NR 324 Adult Health I - Midterm Exam Review 250 Questions,
answers and rationales.
Question 1: A patient with acute exacerbation of COPD is admitted. The arterial blood gas
(ABG) analysis shows: pH 7.31, PaCO2 58 mmHg, HCO3 26 mEq/L, and PaO2 61 mmHg.
Which acid-base imbalance is present?
A) Respiratory alkalosis, uncompensated
B) Respiratory acidosis, partially compensated
C) Respiratory acidosis, uncompensated
D) Metabolic acidosis, uncompensated
Correct Answer: C Respiratory acidosis, uncompensated
Rationale: The pH is acidic (<7.35) and the PaCO2 is elevated (>45 mmHg) driving the acidosis.
The HCO3 is normal, meaning the kidneys have not yet compensated for the respiratory failure,
confirming an uncompensated respiratory acidosis.
Question 2: A client is recovering from a subtotal thyroidectomy. The nurse notes muscle
twitching, a positive Chvostek's sign, and hyperactive deep tendon reflexes. Which electrolyte
abnormality should the nurse suspect?
A) Hypercalcemia
B) Hypocalcemia
C) Hyperkalemia
D) Hyponatremia
Correct Answer: B Hypocalcemia
Rationale: Subtotal thyroidectomy puts the client at risk for accidental removal or damage to the
parathyroid glands, leading to hypocalcemia. Hypocalcemia causes increased neuromuscular
excitability, manifesting as positive Chvostek's/Trousseau's signs and tetany.
Question 3: The nurse is monitoring an adult client receiving a continuous IV infusion of
heparin for a deep vein thrombosis (DVT). Which laboratory values should the nurse monitor to
adjust the dosage?
A) Prothrombin time (PT)
B) International Normalized Ratio (INR)
C) Activated partial thromboplastin time (aPTT)
D) Platelet count only
Correct Answer: C Activated partial thromboplastin time (aPTT)
Rationale: Therapeutic monitoring of unfractionated heparin is guided by the activated partial
thromboplastin time (aPTT) level. Platelets are monitored to check for heparin-induced
thrombocytopenia (HIT), but aPTT adjusts dosing.
,Question 4: A client presents with crushing chest pain, diaphoresis, and radiation down the left
arm. The ECG reveals ST-segment elevation in leads V1 to V4. This indicates an acute
myocardial infarction in which coronary artery territory?
A) Right coronary artery (RCA)
B) Left anterior descending artery (LAD)
C) Left circumflex artery (LCX)
D) Posterior descending artery (PDA)
Correct Answer: B Left anterior descending artery (LAD)
Rationale: ST elevations in leads V1 to V4 indicate an anterior wall myocardial infarction, which
is structurally supplied by the left anterior descending (LAD) coronary artery.
Question 5: A nurse is caring for a patient who is post-operative day 1 following an abdominal
hysterectomy. The patient reports sudden onset shortness of breath and chest pain that
worsens with deep inspiration. What is the priority nursing intervention?
A) Administer an oral analgesic for surgical pain.
B) Encourage the use of the incentive spirometer.
C) Apply supplemental oxygen and notify the provider immediately.
D) Reposition the patient on their left side.
Correct Answer: C Apply supplemental oxygen and notify the provider immediately.
Rationale: Sudden onset chest pain and dyspnea post-operatively strongly indicate a pulmonary
embolism (PE). Applying oxygen stabilizes oxygenation while immediate provider notification
ensures urgent diagnostic testing.
Question 6: A patient with acute exacerbation of COPD is admitted. The arterial blood gas
(ABG) analysis shows: pH 7.31, PaCO2 58 mmHg, HCO3 26 mEq/L, and PaO2 61 mmHg.
Which acid-base imbalance is present?
A) Respiratory alkalosis, uncompensated
B) Respiratory acidosis, partially compensated
C) Respiratory acidosis, uncompensated
D) Metabolic acidosis, uncompensated
Correct Answer: C Respiratory acidosis, uncompensated
Rationale: The pH is acidic (<7.35) and the PaCO2 is elevated (>45 mmHg) driving the acidosis.
The HCO3 is normal, meaning the kidneys have not yet compensated for the respiratory failure,
confirming an uncompensated respiratory acidosis.
Question 7: A client is recovering from a subtotal thyroidectomy. The nurse notes muscle
twitching, a positive Chvostek's sign, and hyperactive deep tendon reflexes. Which electrolyte
abnormality should the nurse suspect?
A) Hypercalcemia
B) Hypocalcemia
C) Hyperkalemia
, D) Hyponatremia
Correct Answer: B Hypocalcemia
Rationale: Subtotal thyroidectomy puts the client at risk for accidental removal or damage to the
parathyroid glands, leading to hypocalcemia. Hypocalcemia causes increased neuromuscular
excitability, manifesting as positive Chvostek's/Trousseau's signs and tetany.
Question 8: The nurse is monitoring an adult client receiving a continuous IV infusion of
heparin for a deep vein thrombosis (DVT). Which laboratory values should the nurse monitor to
adjust the dosage?
A) Prothrombin time (PT)
B) International Normalized Ratio (INR)
C) Activated partial thromboplastin time (aPTT)
D) Platelet count only
Correct Answer: C Activated partial thromboplastin time (aPTT)
Rationale: Therapeutic monitoring of unfractionated heparin is guided by the activated partial
thromboplastin time (aPTT) level. Platelets are monitored to check for heparin-induced
thrombocytopenia (HIT), but aPTT adjusts dosing.
Question 9: A client presents with crushing chest pain, diaphoresis, and radiation down the left
arm. The ECG reveals ST-segment elevation in leads V1 to V4. This indicates an acute
myocardial infarction in which coronary artery territory?
A) Right coronary artery (RCA)
B) Left anterior descending artery (LAD)
C) Left circumflex artery (LCX)
D) Posterior descending artery (PDA)
Correct Answer: B Left anterior descending artery (LAD)
Rationale: ST elevations in leads V1 to V4 indicate an anterior wall myocardial infarction, which
is structurally supplied by the left anterior descending (LAD) coronary artery.
Question 10: A nurse is caring for a patient who is post-operative day 1 following an abdominal
hysterectomy. The patient reports sudden onset shortness of breath and chest pain that
worsens with deep inspiration. What is the priority nursing intervention?
A) Administer an oral analgesic for surgical pain.
B) Encourage the use of the incentive spirometer.
C) Apply supplemental oxygen and notify the provider immediately.
D) Reposition the patient on their left side.
Correct Answer: C Apply supplemental oxygen and notify the provider immediately.
Rationale: Sudden onset chest pain and dyspnea post-operatively strongly indicate a pulmonary
embolism (PE). Applying oxygen stabilizes oxygenation while immediate provider notification
ensures urgent diagnostic testing.
, Question 11: A patient with acute exacerbation of COPD is admitted. The arterial blood gas
(ABG) analysis shows: pH 7.31, PaCO2 58 mmHg, HCO3 26 mEq/L, and PaO2 61 mmHg.
Which acid-base imbalance is present?
A) Respiratory alkalosis, uncompensated
B) Respiratory acidosis, partially compensated
C) Respiratory acidosis, uncompensated
D) Metabolic acidosis, uncompensated
Correct Answer: C Respiratory acidosis, uncompensated
Rationale: The pH is acidic (<7.35) and the PaCO2 is elevated (>45 mmHg) driving the acidosis.
The HCO3 is normal, meaning the kidneys have not yet compensated for the respiratory failure,
confirming an uncompensated respiratory acidosis.
Question 12: A client is recovering from a subtotal thyroidectomy. The nurse notes muscle
twitching, a positive Chvostek's sign, and hyperactive deep tendon reflexes. Which electrolyte
abnormality should the nurse suspect?
A) Hypercalcemia
B) Hypocalcemia
C) Hyperkalemia
D) Hyponatremia
Correct Answer: B Hypocalcemia
Rationale: Subtotal thyroidectomy puts the client at risk for accidental removal or damage to the
parathyroid glands, leading to hypocalcemia. Hypocalcemia causes increased neuromuscular
excitability, manifesting as positive Chvostek's/Trousseau's signs and tetany.
Question 13: The nurse is monitoring an adult client receiving a continuous IV infusion of
heparin for a deep vein thrombosis (DVT). Which laboratory values should the nurse monitor to
adjust the dosage?
A) Prothrombin time (PT)
B) International Normalized Ratio (INR)
C) Activated partial thromboplastin time (aPTT)
D) Platelet count only
Correct Answer: C Activated partial thromboplastin time (aPTT)
Rationale: Therapeutic monitoring of unfractionated heparin is guided by the activated partial
thromboplastin time (aPTT) level. Platelets are monitored to check for heparin-induced
thrombocytopenia (HIT), but aPTT adjusts dosing.
Question 14: A client presents with crushing chest pain, diaphoresis, and radiation down the
left arm. The ECG reveals ST-segment elevation in leads V1 to V4. This indicates an acute
myocardial infarction in which coronary artery territory?
A) Right coronary artery (RCA)
B) Left anterior descending artery (LAD)
answers and rationales.
Question 1: A patient with acute exacerbation of COPD is admitted. The arterial blood gas
(ABG) analysis shows: pH 7.31, PaCO2 58 mmHg, HCO3 26 mEq/L, and PaO2 61 mmHg.
Which acid-base imbalance is present?
A) Respiratory alkalosis, uncompensated
B) Respiratory acidosis, partially compensated
C) Respiratory acidosis, uncompensated
D) Metabolic acidosis, uncompensated
Correct Answer: C Respiratory acidosis, uncompensated
Rationale: The pH is acidic (<7.35) and the PaCO2 is elevated (>45 mmHg) driving the acidosis.
The HCO3 is normal, meaning the kidneys have not yet compensated for the respiratory failure,
confirming an uncompensated respiratory acidosis.
Question 2: A client is recovering from a subtotal thyroidectomy. The nurse notes muscle
twitching, a positive Chvostek's sign, and hyperactive deep tendon reflexes. Which electrolyte
abnormality should the nurse suspect?
A) Hypercalcemia
B) Hypocalcemia
C) Hyperkalemia
D) Hyponatremia
Correct Answer: B Hypocalcemia
Rationale: Subtotal thyroidectomy puts the client at risk for accidental removal or damage to the
parathyroid glands, leading to hypocalcemia. Hypocalcemia causes increased neuromuscular
excitability, manifesting as positive Chvostek's/Trousseau's signs and tetany.
Question 3: The nurse is monitoring an adult client receiving a continuous IV infusion of
heparin for a deep vein thrombosis (DVT). Which laboratory values should the nurse monitor to
adjust the dosage?
A) Prothrombin time (PT)
B) International Normalized Ratio (INR)
C) Activated partial thromboplastin time (aPTT)
D) Platelet count only
Correct Answer: C Activated partial thromboplastin time (aPTT)
Rationale: Therapeutic monitoring of unfractionated heparin is guided by the activated partial
thromboplastin time (aPTT) level. Platelets are monitored to check for heparin-induced
thrombocytopenia (HIT), but aPTT adjusts dosing.
,Question 4: A client presents with crushing chest pain, diaphoresis, and radiation down the left
arm. The ECG reveals ST-segment elevation in leads V1 to V4. This indicates an acute
myocardial infarction in which coronary artery territory?
A) Right coronary artery (RCA)
B) Left anterior descending artery (LAD)
C) Left circumflex artery (LCX)
D) Posterior descending artery (PDA)
Correct Answer: B Left anterior descending artery (LAD)
Rationale: ST elevations in leads V1 to V4 indicate an anterior wall myocardial infarction, which
is structurally supplied by the left anterior descending (LAD) coronary artery.
Question 5: A nurse is caring for a patient who is post-operative day 1 following an abdominal
hysterectomy. The patient reports sudden onset shortness of breath and chest pain that
worsens with deep inspiration. What is the priority nursing intervention?
A) Administer an oral analgesic for surgical pain.
B) Encourage the use of the incentive spirometer.
C) Apply supplemental oxygen and notify the provider immediately.
D) Reposition the patient on their left side.
Correct Answer: C Apply supplemental oxygen and notify the provider immediately.
Rationale: Sudden onset chest pain and dyspnea post-operatively strongly indicate a pulmonary
embolism (PE). Applying oxygen stabilizes oxygenation while immediate provider notification
ensures urgent diagnostic testing.
Question 6: A patient with acute exacerbation of COPD is admitted. The arterial blood gas
(ABG) analysis shows: pH 7.31, PaCO2 58 mmHg, HCO3 26 mEq/L, and PaO2 61 mmHg.
Which acid-base imbalance is present?
A) Respiratory alkalosis, uncompensated
B) Respiratory acidosis, partially compensated
C) Respiratory acidosis, uncompensated
D) Metabolic acidosis, uncompensated
Correct Answer: C Respiratory acidosis, uncompensated
Rationale: The pH is acidic (<7.35) and the PaCO2 is elevated (>45 mmHg) driving the acidosis.
The HCO3 is normal, meaning the kidneys have not yet compensated for the respiratory failure,
confirming an uncompensated respiratory acidosis.
Question 7: A client is recovering from a subtotal thyroidectomy. The nurse notes muscle
twitching, a positive Chvostek's sign, and hyperactive deep tendon reflexes. Which electrolyte
abnormality should the nurse suspect?
A) Hypercalcemia
B) Hypocalcemia
C) Hyperkalemia
, D) Hyponatremia
Correct Answer: B Hypocalcemia
Rationale: Subtotal thyroidectomy puts the client at risk for accidental removal or damage to the
parathyroid glands, leading to hypocalcemia. Hypocalcemia causes increased neuromuscular
excitability, manifesting as positive Chvostek's/Trousseau's signs and tetany.
Question 8: The nurse is monitoring an adult client receiving a continuous IV infusion of
heparin for a deep vein thrombosis (DVT). Which laboratory values should the nurse monitor to
adjust the dosage?
A) Prothrombin time (PT)
B) International Normalized Ratio (INR)
C) Activated partial thromboplastin time (aPTT)
D) Platelet count only
Correct Answer: C Activated partial thromboplastin time (aPTT)
Rationale: Therapeutic monitoring of unfractionated heparin is guided by the activated partial
thromboplastin time (aPTT) level. Platelets are monitored to check for heparin-induced
thrombocytopenia (HIT), but aPTT adjusts dosing.
Question 9: A client presents with crushing chest pain, diaphoresis, and radiation down the left
arm. The ECG reveals ST-segment elevation in leads V1 to V4. This indicates an acute
myocardial infarction in which coronary artery territory?
A) Right coronary artery (RCA)
B) Left anterior descending artery (LAD)
C) Left circumflex artery (LCX)
D) Posterior descending artery (PDA)
Correct Answer: B Left anterior descending artery (LAD)
Rationale: ST elevations in leads V1 to V4 indicate an anterior wall myocardial infarction, which
is structurally supplied by the left anterior descending (LAD) coronary artery.
Question 10: A nurse is caring for a patient who is post-operative day 1 following an abdominal
hysterectomy. The patient reports sudden onset shortness of breath and chest pain that
worsens with deep inspiration. What is the priority nursing intervention?
A) Administer an oral analgesic for surgical pain.
B) Encourage the use of the incentive spirometer.
C) Apply supplemental oxygen and notify the provider immediately.
D) Reposition the patient on their left side.
Correct Answer: C Apply supplemental oxygen and notify the provider immediately.
Rationale: Sudden onset chest pain and dyspnea post-operatively strongly indicate a pulmonary
embolism (PE). Applying oxygen stabilizes oxygenation while immediate provider notification
ensures urgent diagnostic testing.
, Question 11: A patient with acute exacerbation of COPD is admitted. The arterial blood gas
(ABG) analysis shows: pH 7.31, PaCO2 58 mmHg, HCO3 26 mEq/L, and PaO2 61 mmHg.
Which acid-base imbalance is present?
A) Respiratory alkalosis, uncompensated
B) Respiratory acidosis, partially compensated
C) Respiratory acidosis, uncompensated
D) Metabolic acidosis, uncompensated
Correct Answer: C Respiratory acidosis, uncompensated
Rationale: The pH is acidic (<7.35) and the PaCO2 is elevated (>45 mmHg) driving the acidosis.
The HCO3 is normal, meaning the kidneys have not yet compensated for the respiratory failure,
confirming an uncompensated respiratory acidosis.
Question 12: A client is recovering from a subtotal thyroidectomy. The nurse notes muscle
twitching, a positive Chvostek's sign, and hyperactive deep tendon reflexes. Which electrolyte
abnormality should the nurse suspect?
A) Hypercalcemia
B) Hypocalcemia
C) Hyperkalemia
D) Hyponatremia
Correct Answer: B Hypocalcemia
Rationale: Subtotal thyroidectomy puts the client at risk for accidental removal or damage to the
parathyroid glands, leading to hypocalcemia. Hypocalcemia causes increased neuromuscular
excitability, manifesting as positive Chvostek's/Trousseau's signs and tetany.
Question 13: The nurse is monitoring an adult client receiving a continuous IV infusion of
heparin for a deep vein thrombosis (DVT). Which laboratory values should the nurse monitor to
adjust the dosage?
A) Prothrombin time (PT)
B) International Normalized Ratio (INR)
C) Activated partial thromboplastin time (aPTT)
D) Platelet count only
Correct Answer: C Activated partial thromboplastin time (aPTT)
Rationale: Therapeutic monitoring of unfractionated heparin is guided by the activated partial
thromboplastin time (aPTT) level. Platelets are monitored to check for heparin-induced
thrombocytopenia (HIT), but aPTT adjusts dosing.
Question 14: A client presents with crushing chest pain, diaphoresis, and radiation down the
left arm. The ECG reveals ST-segment elevation in leads V1 to V4. This indicates an acute
myocardial infarction in which coronary artery territory?
A) Right coronary artery (RCA)
B) Left anterior descending artery (LAD)
