Adult Health Nursing III – Comprehensive
Final Exam Question Bank
Question 1
A client with acute respiratory distress syndrome (ARDS) is receiving mechanical
ventilation. The nurse notes a plateau pressure of 36 cm H₂O and peak inspiratory
pressure of 52 cm H₂O. Which action should the nurse anticipate?
A) Increasing tidal volume to improve oxygenation
B) Decreasing tidal volume and implementing lung-protective ventilation
C) Increasing PEEP to 20 cm H₂O
D) Decreasing FiO₂ to 21%
Correct Answer: B) Decreasing tidal volume and implementing lung-protective
ventilation
Rationale: Plateau pressure >30 cm H₂O indicates increased risk of barotrauma.
Lung-protective ventilation with low tidal volumes (4-6 mL/kg) reduces ventilator-
induced lung injury and mortality in ARDS.
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 client with chronic obstructive pulmonary disease (COPD) 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.
Final Exam Question Bank
Question 1
A client with acute respiratory distress syndrome (ARDS) is receiving mechanical
ventilation. The nurse notes a plateau pressure of 36 cm H₂O and peak inspiratory
pressure of 52 cm H₂O. Which action should the nurse anticipate?
A) Increasing tidal volume to improve oxygenation
B) Decreasing tidal volume and implementing lung-protective ventilation
C) Increasing PEEP to 20 cm H₂O
D) Decreasing FiO₂ to 21%
Correct Answer: B) Decreasing tidal volume and implementing lung-protective
ventilation
Rationale: Plateau pressure >30 cm H₂O indicates increased risk of barotrauma.
Lung-protective ventilation with low tidal volumes (4-6 mL/kg) reduces ventilator-
induced lung injury and mortality in ARDS.
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 client with chronic obstructive pulmonary disease (COPD) 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.
