NUR 253 MIDTERM EXAM
COMPREHENSIVE STUDY GUIDE
QUESTIONS & ANSWERS (VERIFIED
ANSWERS) WITH EXPERT
EXPLANATIONS | 2026 – 2027 UPDATE
(PDF) GALEN COLLEGE OF NURSING
1. A patient’s arterial blood gas (ABG) results are: pH 7.30, PaCO2 52 mmHg, and HCO3 26
mEq/L. Which acid-base imbalance is the patient experiencing?
A. Respiratory Alkalosis
B. Respiratory Acidosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Answer: B
Conceptual Explanation: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg
indicates a respiratory cause. Since the HCO3 is within normal range, this is
uncompensated respiratory acidosis.
,2. When administering intravenous potassium chloride (KCl) to a patient with severe
hypokalemia, which nursing action is the highest priority?
A. Ensuring the infusion rate does not exceed 10 mEq/hr via peripheral line
B. Administering the medication via IV push for rapid effect
C. Restricting fluid intake during the infusion
D. Monitoring the patient for signs of Chvostek’s sign
Answer: A
Conceptual Explanation: Potassium must never be given IV push as it can cause cardiac
arrest. The standard safety limit for peripheral IV potassium is 10 mEq/hr to prevent
cardiac arrhythmias and vein irritation.
3. A patient presents with a serum sodium level of 118 mEq/L. Which clinical manifestation
should the nurse prioritize for immediate intervention?
A. Increased thirst and dry mucous membranes
B. General malaise and muscle cramps
C. Seizures and altered mental status
D. Orthostatic hypotension
Answer: C
, Conceptual Explanation: Severe hyponatremia (below 120 mEq/L) places the patient at
high risk for cerebral edema, which manifests as seizures, coma, and permanent
neurological damage.
4. During the preoperative assessment, a patient reports a family history of a high fever and
muscle rigidity during surgery. Which medication should the nurse ensure is readily available?
A. Atropine sulfate
B. Dantrolene sodium
C. Naloxone hydrochloride
D. Succinylcholine
Answer: B
Conceptual Explanation: The symptoms described are consistent with Malignant
Hyperthermia, a life-threatening genetic reaction to anesthesia. Dantrolene is the primary
pharmacological treatment.
5. A postoperative patient suddenly develops sharp chest pain, dyspnea, and tachycardia.
What is the nurse’s most appropriate first action?
A. Apply supplemental oxygen and elevate the head of the bed
B. Administer prescribed morphine
C. Obtain a 12-lead EKG
D. Auscultate for a pleural friction rub
COMPREHENSIVE STUDY GUIDE
QUESTIONS & ANSWERS (VERIFIED
ANSWERS) WITH EXPERT
EXPLANATIONS | 2026 – 2027 UPDATE
(PDF) GALEN COLLEGE OF NURSING
1. A patient’s arterial blood gas (ABG) results are: pH 7.30, PaCO2 52 mmHg, and HCO3 26
mEq/L. Which acid-base imbalance is the patient experiencing?
A. Respiratory Alkalosis
B. Respiratory Acidosis
C. Metabolic Acidosis
D. Metabolic Alkalosis
Answer: B
Conceptual Explanation: A pH below 7.35 indicates acidosis. A PaCO2 above 45 mmHg
indicates a respiratory cause. Since the HCO3 is within normal range, this is
uncompensated respiratory acidosis.
,2. When administering intravenous potassium chloride (KCl) to a patient with severe
hypokalemia, which nursing action is the highest priority?
A. Ensuring the infusion rate does not exceed 10 mEq/hr via peripheral line
B. Administering the medication via IV push for rapid effect
C. Restricting fluid intake during the infusion
D. Monitoring the patient for signs of Chvostek’s sign
Answer: A
Conceptual Explanation: Potassium must never be given IV push as it can cause cardiac
arrest. The standard safety limit for peripheral IV potassium is 10 mEq/hr to prevent
cardiac arrhythmias and vein irritation.
3. A patient presents with a serum sodium level of 118 mEq/L. Which clinical manifestation
should the nurse prioritize for immediate intervention?
A. Increased thirst and dry mucous membranes
B. General malaise and muscle cramps
C. Seizures and altered mental status
D. Orthostatic hypotension
Answer: C
, Conceptual Explanation: Severe hyponatremia (below 120 mEq/L) places the patient at
high risk for cerebral edema, which manifests as seizures, coma, and permanent
neurological damage.
4. During the preoperative assessment, a patient reports a family history of a high fever and
muscle rigidity during surgery. Which medication should the nurse ensure is readily available?
A. Atropine sulfate
B. Dantrolene sodium
C. Naloxone hydrochloride
D. Succinylcholine
Answer: B
Conceptual Explanation: The symptoms described are consistent with Malignant
Hyperthermia, a life-threatening genetic reaction to anesthesia. Dantrolene is the primary
pharmacological treatment.
5. A postoperative patient suddenly develops sharp chest pain, dyspnea, and tachycardia.
What is the nurse’s most appropriate first action?
A. Apply supplemental oxygen and elevate the head of the bed
B. Administer prescribed morphine
C. Obtain a 12-lead EKG
D. Auscultate for a pleural friction rub
