1|Page
NRSG 3420 EXAM 3 (NORTHEASTERN) LATEST 2026/
2027 TEST BANK| NRSG 3420 NURSING CARE OF
ADULTS 2 EXAM 3 REVIEW WITH COMPLETE REAL
EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+
A patient with cirrhosis is receiving lactulose for recurrent hepatic
encephalopathy. During the previous 24 hours, the patient had five loose
stools and became more alert. This morning the patient is confused
again, has asterixis, and reports dizziness when standing. Laboratory
results show potassium 3.0 mEq/L and sodium 134 mEq/L. Which
finding most likely contributed to the patient's deterioration?
A. Excessive lactulose-associated fluid and electrolyte loss
B. Increased intestinal ammonia production
C. Progression of portal hypertension
D. Reduced hepatic blood flow from ascites - Correct Answer - A.
Excessive lactulose-associated fluid and electrolyte loss
Lactulose should reduce ammonia absorption while producing a
controlled number of stools. Excessive diarrhea can cause dehydration
and hypokalemia, both of which can worsen encephalopathy and
neurologic status.
A patient with diabetic ketoacidosis is receiving IV regular insulin and
0.9% sodium chloride. Initial laboratory findings were glucose 612
mg/dL, potassium 5.7 mEq/L, pH 7.12, and bicarbonate 9 mEq/L. Four
hours later, glucose is 248 mg/dL, potassium is 3.1 mEq/L, and
bicarbonate is 14 mEq/L. Which intervention is most appropriate?
A. Increase the insulin infusion
pg. 1
,2|Page
B. Administer IV potassium replacement as prescribed
C. Stop all IV fluids
D. Administer sodium bicarbonate immediately - Correct Answer - B.
Administer IV potassium replacement as prescribed
Insulin shifts potassium intracellularly. Once serum potassium falls to
3.1 mEq/L, continued insulin therapy without potassium replacement
can precipitate dangerous hypokalemia and dysrhythmias.
A patient being treated for septic shock has received 3 L of crystalloid
and is receiving norepinephrine through a central venous catheter.
Current findings are BP 92/54 mm Hg, MAP 67 mm Hg, HR 118/min,
urine output 15 mL/hr, lactate 5.1 mmol/L, and cool extremities. Which
finding most strongly indicates that tissue perfusion remains inadequate?
A. Heart rate of 118/min
B. MAP of 67 mm Hg
C. Lactate of 5.1 mmol/L with oliguria
D. Central venous catheter placement - Correct Answer - C. Lactate of
5.1 mmol/L with oliguria
Persistently elevated lactate and oliguria indicate ongoing tissue
hypoperfusion despite initial fluid resuscitation and vasopressor therapy.
A patient with atrial fibrillation takes digoxin and furosemide. The
patient reports nausea, decreased appetite, and seeing yellow-green
halos. Apical pulse is 52/min and potassium is 2.8 mEq/L. Which
medication-related factor most increases the patient's risk for toxicity?
A. Concurrent furosemide-associated potassium loss
B. Atrial fibrillation itself
C. The patient's controlled ventricular rate
pg. 2
,3|Page
D. Digoxin's positive inotropic effect - Correct Answer - A. Concurrent
furosemide-associated potassium loss
Hypokalemia increases myocardial sensitivity to digoxin and
substantially increases the risk of digoxin toxicity. The symptoms and
bradycardia further support toxicity.
A patient with pneumonia develops increasing respiratory distress
despite high-flow oxygen. The patient is tachypneic, using accessory
muscles, and has diffuse bilateral crackles. Chest imaging demonstrates
bilateral diffuse infiltrates. ABG results show pH 7.31, PaCO₂ 48 mm
Hg, and PaO₂ 52 mm Hg despite an FiO₂ of 0.80. Which
pathophysiologic process best explains the oxygenation problem?
A. Increased airway resistance
B. Alveolar flooding with impaired gas exchange
C. Reduced respiratory drive
D. Isolated hypoventilation - Correct Answer - B. Alveolar flooding with
impaired gas exchange
Severe hypoxemia despite a high FiO₂ with bilateral infiltrates is
characteristic of acute respiratory distress syndrome, in which alveolar-
capillary injury causes pulmonary edema and severe shunt physiology.
A patient with acute pancreatitis has received IV fluids and opioid
analgesia for several hours. The patient's abdominal pain initially
decreases, but the nurse now finds BP 86/50 mm Hg, HR 128/min,
respiratory rate 28/min, cool clammy skin, and urine output of 10 mL/hr.
Hematocrit has increased from 42% to 51%. Which complication is most
likely developing?
A. Fluid volume excess
B. Third-spacing with hypovolemic shock
pg. 3
, 4|Page
C. Acute hepatic failure
D. Opioid-induced respiratory depression - Correct Answer - B. Third-
spacing with hypovolemic shock
Severe pancreatitis causes capillary permeability and substantial third-
spacing. Hypotension, tachycardia, oliguria, hemoconcentration, and
cool skin indicate intravascular volume depletion.
A patient with chronic kidney disease is admitted with weakness and
nausea. Laboratory results include potassium 6.8 mEq/L, creatinine 6.1
mg/dL, and bicarbonate 16 mEq/L. The ECG shows peaked T waves
followed by QRS widening. Which prescribed treatment should the
nurse prioritize?
A. Oral sodium bicarbonate
B. IV calcium gluconate
C. Oral potassium binder
D. IV furosemide - Correct Answer - B. IV calcium gluconate
Severe hyperkalemia with ECG changes is immediately life-threatening.
IV calcium stabilizes the cardiac membrane while other treatments shift
or remove potassium.
A patient with a mechanical mitral valve takes warfarin. The patient
develops black, tarry stools and dizziness. Laboratory results show INR
6.8 and hemoglobin 7.9 g/dL. Which finding changes the urgency of the
situation most significantly?
A. Mechanical valve history
B. INR above the therapeutic range
C. Melena accompanied by symptomatic anemia
pg. 4
NRSG 3420 EXAM 3 (NORTHEASTERN) LATEST 2026/
2027 TEST BANK| NRSG 3420 NURSING CARE OF
ADULTS 2 EXAM 3 REVIEW WITH COMPLETE REAL
EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+
A patient with cirrhosis is receiving lactulose for recurrent hepatic
encephalopathy. During the previous 24 hours, the patient had five loose
stools and became more alert. This morning the patient is confused
again, has asterixis, and reports dizziness when standing. Laboratory
results show potassium 3.0 mEq/L and sodium 134 mEq/L. Which
finding most likely contributed to the patient's deterioration?
A. Excessive lactulose-associated fluid and electrolyte loss
B. Increased intestinal ammonia production
C. Progression of portal hypertension
D. Reduced hepatic blood flow from ascites - Correct Answer - A.
Excessive lactulose-associated fluid and electrolyte loss
Lactulose should reduce ammonia absorption while producing a
controlled number of stools. Excessive diarrhea can cause dehydration
and hypokalemia, both of which can worsen encephalopathy and
neurologic status.
A patient with diabetic ketoacidosis is receiving IV regular insulin and
0.9% sodium chloride. Initial laboratory findings were glucose 612
mg/dL, potassium 5.7 mEq/L, pH 7.12, and bicarbonate 9 mEq/L. Four
hours later, glucose is 248 mg/dL, potassium is 3.1 mEq/L, and
bicarbonate is 14 mEq/L. Which intervention is most appropriate?
A. Increase the insulin infusion
pg. 1
,2|Page
B. Administer IV potassium replacement as prescribed
C. Stop all IV fluids
D. Administer sodium bicarbonate immediately - Correct Answer - B.
Administer IV potassium replacement as prescribed
Insulin shifts potassium intracellularly. Once serum potassium falls to
3.1 mEq/L, continued insulin therapy without potassium replacement
can precipitate dangerous hypokalemia and dysrhythmias.
A patient being treated for septic shock has received 3 L of crystalloid
and is receiving norepinephrine through a central venous catheter.
Current findings are BP 92/54 mm Hg, MAP 67 mm Hg, HR 118/min,
urine output 15 mL/hr, lactate 5.1 mmol/L, and cool extremities. Which
finding most strongly indicates that tissue perfusion remains inadequate?
A. Heart rate of 118/min
B. MAP of 67 mm Hg
C. Lactate of 5.1 mmol/L with oliguria
D. Central venous catheter placement - Correct Answer - C. Lactate of
5.1 mmol/L with oliguria
Persistently elevated lactate and oliguria indicate ongoing tissue
hypoperfusion despite initial fluid resuscitation and vasopressor therapy.
A patient with atrial fibrillation takes digoxin and furosemide. The
patient reports nausea, decreased appetite, and seeing yellow-green
halos. Apical pulse is 52/min and potassium is 2.8 mEq/L. Which
medication-related factor most increases the patient's risk for toxicity?
A. Concurrent furosemide-associated potassium loss
B. Atrial fibrillation itself
C. The patient's controlled ventricular rate
pg. 2
,3|Page
D. Digoxin's positive inotropic effect - Correct Answer - A. Concurrent
furosemide-associated potassium loss
Hypokalemia increases myocardial sensitivity to digoxin and
substantially increases the risk of digoxin toxicity. The symptoms and
bradycardia further support toxicity.
A patient with pneumonia develops increasing respiratory distress
despite high-flow oxygen. The patient is tachypneic, using accessory
muscles, and has diffuse bilateral crackles. Chest imaging demonstrates
bilateral diffuse infiltrates. ABG results show pH 7.31, PaCO₂ 48 mm
Hg, and PaO₂ 52 mm Hg despite an FiO₂ of 0.80. Which
pathophysiologic process best explains the oxygenation problem?
A. Increased airway resistance
B. Alveolar flooding with impaired gas exchange
C. Reduced respiratory drive
D. Isolated hypoventilation - Correct Answer - B. Alveolar flooding with
impaired gas exchange
Severe hypoxemia despite a high FiO₂ with bilateral infiltrates is
characteristic of acute respiratory distress syndrome, in which alveolar-
capillary injury causes pulmonary edema and severe shunt physiology.
A patient with acute pancreatitis has received IV fluids and opioid
analgesia for several hours. The patient's abdominal pain initially
decreases, but the nurse now finds BP 86/50 mm Hg, HR 128/min,
respiratory rate 28/min, cool clammy skin, and urine output of 10 mL/hr.
Hematocrit has increased from 42% to 51%. Which complication is most
likely developing?
A. Fluid volume excess
B. Third-spacing with hypovolemic shock
pg. 3
, 4|Page
C. Acute hepatic failure
D. Opioid-induced respiratory depression - Correct Answer - B. Third-
spacing with hypovolemic shock
Severe pancreatitis causes capillary permeability and substantial third-
spacing. Hypotension, tachycardia, oliguria, hemoconcentration, and
cool skin indicate intravascular volume depletion.
A patient with chronic kidney disease is admitted with weakness and
nausea. Laboratory results include potassium 6.8 mEq/L, creatinine 6.1
mg/dL, and bicarbonate 16 mEq/L. The ECG shows peaked T waves
followed by QRS widening. Which prescribed treatment should the
nurse prioritize?
A. Oral sodium bicarbonate
B. IV calcium gluconate
C. Oral potassium binder
D. IV furosemide - Correct Answer - B. IV calcium gluconate
Severe hyperkalemia with ECG changes is immediately life-threatening.
IV calcium stabilizes the cardiac membrane while other treatments shift
or remove potassium.
A patient with a mechanical mitral valve takes warfarin. The patient
develops black, tarry stools and dizziness. Laboratory results show INR
6.8 and hemoglobin 7.9 g/dL. Which finding changes the urgency of the
situation most significantly?
A. Mechanical valve history
B. INR above the therapeutic range
C. Melena accompanied by symptomatic anemia
pg. 4
