BSN3A Final Exam Study Guide with Questions,
Answers and Rationales 2026/2027 Update
Section 1: Foundations of Advanced Nursing Care
Question 1
A 68-year-old woman is admitted to the medical-surgical unit with a diagnosis of acute
decompensated heart failure. During the initial nursing assessment, the nurse notes bilateral 3+
pitting pedal edema, jugular venous distension, and a third heart sound (S3 gallop).
Which pathophysiological mechanism best explains the presence of the S3 heart sound in
this patient?
A. Rapid passive ventricular filling during early diastole against a non-compliant or volume-
overloaded ventricle
B. Forced atrial contraction against a stiff, hypertrophied ventricular wall late in diastole
C. High-velocity turbulent blood flow across a partially stenotic mitral valve orifice
D. Delayed closure of the aortic valve secondary to elevated systemic vascular resistance
Correct Answer: A. Rapid passive ventricular filling during early diastole against a non-
compliant or volume-overloaded ventricle
Rationale: The S3 heart sound occurs early in diastole during the rapid passive filling phase. In
patients with heart failure, blood rushing into a volume-overloaded and dilated ventricle strikes
the compliant ventricular wall, producing audible vibrations. An S4 sound, by contrast, is
associated with atrial contraction against a stiff ventricle late in diastole.
Question 2
A critical care nurse is managing a patient with septic shock who requires norepinephrine
infusion via a peripheral IV line while central venous access is established. The nurse notes
blanching, coolness, and swelling at the insertion site.
What is the immediate priority nursing action to prevent tissue necrosis?
A. Stop the infusion immediately, leave the catheter in place temporarily to attempt
aspiration of residual drug, and administer subcutaneous phentolamine into the affected
area as ordered
, B. Apply warm compresses directly to the site to promote local vasodilation and enhance
drug systemic absorption
C. Flush the peripheral line rapidly with normal saline to clear the remaining vesicant
medication into the central circulation
D. Elevate the affected extremity above the level of the heart and apply ice packs for 30
minutes
Correct Answer: A. Stop the infusion immediately, leave the catheter in place temporarily
to attempt aspiration of residual drug, and administer subcutaneous phentolamine into the
affected area as ordered
Rationale: Norepinephrine is a potent vasoconstrictor and vesicant. Extravasation leads to
severe localized ischemia and tissue necrosis. The infusion must be stopped instantly.
Phentolamine is an alpha-adrenergic antagonist that can be infiltrated subcutaneously around the
site to block local vasoconstriction. Cold compresses (not warm) are indicated for
vasoconstrictor extravasation to reduce metabolic demand and local spread.
Question 3
An intensive care unit nurse is reviewing arterial blood gas (ABG) results for a mechanically
ventilated patient: pH 7.31, PaCO2 55 mmHg, HCO3 24 mEq/L, and PaO2 82 mmHg.
How should the nurse interpret these findings?
A. Uncompensated respiratory acidosis
B. Partially compensated metabolic alkalosis
C. Fully compensated respiratory alkalosis
D. Acute metabolic acidosis with hypoxia
Correct Answer: A. Uncompensated respiratory acidosis
Rationale: A pH of 7.31 indicates acidemia. The PaCO2 is elevated at 55 mmHg (normal: 35 to
45 mmHg), which points to a respiratory etiology for the acid-base disturbance. The bicarbonate
level is normal (24 mEq/L), indicating that the kidneys have not yet initiated metabolic
compensation. Therefore, this is an uncompensated respiratory acidosis.
Question 4
A nurse is caring for a postoperative client who underwent a total thyroidectomy 6 hours ago.
The client reports a tingling sensation around the lips and numbness in the fingertips.
,Which assessment finding should the nurse anticipate during physical examination?
A. Positive Trousseau sign and Chvostek sign
B. Hyperactive deep tendon reflexes combined with muscle rigidity and a resting tremor
C. Decreased blood pressure and bounding peripheral pulses
D. Flaccid paralysis and diminished deep tendon reflexes
Correct Answer: A. Positive Trousseau sign and Chvostek sign
Rationale: Accidental removal of or damage to the parathyroid glands during a thyroidectomy
leads to hypocalcemia. Clinical manifestations of hypocalcemia include neuromuscular
irritability, paresthesias around the mouth and fingers, a positive Chvostek sign (facial twitching
when tapping the facial nerve), and a positive Trousseau sign (carpal spasm induced by inflation
of a blood pressure cuff).
Question 5
A nurse is preparing to administer packed red blood cells (PRBCs) to an adult client with chronic
anemia. Which of the following procedural steps is mandatory prior to initiation?
A. Verify blood product compatibility, expiration date, and client identity at the bedside with
a second licensed nurse using two independent identifiers
B. Warm the blood product in a standard microwave oven on the defrost setting for 45
seconds to prevent hypothermic cardiac irritability
C. Add 50 mL of 5% Dextrose in Water directly into the blood bag to reduce viscosity and
facilitate rapid infusion
D. Administer a prophylactic dose of rapid-acting regular insulin subcutaneously to prevent
secondary hyperglycemia
Correct Answer: A. Verify blood product compatibility, expiration date, and client identity
at the bedside with a second licensed nurse using two independent identifiers
Rationale: Safe blood administration requires a rigorous dual-nurse bedside verification process
to confirm patient identity, blood type, Rh factor, unit number, and expiration date against the
blood bank paperwork and client wristband. Dextrose solutions cause hemolysis of red blood
cells, and normal saline is the only compatible fluid for priming blood administration sets. Blood
should never be warmed in a microwave.
Section 2: Advanced Pharmacology and Critical Therapeutics
, Question 6
A client with a history of acute coronary syndrome is prescribed long-term low-dose aspirin
therapy.
What is the primary mechanism of action of aspirin in secondary cardiovascular
prevention?
A. Irreversible acetylation of platelet cyclooxygenase-1 (COX-1), preventing the synthesis of
thromboxane A2 and inhibiting platelet aggregation for the lifespan of the platelet
B. Reversible inhibition of vitamin K epoxide reductase, halting the synthesis of clotting
factors II, VII, IX, and X
C. Direct binding to antithrombin III, accelerating its neutralisation of activated coagulation
factor X
D. Competitive blockade of glycoprotein IIb/IIIa receptors on the surface of resting platelets
Correct Answer: A. Irreversible acetylation of platelet cyclooxygenase-1 (COX-1),
preventing the synthesis of thromboxane A2 and inhibiting platelet aggregation for the
lifespan of the platelet
Rationale: Aspirin acetylates serine residues on the COX-1 enzyme within platelets. This blocks
the conversion of arachidonic acid to prostaglandin H2, ultimately preventing the formation of
thromboxane A2, a potent vasoconstrictor and inducer of platelet aggregation. Because platelets
lack a nucleus, they cannot synthesise new enzyme, making the effect permanent for the 7 to 10-
day lifespan of the platelet.
Question 7
A patient in the emergency department is diagnosed with an acute ST-elevation myocardial
infarction (STEMI) and is scheduled for emergency percutaneous coronary intervention. The
provider orders an intravenous loading dose of unfractionated heparin.
Which laboratory parameter is primarily utilized to monitor the therapeutic efficacy of
unfractionated heparin?
A. Activated partial thromboplastin time (aPTT)
B. International Normalized Ratio (INR)
C. Prothrombin time (PT) alone
D. Bleeding time assay
Answers and Rationales 2026/2027 Update
Section 1: Foundations of Advanced Nursing Care
Question 1
A 68-year-old woman is admitted to the medical-surgical unit with a diagnosis of acute
decompensated heart failure. During the initial nursing assessment, the nurse notes bilateral 3+
pitting pedal edema, jugular venous distension, and a third heart sound (S3 gallop).
Which pathophysiological mechanism best explains the presence of the S3 heart sound in
this patient?
A. Rapid passive ventricular filling during early diastole against a non-compliant or volume-
overloaded ventricle
B. Forced atrial contraction against a stiff, hypertrophied ventricular wall late in diastole
C. High-velocity turbulent blood flow across a partially stenotic mitral valve orifice
D. Delayed closure of the aortic valve secondary to elevated systemic vascular resistance
Correct Answer: A. Rapid passive ventricular filling during early diastole against a non-
compliant or volume-overloaded ventricle
Rationale: The S3 heart sound occurs early in diastole during the rapid passive filling phase. In
patients with heart failure, blood rushing into a volume-overloaded and dilated ventricle strikes
the compliant ventricular wall, producing audible vibrations. An S4 sound, by contrast, is
associated with atrial contraction against a stiff ventricle late in diastole.
Question 2
A critical care nurse is managing a patient with septic shock who requires norepinephrine
infusion via a peripheral IV line while central venous access is established. The nurse notes
blanching, coolness, and swelling at the insertion site.
What is the immediate priority nursing action to prevent tissue necrosis?
A. Stop the infusion immediately, leave the catheter in place temporarily to attempt
aspiration of residual drug, and administer subcutaneous phentolamine into the affected
area as ordered
, B. Apply warm compresses directly to the site to promote local vasodilation and enhance
drug systemic absorption
C. Flush the peripheral line rapidly with normal saline to clear the remaining vesicant
medication into the central circulation
D. Elevate the affected extremity above the level of the heart and apply ice packs for 30
minutes
Correct Answer: A. Stop the infusion immediately, leave the catheter in place temporarily
to attempt aspiration of residual drug, and administer subcutaneous phentolamine into the
affected area as ordered
Rationale: Norepinephrine is a potent vasoconstrictor and vesicant. Extravasation leads to
severe localized ischemia and tissue necrosis. The infusion must be stopped instantly.
Phentolamine is an alpha-adrenergic antagonist that can be infiltrated subcutaneously around the
site to block local vasoconstriction. Cold compresses (not warm) are indicated for
vasoconstrictor extravasation to reduce metabolic demand and local spread.
Question 3
An intensive care unit nurse is reviewing arterial blood gas (ABG) results for a mechanically
ventilated patient: pH 7.31, PaCO2 55 mmHg, HCO3 24 mEq/L, and PaO2 82 mmHg.
How should the nurse interpret these findings?
A. Uncompensated respiratory acidosis
B. Partially compensated metabolic alkalosis
C. Fully compensated respiratory alkalosis
D. Acute metabolic acidosis with hypoxia
Correct Answer: A. Uncompensated respiratory acidosis
Rationale: A pH of 7.31 indicates acidemia. The PaCO2 is elevated at 55 mmHg (normal: 35 to
45 mmHg), which points to a respiratory etiology for the acid-base disturbance. The bicarbonate
level is normal (24 mEq/L), indicating that the kidneys have not yet initiated metabolic
compensation. Therefore, this is an uncompensated respiratory acidosis.
Question 4
A nurse is caring for a postoperative client who underwent a total thyroidectomy 6 hours ago.
The client reports a tingling sensation around the lips and numbness in the fingertips.
,Which assessment finding should the nurse anticipate during physical examination?
A. Positive Trousseau sign and Chvostek sign
B. Hyperactive deep tendon reflexes combined with muscle rigidity and a resting tremor
C. Decreased blood pressure and bounding peripheral pulses
D. Flaccid paralysis and diminished deep tendon reflexes
Correct Answer: A. Positive Trousseau sign and Chvostek sign
Rationale: Accidental removal of or damage to the parathyroid glands during a thyroidectomy
leads to hypocalcemia. Clinical manifestations of hypocalcemia include neuromuscular
irritability, paresthesias around the mouth and fingers, a positive Chvostek sign (facial twitching
when tapping the facial nerve), and a positive Trousseau sign (carpal spasm induced by inflation
of a blood pressure cuff).
Question 5
A nurse is preparing to administer packed red blood cells (PRBCs) to an adult client with chronic
anemia. Which of the following procedural steps is mandatory prior to initiation?
A. Verify blood product compatibility, expiration date, and client identity at the bedside with
a second licensed nurse using two independent identifiers
B. Warm the blood product in a standard microwave oven on the defrost setting for 45
seconds to prevent hypothermic cardiac irritability
C. Add 50 mL of 5% Dextrose in Water directly into the blood bag to reduce viscosity and
facilitate rapid infusion
D. Administer a prophylactic dose of rapid-acting regular insulin subcutaneously to prevent
secondary hyperglycemia
Correct Answer: A. Verify blood product compatibility, expiration date, and client identity
at the bedside with a second licensed nurse using two independent identifiers
Rationale: Safe blood administration requires a rigorous dual-nurse bedside verification process
to confirm patient identity, blood type, Rh factor, unit number, and expiration date against the
blood bank paperwork and client wristband. Dextrose solutions cause hemolysis of red blood
cells, and normal saline is the only compatible fluid for priming blood administration sets. Blood
should never be warmed in a microwave.
Section 2: Advanced Pharmacology and Critical Therapeutics
, Question 6
A client with a history of acute coronary syndrome is prescribed long-term low-dose aspirin
therapy.
What is the primary mechanism of action of aspirin in secondary cardiovascular
prevention?
A. Irreversible acetylation of platelet cyclooxygenase-1 (COX-1), preventing the synthesis of
thromboxane A2 and inhibiting platelet aggregation for the lifespan of the platelet
B. Reversible inhibition of vitamin K epoxide reductase, halting the synthesis of clotting
factors II, VII, IX, and X
C. Direct binding to antithrombin III, accelerating its neutralisation of activated coagulation
factor X
D. Competitive blockade of glycoprotein IIb/IIIa receptors on the surface of resting platelets
Correct Answer: A. Irreversible acetylation of platelet cyclooxygenase-1 (COX-1),
preventing the synthesis of thromboxane A2 and inhibiting platelet aggregation for the
lifespan of the platelet
Rationale: Aspirin acetylates serine residues on the COX-1 enzyme within platelets. This blocks
the conversion of arachidonic acid to prostaglandin H2, ultimately preventing the formation of
thromboxane A2, a potent vasoconstrictor and inducer of platelet aggregation. Because platelets
lack a nucleus, they cannot synthesise new enzyme, making the effect permanent for the 7 to 10-
day lifespan of the platelet.
Question 7
A patient in the emergency department is diagnosed with an acute ST-elevation myocardial
infarction (STEMI) and is scheduled for emergency percutaneous coronary intervention. The
provider orders an intravenous loading dose of unfractionated heparin.
Which laboratory parameter is primarily utilized to monitor the therapeutic efficacy of
unfractionated heparin?
A. Activated partial thromboplastin time (aPTT)
B. International Normalized Ratio (INR)
C. Prothrombin time (PT) alone
D. Bleeding time assay
