SAN ANTONIO COLLEGE — DEPARTMENT OF NURSING
RNSG 1128: Introduction to Health Care Concepts
Exam 2 Blueprint Study Guide & Comprehensive Examination 2026-2027.
Q1. A nurse is reviewing the arterial blood gas (ABG) results for a client who is hypoventilating due to an
opioid overdose. The results show pH 7.28, PaCO2 54 mmHg, and HCO3 24 mEq/L. Which acid-base imbalance
does the nurse identify?
(A) Respiratory Alkalosis
(B) Metabolic Acidosis
(C) Respiratory Acidosis
(D) Metabolic Alkalosis
✔ Correct Answer: (C) Respiratory Acidosis
Rationale: Respiratory acidosis is characterized by a pH < 7.35 and PaCO2 > 45 mmHg. Hypoventilation causes CO2
retention ('DEPRESS' mnemonic: Drugs/opioids cause respiratory center depression), leading to high carbonic acid
levels in the blood while HCO3 remains initially normal.
Q2. The nurse is caring for an adult client with severe diarrhea who is at risk for fluid volume deficit (FVD).
Which laboratory finding is expected in a client experiencing hypovolemia?
(A) Decreased Serum Osmolality (<270 mOsm/kg)
(B) Elevated Hematocrit and BUN to Creatinine ratio > 20:1
(C) Decreased Hematocrit and decreased BUN
(D) Decreased Urine Specific Gravity (<1.005)
✔ Correct Answer: (B) Elevated Hematocrit and BUN to Creatinine ratio > 20:1
Rationale: In volume depletion (FVD), hemoconcentration results in elevated hemoglobin, hematocrit, BUN, serum
osmolality, and urine specific gravity (>1.020). Normal BUN to creatinine ratio is 10:1; a ratio > 20:1 indicates volume
depletion.
Q3. A client presents with a serum sodium level of 112 mEq/L. The nurse recognizes that severe acute
hyponatremia (<115 mEq/L) places the client at high risk for which critical complication?
(A) Pulmonary edema and hyperreflexia
(B) Increased intracranial pressure, status epilepticus, and brain herniation
(C) Tetany and positive Trousseau sign
(D) Paralytic ileus and prominent U waves
✔ Correct Answer: (B) Increased intracranial pressure, status epilepticus, and brain herniation
Rationale: When serum sodium drops below 115 mEq/L, signs of increasing intracranial pressure occur, including
altered mental status, status epilepticus, papilledema, cerebral edema, brain herniation, and coma due to water
shifting into brain cells.
San Antonio College | Nursing Department — RNSG 1128 Page 1 of 13
, RNSG 1128 Exam 2 Practice Blueprint — Fall 2026
Q4. Which fluid movement process describes the passive movement of water across a semipermeable
membrane from an area of lower solute concentration to an area of higher solute concentration?
(A) Osmosis
(B) Active Transport
(C) Diffusion
(D) Filtration
✔ Correct Answer: (A) Osmosis
Rationale: Osmosis is the movement of fluid across a membrane from an area of lower solute concentration to an
area of higher solute concentration until equilibrium is reached.
Q5. A nurse assesses an older adult client for fluid volume deficit. Which assessment finding provides the
most valid indication of fluid volume status in the geriatric population?
(A) Tongue turgor and slowness in filling of hand veins
(B) Skin turgor on the back of the hand
(C) Subcutaneous skin turgor over the sternum
(D) Presence of presbyopia
✔ Correct Answer: (A) Tongue turgor and slowness in filling of hand veins
Rationale: Assessment of skin turgor is not as valid in older adults due to age-related loss of skin elasticity. Tongue
turgor is unaffected by age, making it and vein filling times more reliable measures of FVD in older adults.
Q6. Which hormone is released by the heart's atria in response to fluid overload and atrial distention to
promote sodium and water excretion?
(A) Antidiuretic Hormone (ADH)
(B) Aldosterone
(C) Renin
(D) Atrial Natriuretic Peptide (ANP)
✔ Correct Answer: (D) Atrial Natriuretic Peptide (ANP)
Rationale: ANP is released by the heart in response to increased blood volume and atrial distention. It decreases
sodium and water reabsorption in the kidneys, opposing ADH and RAAS to reduce blood volume and BP.
Q7. A client's electrocardiogram (ECG) reveals tall, tented T waves, a prolonged PR interval, and a widened
QRS complex. Which electrolyte imbalance does the nurse suspect?
(A) Hypocalcemia (<8.6 mg/dL)
(B) Hypercalcemia (>10.2 mg/dL)
(C) Hyperkalemia (>5.0 mEq/L)
(D) Hypokalemia (<3.5 mEq/L)
✔ Correct Answer: (C) Hyperkalemia (>5.0 mEq/L)
Rationale: Hyperkalemia affects myocardial conduction. Earliest changes (>6.0 mEq/L) are tall tented T waves,
prolonged PR interval, depression of ST segment, loss of P waves, and widening of the QRS complex.
San Antonio College | Nursing Department — RNSG 1128 Page 2 of 13
RNSG 1128: Introduction to Health Care Concepts
Exam 2 Blueprint Study Guide & Comprehensive Examination 2026-2027.
Q1. A nurse is reviewing the arterial blood gas (ABG) results for a client who is hypoventilating due to an
opioid overdose. The results show pH 7.28, PaCO2 54 mmHg, and HCO3 24 mEq/L. Which acid-base imbalance
does the nurse identify?
(A) Respiratory Alkalosis
(B) Metabolic Acidosis
(C) Respiratory Acidosis
(D) Metabolic Alkalosis
✔ Correct Answer: (C) Respiratory Acidosis
Rationale: Respiratory acidosis is characterized by a pH < 7.35 and PaCO2 > 45 mmHg. Hypoventilation causes CO2
retention ('DEPRESS' mnemonic: Drugs/opioids cause respiratory center depression), leading to high carbonic acid
levels in the blood while HCO3 remains initially normal.
Q2. The nurse is caring for an adult client with severe diarrhea who is at risk for fluid volume deficit (FVD).
Which laboratory finding is expected in a client experiencing hypovolemia?
(A) Decreased Serum Osmolality (<270 mOsm/kg)
(B) Elevated Hematocrit and BUN to Creatinine ratio > 20:1
(C) Decreased Hematocrit and decreased BUN
(D) Decreased Urine Specific Gravity (<1.005)
✔ Correct Answer: (B) Elevated Hematocrit and BUN to Creatinine ratio > 20:1
Rationale: In volume depletion (FVD), hemoconcentration results in elevated hemoglobin, hematocrit, BUN, serum
osmolality, and urine specific gravity (>1.020). Normal BUN to creatinine ratio is 10:1; a ratio > 20:1 indicates volume
depletion.
Q3. A client presents with a serum sodium level of 112 mEq/L. The nurse recognizes that severe acute
hyponatremia (<115 mEq/L) places the client at high risk for which critical complication?
(A) Pulmonary edema and hyperreflexia
(B) Increased intracranial pressure, status epilepticus, and brain herniation
(C) Tetany and positive Trousseau sign
(D) Paralytic ileus and prominent U waves
✔ Correct Answer: (B) Increased intracranial pressure, status epilepticus, and brain herniation
Rationale: When serum sodium drops below 115 mEq/L, signs of increasing intracranial pressure occur, including
altered mental status, status epilepticus, papilledema, cerebral edema, brain herniation, and coma due to water
shifting into brain cells.
San Antonio College | Nursing Department — RNSG 1128 Page 1 of 13
, RNSG 1128 Exam 2 Practice Blueprint — Fall 2026
Q4. Which fluid movement process describes the passive movement of water across a semipermeable
membrane from an area of lower solute concentration to an area of higher solute concentration?
(A) Osmosis
(B) Active Transport
(C) Diffusion
(D) Filtration
✔ Correct Answer: (A) Osmosis
Rationale: Osmosis is the movement of fluid across a membrane from an area of lower solute concentration to an
area of higher solute concentration until equilibrium is reached.
Q5. A nurse assesses an older adult client for fluid volume deficit. Which assessment finding provides the
most valid indication of fluid volume status in the geriatric population?
(A) Tongue turgor and slowness in filling of hand veins
(B) Skin turgor on the back of the hand
(C) Subcutaneous skin turgor over the sternum
(D) Presence of presbyopia
✔ Correct Answer: (A) Tongue turgor and slowness in filling of hand veins
Rationale: Assessment of skin turgor is not as valid in older adults due to age-related loss of skin elasticity. Tongue
turgor is unaffected by age, making it and vein filling times more reliable measures of FVD in older adults.
Q6. Which hormone is released by the heart's atria in response to fluid overload and atrial distention to
promote sodium and water excretion?
(A) Antidiuretic Hormone (ADH)
(B) Aldosterone
(C) Renin
(D) Atrial Natriuretic Peptide (ANP)
✔ Correct Answer: (D) Atrial Natriuretic Peptide (ANP)
Rationale: ANP is released by the heart in response to increased blood volume and atrial distention. It decreases
sodium and water reabsorption in the kidneys, opposing ADH and RAAS to reduce blood volume and BP.
Q7. A client's electrocardiogram (ECG) reveals tall, tented T waves, a prolonged PR interval, and a widened
QRS complex. Which electrolyte imbalance does the nurse suspect?
(A) Hypocalcemia (<8.6 mg/dL)
(B) Hypercalcemia (>10.2 mg/dL)
(C) Hyperkalemia (>5.0 mEq/L)
(D) Hypokalemia (<3.5 mEq/L)
✔ Correct Answer: (C) Hyperkalemia (>5.0 mEq/L)
Rationale: Hyperkalemia affects myocardial conduction. Earliest changes (>6.0 mEq/L) are tall tented T waves,
prolonged PR interval, depression of ST segment, loss of P waves, and widening of the QRS complex.
San Antonio College | Nursing Department — RNSG 1128 Page 2 of 13
