1|Page
NRSG 3420 EXAM 1 (NORTHEASTERN) LATEST 2026/
2027 TEST BANK| NRSG 3420 NURSING CARE OF
ADULTS 2 EXAM 1 REVIEW WITH COMPLETE REAL
EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+
A client admitted with acute decompensated heart failure has received
IV furosemide. Two hours later, the client reports increasing weakness
and palpitations. Telemetry shows frequent premature ventricular
contractions. Which finding requires the nurse's immediate attention?
A. Blood pressure 104/68 mm Hg
B. Potassium 2.8 mEq/L
C. Urine output 900 mL
D. Respiratory rate 20/min - Correct Answer - B. Potassium 2.8 mEq/L
Severe hypokalemia increases myocardial irritability and can precipitate
life-threatening ventricular dysrhythmias, particularly after aggressive
diuresis.
A client with COPD becomes increasingly somnolent after receiving
supplemental oxygen. Arterial blood gases are: pH 7.28, PaCO₂ 68 mm
Hg, HCO₃⁻ 30 mEq/L, PaO₂ 58 mm Hg. Which interpretation is most
accurate?
A. Uncompensated metabolic acidosis
B. Fully compensated respiratory acidosis
C. Acute-on-chronic respiratory acidosis with hypoxemia
D. Respiratory alkalosis with metabolic compensation - Correct Answer
- C. Acute-on-chronic respiratory acidosis with hypoxemia
pg. 1
,2|Page
The elevated PaCO₂ with elevated bicarbonate indicates chronic CO₂
retention, while the acidemic pH suggests an acute worsening. The low
PaO₂ indicates significant hypoxemia.
A client develops sudden crushing substernal chest pain while
ambulating. The ECG demonstrates ST-segment elevation in leads II, III,
and aVF. Blood pressure is 86/54 mm Hg, and the lungs are clear. Which
prescribed intervention should the nurse question?
A. Aspirin
B. Oxygen for significant hypoxemia
C. IV fluid bolus
D. Sublingual nitroglycerin - Correct Answer - D. Sublingual
nitroglycerin
Inferior STEMI with hypotension and clear lungs raises concern for
right ventricular involvement and preload dependence. Nitrates can
significantly reduce preload and worsen hypotension.
A client with sepsis has received 30 mL/kg of crystalloid. The blood
pressure remains 82/48 mm Hg, MAP is 59 mm Hg, and urine output is
10 mL/hr. Which intervention should the nurse anticipate next?
A. Initiation of vasopressor therapy
B. Administration of IV furosemide
C. Restriction of IV fluids
D. Administration of oral antihypertensive medication - Correct Answer
- A. Initiation of vasopressor therapy
Persistent hypotension despite adequate fluid resuscitation indicates
septic shock requiring vasopressor support, commonly norepinephrine,
to maintain adequate organ perfusion.
pg. 2
,3|Page
A client with acute kidney injury has a potassium level of 6.7 mEq/L and
peaked T waves on the ECG. Which medication should the nurse expect
to administer first?
A. Sodium polystyrene sulfonate
B. IV calcium gluconate
C. Oral sodium bicarbonate
D. IV furosemide - Correct Answer - B. IV calcium gluconate
With severe hyperkalemia and ECG changes, IV calcium stabilizes the
cardiac membrane immediately. It does not remove potassium but
reduces the immediate risk of lethal dysrhythmia.
A client with a history of atrial fibrillation suddenly develops aphasia
and right-sided weakness. Which additional finding would most strongly
support an acute ischemic stroke rather than a hemorrhagic stroke?
A. Sudden severe headache
B. Vomiting with rapidly decreasing consciousness
C. Absence of intracranial hemorrhage on initial CT
D. Markedly elevated intracranial pressure - Correct Answer - C.
Absence of intracranial hemorrhage on initial CT
Noncontrast CT is commonly used initially to exclude intracranial
hemorrhage. If hemorrhage is absent and clinical findings are consistent
with acute focal neurologic deficit, ischemic stroke becomes more likely.
A client receiving a continuous IV insulin infusion for diabetic
ketoacidosis has the following results: glucose 218 mg/dL, potassium
3.0 mEq/L, pH 7.25. Which action is most appropriate?
A. Increase the insulin infusion rate
B. Hold insulin temporarily and replace potassium
pg. 3
, 4|Page
C. Administer IV sodium bicarbonate immediately
D. Discontinue all IV fluids - Correct Answer - B. Hold insulin
temporarily and replace potassium
Insulin drives potassium intracellularly. When potassium is significantly
low, continuing insulin can precipitate dangerous hypokalemia and
dysrhythmias. Potassium replacement takes priority until the potassium
level is corrected.
A client with cirrhosis becomes increasingly confused and develops
asterixis. Which laboratory abnormality would the nurse expect?
A. Decreased ammonia
B. Increased ammonia
C. Decreased bilirubin
D. Increased serum calcium - Correct Answer - B. Increased ammonia
Hepatic dysfunction decreases the liver's ability to metabolize ammonia.
Accumulation contributes to hepatic encephalopathy, characterized by
confusion and asterixis.
A client with suspected infective endocarditis has a temperature of
39.2°C (102.6°F), new murmur, and chills. Before IV antibiotics are
started, which action is most important if the client's condition permits?
A. Obtain prescribed blood cultures
B. Administer acetaminophen
C. Restrict oral fluids
D. Begin anticoagulation - Correct Answer - A. Obtain prescribed blood
cultures
pg. 4
NRSG 3420 EXAM 1 (NORTHEASTERN) LATEST 2026/
2027 TEST BANK| NRSG 3420 NURSING CARE OF
ADULTS 2 EXAM 1 REVIEW WITH COMPLETE REAL
EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+
A client admitted with acute decompensated heart failure has received
IV furosemide. Two hours later, the client reports increasing weakness
and palpitations. Telemetry shows frequent premature ventricular
contractions. Which finding requires the nurse's immediate attention?
A. Blood pressure 104/68 mm Hg
B. Potassium 2.8 mEq/L
C. Urine output 900 mL
D. Respiratory rate 20/min - Correct Answer - B. Potassium 2.8 mEq/L
Severe hypokalemia increases myocardial irritability and can precipitate
life-threatening ventricular dysrhythmias, particularly after aggressive
diuresis.
A client with COPD becomes increasingly somnolent after receiving
supplemental oxygen. Arterial blood gases are: pH 7.28, PaCO₂ 68 mm
Hg, HCO₃⁻ 30 mEq/L, PaO₂ 58 mm Hg. Which interpretation is most
accurate?
A. Uncompensated metabolic acidosis
B. Fully compensated respiratory acidosis
C. Acute-on-chronic respiratory acidosis with hypoxemia
D. Respiratory alkalosis with metabolic compensation - Correct Answer
- C. Acute-on-chronic respiratory acidosis with hypoxemia
pg. 1
,2|Page
The elevated PaCO₂ with elevated bicarbonate indicates chronic CO₂
retention, while the acidemic pH suggests an acute worsening. The low
PaO₂ indicates significant hypoxemia.
A client develops sudden crushing substernal chest pain while
ambulating. The ECG demonstrates ST-segment elevation in leads II, III,
and aVF. Blood pressure is 86/54 mm Hg, and the lungs are clear. Which
prescribed intervention should the nurse question?
A. Aspirin
B. Oxygen for significant hypoxemia
C. IV fluid bolus
D. Sublingual nitroglycerin - Correct Answer - D. Sublingual
nitroglycerin
Inferior STEMI with hypotension and clear lungs raises concern for
right ventricular involvement and preload dependence. Nitrates can
significantly reduce preload and worsen hypotension.
A client with sepsis has received 30 mL/kg of crystalloid. The blood
pressure remains 82/48 mm Hg, MAP is 59 mm Hg, and urine output is
10 mL/hr. Which intervention should the nurse anticipate next?
A. Initiation of vasopressor therapy
B. Administration of IV furosemide
C. Restriction of IV fluids
D. Administration of oral antihypertensive medication - Correct Answer
- A. Initiation of vasopressor therapy
Persistent hypotension despite adequate fluid resuscitation indicates
septic shock requiring vasopressor support, commonly norepinephrine,
to maintain adequate organ perfusion.
pg. 2
,3|Page
A client with acute kidney injury has a potassium level of 6.7 mEq/L and
peaked T waves on the ECG. Which medication should the nurse expect
to administer first?
A. Sodium polystyrene sulfonate
B. IV calcium gluconate
C. Oral sodium bicarbonate
D. IV furosemide - Correct Answer - B. IV calcium gluconate
With severe hyperkalemia and ECG changes, IV calcium stabilizes the
cardiac membrane immediately. It does not remove potassium but
reduces the immediate risk of lethal dysrhythmia.
A client with a history of atrial fibrillation suddenly develops aphasia
and right-sided weakness. Which additional finding would most strongly
support an acute ischemic stroke rather than a hemorrhagic stroke?
A. Sudden severe headache
B. Vomiting with rapidly decreasing consciousness
C. Absence of intracranial hemorrhage on initial CT
D. Markedly elevated intracranial pressure - Correct Answer - C.
Absence of intracranial hemorrhage on initial CT
Noncontrast CT is commonly used initially to exclude intracranial
hemorrhage. If hemorrhage is absent and clinical findings are consistent
with acute focal neurologic deficit, ischemic stroke becomes more likely.
A client receiving a continuous IV insulin infusion for diabetic
ketoacidosis has the following results: glucose 218 mg/dL, potassium
3.0 mEq/L, pH 7.25. Which action is most appropriate?
A. Increase the insulin infusion rate
B. Hold insulin temporarily and replace potassium
pg. 3
, 4|Page
C. Administer IV sodium bicarbonate immediately
D. Discontinue all IV fluids - Correct Answer - B. Hold insulin
temporarily and replace potassium
Insulin drives potassium intracellularly. When potassium is significantly
low, continuing insulin can precipitate dangerous hypokalemia and
dysrhythmias. Potassium replacement takes priority until the potassium
level is corrected.
A client with cirrhosis becomes increasingly confused and develops
asterixis. Which laboratory abnormality would the nurse expect?
A. Decreased ammonia
B. Increased ammonia
C. Decreased bilirubin
D. Increased serum calcium - Correct Answer - B. Increased ammonia
Hepatic dysfunction decreases the liver's ability to metabolize ammonia.
Accumulation contributes to hepatic encephalopathy, characterized by
confusion and asterixis.
A client with suspected infective endocarditis has a temperature of
39.2°C (102.6°F), new murmur, and chills. Before IV antibiotics are
started, which action is most important if the client's condition permits?
A. Obtain prescribed blood cultures
B. Administer acetaminophen
C. Restrict oral fluids
D. Begin anticoagulation - Correct Answer - A. Obtain prescribed blood
cultures
pg. 4
