BSN3A Midterm Exam Review with Questions,
Answers and Rationales 2026/2027 Update
Section 1: Advanced Perioperative and Critical Care Nursing
Question 1
A perioperative nurse is caring for a client in the post-anesthesia care unit who underwent a
complex abdominal procedure. The client suddenly exhibits tachycardia, muscle rigidity, rapidly
climbing body temperature, and profound metabolic acidosis.
What is the definitive pharmacological antidote for this life-threatening perioperative
emergency?
A. Dantrolene sodium
B. Flumazenil
C. Physostigmine salicylate
D. Naloxone hydrochloride
Correct Answer: A. Dantrolene sodium
Rationale: These clinical manifestations are characteristic of malignant hyperthermia, a
pharmacogenetic crisis triggered by volatile inhalation anesthetics and succinylcholine.
Dantrolene sodium is a skeletal muscle relaxant that acts as the specific antidote by interfering
with the release of calcium ions from the sarcoplasmic reticulum within muscle fibers.
Question 2
A critical care nurse is managing a client with severe traumatic brain injury who has an elevated
intracranial pressure and a reduced mean arterial pressure.
Which physiological interpretation applies when the calculated cerebral perfusion pressure
falls below the acceptable therapeutic target range?
A. The cerebral perfusion pressure is below the recommended therapeutic target range of
sixty to eighty millimeters of mercury, indicating cerebral hypoperfusion
B. The cerebral perfusion pressure represents dangerous cerebral hyperperfusion requiring
emergency antihypertensive therapy
, C. The cerebral perfusion pressure is exactly at the upper boundary of normal intracranial
autoregulation
D. The cerebral perfusion pressure indicates imminent and irreversible brain death without
secondary complications
Correct Answer: A. The cerebral perfusion pressure is below the recommended
therapeutic target range of sixty to eighty millimeters of mercury, indicating cerebral
hypoperfusion
Rationale: Cerebral perfusion pressure is calculated by subtracting intracranial pressure from
mean arterial pressure. Because the acceptable adult therapeutic range for cerebral perfusion
pressure is sixty to eighty millimeters of mercury to maintain adequate oxygen delivery to brain
tissue, values falling below this range indicate cerebral hypoperfusion requiring urgent medical
management.
Question 3
A nurse is caring for a client who sustained severe crush injuries to both lower extremities during
a structural collapse. The client's urine turns dark reddish-brown, and laboratory results reveal
elevated serum creatine kinase and positive urine dipstick for blood with no red blood cells
visible on microscopic urinalysis.
Which condition is responsible for this clinical presentation?
A. Rhabdomyolysis leading to acute tubular necrosis from myoglobin release
B. Acute glomerulonephritis secondary to group A beta-hemolytic streptococcal infection
C. Hemolytic uremic syndrome triggered by Shiga toxin-producing bacterial infection
D. Post-renal obstruction caused by bilateral ureteral calculi and blood clots
Correct Answer: A. Rhabdomyolysis leading to acute tubular necrosis from myoglobin
release
Rationale: Crush injuries damage skeletal muscle, releasing large quantities of myoglobin into
the circulation. Myoglobin is filtered by the glomeruli and precipitates in renal tubules, causing
tubular obstruction and direct cytotoxicity. The urine tests positive for blood on dipstick due to
heme groups, but microscopic examination shows no red blood cells.
Question 4
A medical-surgical nurse is monitoring a client receiving a transfusion of packed red blood cells
who begins to complain of lower back pain, chills, fever, and chest tightness fifteen minutes after
the infusion starts.
,What is the immediate priority nursing action?
A. Stop the blood transfusion immediately, disconnect the tubing, infuse normal saline
through a separate new intravenous line, and notify the blood bank and provider
B. Slow the infusion rate by half and administer a dose of intravenous diphenhydramine
hydrochloride
C. Administer a rapid intravenous bolus of five percent dextrose in water to flush the kidneys
D. Cover the client with warm blankets and monitor vital signs every five minutes until
symptoms subside
Correct Answer: A. Stop the blood transfusion immediately, disconnect the tubing, infuse
normal saline through a separate new intravenous line, and notify the blood bank and
provider
Rationale: Lower back pain, chills, fever, and chest tightness during a blood transfusion are
classic signs of an acute hemolytic transfusion reaction caused by ABO incompatibility. The
transfusion must be stopped immediately to limit the volume of incompatible blood infused.
Maintaining venous access with normal saline using new tubing preserves access for emergency
resuscitation.
Question 5
A critical care nurse is reviewing arterial blood gas results for a client with severe salicylate
toxicity showing elevated pH, decreased carbon dioxide levels, and reduced bicarbonate.
How should the nurse interpret these laboratory values?
A. Compensated respiratory alkalosis or mixed primary respiratory alkalosis and metabolic
acidosis
B. Uncompensated metabolic alkalosis with severe hypoxemia
C. Primary metabolic acidosis with complete respiratory compensation
D. Normal acid-base balance with minor respiratory variation
Correct Answer: A. Compensated respiratory alkalosis or mixed primary respiratory
alkalosis and metabolic acidosis
Rationale: Salicylate toxicity directly stimulates the respiratory center in the medulla, causing
hyperventilation and a primary respiratory alkalosis. Simultaneously, salicylic acid introduces
fixed acids into the bloodstream, creating a metabolic acidosis component. This clinical picture
represents a mixed acid-base disorder characteristic of aspirin overdose.
, Section 2: Advanced Pharmacology, Toxicology, and Critical Therapeutics
Question 6
A nurse is managing a client admitted to the emergency department with severe opioid overdose
resulting in respiratory depression, pinpoint pupils, and coma.
Which medication should the nurse administer to rapidly reverse the central nervous
system and respiratory depression?
A. Naloxone hydrochloride
B. Flumazenil hydrochloride
C. N-acetylcysteine
D. Protamine sulfate
Correct Answer: A. Naloxone hydrochloride
Rationale: Naloxone is a competitive opioid receptor antagonist that displaces opioid molecules
from mu-opioid receptors, rapidly reversing central nervous system depression and restoring
spontaneous respiration in overdose clients.
Question 7
A nurse is preparing to administer intravenous potassium chloride to a client with severe
hypokalemia.
Which safety guideline is mandatory for the administration of intravenous potassium
chloride?
A. Always dilute potassium chloride and administer it via an infusion pump at a safe rate
through a peripheral or central line
B. Administer concentrated potassium chloride as an undiluted intravenous push injection for
rapid correction of cardiac arrhythmias
C. Infuse potassium chloride via gravity tubing without an electronic pump to expedite
repletion
D. Mix potassium chloride into bags of dextrose without rolling the bag to ensure layering
Correct Answer: A. Always dilute potassium chloride and administer it via an infusion
pump at a safe rate through a peripheral or central line
Answers and Rationales 2026/2027 Update
Section 1: Advanced Perioperative and Critical Care Nursing
Question 1
A perioperative nurse is caring for a client in the post-anesthesia care unit who underwent a
complex abdominal procedure. The client suddenly exhibits tachycardia, muscle rigidity, rapidly
climbing body temperature, and profound metabolic acidosis.
What is the definitive pharmacological antidote for this life-threatening perioperative
emergency?
A. Dantrolene sodium
B. Flumazenil
C. Physostigmine salicylate
D. Naloxone hydrochloride
Correct Answer: A. Dantrolene sodium
Rationale: These clinical manifestations are characteristic of malignant hyperthermia, a
pharmacogenetic crisis triggered by volatile inhalation anesthetics and succinylcholine.
Dantrolene sodium is a skeletal muscle relaxant that acts as the specific antidote by interfering
with the release of calcium ions from the sarcoplasmic reticulum within muscle fibers.
Question 2
A critical care nurse is managing a client with severe traumatic brain injury who has an elevated
intracranial pressure and a reduced mean arterial pressure.
Which physiological interpretation applies when the calculated cerebral perfusion pressure
falls below the acceptable therapeutic target range?
A. The cerebral perfusion pressure is below the recommended therapeutic target range of
sixty to eighty millimeters of mercury, indicating cerebral hypoperfusion
B. The cerebral perfusion pressure represents dangerous cerebral hyperperfusion requiring
emergency antihypertensive therapy
, C. The cerebral perfusion pressure is exactly at the upper boundary of normal intracranial
autoregulation
D. The cerebral perfusion pressure indicates imminent and irreversible brain death without
secondary complications
Correct Answer: A. The cerebral perfusion pressure is below the recommended
therapeutic target range of sixty to eighty millimeters of mercury, indicating cerebral
hypoperfusion
Rationale: Cerebral perfusion pressure is calculated by subtracting intracranial pressure from
mean arterial pressure. Because the acceptable adult therapeutic range for cerebral perfusion
pressure is sixty to eighty millimeters of mercury to maintain adequate oxygen delivery to brain
tissue, values falling below this range indicate cerebral hypoperfusion requiring urgent medical
management.
Question 3
A nurse is caring for a client who sustained severe crush injuries to both lower extremities during
a structural collapse. The client's urine turns dark reddish-brown, and laboratory results reveal
elevated serum creatine kinase and positive urine dipstick for blood with no red blood cells
visible on microscopic urinalysis.
Which condition is responsible for this clinical presentation?
A. Rhabdomyolysis leading to acute tubular necrosis from myoglobin release
B. Acute glomerulonephritis secondary to group A beta-hemolytic streptococcal infection
C. Hemolytic uremic syndrome triggered by Shiga toxin-producing bacterial infection
D. Post-renal obstruction caused by bilateral ureteral calculi and blood clots
Correct Answer: A. Rhabdomyolysis leading to acute tubular necrosis from myoglobin
release
Rationale: Crush injuries damage skeletal muscle, releasing large quantities of myoglobin into
the circulation. Myoglobin is filtered by the glomeruli and precipitates in renal tubules, causing
tubular obstruction and direct cytotoxicity. The urine tests positive for blood on dipstick due to
heme groups, but microscopic examination shows no red blood cells.
Question 4
A medical-surgical nurse is monitoring a client receiving a transfusion of packed red blood cells
who begins to complain of lower back pain, chills, fever, and chest tightness fifteen minutes after
the infusion starts.
,What is the immediate priority nursing action?
A. Stop the blood transfusion immediately, disconnect the tubing, infuse normal saline
through a separate new intravenous line, and notify the blood bank and provider
B. Slow the infusion rate by half and administer a dose of intravenous diphenhydramine
hydrochloride
C. Administer a rapid intravenous bolus of five percent dextrose in water to flush the kidneys
D. Cover the client with warm blankets and monitor vital signs every five minutes until
symptoms subside
Correct Answer: A. Stop the blood transfusion immediately, disconnect the tubing, infuse
normal saline through a separate new intravenous line, and notify the blood bank and
provider
Rationale: Lower back pain, chills, fever, and chest tightness during a blood transfusion are
classic signs of an acute hemolytic transfusion reaction caused by ABO incompatibility. The
transfusion must be stopped immediately to limit the volume of incompatible blood infused.
Maintaining venous access with normal saline using new tubing preserves access for emergency
resuscitation.
Question 5
A critical care nurse is reviewing arterial blood gas results for a client with severe salicylate
toxicity showing elevated pH, decreased carbon dioxide levels, and reduced bicarbonate.
How should the nurse interpret these laboratory values?
A. Compensated respiratory alkalosis or mixed primary respiratory alkalosis and metabolic
acidosis
B. Uncompensated metabolic alkalosis with severe hypoxemia
C. Primary metabolic acidosis with complete respiratory compensation
D. Normal acid-base balance with minor respiratory variation
Correct Answer: A. Compensated respiratory alkalosis or mixed primary respiratory
alkalosis and metabolic acidosis
Rationale: Salicylate toxicity directly stimulates the respiratory center in the medulla, causing
hyperventilation and a primary respiratory alkalosis. Simultaneously, salicylic acid introduces
fixed acids into the bloodstream, creating a metabolic acidosis component. This clinical picture
represents a mixed acid-base disorder characteristic of aspirin overdose.
, Section 2: Advanced Pharmacology, Toxicology, and Critical Therapeutics
Question 6
A nurse is managing a client admitted to the emergency department with severe opioid overdose
resulting in respiratory depression, pinpoint pupils, and coma.
Which medication should the nurse administer to rapidly reverse the central nervous
system and respiratory depression?
A. Naloxone hydrochloride
B. Flumazenil hydrochloride
C. N-acetylcysteine
D. Protamine sulfate
Correct Answer: A. Naloxone hydrochloride
Rationale: Naloxone is a competitive opioid receptor antagonist that displaces opioid molecules
from mu-opioid receptors, rapidly reversing central nervous system depression and restoring
spontaneous respiration in overdose clients.
Question 7
A nurse is preparing to administer intravenous potassium chloride to a client with severe
hypokalemia.
Which safety guideline is mandatory for the administration of intravenous potassium
chloride?
A. Always dilute potassium chloride and administer it via an infusion pump at a safe rate
through a peripheral or central line
B. Administer concentrated potassium chloride as an undiluted intravenous push injection for
rapid correction of cardiac arrhythmias
C. Infuse potassium chloride via gravity tubing without an electronic pump to expedite
repletion
D. Mix potassium chloride into bags of dextrose without rolling the bag to ensure layering
Correct Answer: A. Always dilute potassium chloride and administer it via an infusion
pump at a safe rate through a peripheral or central line
