NSG 3450 ADULT HEALTH NURSING
EXAM 1 150 HIGH YIELD CLINICAL
SCENARIOS FEATURING DETAILED
CORRECT ANSWERS WITH RATIONALES
AND CORRECT VERIFIED ANSWERS
INSTANT DOWNLOAD GRADE A+
NSG 3450 Adult Health Nursing Exam 1 Practice Questions
1. A 68-year-old male is admitted to the medical-surgical unit
with severe diarrhea lasting for four days. His vital signs are:
BP 90/60 mmHg, HR 112 bpm, RR 22 breaths/min, and Temp
37.2°C (99°F). His mucous membranes are dry, and his skin
turgor is poor. Which intravenous fluid does the nurse
anticipate the provider will prescribe first to restore
intravascular volume? A. 0.45% Sodium Chloride (Half-Normal
Saline) B. 3% Sodium Chloride (Hypertonic Saline) C. 0.9% Sodium
Chloride (Normal Saline) D. D5W (5% Dextrose in Water) Correct
Answer: C 0.9% Sodium Chloride is an isotonic fluid that remains in
the intravascular space, making it the fluid of choice for rapid volume
expansion in a patient exhibiting signs of hypovolemic shock
(hypotension, tachycardia, poor skin turgor).
2. A patient with chronic kidney disease (CKD) has a recent
laboratory report showing a serum potassium level of 6.8
mEq/L. The nurse reviews the patient’s electrocardiogram
(ECG). Which ECG finding is most indicative of this electrolyte
imbalance and requires immediate intervention? A. Prominent
U waves and flattened T waves B. Peaked T waves and widened QRS
complexes C. ST-segment depression and prolonged QT interval D.
Inverted P waves and shortened PR interval Correct Answer: B
Hyperkalemia (potassium > 5.0 mEq/L) alters cardiac conduction,
classically presenting with tall, peaked T waves, widened QRS
complexes, and eventually a sine wave pattern, which can progress to
ventricular fibrillation or asystole.
,3. A patient is admitted with diabetic ketoacidosis (DKA). The
arterial blood gas (ABG) results are: pH 7.25, PaCO2 30
mmHg, HCO3- 14 mEq/L. How should the nurse interpret
these results? A. Uncompensated metabolic acidosis B. Partially
compensated metabolic acidosis C. Fully compensated respiratory
acidosis D. Partially compensated respiratory alkalosis Correct
Answer: B The low pH and low HCO3- indicate metabolic acidosis.
The low PaCO2 indicates that the respiratory system is compensating
by blowing off CO2 (Kussmaul respirations), but the pH is not yet back
to the normal range (7.35-7.45), making it partially compensated.
4. During preoperative teaching for a patient scheduled for an
open cholecystectomy, the nurse instructs the patient on the
use of an incentive spirometer. Which statement by the patient
indicates a correct understanding of the teaching? A. "I should
blow into the mouthpiece as hard and fast as I can." B. "I will use the
spirometer only if I feel short of breath after surgery." C. "I should inhale
slowly and deeply through the mouthpiece, hold my breath for 3 to 5
seconds, and then exhale normally." D. "I need to use the spirometer
while lying completely flat in bed to maximize lung expansion."
Correct Answer: C The correct technique for an incentive
spirometer involves slow, deep inhalation through the mouthpiece to
maximize alveolar expansion, holding the breath for 3-5 seconds to
keep alveoli open, and then exhaling normally. It should be used while
sitting upright, not flat.
5. A postoperative patient on day 2 following a total hip
arthroplasty suddenly complains of sharp chest pain and
shortness of breath. The patient’s heart rate is 118 bpm, and
oxygen saturation is 88% on room air. What is the nurse’s
priority action? A. Administer the prescribed PRN opioid for pain. B.
Elevate the head of the bed and apply supplemental oxygen. C.
Auscultate the patient’s lung sounds bilaterally. D. Notify the rapid
response team immediately. Correct Answer: B While notifying
the rapid response team is critical, the immediate, independent nursing
priority is to optimize the patient’s oxygenation and ventilation by
elevating the head of the bed (high-Fowler’s) and applying
supplemental oxygen to address the hypoxia.
6. A patient is receiving morphine via a Patient-Controlled
Analgesia (PCA) pump. The nurse assesses the patient and
,notes a respiratory rate of 8 breaths per minute and a sedation
score of 4 (frequently drowsy, difficult to arouse). What is the
nurse’s priority intervention? A. Document the findings and
continue to monitor every 15 minutes. B. Stop the PCA infusion,
stimulate the patient, and prepare to administer naloxone. C. Decrease
the basal rate of the PCA pump by half. D. Encourage the patient to take
deep breaths and use the incentive spirometer. Correct Answer: B
A respiratory rate of 8 and a high sedation score indicate severe opioid-
induced respiratory depression. The nurse must immediately stop the
infusion, attempt to arouse the patient, and prepare to administer the
opioid antagonist naloxone as prescribed.
7. A patient is receiving a unit of packed red blood cells
(PRBCs). Fifteen minutes after the infusion begins, the patient
reports lower back pain and chills, and the nurse notes the
patient’s temperature has risen to 38.5°C (101.3°F). What is
the nurse’s first action? A. Slow the infusion rate and monitor vital
signs. B. Administer diphenhydramine and acetaminophen as
prescribed. C. Stop the transfusion immediately and keep the IV line
open with normal saline. D. Notify the blood bank to send a new unit of
blood. Correct Answer: C These are classic signs of an acute
hemolytic transfusion reaction, a life-threatening emergency. The
immediate priority is to stop the transfusion to prevent further infusion
of incompatible blood, while maintaining IV access with normal saline
for potential emergency medication administration.
8. A 75-year-old female is admitted with a serum sodium level
of 128 mEq/L. She appears confused and lethargic. Which
assessment finding is most consistent with this laboratory
value? A. Hyperactive deep tendon reflexes and muscle twitching B. Dry
mucous membranes, thirst, and restlessness C. Headache, confusion,
and seizures D. Polyuria and extreme thirst Correct Answer: C
Hyponatremia (sodium < 135 mEq/L) causes water to shift into cells,
leading to cellular swelling. In the brain, this causes increased
intracranial pressure, manifesting as headache, confusion, lethargy,
and potentially seizures.
9. A patient with a history of severe COPD is admitted with an
acute exacerbation. The nurse reviews the ABG results: pH
7.32, PaCO2 55 mmHg, HCO3- 28 mEq/L. Which physiological
mechanism is the patient’s body using to compensate for this
, imbalance? A. The kidneys are excreting excess bicarbonate. B. The
kidneys are retaining bicarbonate to buffer the acid. C. The lungs are
hyperventilating to blow off excess CO2. D. The lungs are
hypoventilating to retain CO2. Correct Answer: B The ABG shows
respiratory acidosis (low pH, high PaCO2). The elevated HCO3-
indicates that the kidneys are compensating by retaining bicarbonate
to buffer the excess acid in the blood, though the pH has not yet
returned to normal (partial compensation).
10. A patient is scheduled for a colonoscopy under moderate
sedation. The nurse is reviewing the informed consent form.
What is the nurse’s primary responsibility regarding the
informed consent process? A. Explain the detailed risks and benefits
of the procedure to the patient. B. Witness the patient’s signature and
verify that the patient is signing voluntarily and appears competent. C.
Answer any complex medical questions the patient has about the surgical
technique. D. Ensure the patient’s family has also signed the consent
form. Correct Answer: B The provider is responsible for
explaining the procedure, risks, and benefits. The nurse’s role is to
witness the signature, verify the patient’s identity, ensure the patient is
alert and competent to sign, and confirm that the signing is voluntary.
11. A patient who underwent a total thyroidectomy 24 hours
ago complains of tingling around the mouth and in the
fingertips. The nurse taps the patient’s facial nerve just
anterior to the ear, noting a twitching of the facial muscles.
How should the nurse document this finding? A. Positive
Trousseau’s sign B. Positive Chvostek’s sign C. Positive Babinski reflex D.
Positive Kernig’s sign Correct Answer: B Chvostek’s sign is a
clinical indicator of hypocalcemia, elicited by tapping the facial nerve,
which causes twitching of the facial muscles. This is a common
complication following thyroidectomy due to accidental removal or
damage to the parathyroid glands.
12. A postoperative patient who had abdominal surgery 3 days
ago suddenly reports a "popping" sensation in the abdomen
while coughing. The nurse observes a portion of the bowel
protruding through the surgical incision. What is the nurse’s
immediate action? A. Attempt to gently push the bowel back into the
abdominal cavity. B. Cover the protruding bowel with sterile gauze
moistened with sterile normal saline. C. Apply a tight abdominal binder
EXAM 1 150 HIGH YIELD CLINICAL
SCENARIOS FEATURING DETAILED
CORRECT ANSWERS WITH RATIONALES
AND CORRECT VERIFIED ANSWERS
INSTANT DOWNLOAD GRADE A+
NSG 3450 Adult Health Nursing Exam 1 Practice Questions
1. A 68-year-old male is admitted to the medical-surgical unit
with severe diarrhea lasting for four days. His vital signs are:
BP 90/60 mmHg, HR 112 bpm, RR 22 breaths/min, and Temp
37.2°C (99°F). His mucous membranes are dry, and his skin
turgor is poor. Which intravenous fluid does the nurse
anticipate the provider will prescribe first to restore
intravascular volume? A. 0.45% Sodium Chloride (Half-Normal
Saline) B. 3% Sodium Chloride (Hypertonic Saline) C. 0.9% Sodium
Chloride (Normal Saline) D. D5W (5% Dextrose in Water) Correct
Answer: C 0.9% Sodium Chloride is an isotonic fluid that remains in
the intravascular space, making it the fluid of choice for rapid volume
expansion in a patient exhibiting signs of hypovolemic shock
(hypotension, tachycardia, poor skin turgor).
2. A patient with chronic kidney disease (CKD) has a recent
laboratory report showing a serum potassium level of 6.8
mEq/L. The nurse reviews the patient’s electrocardiogram
(ECG). Which ECG finding is most indicative of this electrolyte
imbalance and requires immediate intervention? A. Prominent
U waves and flattened T waves B. Peaked T waves and widened QRS
complexes C. ST-segment depression and prolonged QT interval D.
Inverted P waves and shortened PR interval Correct Answer: B
Hyperkalemia (potassium > 5.0 mEq/L) alters cardiac conduction,
classically presenting with tall, peaked T waves, widened QRS
complexes, and eventually a sine wave pattern, which can progress to
ventricular fibrillation or asystole.
,3. A patient is admitted with diabetic ketoacidosis (DKA). The
arterial blood gas (ABG) results are: pH 7.25, PaCO2 30
mmHg, HCO3- 14 mEq/L. How should the nurse interpret
these results? A. Uncompensated metabolic acidosis B. Partially
compensated metabolic acidosis C. Fully compensated respiratory
acidosis D. Partially compensated respiratory alkalosis Correct
Answer: B The low pH and low HCO3- indicate metabolic acidosis.
The low PaCO2 indicates that the respiratory system is compensating
by blowing off CO2 (Kussmaul respirations), but the pH is not yet back
to the normal range (7.35-7.45), making it partially compensated.
4. During preoperative teaching for a patient scheduled for an
open cholecystectomy, the nurse instructs the patient on the
use of an incentive spirometer. Which statement by the patient
indicates a correct understanding of the teaching? A. "I should
blow into the mouthpiece as hard and fast as I can." B. "I will use the
spirometer only if I feel short of breath after surgery." C. "I should inhale
slowly and deeply through the mouthpiece, hold my breath for 3 to 5
seconds, and then exhale normally." D. "I need to use the spirometer
while lying completely flat in bed to maximize lung expansion."
Correct Answer: C The correct technique for an incentive
spirometer involves slow, deep inhalation through the mouthpiece to
maximize alveolar expansion, holding the breath for 3-5 seconds to
keep alveoli open, and then exhaling normally. It should be used while
sitting upright, not flat.
5. A postoperative patient on day 2 following a total hip
arthroplasty suddenly complains of sharp chest pain and
shortness of breath. The patient’s heart rate is 118 bpm, and
oxygen saturation is 88% on room air. What is the nurse’s
priority action? A. Administer the prescribed PRN opioid for pain. B.
Elevate the head of the bed and apply supplemental oxygen. C.
Auscultate the patient’s lung sounds bilaterally. D. Notify the rapid
response team immediately. Correct Answer: B While notifying
the rapid response team is critical, the immediate, independent nursing
priority is to optimize the patient’s oxygenation and ventilation by
elevating the head of the bed (high-Fowler’s) and applying
supplemental oxygen to address the hypoxia.
6. A patient is receiving morphine via a Patient-Controlled
Analgesia (PCA) pump. The nurse assesses the patient and
,notes a respiratory rate of 8 breaths per minute and a sedation
score of 4 (frequently drowsy, difficult to arouse). What is the
nurse’s priority intervention? A. Document the findings and
continue to monitor every 15 minutes. B. Stop the PCA infusion,
stimulate the patient, and prepare to administer naloxone. C. Decrease
the basal rate of the PCA pump by half. D. Encourage the patient to take
deep breaths and use the incentive spirometer. Correct Answer: B
A respiratory rate of 8 and a high sedation score indicate severe opioid-
induced respiratory depression. The nurse must immediately stop the
infusion, attempt to arouse the patient, and prepare to administer the
opioid antagonist naloxone as prescribed.
7. A patient is receiving a unit of packed red blood cells
(PRBCs). Fifteen minutes after the infusion begins, the patient
reports lower back pain and chills, and the nurse notes the
patient’s temperature has risen to 38.5°C (101.3°F). What is
the nurse’s first action? A. Slow the infusion rate and monitor vital
signs. B. Administer diphenhydramine and acetaminophen as
prescribed. C. Stop the transfusion immediately and keep the IV line
open with normal saline. D. Notify the blood bank to send a new unit of
blood. Correct Answer: C These are classic signs of an acute
hemolytic transfusion reaction, a life-threatening emergency. The
immediate priority is to stop the transfusion to prevent further infusion
of incompatible blood, while maintaining IV access with normal saline
for potential emergency medication administration.
8. A 75-year-old female is admitted with a serum sodium level
of 128 mEq/L. She appears confused and lethargic. Which
assessment finding is most consistent with this laboratory
value? A. Hyperactive deep tendon reflexes and muscle twitching B. Dry
mucous membranes, thirst, and restlessness C. Headache, confusion,
and seizures D. Polyuria and extreme thirst Correct Answer: C
Hyponatremia (sodium < 135 mEq/L) causes water to shift into cells,
leading to cellular swelling. In the brain, this causes increased
intracranial pressure, manifesting as headache, confusion, lethargy,
and potentially seizures.
9. A patient with a history of severe COPD is admitted with an
acute exacerbation. The nurse reviews the ABG results: pH
7.32, PaCO2 55 mmHg, HCO3- 28 mEq/L. Which physiological
mechanism is the patient’s body using to compensate for this
, imbalance? A. The kidneys are excreting excess bicarbonate. B. The
kidneys are retaining bicarbonate to buffer the acid. C. The lungs are
hyperventilating to blow off excess CO2. D. The lungs are
hypoventilating to retain CO2. Correct Answer: B The ABG shows
respiratory acidosis (low pH, high PaCO2). The elevated HCO3-
indicates that the kidneys are compensating by retaining bicarbonate
to buffer the excess acid in the blood, though the pH has not yet
returned to normal (partial compensation).
10. A patient is scheduled for a colonoscopy under moderate
sedation. The nurse is reviewing the informed consent form.
What is the nurse’s primary responsibility regarding the
informed consent process? A. Explain the detailed risks and benefits
of the procedure to the patient. B. Witness the patient’s signature and
verify that the patient is signing voluntarily and appears competent. C.
Answer any complex medical questions the patient has about the surgical
technique. D. Ensure the patient’s family has also signed the consent
form. Correct Answer: B The provider is responsible for
explaining the procedure, risks, and benefits. The nurse’s role is to
witness the signature, verify the patient’s identity, ensure the patient is
alert and competent to sign, and confirm that the signing is voluntary.
11. A patient who underwent a total thyroidectomy 24 hours
ago complains of tingling around the mouth and in the
fingertips. The nurse taps the patient’s facial nerve just
anterior to the ear, noting a twitching of the facial muscles.
How should the nurse document this finding? A. Positive
Trousseau’s sign B. Positive Chvostek’s sign C. Positive Babinski reflex D.
Positive Kernig’s sign Correct Answer: B Chvostek’s sign is a
clinical indicator of hypocalcemia, elicited by tapping the facial nerve,
which causes twitching of the facial muscles. This is a common
complication following thyroidectomy due to accidental removal or
damage to the parathyroid glands.
12. A postoperative patient who had abdominal surgery 3 days
ago suddenly reports a "popping" sensation in the abdomen
while coughing. The nurse observes a portion of the bowel
protruding through the surgical incision. What is the nurse’s
immediate action? A. Attempt to gently push the bowel back into the
abdominal cavity. B. Cover the protruding bowel with sterile gauze
moistened with sterile normal saline. C. Apply a tight abdominal binder
