1|Page
NRSG 3420 FINAL EXAM (NORTHEASTERN) LATEST
2026/ 2027 TEST BANK| NRSG 3420 NURSING CARE OF
ADULTS 2 FINAL EXAM REVIEW WITH COMPLETE
REAL EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+
A patient with COPD is admitted for an exacerbation. The patient has
received bronchodilators, corticosteroids, and controlled oxygen therapy.
Initially, the patient is alert with a respiratory rate of 30/min. Four hours
later, respiratory rate is 9/min, the patient is difficult to arouse, and ABG
results are pH 7.21, PaCO₂ 88 mm Hg, PaO₂ 58 mm Hg, and HCO₃⁻ 34
mEq/L. Which interpretation is most appropriate?
A. Chronic compensated respiratory acidosis
B. Acute-on-chronic ventilatory failure
C. Uncomplicated metabolic acidosis
D. Improving COPD exacerbation - Correct Answer - B. Acute-on-
chronic ventilatory failure
The elevated bicarbonate indicates chronic compensation, but the
marked rise in PaCO₂, acidemia, hypoxemia, and decreased
consciousness indicate acute deterioration requiring urgent ventilatory
support.
A patient with an acute myocardial infarction develops increasing
dyspnea and hypotension. Assessment reveals diffuse crackles, BP 78/44
mm Hg, HR 118/min, cool skin, and urine output of 15 mL/hr.
Echocardiography shows markedly reduced left ventricular ejection
fraction. Which hemodynamic problem best explains the patient's
condition?
A. Increased cardiac output with systemic vasodilation
pg. 1
,2|Page
B. Reduced myocardial contractility causing inadequate systemic
perfusion
C. Increased venous return causing isolated hypertension
D. Reduced pulmonary vascular resistance - Correct Answer: B.
Reduced myocardial contractility causing inadequate systemic perfusion
Acute MI can severely impair ventricular contractility, producing
reduced cardiac output, pulmonary congestion, hypotension, oliguria,
and cardiogenic shock.
Correct Answer: A. Initiate immediate transcutaneous pacing
pg. 2
,3|Page
The patient has symptomatic severe bradycardia (HR 38/min) with
hypotension and low cardiac output following an inferior MI, consistent
with high-grade AV conduction impairment and possible right-
ventricular involvement. Because the patient is hemodynamically
unstable, immediate pacing is indicated to restore an adequate heart rate
and perfusion.
A patient with cirrhosis is admitted with increasing abdominal distention
and confusion. The patient takes spironolactone and furosemide and has
recently had poor oral intake. Assessment reveals BP 86/50 mm Hg,
sodium 125 mEq/L, potassium 2.8 mEq/L, creatinine 2.1 mg/dL, and
asterixis. Which factor is most likely worsening the patient's
encephalopathy?
A. Excessive diuresis causing hypovolemia and hypokalemia
B. Increased sodium intake
C. Improved renal perfusion
D. Increased hepatic protein synthesis - Correct Answer - A. Excessive
diuresis causing hypovolemia and hypokalemia
Overdiuresis can cause intravascular depletion and hypokalemia, both of
which can worsen hepatic encephalopathy while also precipitating renal
dysfunction.
A patient with chronic kidney disease presents with weakness and
palpitations. Potassium is 7.0 mEq/L and the ECG shows peaked T
waves followed by QRS widening. The patient has received IV calcium
gluconate, and the ECG temporarily improves. Which treatment should
the nurse understand is still necessary?
A. Definitive potassium removal or redistribution
B. Additional calcium as the sole treatment
C. Potassium supplementation
pg. 3
, 4|Page
D. Fluid restriction only - Correct Answer - A. Definitive potassium
removal or redistribution
Calcium stabilizes the cardiac membrane but does not remove
potassium. Insulin/glucose, beta₂ agonists, potassium binders, or dialysis
may be required depending on the clinical situation.
A patient with severe asthma has received repeated nebulized albuterol
and IV corticosteroids. The patient initially has loud wheezing and
severe tachypnea. Later, the respiratory rate falls to 10/min, wheezing
becomes barely audible, PaCO₂ increases from 36 to 62 mm Hg, and the
patient becomes lethargic. Which finding is most concerning?
A. Reduced wheezing
B. Rising PaCO₂ with decreasing respiratory effort
C. Previous corticosteroid administration
D. Decreased respiratory rate alone - Correct Answer - B. Rising PaCO₂
with decreasing respiratory effort
Rising PaCO₂ in severe asthma indicates worsening ventilation and
respiratory muscle fatigue. A quieter chest can represent critically
reduced airflow rather than improvement.
A patient with end-stage kidney disease missed dialysis for three days.
The patient presents with dyspnea, peripheral edema, potassium 6.5
mEq/L, bicarbonate 15 mEq/L, and pulmonary crackles. ECG
demonstrates peaked T waves. Which intervention addresses the greatest
number of life-threatening abnormalities?
A. Oral potassium restriction
B. Hemodialysis
C. Increased oral fluid intake
pg. 4
NRSG 3420 FINAL EXAM (NORTHEASTERN) LATEST
2026/ 2027 TEST BANK| NRSG 3420 NURSING CARE OF
ADULTS 2 FINAL EXAM REVIEW WITH COMPLETE
REAL EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+
A patient with COPD is admitted for an exacerbation. The patient has
received bronchodilators, corticosteroids, and controlled oxygen therapy.
Initially, the patient is alert with a respiratory rate of 30/min. Four hours
later, respiratory rate is 9/min, the patient is difficult to arouse, and ABG
results are pH 7.21, PaCO₂ 88 mm Hg, PaO₂ 58 mm Hg, and HCO₃⁻ 34
mEq/L. Which interpretation is most appropriate?
A. Chronic compensated respiratory acidosis
B. Acute-on-chronic ventilatory failure
C. Uncomplicated metabolic acidosis
D. Improving COPD exacerbation - Correct Answer - B. Acute-on-
chronic ventilatory failure
The elevated bicarbonate indicates chronic compensation, but the
marked rise in PaCO₂, acidemia, hypoxemia, and decreased
consciousness indicate acute deterioration requiring urgent ventilatory
support.
A patient with an acute myocardial infarction develops increasing
dyspnea and hypotension. Assessment reveals diffuse crackles, BP 78/44
mm Hg, HR 118/min, cool skin, and urine output of 15 mL/hr.
Echocardiography shows markedly reduced left ventricular ejection
fraction. Which hemodynamic problem best explains the patient's
condition?
A. Increased cardiac output with systemic vasodilation
pg. 1
,2|Page
B. Reduced myocardial contractility causing inadequate systemic
perfusion
C. Increased venous return causing isolated hypertension
D. Reduced pulmonary vascular resistance - Correct Answer: B.
Reduced myocardial contractility causing inadequate systemic perfusion
Acute MI can severely impair ventricular contractility, producing
reduced cardiac output, pulmonary congestion, hypotension, oliguria,
and cardiogenic shock.
Correct Answer: A. Initiate immediate transcutaneous pacing
pg. 2
,3|Page
The patient has symptomatic severe bradycardia (HR 38/min) with
hypotension and low cardiac output following an inferior MI, consistent
with high-grade AV conduction impairment and possible right-
ventricular involvement. Because the patient is hemodynamically
unstable, immediate pacing is indicated to restore an adequate heart rate
and perfusion.
A patient with cirrhosis is admitted with increasing abdominal distention
and confusion. The patient takes spironolactone and furosemide and has
recently had poor oral intake. Assessment reveals BP 86/50 mm Hg,
sodium 125 mEq/L, potassium 2.8 mEq/L, creatinine 2.1 mg/dL, and
asterixis. Which factor is most likely worsening the patient's
encephalopathy?
A. Excessive diuresis causing hypovolemia and hypokalemia
B. Increased sodium intake
C. Improved renal perfusion
D. Increased hepatic protein synthesis - Correct Answer - A. Excessive
diuresis causing hypovolemia and hypokalemia
Overdiuresis can cause intravascular depletion and hypokalemia, both of
which can worsen hepatic encephalopathy while also precipitating renal
dysfunction.
A patient with chronic kidney disease presents with weakness and
palpitations. Potassium is 7.0 mEq/L and the ECG shows peaked T
waves followed by QRS widening. The patient has received IV calcium
gluconate, and the ECG temporarily improves. Which treatment should
the nurse understand is still necessary?
A. Definitive potassium removal or redistribution
B. Additional calcium as the sole treatment
C. Potassium supplementation
pg. 3
, 4|Page
D. Fluid restriction only - Correct Answer - A. Definitive potassium
removal or redistribution
Calcium stabilizes the cardiac membrane but does not remove
potassium. Insulin/glucose, beta₂ agonists, potassium binders, or dialysis
may be required depending on the clinical situation.
A patient with severe asthma has received repeated nebulized albuterol
and IV corticosteroids. The patient initially has loud wheezing and
severe tachypnea. Later, the respiratory rate falls to 10/min, wheezing
becomes barely audible, PaCO₂ increases from 36 to 62 mm Hg, and the
patient becomes lethargic. Which finding is most concerning?
A. Reduced wheezing
B. Rising PaCO₂ with decreasing respiratory effort
C. Previous corticosteroid administration
D. Decreased respiratory rate alone - Correct Answer - B. Rising PaCO₂
with decreasing respiratory effort
Rising PaCO₂ in severe asthma indicates worsening ventilation and
respiratory muscle fatigue. A quieter chest can represent critically
reduced airflow rather than improvement.
A patient with end-stage kidney disease missed dialysis for three days.
The patient presents with dyspnea, peripheral edema, potassium 6.5
mEq/L, bicarbonate 15 mEq/L, and pulmonary crackles. ECG
demonstrates peaked T waves. Which intervention addresses the greatest
number of life-threatening abnormalities?
A. Oral potassium restriction
B. Hemodialysis
C. Increased oral fluid intake
pg. 4
