RNSG 2539 FINAL EXAM – QUESTIONS
AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A
| INSTANT DOWNLOAD PDF
Core Domains
Hemodynamics, Shock, and Multi-Organ Dysfunction
Gas Exchange and Acid-Base Balance
Clotting, Immunity, and Hematologic Disorders
Fluid, Electrolyte, and Metabolic Regulation
Perfusion, Cardiac, and Neurologic Emergencies
Gastrointestinal, Pancreatic, and Hepatic Disorders
Cognition, Mental Health, and Interpersonal Relationships
Leadership, Delegation, and Ethical Practice
Nutrition and Tissue Integrity
Emergency Preparedness and Critical Decision-Making
Introduction
The RNSG 2539 Final Examination assesses the nursing student's
mastery of advanced health care concepts and clinical judgment
required for safe, evidence-based practice. This comprehensive
exam evaluates knowledge across hemodynamics, gas exchange,
clotting, fluid balance, metabolism, perfusion, and interpersonal
relationships. Questions incorporate multiple-choice and
scenario-based formats requiring prioritization, clinical reasoning,
and real-world application. Emphasis is placed on recognizing life-
threatening complications, interpreting diagnostic data, and
,implementing appropriate nursing interventions. This assessment
ensures graduates demonstrate the critical thinking skills
necessary for transitioning to professional nursing practice.
SECTION ONE: QUESTIONS 1–75
Question 1
A client has the following arterial blood gas (ABG) values: pH 7.12;
PaCO2 40 mm Hg; and HCO3- 15 mEq/L. These ABG values
suggest which disorder?
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
🟢 B. Metabolic acidosis
🔴 RATIONALE: A pH below 7.35 indicates acidosis. The PaCO2 is
normal (35-45 mm Hg), ruling out a respiratory cause. The HCO3-
of 15 mEq/L is low (normal 22-26 mEq/L), indicating a metabolic
acidosis. The low pH with low bicarbonate and normal PaCO2
confirms uncompensated metabolic acidosis .
Question 2
As status asthmaticus worsens, the nurse would expect which
acid-base imbalance?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
🟢 C. Respiratory acidosis
,🔴 RATIONALE: Status asthmaticus causes severe bronchospasm
and air trapping, leading to hypoventilation and CO2 retention. As
the condition worsens, PaCO2 rises, causing respiratory acidosis.
Early asthma may cause respiratory alkalosis from
hyperventilation, but worsening status asthmaticus progresses to
respiratory acidosis .
Question 3
A patient with septic shock has a mean arterial pressure (MAP) of
52 mm Hg. What is the priority intervention?
A. Administer broad-spectrum antibiotics
B. Start norepinephrine infusion
C. Give 30 mL/kg crystalloid bolus
D. Obtain blood cultures
🟢 C. Give 30 mL/kg crystalloid bolus
🔴 RATIONALE: In septic shock, initial management is 30 mL/kg IV
crystalloid within 3 hours to improve MAP to a target of ≥65 mm
Hg. Fluid resuscitation is the first priority to restore intravascular
volume before initiating vasopressors. Antibiotics and cultures
follow but do not precede fluid resuscitation in the immediate
management of hypotension .
Question 4
Which type of shock is characterized by decreased systemic
vascular resistance (SVR) and increased cardiac output (CO) in
early stages?
A. Cardiogenic shock
B. Hypovolemic shock
C. Distributive shock
D. Obstructive shock
, 🟢 C. Distributive shock
🔴 RATIONALE: Distributive shock (septic, neurogenic,
anaphylactic) causes massive vasodilation leading to low SVR.
Early septic shock may show normal or high CO due to
compensatory mechanisms. Cardiogenic shock has low CO and
high SVR. Hypovolemic shock has low CO and high SVR .
Question 5
A patient with a pulmonary artery catheter shows: Cardiac index
1.6 L/min/m², PAOP 22 mm Hg, SVR 1800 dynes/sec/cm⁻⁵. Which
shock type is this?
A. Hypovolemic
B. Distributive
C. Cardiogenic
D. Obstructive
🟢 C. Cardiogenic
🔴 RATIONALE: Low cardiac index (normal 2.5-4.0 L/min/m²) +
high PAOP (normal 6-12 mm Hg) indicating fluid overload + high
SVR (normal 800-1200 dynes/sec/cm⁻⁵) indicating
vasoconstriction is the classic hemodynamic profile of cardiogenic
shock from pump failure .
Question 6
A patient with a traumatic brain injury has an intracranial pressure
(ICP) of 24 mm Hg. Which action should the nurse take first?
A. Administer mannitol IV
B. Elevate the head of the bed to 30 degrees
C. Hyperventilate the patient via bag-valve mask
D. Notify the healthcare provider
AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026 Q&A
| INSTANT DOWNLOAD PDF
Core Domains
Hemodynamics, Shock, and Multi-Organ Dysfunction
Gas Exchange and Acid-Base Balance
Clotting, Immunity, and Hematologic Disorders
Fluid, Electrolyte, and Metabolic Regulation
Perfusion, Cardiac, and Neurologic Emergencies
Gastrointestinal, Pancreatic, and Hepatic Disorders
Cognition, Mental Health, and Interpersonal Relationships
Leadership, Delegation, and Ethical Practice
Nutrition and Tissue Integrity
Emergency Preparedness and Critical Decision-Making
Introduction
The RNSG 2539 Final Examination assesses the nursing student's
mastery of advanced health care concepts and clinical judgment
required for safe, evidence-based practice. This comprehensive
exam evaluates knowledge across hemodynamics, gas exchange,
clotting, fluid balance, metabolism, perfusion, and interpersonal
relationships. Questions incorporate multiple-choice and
scenario-based formats requiring prioritization, clinical reasoning,
and real-world application. Emphasis is placed on recognizing life-
threatening complications, interpreting diagnostic data, and
,implementing appropriate nursing interventions. This assessment
ensures graduates demonstrate the critical thinking skills
necessary for transitioning to professional nursing practice.
SECTION ONE: QUESTIONS 1–75
Question 1
A client has the following arterial blood gas (ABG) values: pH 7.12;
PaCO2 40 mm Hg; and HCO3- 15 mEq/L. These ABG values
suggest which disorder?
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
🟢 B. Metabolic acidosis
🔴 RATIONALE: A pH below 7.35 indicates acidosis. The PaCO2 is
normal (35-45 mm Hg), ruling out a respiratory cause. The HCO3-
of 15 mEq/L is low (normal 22-26 mEq/L), indicating a metabolic
acidosis. The low pH with low bicarbonate and normal PaCO2
confirms uncompensated metabolic acidosis .
Question 2
As status asthmaticus worsens, the nurse would expect which
acid-base imbalance?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
🟢 C. Respiratory acidosis
,🔴 RATIONALE: Status asthmaticus causes severe bronchospasm
and air trapping, leading to hypoventilation and CO2 retention. As
the condition worsens, PaCO2 rises, causing respiratory acidosis.
Early asthma may cause respiratory alkalosis from
hyperventilation, but worsening status asthmaticus progresses to
respiratory acidosis .
Question 3
A patient with septic shock has a mean arterial pressure (MAP) of
52 mm Hg. What is the priority intervention?
A. Administer broad-spectrum antibiotics
B. Start norepinephrine infusion
C. Give 30 mL/kg crystalloid bolus
D. Obtain blood cultures
🟢 C. Give 30 mL/kg crystalloid bolus
🔴 RATIONALE: In septic shock, initial management is 30 mL/kg IV
crystalloid within 3 hours to improve MAP to a target of ≥65 mm
Hg. Fluid resuscitation is the first priority to restore intravascular
volume before initiating vasopressors. Antibiotics and cultures
follow but do not precede fluid resuscitation in the immediate
management of hypotension .
Question 4
Which type of shock is characterized by decreased systemic
vascular resistance (SVR) and increased cardiac output (CO) in
early stages?
A. Cardiogenic shock
B. Hypovolemic shock
C. Distributive shock
D. Obstructive shock
, 🟢 C. Distributive shock
🔴 RATIONALE: Distributive shock (septic, neurogenic,
anaphylactic) causes massive vasodilation leading to low SVR.
Early septic shock may show normal or high CO due to
compensatory mechanisms. Cardiogenic shock has low CO and
high SVR. Hypovolemic shock has low CO and high SVR .
Question 5
A patient with a pulmonary artery catheter shows: Cardiac index
1.6 L/min/m², PAOP 22 mm Hg, SVR 1800 dynes/sec/cm⁻⁵. Which
shock type is this?
A. Hypovolemic
B. Distributive
C. Cardiogenic
D. Obstructive
🟢 C. Cardiogenic
🔴 RATIONALE: Low cardiac index (normal 2.5-4.0 L/min/m²) +
high PAOP (normal 6-12 mm Hg) indicating fluid overload + high
SVR (normal 800-1200 dynes/sec/cm⁻⁵) indicating
vasoconstriction is the classic hemodynamic profile of cardiogenic
shock from pump failure .
Question 6
A patient with a traumatic brain injury has an intracranial pressure
(ICP) of 24 mm Hg. Which action should the nurse take first?
A. Administer mannitol IV
B. Elevate the head of the bed to 30 degrees
C. Hyperventilate the patient via bag-valve mask
D. Notify the healthcare provider
