Adult Health Nursing III – Final Exam Practice
Questions & Detailed Rationales
Question 1
A nurse is caring for a client with acute respiratory distress syndrome (ARDS) who
is receiving mechanical ventilation. Which ventilator setting should the nurse
anticipate to prevent barotrauma?
A) Tidal volume of 10-12 mL/kg
B) Tidal volume of 4-6 mL/kg
C) High peak inspiratory pressure
D) Low positive end-expiratory pressure
Correct Answer: B) Tidal volume of 4-6 mL/kg
Rationale: Low tidal volume ventilation (4-6 mL/kg predicted body weight) is the
standard of care for ARDS to prevent barotrauma and volutrauma. High tidal
volumes can worsen lung injury and increase mortality.
Question 2
A client with heart failure is prescribed both digoxin and furosemide. Which
laboratory value should the nurse monitor most closely?
A) Serum sodium
B) Serum potassium
,C) Serum calcium
D) Serum magnesium
Correct Answer: B) Serum potassium
Rationale: Furosemide causes potassium loss, and hypokalemia increases the risk
of digoxin toxicity. Serum potassium should be monitored closely, and potassium
supplements may be prescribed to maintain normal levels.
Question 3
A nurse is assessing a client with chronic obstructive pulmonary disease (COPD)
who has a barrel chest. Which pathophysiology explains this finding?
A) Increased lung compliance
B) Air trapping and hyperinflation
C) Decreased residual volume
D) Improved gas exchange
Correct Answer: B) Air trapping and hyperinflation
Rationale: Barrel chest in COPD results from air trapping and hyperinflation due
to loss of elastic recoil. This increases the anterior-posterior diameter of the chest
and flattens the diaphragm.
Question 4
A client with acute myocardial infarction is receiving intravenous nitroglycerin.
Which finding indicates a therapeutic effect?
,A) Relief of chest pain
B) Increased heart rate
C) Increased blood pressure
D) Decreased urine output
Correct Answer: A) Relief of chest pain
Rationale: Nitroglycerin dilates coronary arteries, improving blood flow and
relieving chest pain. It also reduces preload and afterload, decreasing myocardial
oxygen demand and limiting infarct size.
Question 5
A nurse is caring for a client with a chest tube following a pneumothorax. Which
finding indicates the lung has re-expanded?
A) Continuous bubbling in the water seal chamber
B) Tidaling in the water seal chamber
C) Absence of tidaling with stable respiratory status
D) Increased drainage in the collection chamber
Correct Answer: C) Absence of tidaling with stable respiratory status
Rationale: Absence of tidaling with stable respiratory status and improved breath
sounds indicates lung re-expansion. Continuous bubbling indicates an air leak, and
tidaling indicates connection to the pleural space.
, Question 6
A client with acute kidney injury (AKI) has a serum potassium level of 7.0 mEq/L.
Which intervention should the nurse implement first?
A) Administer sodium polystyrene sulfonate
B) Administer intravenous calcium gluconate
C) Prepare for hemodialysis
D) Restrict dietary potassium
Correct Answer: B) Administer intravenous calcium gluconate
Rationale: Calcium gluconate is administered first to stabilize cardiac membranes
and prevent life-threatening dysrhythmias from hyperkalemia. It does not lower
potassium but protects the heart while other measures are implemented.
Question 7
A nurse is teaching a client with type 1 diabetes mellitus about sick-day
management. Which statement indicates the client needs further instruction?
A) "I will check my blood glucose every 4 hours."
B) "I will continue taking my insulin even if I cannot eat."
C) "I will stop my insulin if my blood glucose is normal."
D) "I will drink plenty of fluids."
Correct Answer: C) "I will stop my insulin if my blood glucose is normal."
Rationale: Clients with type 1 diabetes should never stop insulin during illness,
even if blood glucose is normal, because stress hormones can cause hyperglycemia.
Insulin should be continued, and blood glucose monitored frequently.
Questions & Detailed Rationales
Question 1
A nurse is caring for a client with acute respiratory distress syndrome (ARDS) who
is receiving mechanical ventilation. Which ventilator setting should the nurse
anticipate to prevent barotrauma?
A) Tidal volume of 10-12 mL/kg
B) Tidal volume of 4-6 mL/kg
C) High peak inspiratory pressure
D) Low positive end-expiratory pressure
Correct Answer: B) Tidal volume of 4-6 mL/kg
Rationale: Low tidal volume ventilation (4-6 mL/kg predicted body weight) is the
standard of care for ARDS to prevent barotrauma and volutrauma. High tidal
volumes can worsen lung injury and increase mortality.
Question 2
A client with heart failure is prescribed both digoxin and furosemide. Which
laboratory value should the nurse monitor most closely?
A) Serum sodium
B) Serum potassium
,C) Serum calcium
D) Serum magnesium
Correct Answer: B) Serum potassium
Rationale: Furosemide causes potassium loss, and hypokalemia increases the risk
of digoxin toxicity. Serum potassium should be monitored closely, and potassium
supplements may be prescribed to maintain normal levels.
Question 3
A nurse is assessing a client with chronic obstructive pulmonary disease (COPD)
who has a barrel chest. Which pathophysiology explains this finding?
A) Increased lung compliance
B) Air trapping and hyperinflation
C) Decreased residual volume
D) Improved gas exchange
Correct Answer: B) Air trapping and hyperinflation
Rationale: Barrel chest in COPD results from air trapping and hyperinflation due
to loss of elastic recoil. This increases the anterior-posterior diameter of the chest
and flattens the diaphragm.
Question 4
A client with acute myocardial infarction is receiving intravenous nitroglycerin.
Which finding indicates a therapeutic effect?
,A) Relief of chest pain
B) Increased heart rate
C) Increased blood pressure
D) Decreased urine output
Correct Answer: A) Relief of chest pain
Rationale: Nitroglycerin dilates coronary arteries, improving blood flow and
relieving chest pain. It also reduces preload and afterload, decreasing myocardial
oxygen demand and limiting infarct size.
Question 5
A nurse is caring for a client with a chest tube following a pneumothorax. Which
finding indicates the lung has re-expanded?
A) Continuous bubbling in the water seal chamber
B) Tidaling in the water seal chamber
C) Absence of tidaling with stable respiratory status
D) Increased drainage in the collection chamber
Correct Answer: C) Absence of tidaling with stable respiratory status
Rationale: Absence of tidaling with stable respiratory status and improved breath
sounds indicates lung re-expansion. Continuous bubbling indicates an air leak, and
tidaling indicates connection to the pleural space.
, Question 6
A client with acute kidney injury (AKI) has a serum potassium level of 7.0 mEq/L.
Which intervention should the nurse implement first?
A) Administer sodium polystyrene sulfonate
B) Administer intravenous calcium gluconate
C) Prepare for hemodialysis
D) Restrict dietary potassium
Correct Answer: B) Administer intravenous calcium gluconate
Rationale: Calcium gluconate is administered first to stabilize cardiac membranes
and prevent life-threatening dysrhythmias from hyperkalemia. It does not lower
potassium but protects the heart while other measures are implemented.
Question 7
A nurse is teaching a client with type 1 diabetes mellitus about sick-day
management. Which statement indicates the client needs further instruction?
A) "I will check my blood glucose every 4 hours."
B) "I will continue taking my insulin even if I cannot eat."
C) "I will stop my insulin if my blood glucose is normal."
D) "I will drink plenty of fluids."
Correct Answer: C) "I will stop my insulin if my blood glucose is normal."
Rationale: Clients with type 1 diabetes should never stop insulin during illness,
even if blood glucose is normal, because stress hormones can cause hyperglycemia.
Insulin should be continued, and blood glucose monitored frequently.
