Nightingale College BSN 346 Exam 2 (pdf) | 2026/2027 | Concepts of
Nursing III Q&A | Nursing
1. A patient's arterial blood gas results show a pH of 7.31, PaCO2 of 52
mmHg, and HCO3 of 24 mEq/L. Which acid-base imbalance is occurring?
A) Metabolic Alkalosis
B) Respiratory Alkalosis
C) Respiratory Acidosis
D) Metabolic Acidosis
Correct Answer: Respiratory Acidosis
Rationale: The pH is below 7.35, indicating acidosis. The PaCO2 is elevated
above 45 mmHg, indicating a respiratory cause. The bicarbonate level is
normal, ruling out a metabolic component. This is uncompensated
respiratory acidosis.
2. The nurse receives a change-of-shift report. Which patient should the
nurse assess first?
A) A patient 2 hours post-thyroidectomy with a hoarse voice and stridor
B) A patient with heart failure reporting 2+ pitting edema
C) A patient with COPD and an oxygen saturation of 89%
D) A patient with a fracture requesting pain medication
Correct Answer: A patient 2 hours post-thyroidectomy with a hoarse voice
and stridor
Rationale: Stridor is a high-pitched sound indicating upper airway
obstruction, which is the highest priority according to the ABC (Airway,
Breathing, Circulation) framework. This patient is at immediate risk of
respiratory failure.
,3. A patient arrives at the emergency department with an SpO2 of 78% and
cyanosis. What is the priority nursing action?
A) Obtain an arterial blood gas
B) Apply supplemental oxygen
C) Encourage coughing and deep breathing
D) Document the findings
Correct Answer: Apply supplemental oxygen
Rationale: Severe hypoxia (SpO2 < 90%) requires immediate oxygen therapy
to prevent tissue damage and organ failure. Obtaining an ABG, encouraging
coughing, and documenting are important but secondary to correcting the
hypoxia.
4. Which assessment finding is most suggestive of acute respiratory failure?
A) Respiratory rate of 8 breaths per minute
B) Respiratory rate of 18 breaths per minute
C) Blood pressure of 120/80 mmHg
D) Temperature of 37°C (98.6°F)
Correct Answer: Respiratory rate of 8 breaths per minute
Rationale: A respiratory rate of 8 breaths per minute indicates bradypnea
and suggests ventilatory failure. This is a critical finding that requires
immediate intervention to prevent further respiratory compromise.
5. A post-operative patient suddenly develops chest pain and dyspnea. What
is the priority concern?
,A) Pneumonia
B) Pulmonary embolism
C) Anxiety attack
D) Atelectasis
Correct Answer: Pulmonary embolism
Rationale: The sudden onset of chest pain and dyspnea in a post-operative
patient strongly suggests a pulmonary embolism, which is a life-threatening
emergency requiring immediate assessment and intervention.
6. A patient with heart failure reports sudden shortness of breath. What is
the nurse's first action?
A) Administer a PRN diuretic
B) Elevate the head of the bed
C) Check the patient's oxygen saturation
D) Notify the healthcare provider
Correct Answer: Elevate the head of the bed
Rationale: Elevating the head of the bed improves lung expansion and
reduces the work of breathing immediately. This is the first action to take
before further assessment or interventions.
7. Which laboratory value requires immediate action due to the risk of life-
threatening complications?
A) Serum sodium of 138 mEq/L
B) Serum potassium of 6.2 mEq/L
C) Serum calcium of 9.0 mg/dL
, D) Serum chloride of 100 mEq/L
Correct Answer: Serum potassium of 6.2 mEq/L
Rationale: A serum potassium of 6.2 mEq/L indicates severe hyperkalemia,
which can cause fatal cardiac dysrhythmias. This requires immediate
intervention, such as administering calcium gluconate, insulin with glucose,
or kayexalate.
8. Which finding is an early sign of hypoxia?
A) Restlessness and agitation
B) Bradycardia
C) Skin rash
D) Constipation
Correct Answer: Restlessness and agitation
Rationale: Early hypoxia causes central nervous system stimulation, leading
to restlessness, agitation, and confusion. Bradycardia is a late sign of severe
hypoxia.
9. An arterial blood gas shows a PaO2 of 55 mmHg. This indicates:
A) Severe hypoxemia
B) Normal oxygenation
C) Hyperglycemia
D) Alkalosis
Correct Answer: Severe hypoxemia
Nursing III Q&A | Nursing
1. A patient's arterial blood gas results show a pH of 7.31, PaCO2 of 52
mmHg, and HCO3 of 24 mEq/L. Which acid-base imbalance is occurring?
A) Metabolic Alkalosis
B) Respiratory Alkalosis
C) Respiratory Acidosis
D) Metabolic Acidosis
Correct Answer: Respiratory Acidosis
Rationale: The pH is below 7.35, indicating acidosis. The PaCO2 is elevated
above 45 mmHg, indicating a respiratory cause. The bicarbonate level is
normal, ruling out a metabolic component. This is uncompensated
respiratory acidosis.
2. The nurse receives a change-of-shift report. Which patient should the
nurse assess first?
A) A patient 2 hours post-thyroidectomy with a hoarse voice and stridor
B) A patient with heart failure reporting 2+ pitting edema
C) A patient with COPD and an oxygen saturation of 89%
D) A patient with a fracture requesting pain medication
Correct Answer: A patient 2 hours post-thyroidectomy with a hoarse voice
and stridor
Rationale: Stridor is a high-pitched sound indicating upper airway
obstruction, which is the highest priority according to the ABC (Airway,
Breathing, Circulation) framework. This patient is at immediate risk of
respiratory failure.
,3. A patient arrives at the emergency department with an SpO2 of 78% and
cyanosis. What is the priority nursing action?
A) Obtain an arterial blood gas
B) Apply supplemental oxygen
C) Encourage coughing and deep breathing
D) Document the findings
Correct Answer: Apply supplemental oxygen
Rationale: Severe hypoxia (SpO2 < 90%) requires immediate oxygen therapy
to prevent tissue damage and organ failure. Obtaining an ABG, encouraging
coughing, and documenting are important but secondary to correcting the
hypoxia.
4. Which assessment finding is most suggestive of acute respiratory failure?
A) Respiratory rate of 8 breaths per minute
B) Respiratory rate of 18 breaths per minute
C) Blood pressure of 120/80 mmHg
D) Temperature of 37°C (98.6°F)
Correct Answer: Respiratory rate of 8 breaths per minute
Rationale: A respiratory rate of 8 breaths per minute indicates bradypnea
and suggests ventilatory failure. This is a critical finding that requires
immediate intervention to prevent further respiratory compromise.
5. A post-operative patient suddenly develops chest pain and dyspnea. What
is the priority concern?
,A) Pneumonia
B) Pulmonary embolism
C) Anxiety attack
D) Atelectasis
Correct Answer: Pulmonary embolism
Rationale: The sudden onset of chest pain and dyspnea in a post-operative
patient strongly suggests a pulmonary embolism, which is a life-threatening
emergency requiring immediate assessment and intervention.
6. A patient with heart failure reports sudden shortness of breath. What is
the nurse's first action?
A) Administer a PRN diuretic
B) Elevate the head of the bed
C) Check the patient's oxygen saturation
D) Notify the healthcare provider
Correct Answer: Elevate the head of the bed
Rationale: Elevating the head of the bed improves lung expansion and
reduces the work of breathing immediately. This is the first action to take
before further assessment or interventions.
7. Which laboratory value requires immediate action due to the risk of life-
threatening complications?
A) Serum sodium of 138 mEq/L
B) Serum potassium of 6.2 mEq/L
C) Serum calcium of 9.0 mg/dL
, D) Serum chloride of 100 mEq/L
Correct Answer: Serum potassium of 6.2 mEq/L
Rationale: A serum potassium of 6.2 mEq/L indicates severe hyperkalemia,
which can cause fatal cardiac dysrhythmias. This requires immediate
intervention, such as administering calcium gluconate, insulin with glucose,
or kayexalate.
8. Which finding is an early sign of hypoxia?
A) Restlessness and agitation
B) Bradycardia
C) Skin rash
D) Constipation
Correct Answer: Restlessness and agitation
Rationale: Early hypoxia causes central nervous system stimulation, leading
to restlessness, agitation, and confusion. Bradycardia is a late sign of severe
hypoxia.
9. An arterial blood gas shows a PaO2 of 55 mmHg. This indicates:
A) Severe hypoxemia
B) Normal oxygenation
C) Hyperglycemia
D) Alkalosis
Correct Answer: Severe hypoxemia
