NUR 390 Exam 3 V3 | NUR 390 Nursing Care of the
Adult I | Actual Q&A with Rationale (NUR390 Exam
3) | Concordia
1. A client with Chronic Obstructive Pulmonary Disease (COPD) is experiencing mild dyspnea.
Which nursing intervention should the nurse implement first to promote better gas
exchange?
A. Administer oxygen at 6L/min via simple mask.
B. Increase the client’s fluid intake to 3L per day.
C. Instruct the client to perform pursed-lip breathing.
D. Place the client in a supine position.
Correct Answer: C
Explanation: Pursed-lip breathing helps to maintain positive airway pressure and
prevents alveolar collapse during expiration. This technique allows the client to exhale
more CO2 and reduces the work of breathing. Administering high-flow oxygen to a COPD
client can be dangerous as it may suppress their hypoxic drive to breathe.
2. A nurse is reviewing the Arterial Blood Gas (ABG) results for a client with exacerbation of
asthma: pH 7.30, PaCO2 52 mmHg, HCO3 26 mEq/L. How should the nurse interpret these
findings?
A. Metabolic Acidosis
B. Respiratory Alkalosis
,C. Respiratory Acidosis
D. Metabolic Alkalosis
Correct Answer: C
Explanation: The pH is below 7.35, indicating acidosis, and the PaCO2 is elevated above 45
mmHg, which points to a respiratory cause. The bicarbonate (HCO3) level is within the
normal range, indicating no compensation yet. This pattern is characteristic of respiratory
acidosis due to hypoventilation or airway obstruction in asthma.
3. A client is diagnosed with Acute Kidney Injury (AKI) and is in the oliguric phase. Which
clinical manifestation should the nurse monitor for closely?
A. Hypokalemia and hypotension
B. Increased urinary output and dehydration
C. Hyperkalemia and fluid volume excess
D. Metabolic alkalosis and hypernatremia
Correct Answer: C
Explanation: During the oliguric phase of AKI, the kidneys are unable to excrete waste
products, electrolytes, or excess water. This leads to hyperkalemia, which is life-
threatening due to potential cardiac arrhythmias, and fluid volume excess evidenced by
edema and hypertension. The nurse must strictly monitor intake and output and cardiac
rhythm.
, 4. The nurse is providing discharge teaching to a client with Chronic Kidney Disease (CKD)
who is starting hemodialysis. Which dietary instruction is most appropriate?
A. Limit protein intake to high-biological value sources and restrict phosphorus.
B. Increase intake of high-potassium fruits like bananas.
C. Consume at least 3,000 mL of fluids daily.
D. Use salt substitutes to season food instead of table salt.
Correct Answer: A
Explanation: CKD patients must limit protein to reduce nitrogenous waste but ensure the
protein consumed is of high quality. Phosphorus restriction is necessary because the
kidneys cannot excrete it, leading to bone disease. Salt substitutes should be avoided
because they often contain potassium, which can lead to dangerous hyperkalemia.
5. A nurse is caring for a client with a new Arteriovenous (AV) fistula in the left arm. Which
action is essential for the nurse to perform?
A. Draw blood from the left arm for routine morning labs.
B. Palpate for a thrill and auscultate for a bruit over the site.
C. Obtain blood pressure readings using the left arm.
D. Apply a tight pressure dressing to the site to prevent bleeding.
Correct Answer: B
Adult I | Actual Q&A with Rationale (NUR390 Exam
3) | Concordia
1. A client with Chronic Obstructive Pulmonary Disease (COPD) is experiencing mild dyspnea.
Which nursing intervention should the nurse implement first to promote better gas
exchange?
A. Administer oxygen at 6L/min via simple mask.
B. Increase the client’s fluid intake to 3L per day.
C. Instruct the client to perform pursed-lip breathing.
D. Place the client in a supine position.
Correct Answer: C
Explanation: Pursed-lip breathing helps to maintain positive airway pressure and
prevents alveolar collapse during expiration. This technique allows the client to exhale
more CO2 and reduces the work of breathing. Administering high-flow oxygen to a COPD
client can be dangerous as it may suppress their hypoxic drive to breathe.
2. A nurse is reviewing the Arterial Blood Gas (ABG) results for a client with exacerbation of
asthma: pH 7.30, PaCO2 52 mmHg, HCO3 26 mEq/L. How should the nurse interpret these
findings?
A. Metabolic Acidosis
B. Respiratory Alkalosis
,C. Respiratory Acidosis
D. Metabolic Alkalosis
Correct Answer: C
Explanation: The pH is below 7.35, indicating acidosis, and the PaCO2 is elevated above 45
mmHg, which points to a respiratory cause. The bicarbonate (HCO3) level is within the
normal range, indicating no compensation yet. This pattern is characteristic of respiratory
acidosis due to hypoventilation or airway obstruction in asthma.
3. A client is diagnosed with Acute Kidney Injury (AKI) and is in the oliguric phase. Which
clinical manifestation should the nurse monitor for closely?
A. Hypokalemia and hypotension
B. Increased urinary output and dehydration
C. Hyperkalemia and fluid volume excess
D. Metabolic alkalosis and hypernatremia
Correct Answer: C
Explanation: During the oliguric phase of AKI, the kidneys are unable to excrete waste
products, electrolytes, or excess water. This leads to hyperkalemia, which is life-
threatening due to potential cardiac arrhythmias, and fluid volume excess evidenced by
edema and hypertension. The nurse must strictly monitor intake and output and cardiac
rhythm.
, 4. The nurse is providing discharge teaching to a client with Chronic Kidney Disease (CKD)
who is starting hemodialysis. Which dietary instruction is most appropriate?
A. Limit protein intake to high-biological value sources and restrict phosphorus.
B. Increase intake of high-potassium fruits like bananas.
C. Consume at least 3,000 mL of fluids daily.
D. Use salt substitutes to season food instead of table salt.
Correct Answer: A
Explanation: CKD patients must limit protein to reduce nitrogenous waste but ensure the
protein consumed is of high quality. Phosphorus restriction is necessary because the
kidneys cannot excrete it, leading to bone disease. Salt substitutes should be avoided
because they often contain potassium, which can lead to dangerous hyperkalemia.
5. A nurse is caring for a client with a new Arteriovenous (AV) fistula in the left arm. Which
action is essential for the nurse to perform?
A. Draw blood from the left arm for routine morning labs.
B. Palpate for a thrill and auscultate for a bruit over the site.
C. Obtain blood pressure readings using the left arm.
D. Apply a tight pressure dressing to the site to prevent bleeding.
Correct Answer: B
