BSN Semester 3 Final Exam (Cumulative) - 2026 Update
1. A nurse is caring for a client with a history of heart failure who is taking
Digoxin. Which of the following laboratory values would most likely indicate a
risk for digoxin toxicity?
A. Serum sodium 138 mEq/L
B. Serum calcium 9.5 mg/dL
C. Serum potassium 3.2 mEq/L
D. Serum magnesium 2.0 mEq/L
Answer: C
Rationale: Hypokalemia (low potassium) increases the risk of digoxin toxicity because
potassium and digoxin compete for binding sites on the sodium-potassium ATPase pump.
2. An arterial blood gas (ABG) report shows: pH 7.30, PaCO2 52 mmHg, and
HCO3 24 mEq/L. Which acid-base imbalance is the client experiencing?
A. Respiratory Acidosis
B. Metabolic Alkalosis
C. Metabolic Acidosis
D. Respiratory Alkalosis
Answer: A
Rationale: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg indicates a
respiratory cause. Since the bicarbonate is normal, it is uncompensated respiratory
acidosis.
,3. Which of the following is a priority nursing intervention for a client
experiencing an acute manic episode of bipolar disorder?
A. Placing the client in a room with a talkative roommate
B. Encouraging participation in group therapy sessions
C. Providing a high-calorie finger-food diet
D. Administering a stimulant medication as ordered
Answer: C
Rationale: Clients in a manic phase have high energy and are often too distracted to sit for
meals; high-calorie finger foods provide necessary nutrition while allowing them to move.
4. A nurse is monitoring a client after a thyroidectomy. The nurse notes the
client has muscle twitching and a positive Chvostek’s sign. Which medication
should the nurse prepare to administer?
A. Calcium Gluconate
B. Sodium Bicarbonate
C. Potassium Chloride
D. Magnesium Sulfate
Answer: A
Rationale: A positive Chvostek’s sign and muscle twitching are signs of hypocalcemia,
which can occur if the parathyroid glands are accidentally damaged or removed during a
thyroidectomy.
5. A client is diagnosed with Diabetic Ketoacidosis (DKA). Which of the following
insulin types is the only one that can be administered intravenously?
A. Insulin Glargine (Lantus)
B. Insulin Lispro (Humalog)
C. Regular Insulin (Humulin R)
D. NPH Insulin (Humulin N)
Answer: C
, Rationale: Regular insulin is the only insulin that is safe for intravenous administration in
acute settings like DKA management.
6. A nurse is caring for a pregnant client at 34 weeks gestation diagnosed with
preeclampsia. Which finding is the most concerning and should be reported
immediately?
A. 1+ pitting edema in the lower extremities
B. Urinary output of 20 mL/hour
C. Blood pressure of 142/92 mmHg
D. Trace protein in the urine
Answer: B
Rationale: A urinary output of less than 30 mL/hour indicates impaired renal perfusion,
which is a sign of worsening preeclampsia or progressing to eclampsia.
7. A pediatric client with cystic fibrosis is prescribed pancrelipase. When should
the nurse instruct the parents to administer this medication?
A. Once daily in the morning
B. With every meal and snack
C. Two hours after every meal
D. Only when the child has a fatty stool
Answer: B
Rationale: Pancreatic enzymes are necessary to aid digestion and must be taken with all
meals and snacks to effectively break down fats and proteins.
1. A nurse is caring for a client with a history of heart failure who is taking
Digoxin. Which of the following laboratory values would most likely indicate a
risk for digoxin toxicity?
A. Serum sodium 138 mEq/L
B. Serum calcium 9.5 mg/dL
C. Serum potassium 3.2 mEq/L
D. Serum magnesium 2.0 mEq/L
Answer: C
Rationale: Hypokalemia (low potassium) increases the risk of digoxin toxicity because
potassium and digoxin compete for binding sites on the sodium-potassium ATPase pump.
2. An arterial blood gas (ABG) report shows: pH 7.30, PaCO2 52 mmHg, and
HCO3 24 mEq/L. Which acid-base imbalance is the client experiencing?
A. Respiratory Acidosis
B. Metabolic Alkalosis
C. Metabolic Acidosis
D. Respiratory Alkalosis
Answer: A
Rationale: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg indicates a
respiratory cause. Since the bicarbonate is normal, it is uncompensated respiratory
acidosis.
,3. Which of the following is a priority nursing intervention for a client
experiencing an acute manic episode of bipolar disorder?
A. Placing the client in a room with a talkative roommate
B. Encouraging participation in group therapy sessions
C. Providing a high-calorie finger-food diet
D. Administering a stimulant medication as ordered
Answer: C
Rationale: Clients in a manic phase have high energy and are often too distracted to sit for
meals; high-calorie finger foods provide necessary nutrition while allowing them to move.
4. A nurse is monitoring a client after a thyroidectomy. The nurse notes the
client has muscle twitching and a positive Chvostek’s sign. Which medication
should the nurse prepare to administer?
A. Calcium Gluconate
B. Sodium Bicarbonate
C. Potassium Chloride
D. Magnesium Sulfate
Answer: A
Rationale: A positive Chvostek’s sign and muscle twitching are signs of hypocalcemia,
which can occur if the parathyroid glands are accidentally damaged or removed during a
thyroidectomy.
5. A client is diagnosed with Diabetic Ketoacidosis (DKA). Which of the following
insulin types is the only one that can be administered intravenously?
A. Insulin Glargine (Lantus)
B. Insulin Lispro (Humalog)
C. Regular Insulin (Humulin R)
D. NPH Insulin (Humulin N)
Answer: C
, Rationale: Regular insulin is the only insulin that is safe for intravenous administration in
acute settings like DKA management.
6. A nurse is caring for a pregnant client at 34 weeks gestation diagnosed with
preeclampsia. Which finding is the most concerning and should be reported
immediately?
A. 1+ pitting edema in the lower extremities
B. Urinary output of 20 mL/hour
C. Blood pressure of 142/92 mmHg
D. Trace protein in the urine
Answer: B
Rationale: A urinary output of less than 30 mL/hour indicates impaired renal perfusion,
which is a sign of worsening preeclampsia or progressing to eclampsia.
7. A pediatric client with cystic fibrosis is prescribed pancrelipase. When should
the nurse instruct the parents to administer this medication?
A. Once daily in the morning
B. With every meal and snack
C. Two hours after every meal
D. Only when the child has a fatty stool
Answer: B
Rationale: Pancreatic enzymes are necessary to aid digestion and must be taken with all
meals and snacks to effectively break down fats and proteins.
