Adult Health Nursing III – Comprehensive
Exam Questions, Answers & Rationales
Question 1
A nurse is caring for a client with acute respiratory distress syndrome (ARDS) who
is receiving mechanical ventilation. Which of the following ventilator settings
should the nurse anticipate to prevent further lung injury?
A) High tidal volumes of 10-12 mL/kg
B) Low tidal volumes of 4-6 mL/kg
C) High positive end-expiratory pressure (PEEP) of 20 cm H₂O
D) Low FiO₂ of 21%
Correct Answer: B) Low tidal volumes 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 ventilator-induced lung injury. High tidal
volumes can cause barotrauma and volutrauma, worsening outcomes in ARDS
patients.
Question 2
A client with heart failure is prescribed 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 is a loop diuretic that causes potassium excretion, leading
to hypokalemia. Hypokalemia can precipitate cardiac dysrhythmias, especially in
clients with heart failure who may already be on digoxin.
Question 3
A nurse is assessing a client with chronic obstructive pulmonary disease (COPD).
Which finding indicates the client is experiencing a exacerbation?
A) Increased sputum production and purulence
B) Respiratory rate of 16 breaths per minute
C) Oxygen saturation of 92%
D) Mild dyspnea on exertion
Correct Answer: A) Increased sputum production and purulence
Rationale: COPD exacerbation is characterized by increased dyspnea, sputum
volume, and sputum purulence. These changes indicate acute worsening of the
disease requiring prompt intervention and possible antibiotic therapy.
Question 4
A client with acute myocardial infarction is receiving morphine sulfate. Which of
the following is the primary reason for administering morphine in this client?
,A) To prevent infection
B) To reduce anxiety and pain
C) To increase heart rate
D) To lower blood glucose
Correct Answer: B) To reduce anxiety and pain
Rationale: Morphine is administered in acute myocardial infarction to relieve pain,
reduce anxiety, and decrease myocardial oxygen demand through vasodilation.
This helps limit infarct size and reduces the risk of complications.
Question 5
A nurse is caring for a client with a chest tube following a thoracotomy. Which
finding requires immediate intervention?
A) Bubbling in the water seal chamber that stops after 24 hours
B) Continuous bubbling in the water seal chamber
C) Drainage of 50 mL in the first hour
D) Tidaling in the water seal chamber
Correct Answer: B) Continuous bubbling in the water seal chamber
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in
the system, which can lead to ineffective lung expansion and pneumothorax. This
requires immediate assessment and intervention to identify and correct the leak.
, Question 6
A client with acute kidney injury (AKI) has a serum potassium level of 6.8 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 newly diagnosed type 1 diabetes mellitus about
insulin administration. Which statement indicates the client needs further
instruction?
A) "I will rotate injection sites to prevent lipodystrophy."
B) "I will store unopened insulin in the refrigerator."
C) "I will inject insulin into the same site each time for consistency."
D) "I will check my blood glucose before meals."
Correct Answer: C) "I will inject insulin into the same site each time for
consistency."
Exam Questions, Answers & Rationales
Question 1
A nurse is caring for a client with acute respiratory distress syndrome (ARDS) who
is receiving mechanical ventilation. Which of the following ventilator settings
should the nurse anticipate to prevent further lung injury?
A) High tidal volumes of 10-12 mL/kg
B) Low tidal volumes of 4-6 mL/kg
C) High positive end-expiratory pressure (PEEP) of 20 cm H₂O
D) Low FiO₂ of 21%
Correct Answer: B) Low tidal volumes 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 ventilator-induced lung injury. High tidal
volumes can cause barotrauma and volutrauma, worsening outcomes in ARDS
patients.
Question 2
A client with heart failure is prescribed 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 is a loop diuretic that causes potassium excretion, leading
to hypokalemia. Hypokalemia can precipitate cardiac dysrhythmias, especially in
clients with heart failure who may already be on digoxin.
Question 3
A nurse is assessing a client with chronic obstructive pulmonary disease (COPD).
Which finding indicates the client is experiencing a exacerbation?
A) Increased sputum production and purulence
B) Respiratory rate of 16 breaths per minute
C) Oxygen saturation of 92%
D) Mild dyspnea on exertion
Correct Answer: A) Increased sputum production and purulence
Rationale: COPD exacerbation is characterized by increased dyspnea, sputum
volume, and sputum purulence. These changes indicate acute worsening of the
disease requiring prompt intervention and possible antibiotic therapy.
Question 4
A client with acute myocardial infarction is receiving morphine sulfate. Which of
the following is the primary reason for administering morphine in this client?
,A) To prevent infection
B) To reduce anxiety and pain
C) To increase heart rate
D) To lower blood glucose
Correct Answer: B) To reduce anxiety and pain
Rationale: Morphine is administered in acute myocardial infarction to relieve pain,
reduce anxiety, and decrease myocardial oxygen demand through vasodilation.
This helps limit infarct size and reduces the risk of complications.
Question 5
A nurse is caring for a client with a chest tube following a thoracotomy. Which
finding requires immediate intervention?
A) Bubbling in the water seal chamber that stops after 24 hours
B) Continuous bubbling in the water seal chamber
C) Drainage of 50 mL in the first hour
D) Tidaling in the water seal chamber
Correct Answer: B) Continuous bubbling in the water seal chamber
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in
the system, which can lead to ineffective lung expansion and pneumothorax. This
requires immediate assessment and intervention to identify and correct the leak.
, Question 6
A client with acute kidney injury (AKI) has a serum potassium level of 6.8 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 newly diagnosed type 1 diabetes mellitus about
insulin administration. Which statement indicates the client needs further
instruction?
A) "I will rotate injection sites to prevent lipodystrophy."
B) "I will store unopened insulin in the refrigerator."
C) "I will inject insulin into the same site each time for consistency."
D) "I will check my blood glucose before meals."
Correct Answer: C) "I will inject insulin into the same site each time for
consistency."
