NR324/NR 324 Exam 1 V3 | Adult Health I
Q&A with Rationale | Chamberlain
University
1. A patient is admitted with a pH of 7.28, a PaCO2 of 50 mmHg, and an HCO3 of 24 mEq/L.
Which acid-base imbalance does this represent?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Alkalosis
D. Respiratory Acidosis
Correct Answer: D
Rationale: The pH is lower than 7.35, which indicates acidosis. The PaCO2 is elevated
above 45 mmHg, while the bicarbonate remains in the normal range. This pattern confirms
a primary respiratory origin for the acidotic state.
2. Which nursing intervention is a priority for a patient diagnosed with community-acquired
pneumonia and a pulse oximetry reading of 88% on room air?
A. Apply supplemental oxygen
B. Administer the prescribed antibiotic
C. Obtain a sputum culture
,D. Educate the patient on incentive spirometry
Correct Answer: A
Rationale: Airway and oxygenation are the highest priorities according to the ABC
framework. A saturation of 88% is significantly below the therapeutic target for a patient
with pneumonia. Providing oxygen helps stabilize the patient’s physiological status before
diagnostic procedures or medications are completed.
3. A patient with Chronic Obstructive Pulmonary Disease (COPD) is being discharged. Which
statement by the patient indicates understanding of pursed-lip breathing?
A. It helps me take deeper breaths by strengthening my diaphragm.
B. It is used primarily to clear secretions from my large airways.
C. It prevents my airways from collapsing by creating pressure.
D. I should use it only when I am using my rescue inhaler.
Correct Answer: C
Rationale: Pursed-lip breathing prolongs exhalation and maintains positive pressure in
the airways. This prevents alveolar collapse and helps the patient exhale more trapped
CO2. It is a key management strategy for patients with obstructive lung diseases like
emphysema.
4. The nurse notes a positive Chvostek’s sign in a patient following a thyroidectomy. Which
electrolyte imbalance does this suggest?
A. Hyperkalemia
, B. Hyponatremia
C. Hypocalcemia
D. Hypophosphatemia
Correct Answer: C
Rationale: Hypocalcemia commonly occurs after thyroid surgery if the parathyroid glands
are accidentally damaged or removed. A positive Chvostek sign, indicated by facial
twitching when the facial nerve is tapped, is a classic sign of neuromuscular irritability. The
nurse should immediately prepare to administer calcium gluconate as ordered.
5. A patient with a history of heart failure presents with peripheral edema, jugular venous
distention, and crackles in the lung bases. Which IV fluid would be contraindicated?
A. 0.45% Sodium Chloride
B. Dextrose 5% in Water
C. Lactated Ringer’s
D. 0.9% Sodium Chloride
Correct Answer: D
Rationale: The patient is showing clear signs of fluid volume excess or hypervolemia. 0.9%
Sodium Chloride is an isotonic solution that remains in the intravascular space, potentially
worsening the overload. In heart failure, isotonic volume expansion must be monitored
very carefully or avoided during exacerbations.
Q&A with Rationale | Chamberlain
University
1. A patient is admitted with a pH of 7.28, a PaCO2 of 50 mmHg, and an HCO3 of 24 mEq/L.
Which acid-base imbalance does this represent?
A. Metabolic Acidosis
B. Metabolic Alkalosis
C. Respiratory Alkalosis
D. Respiratory Acidosis
Correct Answer: D
Rationale: The pH is lower than 7.35, which indicates acidosis. The PaCO2 is elevated
above 45 mmHg, while the bicarbonate remains in the normal range. This pattern confirms
a primary respiratory origin for the acidotic state.
2. Which nursing intervention is a priority for a patient diagnosed with community-acquired
pneumonia and a pulse oximetry reading of 88% on room air?
A. Apply supplemental oxygen
B. Administer the prescribed antibiotic
C. Obtain a sputum culture
,D. Educate the patient on incentive spirometry
Correct Answer: A
Rationale: Airway and oxygenation are the highest priorities according to the ABC
framework. A saturation of 88% is significantly below the therapeutic target for a patient
with pneumonia. Providing oxygen helps stabilize the patient’s physiological status before
diagnostic procedures or medications are completed.
3. A patient with Chronic Obstructive Pulmonary Disease (COPD) is being discharged. Which
statement by the patient indicates understanding of pursed-lip breathing?
A. It helps me take deeper breaths by strengthening my diaphragm.
B. It is used primarily to clear secretions from my large airways.
C. It prevents my airways from collapsing by creating pressure.
D. I should use it only when I am using my rescue inhaler.
Correct Answer: C
Rationale: Pursed-lip breathing prolongs exhalation and maintains positive pressure in
the airways. This prevents alveolar collapse and helps the patient exhale more trapped
CO2. It is a key management strategy for patients with obstructive lung diseases like
emphysema.
4. The nurse notes a positive Chvostek’s sign in a patient following a thyroidectomy. Which
electrolyte imbalance does this suggest?
A. Hyperkalemia
, B. Hyponatremia
C. Hypocalcemia
D. Hypophosphatemia
Correct Answer: C
Rationale: Hypocalcemia commonly occurs after thyroid surgery if the parathyroid glands
are accidentally damaged or removed. A positive Chvostek sign, indicated by facial
twitching when the facial nerve is tapped, is a classic sign of neuromuscular irritability. The
nurse should immediately prepare to administer calcium gluconate as ordered.
5. A patient with a history of heart failure presents with peripheral edema, jugular venous
distention, and crackles in the lung bases. Which IV fluid would be contraindicated?
A. 0.45% Sodium Chloride
B. Dextrose 5% in Water
C. Lactated Ringer’s
D. 0.9% Sodium Chloride
Correct Answer: D
Rationale: The patient is showing clear signs of fluid volume excess or hypervolemia. 0.9%
Sodium Chloride is an isotonic solution that remains in the intravascular space, potentially
worsening the overload. In heart failure, isotonic volume expansion must be monitored
very carefully or avoided during exacerbations.
