NSG 3800 Adult Health II Practice Exam 2026
NSG 3800 Adult Health II Practice Exam
2026 Edition 100 Advanced Questions with
Answers and Detailed Rationales
Part 1: Questions 1–25
Topics: Fluid & Electrolyte Balance, Acid–Base Disorders, Hematology, Shock, Clinical
Judgment, and Priority Nursing Care
Question 1
A patient with severe vomiting for 3 days has the following ABG results:
pH: 7.50
PaCO₂: 47 mmHg
HCO₃⁻: 35 mEq/L
How should the nurse interpret these findings?
A. Respiratory acidosis with compensation
B. Fully compensated metabolic alkalosis
C. Partially compensated metabolic alkalosis
D. Uncompensated metabolic alkalosis
Correct Answer: C
Rationale:
The pH is elevated (alkalemia), HCO₃⁻ is elevated (primary metabolic alkalosis), and PaCO₂ is
elevated due to respiratory compensation. Since the pH remains abnormal, compensation is
partial.
Question 2
A patient with septic shock has a serum lactate level of 5.8 mmol/L despite fluid resuscitation.
What does this finding most strongly indicate?
A. Adequate tissue perfusion
B. Persistent tissue hypoxia
, NSG 3800 Adult Health II Practice Exam 2026
C. Renal failure
D. Hyperventilation
Correct Answer: B
Rationale:
Elevated lactate reflects anaerobic metabolism due to inadequate tissue oxygenation and is
associated with increased mortality in septic shock.
Question 3
A patient receiving intravenous insulin for diabetic ketoacidosis has the following laboratory
results:
Glucose: 240 mg/dL
Potassium: 3.1 mEq/L
Which nursing action is the priority?
A. Increase the insulin infusion.
B. Administer potassium replacement as prescribed.
C. Restrict oral fluids.
D. Prepare the patient for dialysis.
Correct Answer: B
Rationale:
Insulin shifts potassium into cells, increasing the risk of severe hypokalemia. Potassium
replacement is essential before increasing insulin if potassium is low.
Question 4
Which assessment finding is most concerning in a patient receiving packed red blood cells?
A. Temperature increase of 0.5°C (0.9°F)
B. Blood pressure of 130/80 mmHg
C. New onset of low back pain and chills
D. Heart rate of 92 beats/min
Correct Answer: C
, NSG 3800 Adult Health II Practice Exam 2026
Rationale:
Low back pain, chills, fever, and hypotension are classic signs of an acute hemolytic transfusion
reaction. Stop the transfusion immediately and notify the provider.
Question 5
A patient with syndrome of inappropriate antidiuretic hormone secretion (SIADH) has a serum
sodium level of 118 mEq/L. Which intervention has the highest priority?
A. Encourage oral water intake.
B. Initiate seizure precautions.
C. Administer hypotonic IV fluids.
D. Increase dietary potassium.
Correct Answer: B
Rationale:
Severe hyponatremia increases the risk of cerebral edema and seizures. Safety measures take
priority while definitive treatment is initiated.
Question 6
A patient develops hyperkalemia with ECG changes. Which medication should the nurse
anticipate administering first to stabilize the myocardium?
A. Sodium polystyrene sulfonate
B. Regular insulin
C. Calcium gluconate
D. Furosemide
Correct Answer: C
Rationale:
Calcium gluconate stabilizes cardiac cell membranes and reduces the risk of life-threatening
dysrhythmias. It does not lower potassium but buys time for other therapies.
Question 7
A patient with acute gastrointestinal bleeding presents with:
, NSG 3800 Adult Health II Practice Exam 2026
BP: 82/48 mmHg
HR: 132 beats/min
Cool, clammy skin
Confusion
Which stage of shock is most likely?
A. Initial
B. Compensatory
C. Progressive
D. Refractory
Correct Answer: C
Rationale:
Hypotension, altered mental status, and poor perfusion indicate progressive shock, requiring
aggressive resuscitation.
Question 8
Which patient is at greatest risk for developing refeeding syndrome?
A. Patient with obesity starting a low-calorie diet
B. Patient with severe malnutrition receiving enteral nutrition
C. Patient with hypertension
D. Patient receiving corticosteroids
Correct Answer: B
Rationale:
Refeeding syndrome can cause rapid intracellular shifts of phosphate, potassium, and magnesium
after nutrition is restarted in severely malnourished patients.
Question 9
A patient with metabolic acidosis is expected to exhibit which compensatory response?
A. Bradycardia
B. Slow, shallow respirations
C. Rapid, deep respirations
D. Decreased urine output
NSG 3800 Adult Health II Practice Exam
2026 Edition 100 Advanced Questions with
Answers and Detailed Rationales
Part 1: Questions 1–25
Topics: Fluid & Electrolyte Balance, Acid–Base Disorders, Hematology, Shock, Clinical
Judgment, and Priority Nursing Care
Question 1
A patient with severe vomiting for 3 days has the following ABG results:
pH: 7.50
PaCO₂: 47 mmHg
HCO₃⁻: 35 mEq/L
How should the nurse interpret these findings?
A. Respiratory acidosis with compensation
B. Fully compensated metabolic alkalosis
C. Partially compensated metabolic alkalosis
D. Uncompensated metabolic alkalosis
Correct Answer: C
Rationale:
The pH is elevated (alkalemia), HCO₃⁻ is elevated (primary metabolic alkalosis), and PaCO₂ is
elevated due to respiratory compensation. Since the pH remains abnormal, compensation is
partial.
Question 2
A patient with septic shock has a serum lactate level of 5.8 mmol/L despite fluid resuscitation.
What does this finding most strongly indicate?
A. Adequate tissue perfusion
B. Persistent tissue hypoxia
, NSG 3800 Adult Health II Practice Exam 2026
C. Renal failure
D. Hyperventilation
Correct Answer: B
Rationale:
Elevated lactate reflects anaerobic metabolism due to inadequate tissue oxygenation and is
associated with increased mortality in septic shock.
Question 3
A patient receiving intravenous insulin for diabetic ketoacidosis has the following laboratory
results:
Glucose: 240 mg/dL
Potassium: 3.1 mEq/L
Which nursing action is the priority?
A. Increase the insulin infusion.
B. Administer potassium replacement as prescribed.
C. Restrict oral fluids.
D. Prepare the patient for dialysis.
Correct Answer: B
Rationale:
Insulin shifts potassium into cells, increasing the risk of severe hypokalemia. Potassium
replacement is essential before increasing insulin if potassium is low.
Question 4
Which assessment finding is most concerning in a patient receiving packed red blood cells?
A. Temperature increase of 0.5°C (0.9°F)
B. Blood pressure of 130/80 mmHg
C. New onset of low back pain and chills
D. Heart rate of 92 beats/min
Correct Answer: C
, NSG 3800 Adult Health II Practice Exam 2026
Rationale:
Low back pain, chills, fever, and hypotension are classic signs of an acute hemolytic transfusion
reaction. Stop the transfusion immediately and notify the provider.
Question 5
A patient with syndrome of inappropriate antidiuretic hormone secretion (SIADH) has a serum
sodium level of 118 mEq/L. Which intervention has the highest priority?
A. Encourage oral water intake.
B. Initiate seizure precautions.
C. Administer hypotonic IV fluids.
D. Increase dietary potassium.
Correct Answer: B
Rationale:
Severe hyponatremia increases the risk of cerebral edema and seizures. Safety measures take
priority while definitive treatment is initiated.
Question 6
A patient develops hyperkalemia with ECG changes. Which medication should the nurse
anticipate administering first to stabilize the myocardium?
A. Sodium polystyrene sulfonate
B. Regular insulin
C. Calcium gluconate
D. Furosemide
Correct Answer: C
Rationale:
Calcium gluconate stabilizes cardiac cell membranes and reduces the risk of life-threatening
dysrhythmias. It does not lower potassium but buys time for other therapies.
Question 7
A patient with acute gastrointestinal bleeding presents with:
, NSG 3800 Adult Health II Practice Exam 2026
BP: 82/48 mmHg
HR: 132 beats/min
Cool, clammy skin
Confusion
Which stage of shock is most likely?
A. Initial
B. Compensatory
C. Progressive
D. Refractory
Correct Answer: C
Rationale:
Hypotension, altered mental status, and poor perfusion indicate progressive shock, requiring
aggressive resuscitation.
Question 8
Which patient is at greatest risk for developing refeeding syndrome?
A. Patient with obesity starting a low-calorie diet
B. Patient with severe malnutrition receiving enteral nutrition
C. Patient with hypertension
D. Patient receiving corticosteroids
Correct Answer: B
Rationale:
Refeeding syndrome can cause rapid intracellular shifts of phosphate, potassium, and magnesium
after nutrition is restarted in severely malnourished patients.
Question 9
A patient with metabolic acidosis is expected to exhibit which compensatory response?
A. Bradycardia
B. Slow, shallow respirations
C. Rapid, deep respirations
D. Decreased urine output
