81
, A) Increased heart rate and weight loss
B) Decreased fatigue and improved energy levels
C) Cold intolerance and constipation
D) Bradycardia and dry skin
Correct Answer: B) Decreased fatigue and improved energy levels
Rationale: Hypothyroidism (low thyroid hormone) slows metabolism, causing fatigue, weight
gain, cold intolerance, bradycardia, constipation, and dry skin. Levothyroxine (Synthroid) is
synthetic T4 that replaces the hormone, gradually increasing metabolic rate. Therapeutic
effects appear in 1–2 weeks (energy, warmth, regular bowel movements) and full effects in 6–8
weeks. Options C and D are symptoms of untreated hypothyroidism. Option A could indicate
over-replacement (hyperthyroidism symptoms). Nurses monitor TSH levels (goal usually 0.4–4.0
mIU/L), teach lifelong therapy, and advise taking the medication on an empty stomach in the
morning, separated from calcium/iron.
8. Which intervention is priority for a client experiencing acute upper gastrointestinal bleed?
A) Administer stool softeners
B) Establish two large-bore IV lines and monitor vital signs
C) Prepare the client for immediate endoscopy only
D) Encourage oral intake of clear liquids
Correct Answer: B) Establish two large-bore IV lines and monitor vital signs
Rationale: Acute upper GI bleed (e.g., from peptic ulcer or esophageal varices) can cause rapid
hypovolemic shock. Priority is airway/breathing/circulation (ABC): secure large-bore IV access
for fluid resuscitation and possible blood transfusion, frequent vital signs, oxygen if needed,
and hemoglobin/hematocrit monitoring. Endoscopy is diagnostic/therapeutic but not the
immediate priority over stabilization. Stool softeners and oral intake are contraindicated until
bleeding is controlled. In Adult Health II, nurses emphasize hemodynamic stability, NG lavage if
ordered, and proton pump inhibitors (e.g., pantoprazole) to reduce acid.
9. A client with acute kidney injury (AKI) has a serum potassium of 6.2 mEq/L. Which ECG
change should the nurse anticipate?
A) Prolonged PR interval and flattened T waves
B) Peaked T waves and widened QRS complex
C) U waves and ST depression
D) Normal sinus rhythm with no changes
Page 4 of 81
for 2026–2027 Includes exam-style
questions, answers, and detailed
rationales
1. A nurse is caring for a client with hyponatremia secondary to SIADH. Which finding should
the nurse expect?
A) Increased urine output with low specific gravity
B) Decreased urine output with high urine osmolality
C) Hypernatremia with thirst and dry mucous membranes
D) Weight loss and bounding pulses
Correct Answer: B) Decreased urine output with high urine osmolality
Rationale: In Syndrome of Inappropriate Antidiuretic Hormone (SIADH), excessive ADH
secretion causes the kidneys to retain water, leading to dilutional hyponatremia, concentrated
urine (high urine osmolality >100 mOsm/kg and often > serum osmolality), and oliguria. This
results in fluid volume excess with symptoms like headache, confusion, and weight gain. Option
A describes diabetes insipidus (opposite problem). Option C is consistent with
hypernatremia/dehydration, and Option D suggests fluid volume deficit. Nursing priority
includes strict I&O monitoring, fluid restriction, and hypertonic saline in severe cases to prevent
seizures or cerebral edema.
2. Which laboratory value is most important for the nurse to monitor in a client receiving
furosemide (Lasix) for heart failure?
A) Serum potassium
B) Serum sodium
C) Blood glucose
D) Serum calcium
Correct Answer: A) Serum potassium
Rationale: Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption in the
loop of Henle, causing significant potassium excretion (hypokalemia). Hypokalemia can lead to
cardiac dysrhythmias, muscle weakness, and digoxin toxicity if the client is also on digitalis.
Page 1 of 81
,While sodium and calcium can be affected, potassium is the most critical due to its direct
impact on cardiac conduction. Blood glucose is more relevant for thiazides or corticosteroids.
Nurses must monitor electrolytes frequently, supplement potassium as ordered, and teach
clients about potassium-rich foods.
3. A client with chronic obstructive pulmonary disease (COPD) is admitted with acute
exacerbation. The nurse notes pursed-lip breathing and use of accessory muscles. This is
primarily an attempt to:
A) Increase oxygen delivery to tissues
B) Prevent alveolar collapse and improve gas exchange
C) Decrease carbon dioxide retention
D) Compensate for metabolic acidosis
Correct Answer: B) Prevent alveolar collapse and improve gas exchange
Rationale: In COPD (especially emphysema), loss of elastic recoil and airway collapse occur
during expiration. Pursed-lip breathing creates positive end-expiratory pressure (PEEP), which
stents open small airways, prolongs expiration, reduces air trapping, and improves ventilation-
perfusion matching. This helps reduce dyspnea and CO₂ retention over time. Option A is more
related to supplemental oxygen. Option C is partially true but not the primary mechanism.
Option D relates to Kussmaul breathing in diabetic ketoacidosis. Nursing interventions include
positioning in high Fowler’s, teaching pursed-lip breathing, and monitoring ABGs for respiratory
acidosis.
4. Which symptom is most indicative of hypocalcemia in a postoperative client after
thyroidectomy?
A) Tetany and positive Chvostek’s sign
B) Muscle weakness and constipation
C) Bradycardia and hypotension
D) Polyuria and polydipsia
Correct Answer: A) Tetany and positive Chvostek’s sign
Rationale: Accidental removal or damage to parathyroid glands during thyroidectomy can cause
hypoparathyroidism, leading to hypocalcemia. Low calcium increases neuromuscular
excitability, causing tetany, paresthesia, muscle spasms, and positive Chvostek’s sign (facial
twitching when tapping the cheek) or Trousseau’s sign (carpopedal spasm with BP cuff). Option
B describes hypercalcemia. Option C may occur in severe cases but is not the hallmark. Option
D indicates diabetes insipidus. Immediate nursing actions include monitoring serum calcium,
Page 2 of 81
,administering IV calcium gluconate if ordered, and ensuring airway patency due to
laryngospasm risk.
5. A nurse is teaching a client with iron deficiency anemia. Which dietary instruction is most
appropriate?
A) Increase intake of dairy products with meals
B) Take iron supplements with orange juice on an empty stomach
C) Consume high-fiber foods to prevent constipation from iron
D) Avoid vitamin C while taking iron
Correct Answer: B) Take iron supplements with orange juice on an empty stomach
Rationale: Iron deficiency anemia results from inadequate iron for hemoglobin synthesis,
leading to microcytic hypochromic RBCs, fatigue, and pallor. Vitamin C (ascorbic acid) enhances
non-heme iron absorption by reducing it to a more absorbable form and countering inhibitors
like calcium or tannins. Taking iron on an empty stomach maximizes absorption, though it may
cause GI upset. Dairy (calcium) and antacids inhibit absorption (Option A and D are wrong).
High-fiber foods can bind iron, but constipation is a side effect of iron therapy, so stool
softeners are often recommended. Nurses should teach black tarry stools as normal and when
to report severe GI distress.
6. Which arterial blood gas (ABG) result is consistent with compensated respiratory acidosis in a
client with COPD?
A) pH 7.35, PaCO₂ 50 mmHg, HCO₃⁻ 28 mEq/L
B) pH 7.25, PaCO₂ 60 mmHg, HCO₃⁻ 24 mEq/L
C) pH 7.50, PaCO₂ 30 mmHg, HCO₃⁻ 22 mEq/L
D) pH 7.28, PaCO₂ 32 mmHg, HCO₃⁻ 18 mEq/L
Correct Answer: A) pH 7.35, PaCO₂ 50 mmHg, HCO₃⁻ 28 mEq/L
Rationale: Chronic COPD causes CO₂ retention (hypercapnia), leading to respiratory acidosis.
Over time, the kidneys compensate by retaining bicarbonate (HCO₃⁻), normalizing pH (7.35–
7.45) while PaCO₂ remains elevated and HCO₃⁻ is elevated. Option B is uncompensated
respiratory acidosis. Option C is compensated respiratory alkalosis. Option D is partially
compensated metabolic acidosis. In NSG 3800, nurses must interpret ABGs to guide oxygen
therapy (avoid high-flow O₂ in chronic retainers to prevent suppressing hypoxic drive) and
monitor for acute-on-chronic failure.
7. A client with hypothyroidism is started on levothyroxine. The nurse should monitor for which
expected therapeutic effect?
Page 3 of 81
, A) Increased heart rate and weight loss
B) Decreased fatigue and improved energy levels
C) Cold intolerance and constipation
D) Bradycardia and dry skin
Correct Answer: B) Decreased fatigue and improved energy levels
Rationale: Hypothyroidism (low thyroid hormone) slows metabolism, causing fatigue, weight
gain, cold intolerance, bradycardia, constipation, and dry skin. Levothyroxine (Synthroid) is
synthetic T4 that replaces the hormone, gradually increasing metabolic rate. Therapeutic
effects appear in 1–2 weeks (energy, warmth, regular bowel movements) and full effects in 6–8
weeks. Options C and D are symptoms of untreated hypothyroidism. Option A could indicate
over-replacement (hyperthyroidism symptoms). Nurses monitor TSH levels (goal usually 0.4–4.0
mIU/L), teach lifelong therapy, and advise taking the medication on an empty stomach in the
morning, separated from calcium/iron.
8. Which intervention is priority for a client experiencing acute upper gastrointestinal bleed?
A) Administer stool softeners
B) Establish two large-bore IV lines and monitor vital signs
C) Prepare the client for immediate endoscopy only
D) Encourage oral intake of clear liquids
Correct Answer: B) Establish two large-bore IV lines and monitor vital signs
Rationale: Acute upper GI bleed (e.g., from peptic ulcer or esophageal varices) can cause rapid
hypovolemic shock. Priority is airway/breathing/circulation (ABC): secure large-bore IV access
for fluid resuscitation and possible blood transfusion, frequent vital signs, oxygen if needed,
and hemoglobin/hematocrit monitoring. Endoscopy is diagnostic/therapeutic but not the
immediate priority over stabilization. Stool softeners and oral intake are contraindicated until
bleeding is controlled. In Adult Health II, nurses emphasize hemodynamic stability, NG lavage if
ordered, and proton pump inhibitors (e.g., pantoprazole) to reduce acid.
9. A client with acute kidney injury (AKI) has a serum potassium of 6.2 mEq/L. Which ECG
change should the nurse anticipate?
A) Prolonged PR interval and flattened T waves
B) Peaked T waves and widened QRS complex
C) U waves and ST depression
D) Normal sinus rhythm with no changes
Page 4 of 81
