NUR 390 Exam 3 V1 | NUR 390 Nursing Care of the
Adult I | Actual Q&A with Rationale (NUR390 Exam
3) | Concordia
1. A patient is admitted with a pH of 7.28, a PaCO2 of 50 mmHg, and an HCO3- of 25 mEq/L.
Which acid-base imbalance is this patient experiencing?
A. Metabolic Acidosis
B. Respiratory Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Correct Answer: B
Explanation: The pH of 7.28 is below the normal range of 7.35-7.45, indicating acidosis.
The PaCO2 is elevated at 50 mmHg (normal 35-45), while the HCO3- is within the normal
range of 22-26 mEq/L. This clinical picture confirms a respiratory origin for the acidosis,
commonly caused by hypoventilation or COPD.
2. A nurse is caring for a patient with chronic kidney disease (CKD). Which of the following
findings would be most indicative of secondary hyperparathyroidism?
A. Low serum phosphorus levels
B. High serum calcium levels
C. Decreased creatinine levels
,D. Elevated serum phosphorus and low serum calcium
Correct Answer: D
Explanation: In CKD, the kidneys fail to excrete phosphorus, leading to
hyperphosphatemia. High phosphorus levels bind to calcium, causing hypocalcemia, which
stimulates the parathyroid glands to release PTH. This compensatory mechanism is known
as secondary hyperparathyroidism and can lead to renal osteodystrophy.
3. A patient with cirrhosis is scheduled for a paracentesis. Which nursing intervention is the
priority before the procedure?
A. Position the patient on their left side
B. Instruct the patient to void
C. Maintain NPO status for 12 hours
D. Administer a sedative
Correct Answer: B
Explanation: Having the patient void before a paracentesis is critical to prevent accidental
bladder puncture during the needle insertion. The bladder should be empty to ensure it is
out of the way of the trocar. Safety is the priority during invasive procedures involving the
abdominal cavity.
4. Which clinical manifestation should the nurse expect in a patient experiencing a hemolytic
blood transfusion reaction? (Select All That Apply)
A. Low back pain
, B. Hypotension
C. Tachycardia
D. Apprehension
E. Bradycardia
Correct Answer: ABCD
Explanation: A hemolytic reaction occurs when the recipient’s antibodies attack the
donor’s red blood cells. Common symptoms include low back pain, hypotension,
tachycardia, and a feeling of impending doom or apprehension. Bradycardia is not
associated with this type of acute reaction; instead, the heart rate increases to compensate
for potential shock.
5. A patient with acute pancreatitis is NPO and has a nasogastric (NG) tube to low
intermittent suction. What is the primary rationale for this intervention?
A. To prevent metabolic alkalosis
B. To reduce pancreatic enzyme secretion
C. To facilitate the removal of gallstones
D. To provide a route for enteral feeding
Correct Answer: B
Explanation: NPO status and NG suction are used to rest the pancreas by decreasing the
stimulus for pancreatic enzyme secretion. Gastric acid entering the duodenum stimulates
Adult I | Actual Q&A with Rationale (NUR390 Exam
3) | Concordia
1. A patient is admitted with a pH of 7.28, a PaCO2 of 50 mmHg, and an HCO3- of 25 mEq/L.
Which acid-base imbalance is this patient experiencing?
A. Metabolic Acidosis
B. Respiratory Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Correct Answer: B
Explanation: The pH of 7.28 is below the normal range of 7.35-7.45, indicating acidosis.
The PaCO2 is elevated at 50 mmHg (normal 35-45), while the HCO3- is within the normal
range of 22-26 mEq/L. This clinical picture confirms a respiratory origin for the acidosis,
commonly caused by hypoventilation or COPD.
2. A nurse is caring for a patient with chronic kidney disease (CKD). Which of the following
findings would be most indicative of secondary hyperparathyroidism?
A. Low serum phosphorus levels
B. High serum calcium levels
C. Decreased creatinine levels
,D. Elevated serum phosphorus and low serum calcium
Correct Answer: D
Explanation: In CKD, the kidneys fail to excrete phosphorus, leading to
hyperphosphatemia. High phosphorus levels bind to calcium, causing hypocalcemia, which
stimulates the parathyroid glands to release PTH. This compensatory mechanism is known
as secondary hyperparathyroidism and can lead to renal osteodystrophy.
3. A patient with cirrhosis is scheduled for a paracentesis. Which nursing intervention is the
priority before the procedure?
A. Position the patient on their left side
B. Instruct the patient to void
C. Maintain NPO status for 12 hours
D. Administer a sedative
Correct Answer: B
Explanation: Having the patient void before a paracentesis is critical to prevent accidental
bladder puncture during the needle insertion. The bladder should be empty to ensure it is
out of the way of the trocar. Safety is the priority during invasive procedures involving the
abdominal cavity.
4. Which clinical manifestation should the nurse expect in a patient experiencing a hemolytic
blood transfusion reaction? (Select All That Apply)
A. Low back pain
, B. Hypotension
C. Tachycardia
D. Apprehension
E. Bradycardia
Correct Answer: ABCD
Explanation: A hemolytic reaction occurs when the recipient’s antibodies attack the
donor’s red blood cells. Common symptoms include low back pain, hypotension,
tachycardia, and a feeling of impending doom or apprehension. Bradycardia is not
associated with this type of acute reaction; instead, the heart rate increases to compensate
for potential shock.
5. A patient with acute pancreatitis is NPO and has a nasogastric (NG) tube to low
intermittent suction. What is the primary rationale for this intervention?
A. To prevent metabolic alkalosis
B. To reduce pancreatic enzyme secretion
C. To facilitate the removal of gallstones
D. To provide a route for enteral feeding
Correct Answer: B
Explanation: NPO status and NG suction are used to rest the pancreas by decreasing the
stimulus for pancreatic enzyme secretion. Gastric acid entering the duodenum stimulates
