, Question 1
A patient with acute decompensated heart failure is receiving IV furosemide.
Which assessment finding, if noted 30 minutes after administration, most
urgently indicates a need to reassess the plan of care?
A. Urine output of 150 mL in the past hour
B. New-onset confusion with a blood pressure of 88/54 mm Hg
C. Serum potassium of 3.8 mEq/L
D. Bibasilar crackles that are unchanged from admission
Correct Answer: B - New-onset confusion with a blood pressure
of 88/54 mm Hg
RATIONALE
New confusion with hypotension after IV loop diuretic suggests
hypoperfusion and possible excessive diuresis, requiring immediate
reassessment; the other findings are either expected therapeutic effects
or not immediately dangerous.
Question 2
Which pathophysiologic mechanism best explains why a patient with chronic
obstructive pulmonary disease (COPD) and a PaCO2 of 60 mm Hg may have a
normal pH?
A. Increased renal excretion of bicarbonate
B. Compensatory hyperventilation
C. Renal retention of bicarbonate
D. Decreased production of carbonic acid
Correct Answer: C - Renal retention of bicarbonate
RATIONALE
Chronic CO2 retention triggers renal compensation via bicarbonate
retention, normalizing pH; hyperventilation would lower PaCO2, and
the other options do not reflect chronic compensation.
Page 2
, Question 3
A patient with type 1 diabetes develops diaphoresis, tremors, and a blood
glucose of 52 mg/dL. Which action should the nurse take first?
A. Administer 1 mg glucagon IM
B. Give 15 g of oral glucose gel
C. Start an IV infusion of D5W
D. Recheck blood glucose in 15 minutes
Correct Answer: B - Give 15 g of oral glucose gel
RATIONALE
For a conscious patient with hypoglycemia, the first step is 15 g of
rapid-acting oral carbohydrate (rule of 15); glucagon or IV dextrose is
reserved for unresponsive patients, and rechecking without treatment
delays care.
Question 4
A patient with acute kidney injury has a serum potassium of 6.8 mEq/L and
peaked T waves on ECG. Which intervention should the nurse anticipate as the
priority?
A. Administer sodium polystyrene sulfonate
B. Initiate hemodialysis
C. Give calcium gluconate IV
D. Administer regular insulin with dextrose
Correct Answer: C - Give calcium gluconate IV
RATIONALE
Calcium gluconate is the immediate cardioprotective treatment for
hyperkalemia with ECG changes; other measures lower potassium but
do not protect the myocardium as rapidly.
Page 3
A patient with acute decompensated heart failure is receiving IV furosemide.
Which assessment finding, if noted 30 minutes after administration, most
urgently indicates a need to reassess the plan of care?
A. Urine output of 150 mL in the past hour
B. New-onset confusion with a blood pressure of 88/54 mm Hg
C. Serum potassium of 3.8 mEq/L
D. Bibasilar crackles that are unchanged from admission
Correct Answer: B - New-onset confusion with a blood pressure
of 88/54 mm Hg
RATIONALE
New confusion with hypotension after IV loop diuretic suggests
hypoperfusion and possible excessive diuresis, requiring immediate
reassessment; the other findings are either expected therapeutic effects
or not immediately dangerous.
Question 2
Which pathophysiologic mechanism best explains why a patient with chronic
obstructive pulmonary disease (COPD) and a PaCO2 of 60 mm Hg may have a
normal pH?
A. Increased renal excretion of bicarbonate
B. Compensatory hyperventilation
C. Renal retention of bicarbonate
D. Decreased production of carbonic acid
Correct Answer: C - Renal retention of bicarbonate
RATIONALE
Chronic CO2 retention triggers renal compensation via bicarbonate
retention, normalizing pH; hyperventilation would lower PaCO2, and
the other options do not reflect chronic compensation.
Page 2
, Question 3
A patient with type 1 diabetes develops diaphoresis, tremors, and a blood
glucose of 52 mg/dL. Which action should the nurse take first?
A. Administer 1 mg glucagon IM
B. Give 15 g of oral glucose gel
C. Start an IV infusion of D5W
D. Recheck blood glucose in 15 minutes
Correct Answer: B - Give 15 g of oral glucose gel
RATIONALE
For a conscious patient with hypoglycemia, the first step is 15 g of
rapid-acting oral carbohydrate (rule of 15); glucagon or IV dextrose is
reserved for unresponsive patients, and rechecking without treatment
delays care.
Question 4
A patient with acute kidney injury has a serum potassium of 6.8 mEq/L and
peaked T waves on ECG. Which intervention should the nurse anticipate as the
priority?
A. Administer sodium polystyrene sulfonate
B. Initiate hemodialysis
C. Give calcium gluconate IV
D. Administer regular insulin with dextrose
Correct Answer: C - Give calcium gluconate IV
RATIONALE
Calcium gluconate is the immediate cardioprotective treatment for
hyperkalemia with ECG changes; other measures lower potassium but
do not protect the myocardium as rapidly.
Page 3
