NURS 231 FINAL EXAM VERSION A AND B (2 LATEST
VERSIONS ) ACTUAL EXAM QUESTIONS AND CORRECT
ANSWERS|ALREADY GRADED A+ (PORTAGE LEARNING)
What are the normal's for the following labs
1) Urine Specific Gravity
2) Serum Osmolality
3) ABG (pH, HCO3, PaCO2, PaO2)
4) troponin I
5) electrolyte panel( Na+, K+, Ca+, Mg+)
6) BUN & Creatinine
7) CBC ( hgb, hct, RBC, WBC, platelets) - ANSWER: 1) 1.000-1.030
2) 270-300
3) pH 7.35-7.45// HC03 22-26// PaCO2 35-45// Pa02 80-100
4) troponin I <0.03 ng/mL
5) Na+ 135-145//K+ 3.5-5// Ca+ 9-10.5//Mg+ 1.2-2
6) BUN 10-20//Creat 0.5-1.2
7) hgb 12-18// hct 37-52%// rbc 4.2-6.1// wbc 5,000-10,000// platelets 150,000-
400,000
Match the lab profile with the most likely fluid imbalance like A) Fluid Volume Deficit
2) Fluid Volume Excess
1) ____Na 148; Hct 40% yesterday, 49% today; serum osmolarity 308
2) ____Hgb 13.2 yesterday, 10.1 today; Urine specific gravity 1.001
3) ____BUN 45; Cr 0.7 - ANSWER: 1) A
2) B
3) A
The nurse is preparing to administer lisinopril (Zestril) to a patient with acute
coronary syndrome. Which of the following findings should prompt the nurse to hold
the medication and consult the healthcare provider?
a) Serum sodium level 134
b) Serum potassium 5.6
c) Heart rate 58
d) Blood pressure 125/78 - ANSWER: b) Serum potassium 5.6
*ACE inhibitors can cause/exacerbate hyperkalemia.
The nurse is caring for a patient who is in hypovolemic shock following an extensive
burn injury. What is the intravenous fluid of choice for this patient in the emergent
phase of treatment?
a) Lactated Ringers
b) 0.45 NS with 20 mEq potassium chloride
c) Fresh Frozen Plasma
d) 5% Dextrose in saline - ANSWER: a) Lactated Ringers
*Isotonic solutions (crystalloids) are used to restore fluid volume in patients with
shock. Lactated Ringers is isotonic. Normal saline is also isotonic.
,The client on a ventilator is assessed for untoward responses to the therapy. Which
of the following would indicate a possible complication of ventilator therapy?
a) Blood pressure has increased 5mmHg in the last 24 hours
b) Lung sounds absent on one side.
c) Forceful cough periodically
d) Broncho-vesicular breath sounds throughout peripheral lung fields. - ANSWER: b)
Lung sounds absent on one side.
*This may indicate a pneumothorax--a complication caused by barotrauma.
The pressure reading during inspiration on the ventilator of a client receiving
mechanical ventilation is high and alarming intermittently. What is the nurse's first
action?
a) Assess the client's oxygenation.
b) Call the RT to check the ventilator settings.
c) Listen for bilateral lung sounds.
d) Determine whether an air leak is present in the client's endotracheal tube cuff. -
ANSWER: a) Assess the client's oxygenation.
Which assessment finding best indicates that fluid resuscitation therapy for the
patient with hypertonic dehydration has acheived the desired effect?
a) Peripheral pulses changed from 1+ to 3+
b) Neck veins slightly distended @ 30 degrees
c) Serum sodium level has changed from 151 to 143.
d) Pulse oximetry shows oxygen saturation of 95% - ANSWER: c) Serum sodium level
has changed from 151 to 143.
Which intravenous solution should you be prepared to administer to a patient with
isotonic dehydration?
a) 0.45% saline
b) Dextrose 5% in water
c) Dextrose 10% in water
d) 0.9% saline - ANSWER: d) 0.9% saline
A patient is receiving dobutamine [Dobutrex] as a continuous infusion in the
immediate postoperative period. The patient also is receiving a diuretic. What
adverse drug reactions are possible in this patient? (select all that apply)
a)Angina
b)Hypotension
c)Dysrhythmias
d)Oliguria
e)Tachycardia - ANSWER: a)Angina
c)Dysrhythmias
e)Tachycardia
*Is a beta1 aderenergic agonist; general anesthetics can increase the likelihood of
dysrhythmias. Dobutamine elevates BP by increasing CO. Diuretics complement the
,beneficial effects of dobutamine on the kidney, so urine output would be increased,
not decreased.
A patient who has severe sepsis is receiving an intravenous normal saline infusion.
She weighs 78 kgs. Which of the following is an indicator that the therapeutic goal
has been met?
a) 250 mL of urine in the past 6 hours
b) Arterial blood pressure is 90/42
c) Central Venous Pressure is 2 mm Hg
d) Patient's heart rate is 101 - ANSWER: a) 250 mL of urine in the past 6 hours
*Fluid resuscitation goals in sepsis are: MAP > 65, UO . 0.5 mL/kg/hr, and/or CVP 8-
12 mm Hg.
The nurse is caring for Mrs. B, who has a pulmonary embolus. She is started on a
heparin drip and 4 hours later the aPTT is 70 seconds (lab control or "normal" value
is 40 secs). The nurse should:
a) Notify the provider and request an order for warfarin (Coumadin).
b) Notify the provider and request a decrease in the heparin dose.
c) Continue the present order for heparin.
d) Hold the heparin and notify the physician. - ANSWER: c) Continue the present
order for heparin.
*The aPTT is therapeutic for a heparinized patient with a PE. A therapeutic aPTT for a
heparinized patient is 1.5-2x the "normal" or "control" value. Review also the
heparin protocol calculations. We did an example on the PE case study.
A patient with a diagnosis of myocardial infarction is admitted to your unit. Which of
the patient's statements would alert you to the possibility of acute heart failure?
a) "I think my dose of digoxin may need to be increased."
b) "I have noticed a lack of appetite lately."
c) "I have trouble remembering things lately."
d) "I'm feeling short of breath when I walk to the bathroom." - ANSWER: d) "I'm
feeling short of breath when I walk to the bathroom."
*Activity intolerance is a symptom of heart failure, due to dyspnea on exertion.
The nurse is caring for patients on a cardiac unit. Which patient should the nurse
assess first?
a) The patient diagnosed with Heart Failure who has bilateral 3+ peripheral edema.
b) The patient diagnosed with mitral valve regurgitation who has dyspnea on
exertion.
c) The patient diagnosed with angina who is reporting chest pain.
d) The patient diagnosed with pericarditis who has a temperature of 100 degrees F. -
ANSWER: c) The patient diagnosed with angina who is reporting chest pain.
, *A patient with a history of angina should be pain-free. If he/she is not, then there
may be myocardial ischemia occurring. All of the other choices represent expected,
but non-lifethreatening findings for the diagnosis.
The nurse is caring for a patient with Diabetic Ketoacidosis. Which of the following is
the most concerning assessment finding?
a) Blood pressure is 103/78.
b) Blood sugar is 565.
c) Urine is dark and cloudy.
d) Patient is confused and agitated. - ANSWER: d) Patient is confused and agitated.
*A patient in DKA is at risk for impaired central perfusion, secondary to hypovolemia.
Confused and agitated is an indicator of poor perfusion to the brain and is the
priority issue. Blood pressure is acceptable, but note the narrowed pulse pressure
indicating compensatory vasoconstriction.
You are monitoring the patient undergoing exercise EKG (stress test). Which of the
following criteria would indicate that the test should be stopped prematurely?
a) If the patient's respiratory rate exceeds 24 breaths/minute
b) When the incline of the treadmill reaches 10% elevation
c) If the patient's EKG indicates significant ST segment depression
d) When the patient's heart rate reaches 120 beats/minute - ANSWER: c) If the
patient's EKG indicates significant ST segment depression
*ST depression may indicate cardiac ischemia. All other choices are expected.
A patient is admitted to the intensive care unit for treatment of shock. The
prescriber orders norepinephring (Levophed). The nurse expects this drug to
increase tissue perfusion in this patient by primarily activating:
a) alpha1 receptors to cause vasodilation.
b) beta2 receptors to cause bronchodilation.
c) beta1 receptors to cause a positive inotropic effect.
d) alpha1 receptors to increase blood pressure. - ANSWER: d) alpha1 receptors to
increase blood pressure.
A patient comes into the emergency department with extensive bleeding from face,
arm, and chest wounds. What is the earliest manifestation of hypovolemic shock
likely to be detected in this patient?
a) Increased respiratory rate.
b) Increased heart rate.
c) Decreased blood pressure.
d) Cool, pale skin. - ANSWER: b) Increased heart rate.
Your patient had sudden, sharp chest pain and is breathing rapidly. The provisional
diagnosis is acute pulmonary embolism. Which of the following arterial blood gas
results would you expect to see during the first 20 minutes after the start of this
episode?
VERSIONS ) ACTUAL EXAM QUESTIONS AND CORRECT
ANSWERS|ALREADY GRADED A+ (PORTAGE LEARNING)
What are the normal's for the following labs
1) Urine Specific Gravity
2) Serum Osmolality
3) ABG (pH, HCO3, PaCO2, PaO2)
4) troponin I
5) electrolyte panel( Na+, K+, Ca+, Mg+)
6) BUN & Creatinine
7) CBC ( hgb, hct, RBC, WBC, platelets) - ANSWER: 1) 1.000-1.030
2) 270-300
3) pH 7.35-7.45// HC03 22-26// PaCO2 35-45// Pa02 80-100
4) troponin I <0.03 ng/mL
5) Na+ 135-145//K+ 3.5-5// Ca+ 9-10.5//Mg+ 1.2-2
6) BUN 10-20//Creat 0.5-1.2
7) hgb 12-18// hct 37-52%// rbc 4.2-6.1// wbc 5,000-10,000// platelets 150,000-
400,000
Match the lab profile with the most likely fluid imbalance like A) Fluid Volume Deficit
2) Fluid Volume Excess
1) ____Na 148; Hct 40% yesterday, 49% today; serum osmolarity 308
2) ____Hgb 13.2 yesterday, 10.1 today; Urine specific gravity 1.001
3) ____BUN 45; Cr 0.7 - ANSWER: 1) A
2) B
3) A
The nurse is preparing to administer lisinopril (Zestril) to a patient with acute
coronary syndrome. Which of the following findings should prompt the nurse to hold
the medication and consult the healthcare provider?
a) Serum sodium level 134
b) Serum potassium 5.6
c) Heart rate 58
d) Blood pressure 125/78 - ANSWER: b) Serum potassium 5.6
*ACE inhibitors can cause/exacerbate hyperkalemia.
The nurse is caring for a patient who is in hypovolemic shock following an extensive
burn injury. What is the intravenous fluid of choice for this patient in the emergent
phase of treatment?
a) Lactated Ringers
b) 0.45 NS with 20 mEq potassium chloride
c) Fresh Frozen Plasma
d) 5% Dextrose in saline - ANSWER: a) Lactated Ringers
*Isotonic solutions (crystalloids) are used to restore fluid volume in patients with
shock. Lactated Ringers is isotonic. Normal saline is also isotonic.
,The client on a ventilator is assessed for untoward responses to the therapy. Which
of the following would indicate a possible complication of ventilator therapy?
a) Blood pressure has increased 5mmHg in the last 24 hours
b) Lung sounds absent on one side.
c) Forceful cough periodically
d) Broncho-vesicular breath sounds throughout peripheral lung fields. - ANSWER: b)
Lung sounds absent on one side.
*This may indicate a pneumothorax--a complication caused by barotrauma.
The pressure reading during inspiration on the ventilator of a client receiving
mechanical ventilation is high and alarming intermittently. What is the nurse's first
action?
a) Assess the client's oxygenation.
b) Call the RT to check the ventilator settings.
c) Listen for bilateral lung sounds.
d) Determine whether an air leak is present in the client's endotracheal tube cuff. -
ANSWER: a) Assess the client's oxygenation.
Which assessment finding best indicates that fluid resuscitation therapy for the
patient with hypertonic dehydration has acheived the desired effect?
a) Peripheral pulses changed from 1+ to 3+
b) Neck veins slightly distended @ 30 degrees
c) Serum sodium level has changed from 151 to 143.
d) Pulse oximetry shows oxygen saturation of 95% - ANSWER: c) Serum sodium level
has changed from 151 to 143.
Which intravenous solution should you be prepared to administer to a patient with
isotonic dehydration?
a) 0.45% saline
b) Dextrose 5% in water
c) Dextrose 10% in water
d) 0.9% saline - ANSWER: d) 0.9% saline
A patient is receiving dobutamine [Dobutrex] as a continuous infusion in the
immediate postoperative period. The patient also is receiving a diuretic. What
adverse drug reactions are possible in this patient? (select all that apply)
a)Angina
b)Hypotension
c)Dysrhythmias
d)Oliguria
e)Tachycardia - ANSWER: a)Angina
c)Dysrhythmias
e)Tachycardia
*Is a beta1 aderenergic agonist; general anesthetics can increase the likelihood of
dysrhythmias. Dobutamine elevates BP by increasing CO. Diuretics complement the
,beneficial effects of dobutamine on the kidney, so urine output would be increased,
not decreased.
A patient who has severe sepsis is receiving an intravenous normal saline infusion.
She weighs 78 kgs. Which of the following is an indicator that the therapeutic goal
has been met?
a) 250 mL of urine in the past 6 hours
b) Arterial blood pressure is 90/42
c) Central Venous Pressure is 2 mm Hg
d) Patient's heart rate is 101 - ANSWER: a) 250 mL of urine in the past 6 hours
*Fluid resuscitation goals in sepsis are: MAP > 65, UO . 0.5 mL/kg/hr, and/or CVP 8-
12 mm Hg.
The nurse is caring for Mrs. B, who has a pulmonary embolus. She is started on a
heparin drip and 4 hours later the aPTT is 70 seconds (lab control or "normal" value
is 40 secs). The nurse should:
a) Notify the provider and request an order for warfarin (Coumadin).
b) Notify the provider and request a decrease in the heparin dose.
c) Continue the present order for heparin.
d) Hold the heparin and notify the physician. - ANSWER: c) Continue the present
order for heparin.
*The aPTT is therapeutic for a heparinized patient with a PE. A therapeutic aPTT for a
heparinized patient is 1.5-2x the "normal" or "control" value. Review also the
heparin protocol calculations. We did an example on the PE case study.
A patient with a diagnosis of myocardial infarction is admitted to your unit. Which of
the patient's statements would alert you to the possibility of acute heart failure?
a) "I think my dose of digoxin may need to be increased."
b) "I have noticed a lack of appetite lately."
c) "I have trouble remembering things lately."
d) "I'm feeling short of breath when I walk to the bathroom." - ANSWER: d) "I'm
feeling short of breath when I walk to the bathroom."
*Activity intolerance is a symptom of heart failure, due to dyspnea on exertion.
The nurse is caring for patients on a cardiac unit. Which patient should the nurse
assess first?
a) The patient diagnosed with Heart Failure who has bilateral 3+ peripheral edema.
b) The patient diagnosed with mitral valve regurgitation who has dyspnea on
exertion.
c) The patient diagnosed with angina who is reporting chest pain.
d) The patient diagnosed with pericarditis who has a temperature of 100 degrees F. -
ANSWER: c) The patient diagnosed with angina who is reporting chest pain.
, *A patient with a history of angina should be pain-free. If he/she is not, then there
may be myocardial ischemia occurring. All of the other choices represent expected,
but non-lifethreatening findings for the diagnosis.
The nurse is caring for a patient with Diabetic Ketoacidosis. Which of the following is
the most concerning assessment finding?
a) Blood pressure is 103/78.
b) Blood sugar is 565.
c) Urine is dark and cloudy.
d) Patient is confused and agitated. - ANSWER: d) Patient is confused and agitated.
*A patient in DKA is at risk for impaired central perfusion, secondary to hypovolemia.
Confused and agitated is an indicator of poor perfusion to the brain and is the
priority issue. Blood pressure is acceptable, but note the narrowed pulse pressure
indicating compensatory vasoconstriction.
You are monitoring the patient undergoing exercise EKG (stress test). Which of the
following criteria would indicate that the test should be stopped prematurely?
a) If the patient's respiratory rate exceeds 24 breaths/minute
b) When the incline of the treadmill reaches 10% elevation
c) If the patient's EKG indicates significant ST segment depression
d) When the patient's heart rate reaches 120 beats/minute - ANSWER: c) If the
patient's EKG indicates significant ST segment depression
*ST depression may indicate cardiac ischemia. All other choices are expected.
A patient is admitted to the intensive care unit for treatment of shock. The
prescriber orders norepinephring (Levophed). The nurse expects this drug to
increase tissue perfusion in this patient by primarily activating:
a) alpha1 receptors to cause vasodilation.
b) beta2 receptors to cause bronchodilation.
c) beta1 receptors to cause a positive inotropic effect.
d) alpha1 receptors to increase blood pressure. - ANSWER: d) alpha1 receptors to
increase blood pressure.
A patient comes into the emergency department with extensive bleeding from face,
arm, and chest wounds. What is the earliest manifestation of hypovolemic shock
likely to be detected in this patient?
a) Increased respiratory rate.
b) Increased heart rate.
c) Decreased blood pressure.
d) Cool, pale skin. - ANSWER: b) Increased heart rate.
Your patient had sudden, sharp chest pain and is breathing rapidly. The provisional
diagnosis is acute pulmonary embolism. Which of the following arterial blood gas
results would you expect to see during the first 20 minutes after the start of this
episode?
