NR 324 Adult Health I Exam 2 (Weeks 4-7) Prep Document |
2026/2027 Edition | 250 Verified Questions
NR 324 Adult Health I Exam 2 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED A+. 100% Verified
Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive exam preparation document covers NR 324 Adult Health I Exam 2, focusing on
Weeks 4-7 content. It includes 250 verified questions with detailed rationales to ensure mastery of
adult health nursing concepts. Designed for the 2026/2027 academic year, this resource is updated to
reflect the latest evidence-based practice guidelines. Each question is accompanied by a thorough
explanation to promote deep understanding and retention.
Abstract:
This document provides a rigorous preparation tool for NR 324 Adult Health I Exam 2, covering Weeks 4-7 of the
curriculum. The 250 verified questions are meticulously crafted to align with the 2026/2027 academic year
standards and reflect the most current clinical guidelines. Each question includes a detailed rationale that explains
the correct answer and analyzes each distractor, fostering critical thinking and clinical reasoning. The content
spans major adult health domains including cardiovascular, respiratory, renal, endocrine, gastrointestinal, and
perioperative nursing. This resource is designed to help nursing students achieve a deep understanding of adult
health concepts and excel in their examinations. The rationales are structured to reinforce key pathophysiological
principles, nursing interventions, and pharmacological considerations. By engaging with this material, students
can confidently prepare for the exam and apply knowledge to real-world clinical scenarios.
Content Area Overview:
Content Area Questions Key Topics Weight
Cardiovascular Disorders 1-50 Heart failure, coronary artery disease, 20%
hypertension, dysrhythmias, myocardial
infarction
Respiratory Conditions 51-100 COPD, pneumonia, asthma, pulmonary 20%
embolism, acute respiratory distress
syndrome
Renal and Urinary Systems 101-140 Acute kidney injury, chronic kidney disease, 16%
urinary tract infections, renal calculi
Endocrine Disorders 141-180 Diabetes mellitus, diabetic ketoacidosis, 16%
hyperthyroidism, hypothyroidism, Cushing's
syndrome
Gastrointestinal Issues 181-220 Peptic ulcer disease, pancreatitis, liver 16%
cirrhosis, cholecystitis, bowel obstruction
Perioperative Nursing 221-250 Preoperative assessment, intraoperative care, 12%
postoperative complications, pain
management
Page 1
,Q1. A patient with chronic kidney disease (stage 4) is admitted with hyperkalemia (K+ 6.8 mEq/L).
Which intervention should the nurse implement first?
A. Administer intravenous calcium gluconate
B. Administer sodium polystyrene sulfonate (Kayexalate)
C. Initiate hemodialysis
D. Administer nebulized albuterol
Correct Answer: A. Administer intravenous calcium gluconate
Rationale: Intravenous calcium gluconate is the first-line intervention to stabilize the cardiac membrane
and prevent life-threatening arrhythmias in severe hyperkalemia. Sodium polystyrene sulfonate works
slowly, dialysis is definitive but not immediately available, and albuterol is adjunctive.
Why Wrong:
B - Kayexalate works over hours and does not rapidly lower potassium or protect the heart.
C - Hemodialysis is definitive but requires vascular access and setup time; not the first emergency
step.
D - Nebulized albuterol can shift potassium intracellularly but is not as rapid or cardioprotective as
calcium.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 52
Q2. Which laboratory finding is most consistent with prerenal acute kidney injury (AKI) rather
than intrarenal AKI?
A. Urine sodium < 20 mEq/L
B. Fractional excretion of sodium (FeNa) > 2%
C. Urine osmolality < 350 mOsm/kg
D. Urine sediment with muddy brown casts
Correct Answer: A. Urine sodium < 20 mEq/L
Rationale: In prerenal AKI, the kidneys are hypoperfused but intact, leading to concentrated urine with
low sodium (<20 mEq/L) and low FeNa (<1%). Intrarenal AKI (e.g., acute tubular necrosis) shows high
FeNa, low osmolality, and casts.
Why Wrong:
B - FeNa >2% suggests intrarenal AKI; prerenal usually <1%.
C - Low urine osmolality indicates inability to concentrate, typical of intrarenal AKI.
D - Muddy brown casts are specific to acute tubular necrosis (intrarenal).
Reference: Porth, C.M. (2025). Pathophysiology: Concepts of Altered Health States, 11th Ed., Ch. 29
Page 2
,Q3. A patient with heart failure (HFrEF) is started on sacubitril/valsartan. Which mechanism best
explains the benefit of this combination?
A. Inhibition of neprilysin increases natriuretic peptides while ARB blocks angiotensin II
B. Combined beta-blockade and diuresis reduce preload
C. Direct vasodilation via nitric oxide release
D. Aldosterone antagonism reduces sodium retention
Correct Answer: A. Inhibition of neprilysin increases natriuretic peptides while ARB blocks
angiotensin II
Rationale: Sacubitril inhibits neprilysin, increasing levels of natriuretic peptides (which promote
vasodilation and natriuresis), while valsartan (ARB) blocks angiotensin II. This dual action improves
outcomes in HFrEF beyond ACE inhibition alone.
Why Wrong:
B - Sacubitril/valsartan has no beta-blocker activity; diuresis is indirect.
C - Nitric oxide release is not its primary mechanism.
D - Aldosterone antagonism is not a property of this drug combination.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 38
Q4. A patient with cirrhosis and ascites develops hepatic encephalopathy. Which intervention
should the nurse question?
A. Lactulose 30 mL orally every 6 hours
B. Rifaximin 550 mg orally twice daily
C. Furosemide 40 mg intravenously daily
D. Albumin 25% 100 mL intravenously daily
Correct Answer: D. Albumin 25% 100 mL intravenously daily
Rationale: Albumin is used for volume expansion in spontaneous bacterial peritonitis or large-volume
paracentesis, not for encephalopathy. Lactulose and rifaximin reduce ammonia levels; furosemide may be
used for ascites but does not treat encephalopathy directly.
Why Wrong:
A - Lactulose is standard for reducing ammonia by acidifying the colon.
B - Rifaximin is a nonabsorbable antibiotic that reduces gut bacteria producing ammonia.
C - Furosemide is used for ascites management but is not contraindicated in encephalopathy.
Reference: Lewis, S.L. et al. (2026). Medical-Surgical Nursing, 10th Ed., Ch. 43
Page 3
, Q5. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled ventilation
with plateau pressure of 32 cm H2O. Which ventilator adjustment is most appropriate to prevent
ventilator-induced lung injury?
A. Increase positive end-expiratory pressure (PEEP) to 20 cm H2O
B. Decrease tidal volume to 6 mL/kg predicted body weight
C. Increase inspiratory time to 1.5 seconds
D. Switch to pressure-controlled ventilation
Correct Answer: B. Decrease tidal volume to 6 mL/kg predicted body weight
Rationale: Low tidal volume ventilation (6 mL/kg PBW) is the cornerstone of lung-protective ventilation
to reduce volutrauma and barotrauma. Plateau pressure >30 cm H2O indicates excessive distending
pressure; reducing tidal volume is the primary intervention.
Why Wrong:
A - Increasing PEEP may improve oxygenation but does not directly lower plateau pressure.
C - Increasing inspiratory time may improve oxygenation but does not reduce plateau pressure.
D - Switching to pressure-controlled ventilation does not guarantee lower tidal volumes.
Reference: Urden, L.D. et al. (2026). Critical Care Nursing, 9th Ed., Ch. 16
Q6. A patient with diabetic ketoacidosis (DKA) has a serum potassium of 3.2 mEq/L on admission.
The nurse should anticipate which action?
A. Initiate insulin infusion immediately without waiting for potassium
B. Hold insulin and administer potassium replacement first
C. Administer sodium bicarbonate to correct acidosis
D. Start 0.9% normal saline at 250 mL/hr
Correct Answer: B. Hold insulin and administer potassium replacement first
Rationale: Insulin drives potassium into cells, worsening hypokalemia. In DKA with hypokalemia,
potassium must be replaced before starting insulin to prevent life-threatening cardiac arrhythmias. Fluid
resuscitation with normal saline is appropriate but insulin should be delayed.
Why Wrong:
A - Insulin without potassium replacement can cause severe hypokalemia.
C - Bicarbonate is not indicated unless pH <6.9; it does not address potassium.
D - Fluids are needed but do not correct hypokalemia.
Reference: American Diabetes Association (2026). Standards of Care, Diabetes Care
Page 4
2026/2027 Edition | 250 Verified Questions
NR 324 Adult Health I Exam 2 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED A+. 100% Verified
Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive exam preparation document covers NR 324 Adult Health I Exam 2, focusing on
Weeks 4-7 content. It includes 250 verified questions with detailed rationales to ensure mastery of
adult health nursing concepts. Designed for the 2026/2027 academic year, this resource is updated to
reflect the latest evidence-based practice guidelines. Each question is accompanied by a thorough
explanation to promote deep understanding and retention.
Abstract:
This document provides a rigorous preparation tool for NR 324 Adult Health I Exam 2, covering Weeks 4-7 of the
curriculum. The 250 verified questions are meticulously crafted to align with the 2026/2027 academic year
standards and reflect the most current clinical guidelines. Each question includes a detailed rationale that explains
the correct answer and analyzes each distractor, fostering critical thinking and clinical reasoning. The content
spans major adult health domains including cardiovascular, respiratory, renal, endocrine, gastrointestinal, and
perioperative nursing. This resource is designed to help nursing students achieve a deep understanding of adult
health concepts and excel in their examinations. The rationales are structured to reinforce key pathophysiological
principles, nursing interventions, and pharmacological considerations. By engaging with this material, students
can confidently prepare for the exam and apply knowledge to real-world clinical scenarios.
Content Area Overview:
Content Area Questions Key Topics Weight
Cardiovascular Disorders 1-50 Heart failure, coronary artery disease, 20%
hypertension, dysrhythmias, myocardial
infarction
Respiratory Conditions 51-100 COPD, pneumonia, asthma, pulmonary 20%
embolism, acute respiratory distress
syndrome
Renal and Urinary Systems 101-140 Acute kidney injury, chronic kidney disease, 16%
urinary tract infections, renal calculi
Endocrine Disorders 141-180 Diabetes mellitus, diabetic ketoacidosis, 16%
hyperthyroidism, hypothyroidism, Cushing's
syndrome
Gastrointestinal Issues 181-220 Peptic ulcer disease, pancreatitis, liver 16%
cirrhosis, cholecystitis, bowel obstruction
Perioperative Nursing 221-250 Preoperative assessment, intraoperative care, 12%
postoperative complications, pain
management
Page 1
,Q1. A patient with chronic kidney disease (stage 4) is admitted with hyperkalemia (K+ 6.8 mEq/L).
Which intervention should the nurse implement first?
A. Administer intravenous calcium gluconate
B. Administer sodium polystyrene sulfonate (Kayexalate)
C. Initiate hemodialysis
D. Administer nebulized albuterol
Correct Answer: A. Administer intravenous calcium gluconate
Rationale: Intravenous calcium gluconate is the first-line intervention to stabilize the cardiac membrane
and prevent life-threatening arrhythmias in severe hyperkalemia. Sodium polystyrene sulfonate works
slowly, dialysis is definitive but not immediately available, and albuterol is adjunctive.
Why Wrong:
B - Kayexalate works over hours and does not rapidly lower potassium or protect the heart.
C - Hemodialysis is definitive but requires vascular access and setup time; not the first emergency
step.
D - Nebulized albuterol can shift potassium intracellularly but is not as rapid or cardioprotective as
calcium.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 52
Q2. Which laboratory finding is most consistent with prerenal acute kidney injury (AKI) rather
than intrarenal AKI?
A. Urine sodium < 20 mEq/L
B. Fractional excretion of sodium (FeNa) > 2%
C. Urine osmolality < 350 mOsm/kg
D. Urine sediment with muddy brown casts
Correct Answer: A. Urine sodium < 20 mEq/L
Rationale: In prerenal AKI, the kidneys are hypoperfused but intact, leading to concentrated urine with
low sodium (<20 mEq/L) and low FeNa (<1%). Intrarenal AKI (e.g., acute tubular necrosis) shows high
FeNa, low osmolality, and casts.
Why Wrong:
B - FeNa >2% suggests intrarenal AKI; prerenal usually <1%.
C - Low urine osmolality indicates inability to concentrate, typical of intrarenal AKI.
D - Muddy brown casts are specific to acute tubular necrosis (intrarenal).
Reference: Porth, C.M. (2025). Pathophysiology: Concepts of Altered Health States, 11th Ed., Ch. 29
Page 2
,Q3. A patient with heart failure (HFrEF) is started on sacubitril/valsartan. Which mechanism best
explains the benefit of this combination?
A. Inhibition of neprilysin increases natriuretic peptides while ARB blocks angiotensin II
B. Combined beta-blockade and diuresis reduce preload
C. Direct vasodilation via nitric oxide release
D. Aldosterone antagonism reduces sodium retention
Correct Answer: A. Inhibition of neprilysin increases natriuretic peptides while ARB blocks
angiotensin II
Rationale: Sacubitril inhibits neprilysin, increasing levels of natriuretic peptides (which promote
vasodilation and natriuresis), while valsartan (ARB) blocks angiotensin II. This dual action improves
outcomes in HFrEF beyond ACE inhibition alone.
Why Wrong:
B - Sacubitril/valsartan has no beta-blocker activity; diuresis is indirect.
C - Nitric oxide release is not its primary mechanism.
D - Aldosterone antagonism is not a property of this drug combination.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 38
Q4. A patient with cirrhosis and ascites develops hepatic encephalopathy. Which intervention
should the nurse question?
A. Lactulose 30 mL orally every 6 hours
B. Rifaximin 550 mg orally twice daily
C. Furosemide 40 mg intravenously daily
D. Albumin 25% 100 mL intravenously daily
Correct Answer: D. Albumin 25% 100 mL intravenously daily
Rationale: Albumin is used for volume expansion in spontaneous bacterial peritonitis or large-volume
paracentesis, not for encephalopathy. Lactulose and rifaximin reduce ammonia levels; furosemide may be
used for ascites but does not treat encephalopathy directly.
Why Wrong:
A - Lactulose is standard for reducing ammonia by acidifying the colon.
B - Rifaximin is a nonabsorbable antibiotic that reduces gut bacteria producing ammonia.
C - Furosemide is used for ascites management but is not contraindicated in encephalopathy.
Reference: Lewis, S.L. et al. (2026). Medical-Surgical Nursing, 10th Ed., Ch. 43
Page 3
, Q5. A patient with acute respiratory distress syndrome (ARDS) is on volume-controlled ventilation
with plateau pressure of 32 cm H2O. Which ventilator adjustment is most appropriate to prevent
ventilator-induced lung injury?
A. Increase positive end-expiratory pressure (PEEP) to 20 cm H2O
B. Decrease tidal volume to 6 mL/kg predicted body weight
C. Increase inspiratory time to 1.5 seconds
D. Switch to pressure-controlled ventilation
Correct Answer: B. Decrease tidal volume to 6 mL/kg predicted body weight
Rationale: Low tidal volume ventilation (6 mL/kg PBW) is the cornerstone of lung-protective ventilation
to reduce volutrauma and barotrauma. Plateau pressure >30 cm H2O indicates excessive distending
pressure; reducing tidal volume is the primary intervention.
Why Wrong:
A - Increasing PEEP may improve oxygenation but does not directly lower plateau pressure.
C - Increasing inspiratory time may improve oxygenation but does not reduce plateau pressure.
D - Switching to pressure-controlled ventilation does not guarantee lower tidal volumes.
Reference: Urden, L.D. et al. (2026). Critical Care Nursing, 9th Ed., Ch. 16
Q6. A patient with diabetic ketoacidosis (DKA) has a serum potassium of 3.2 mEq/L on admission.
The nurse should anticipate which action?
A. Initiate insulin infusion immediately without waiting for potassium
B. Hold insulin and administer potassium replacement first
C. Administer sodium bicarbonate to correct acidosis
D. Start 0.9% normal saline at 250 mL/hr
Correct Answer: B. Hold insulin and administer potassium replacement first
Rationale: Insulin drives potassium into cells, worsening hypokalemia. In DKA with hypokalemia,
potassium must be replaced before starting insulin to prevent life-threatening cardiac arrhythmias. Fluid
resuscitation with normal saline is appropriate but insulin should be delayed.
Why Wrong:
A - Insulin without potassium replacement can cause severe hypokalemia.
C - Bicarbonate is not indicated unless pH <6.9; it does not address potassium.
D - Fluids are needed but do not correct hypokalemia.
Reference: American Diabetes Association (2026). Standards of Care, Diabetes Care
Page 4
