NRSG 201 Exam 4 V1 | NRSG 201 Med
Surg 1 | Actual Q&A with Rationale
(NRSG201 Exam 4) | Ivy Tech
1. A patient with Acute Kidney Injury (AKI) has a potassium level of 6.8 mEq/L and exhibits
peaked T-waves on the ECG. Which order should the nurse implement first?
A. Administer Sodium Polystyrene Sulfonate (Kayexalate) orally.
B. Administer intravenous regular insulin and 50% dextrose.
C. Initiate a low-potassium diet immediately.
D. Prepare the patient for an emergency kidney ultrasound.
Correct Answer: B
A potassium level of 6.8 mEq/L is life-threatening and requires immediate intervention to
shift potassium back into the cells. Intravenous regular insulin followed by dextrose is the
fastest method to achieve this shift and stabilize the cardiac membrane in an acute setting.
While Kayexalate removes potassium from the body, it has a slow onset of action and is not
appropriate for emergent stabilization.
2. An arterial blood gas (ABG) result shows: pH 7.31, PaCO2 52 mmHg, and HCO3 24 mEq/L.
How should the nurse interpret these findings?
A. Respiratory Acidosis
B. Metabolic Acidosis
,C. Metabolic Alkalosis
D. Respiratory Alkalosis
Correct Answer: A
The pH of 7.31 indicates acidosis as it is below the normal range of 7.35 to 7.45. The
PaCO2 is elevated at 52 mmHg, which points toward a respiratory cause for the acidic state.
Since the bicarbonate (HCO3) is within the normal range of 22 to 26 mEq/L, this is an
uncompensated respiratory acidosis typically seen in hypoventilation.
3. A client with Chronic Kidney Disease (CKD) is prescribed Epoetin Alfa. What is the primary
therapeutic goal of this medication?
A. To lower the serum potassium level.
B. To decrease serum phosphorus levels.
C. To promote the excretion of nitrogenous wastes.
D. To increase hemoglobin and hematocrit levels.
Correct Answer: D
Epoetin Alfa is a synthetic version of erythropoietin, a hormone normally produced by the
kidneys to stimulate red blood cell production. In CKD, the kidneys fail to produce enough
erythropoietin, leading to chronic anemia. The effectiveness of this treatment is monitored
through serial blood counts to ensure hemoglobin reaches the target range of 10 to 12
g/dL.
, 4. During the emergent phase of burn care, which electrolyte imbalance is the nurse most
likely to observe?
A. Hypokalemia
B. Hypernatremia
C. Hyperkalemia
D. Hypercalcemia
Correct Answer: C
In the emergent phase of a major burn, massive cell destruction occurs, releasing
intracellular potassium into the extracellular space. This results in hyperkalemia, which
poses a significant risk for cardiac arrhythmias. Simultaneously, sodium typically moves
into the interstitial space as fluid shifts occur, often leading to hyponatremia.
5. A patient with an arteriovenous (AV) fistula in the left arm is admitted for surgery. Which
action by the nurse is essential for site preservation?
A. Aspirate 5 mL of blood from the fistula daily to ensure patency.
B. Apply a tight pressure dressing to the site after every shift.
C. Ensure that no blood pressures or venipunctures are performed on the left arm.
D. Irrigate the fistula with heparinized saline every 8 hours.
Correct Answer: C
Surg 1 | Actual Q&A with Rationale
(NRSG201 Exam 4) | Ivy Tech
1. A patient with Acute Kidney Injury (AKI) has a potassium level of 6.8 mEq/L and exhibits
peaked T-waves on the ECG. Which order should the nurse implement first?
A. Administer Sodium Polystyrene Sulfonate (Kayexalate) orally.
B. Administer intravenous regular insulin and 50% dextrose.
C. Initiate a low-potassium diet immediately.
D. Prepare the patient for an emergency kidney ultrasound.
Correct Answer: B
A potassium level of 6.8 mEq/L is life-threatening and requires immediate intervention to
shift potassium back into the cells. Intravenous regular insulin followed by dextrose is the
fastest method to achieve this shift and stabilize the cardiac membrane in an acute setting.
While Kayexalate removes potassium from the body, it has a slow onset of action and is not
appropriate for emergent stabilization.
2. An arterial blood gas (ABG) result shows: pH 7.31, PaCO2 52 mmHg, and HCO3 24 mEq/L.
How should the nurse interpret these findings?
A. Respiratory Acidosis
B. Metabolic Acidosis
,C. Metabolic Alkalosis
D. Respiratory Alkalosis
Correct Answer: A
The pH of 7.31 indicates acidosis as it is below the normal range of 7.35 to 7.45. The
PaCO2 is elevated at 52 mmHg, which points toward a respiratory cause for the acidic state.
Since the bicarbonate (HCO3) is within the normal range of 22 to 26 mEq/L, this is an
uncompensated respiratory acidosis typically seen in hypoventilation.
3. A client with Chronic Kidney Disease (CKD) is prescribed Epoetin Alfa. What is the primary
therapeutic goal of this medication?
A. To lower the serum potassium level.
B. To decrease serum phosphorus levels.
C. To promote the excretion of nitrogenous wastes.
D. To increase hemoglobin and hematocrit levels.
Correct Answer: D
Epoetin Alfa is a synthetic version of erythropoietin, a hormone normally produced by the
kidneys to stimulate red blood cell production. In CKD, the kidneys fail to produce enough
erythropoietin, leading to chronic anemia. The effectiveness of this treatment is monitored
through serial blood counts to ensure hemoglobin reaches the target range of 10 to 12
g/dL.
, 4. During the emergent phase of burn care, which electrolyte imbalance is the nurse most
likely to observe?
A. Hypokalemia
B. Hypernatremia
C. Hyperkalemia
D. Hypercalcemia
Correct Answer: C
In the emergent phase of a major burn, massive cell destruction occurs, releasing
intracellular potassium into the extracellular space. This results in hyperkalemia, which
poses a significant risk for cardiac arrhythmias. Simultaneously, sodium typically moves
into the interstitial space as fluid shifts occur, often leading to hyponatremia.
5. A patient with an arteriovenous (AV) fistula in the left arm is admitted for surgery. Which
action by the nurse is essential for site preservation?
A. Aspirate 5 mL of blood from the fistula daily to ensure patency.
B. Apply a tight pressure dressing to the site after every shift.
C. Ensure that no blood pressures or venipunctures are performed on the left arm.
D. Irrigate the fistula with heparinized saline every 8 hours.
Correct Answer: C
