NSG 3850 ALL EXAMS QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026
Q&A |LATEST EXAM UPDATE 2026/2027
SECTION ONE: QUESTIONS 1–100
1. A patient with heart failure has a serum sodium level of 118 mEq/L. Which assessment finding requires
immediate intervention?
A. Muscle cramps
B. Lethargy and confusion
C. Nausea
D. Dry mucous membranes
🟢 B. Lethargy and confusion
🔴 RATIONALE: Severe hyponatremia (serum sodium <120 mEq/L) leads to cerebral edema and neurological
impairment. Altered mental status indicates brain swelling and requires urgent intervention .
2. A patient with chronic kidney disease has a serum potassium level of 6.2 mEq/L. Which intervention
should the nurse implement first?
,A. Administer potassium supplements
B. Prepare for hemodialysis
C. Encourage increased dietary potassium
D. Administer a potassium-sparing diuretic
🟢 B. Prepare for hemodialysis
🔴 RATIONALE: A potassium level above 6.0 mEq/L is life-threatening and can cause fatal cardiac arrhythmias.
Hemodialysis is the fastest method to remove excess potassium in severe cases .
3. A patient's arterial blood gas shows: pH 7.28, PaCO2 55 mm Hg, HCO3 24 mEq/L. The nurse interprets this
as:
A. Metabolic acidosis, uncompensated
B. Metabolic alkalosis, partially compensated
C. Respiratory acidosis, uncompensated
D. Respiratory acidosis, fully compensated
🟢 C. Respiratory acidosis, uncompensated
🔴 RATIONALE: A low pH (7.28) indicates acidosis. Elevated PaCO2 (>45 mm Hg) indicates respiratory acidosis.
Normal HCO3 (24 mEq/L) shows no renal compensation has occurred .
4. Which laboratory finding is consistent with a diagnosis of iron-deficiency anemia?
A. Elevated total iron-binding capacity
B. Elevated MCHC and MCV
,C. Elevated total and indirect bilirubin
D. Positive direct or indirect Coombs test
🟢 A. Elevated total iron-binding capacity
🔴 RATIONALE: In iron-deficiency anemia, total iron-binding capacity (TIBC) is elevated because the body
attempts to bind available iron. MCV and MCHC are low, not elevated .
5. A patient with hyperkalemia (6.8 mEq/L) has ECG changes. Which intervention should the nurse perform
FIRST?
A. Administer sodium polystyrene sulfonate (Kayexalate) orally
B. Give IV calcium gluconate
C. Start insulin with dextrose IV
D. Administer IV furosemide
🟢 B. Give IV calcium gluconate
🔴 RATIONALE: Calcium gluconate stabilizes the cardiac membrane immediately, preventing life-threatening
dysrhythmias. Insulin/glucose and Kayexalate take longer to shift or excrete potassium .
6. A client has experienced a narcotic overdose. What acid-base imbalance should the nurse expect to
observe?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
, 🟢 A. Respiratory acidosis
🔴 RATIONALE: Narcotic overdose causes respiratory depression, leading to hypoventilation and CO2 retention,
resulting in respiratory acidosis .
7. A patient with a magnesium level of 1.2 mg/dL (normal 1.7-2.2). What is the priority nursing action?
A. Administer IV push calcium gluconate
B. Restrict dietary magnesium
C. Initiate fall precautions
D. Prepare for dialysis
🟢 C. Initiate fall precautions
🔴 RATIONALE: Hypomagnesemia increases the risk of seizures and dysrhythmias. Fall precautions are critical to
prevent injury. Calcium gluconate is for magnesium toxicity .
8. A patient with severe vomiting has ABG: pH 7.48, PaCO2 45, HCO3 31. Interpretation?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Metabolic alkalosis
D. Respiratory acidosis
🟢 C. Metabolic alkalosis
🔴 RATIONALE: Loss of gastric acid (HCl) through vomiting causes metabolic alkalosis. The elevated HCO3 (31
mEq/L) confirms the metabolic origin .
Q&A |LATEST EXAM UPDATE 2026/2027
SECTION ONE: QUESTIONS 1–100
1. A patient with heart failure has a serum sodium level of 118 mEq/L. Which assessment finding requires
immediate intervention?
A. Muscle cramps
B. Lethargy and confusion
C. Nausea
D. Dry mucous membranes
🟢 B. Lethargy and confusion
🔴 RATIONALE: Severe hyponatremia (serum sodium <120 mEq/L) leads to cerebral edema and neurological
impairment. Altered mental status indicates brain swelling and requires urgent intervention .
2. A patient with chronic kidney disease has a serum potassium level of 6.2 mEq/L. Which intervention
should the nurse implement first?
,A. Administer potassium supplements
B. Prepare for hemodialysis
C. Encourage increased dietary potassium
D. Administer a potassium-sparing diuretic
🟢 B. Prepare for hemodialysis
🔴 RATIONALE: A potassium level above 6.0 mEq/L is life-threatening and can cause fatal cardiac arrhythmias.
Hemodialysis is the fastest method to remove excess potassium in severe cases .
3. A patient's arterial blood gas shows: pH 7.28, PaCO2 55 mm Hg, HCO3 24 mEq/L. The nurse interprets this
as:
A. Metabolic acidosis, uncompensated
B. Metabolic alkalosis, partially compensated
C. Respiratory acidosis, uncompensated
D. Respiratory acidosis, fully compensated
🟢 C. Respiratory acidosis, uncompensated
🔴 RATIONALE: A low pH (7.28) indicates acidosis. Elevated PaCO2 (>45 mm Hg) indicates respiratory acidosis.
Normal HCO3 (24 mEq/L) shows no renal compensation has occurred .
4. Which laboratory finding is consistent with a diagnosis of iron-deficiency anemia?
A. Elevated total iron-binding capacity
B. Elevated MCHC and MCV
,C. Elevated total and indirect bilirubin
D. Positive direct or indirect Coombs test
🟢 A. Elevated total iron-binding capacity
🔴 RATIONALE: In iron-deficiency anemia, total iron-binding capacity (TIBC) is elevated because the body
attempts to bind available iron. MCV and MCHC are low, not elevated .
5. A patient with hyperkalemia (6.8 mEq/L) has ECG changes. Which intervention should the nurse perform
FIRST?
A. Administer sodium polystyrene sulfonate (Kayexalate) orally
B. Give IV calcium gluconate
C. Start insulin with dextrose IV
D. Administer IV furosemide
🟢 B. Give IV calcium gluconate
🔴 RATIONALE: Calcium gluconate stabilizes the cardiac membrane immediately, preventing life-threatening
dysrhythmias. Insulin/glucose and Kayexalate take longer to shift or excrete potassium .
6. A client has experienced a narcotic overdose. What acid-base imbalance should the nurse expect to
observe?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
, 🟢 A. Respiratory acidosis
🔴 RATIONALE: Narcotic overdose causes respiratory depression, leading to hypoventilation and CO2 retention,
resulting in respiratory acidosis .
7. A patient with a magnesium level of 1.2 mg/dL (normal 1.7-2.2). What is the priority nursing action?
A. Administer IV push calcium gluconate
B. Restrict dietary magnesium
C. Initiate fall precautions
D. Prepare for dialysis
🟢 C. Initiate fall precautions
🔴 RATIONALE: Hypomagnesemia increases the risk of seizures and dysrhythmias. Fall precautions are critical to
prevent injury. Calcium gluconate is for magnesium toxicity .
8. A patient with severe vomiting has ABG: pH 7.48, PaCO2 45, HCO3 31. Interpretation?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Metabolic alkalosis
D. Respiratory acidosis
🟢 C. Metabolic alkalosis
🔴 RATIONALE: Loss of gastric acid (HCl) through vomiting causes metabolic alkalosis. The elevated HCO3 (31
mEq/L) confirms the metabolic origin .
