NUR 334 ADVANCED NURSING
MIDTERM EXAM QUESTIONS AND
DETAILED ANSWERS 2026/2027
1. A patient presents with a pH of 7.25, PaCO2 of 55 mmHg, and HCO3 of 28 mEq/L. Which
acid-base imbalance is occurring?
A. Uncompensated Respiratory Acidosis
B. Partially Compensated Metabolic Alkalosis
C. Fully Compensated Metabolic Acidosis
D. Partially Compensated Respiratory Acidosis
Answer: D
Conceptual Explanation: The pH is acidic (<7.35), the PaCO2 is high (>45) causing the
acidity, and the HCO3 is high (>26) indicating the kidneys are attempting to compensate,
making it partially compensated respiratory acidosis.
2. Which of the following is the most sensitive early indicator of increased intracranial
pressure (ICP)?
A. Cushing’s triad
B. Fixed and dilated pupils
C. Decerebrate posturing
,D. Change in Level of Consciousness (LOC)
Answer: D
Conceptual Explanation: A change in LOC is the earliest and most sensitive sign of
increased ICP. Cushing’s triad and posturing are late signs.
3. A patient with Acute Renal Failure has a potassium level of 6.8 mEq/L. Which medication
should the nurse prioritize to protect the heart?
A. Sodium Polystyrene Sulfonate
B. Furosemide
C. Calcium Gluconate
D. Regular Insulin and Dextrose
Answer: C
Conceptual Explanation: Calcium gluconate does not lower potassium but is administered
to stabilize the myocardial cell membrane and prevent life-threatening arrhythmias.
4. Which clinical manifestation is a hallmark of Acute Respiratory Distress Syndrome (ARDS)?
A. Hypercapnia responsive to oxygen
B. Refractory hypoxemia
C. Increased lung compliance
D. Bronchospasm relieved by Albuterol
, Answer: B
Conceptual Explanation: Refractory hypoxemia, where oxygen levels stay low despite
increasing FiO2, is the hallmark sign of ARDS due to massive shunting.
5. Following a spinal cord injury at T4, a patient complains of a severe headache and has a BP
of 210/110. What is the first action?
A. Administer Hydralazine IV
B. Notify the physician immediately
C. Lower the head of the bed
D. Check for bladder distention
Answer: D
Conceptual Explanation: Autonomic Dysreflexia is a medical emergency. The priority is to
remove the stimulus (often a full bladder or bowel) while sitting the patient upright.
6. In the compensatory stage of shock, which physiological response maintains cardiac
output?
A. Decrease in heart rate
B. Decreased production of ADH
C. Vasodilation of peripheral vessels
D. Activation of the Renin-Angiotensin-Aldosterone System (RAAS)
Answer: D
MIDTERM EXAM QUESTIONS AND
DETAILED ANSWERS 2026/2027
1. A patient presents with a pH of 7.25, PaCO2 of 55 mmHg, and HCO3 of 28 mEq/L. Which
acid-base imbalance is occurring?
A. Uncompensated Respiratory Acidosis
B. Partially Compensated Metabolic Alkalosis
C. Fully Compensated Metabolic Acidosis
D. Partially Compensated Respiratory Acidosis
Answer: D
Conceptual Explanation: The pH is acidic (<7.35), the PaCO2 is high (>45) causing the
acidity, and the HCO3 is high (>26) indicating the kidneys are attempting to compensate,
making it partially compensated respiratory acidosis.
2. Which of the following is the most sensitive early indicator of increased intracranial
pressure (ICP)?
A. Cushing’s triad
B. Fixed and dilated pupils
C. Decerebrate posturing
,D. Change in Level of Consciousness (LOC)
Answer: D
Conceptual Explanation: A change in LOC is the earliest and most sensitive sign of
increased ICP. Cushing’s triad and posturing are late signs.
3. A patient with Acute Renal Failure has a potassium level of 6.8 mEq/L. Which medication
should the nurse prioritize to protect the heart?
A. Sodium Polystyrene Sulfonate
B. Furosemide
C. Calcium Gluconate
D. Regular Insulin and Dextrose
Answer: C
Conceptual Explanation: Calcium gluconate does not lower potassium but is administered
to stabilize the myocardial cell membrane and prevent life-threatening arrhythmias.
4. Which clinical manifestation is a hallmark of Acute Respiratory Distress Syndrome (ARDS)?
A. Hypercapnia responsive to oxygen
B. Refractory hypoxemia
C. Increased lung compliance
D. Bronchospasm relieved by Albuterol
, Answer: B
Conceptual Explanation: Refractory hypoxemia, where oxygen levels stay low despite
increasing FiO2, is the hallmark sign of ARDS due to massive shunting.
5. Following a spinal cord injury at T4, a patient complains of a severe headache and has a BP
of 210/110. What is the first action?
A. Administer Hydralazine IV
B. Notify the physician immediately
C. Lower the head of the bed
D. Check for bladder distention
Answer: D
Conceptual Explanation: Autonomic Dysreflexia is a medical emergency. The priority is to
remove the stimulus (often a full bladder or bowel) while sitting the patient upright.
6. In the compensatory stage of shock, which physiological response maintains cardiac
output?
A. Decrease in heart rate
B. Decreased production of ADH
C. Vasodilation of peripheral vessels
D. Activation of the Renin-Angiotensin-Aldosterone System (RAAS)
Answer: D
