NYC DCAS ELECTRICIAN EXAM - ()
UP-TO-DATE ACTUAL EXAM QUESTIONS AND
100% ACCURATE SOLUTIONS | VERIFIED
1. A patient with diabetic ketoacidosis (DKA) presents with serum glucose 450 mg/dL, pH 7.1,
bicarbonate 10 mEq/L, and anion gap 20. After initiating intravenous fluids and insulin therapy,
which laboratory finding best indicates resolution of the ketoacidosis?
A. Bicarbonate >20 mEq/L
B. Anion gap <12 mEq/L
C. pH >7.35
D. Serum glucose <200 mg/dL
Answer: B
Rationale: Resolution of DKA is defined by closure of the anion gap (<12). Glucose may normalize
before acidosis resolves. Bicarbonate and pH improve but lag behind anion gap normalization. Using
glucose as endpoint risks premature insulin cessation.
2. A nurse is providing discharge teaching to a client with a new colostomy. Which statement by
the client indicates understanding of stoma care?
A. I should expect the stoma to be dark purple and dry.
B. I should expect the stoma to be blue and moist.
C. I should expect the stoma to be bright red and moist.
D. I should expect the stoma to be pale and dry.
Answer: C
Rationale: A healthy stoma is bright red and moist (like oral mucosa). Alcohol damages the stoma tissue.
Pouches are changed every 3-7 days, not daily. Heating pads can cause burns; stomas have no nerve
endings, so injury may go unnoticed.
3. A nurse is preparing to administer a blood transfusion to a patient with a history of multiple
transfusions. Which premedication order should the nurse question?
A. Furosemide 40 mg intravenously
B. Diphenhydramine 25 mg orally
C. Acetaminophen 650 mg orally
D. Hydrocortisone 100 mg intravenously
Answer: A
Rationale: Furosemide is sometimes used to prevent fluid overload, but it is not a standard premedication
for transfusion reactions. Options A, B, and C are commonly used to prevent allergic or febrile
reactions. The nurse should question the furosemide order unless there is specific indication of fluid
overload risk.
Page 1
,4. A nurse is caring for a patient with chronic kidney disease who has an elevated serum phosphate
level. Which medication order should the nurse anticipate?
A. Aluminum hydroxide 600 mg orally three times daily.
B. Sevelamer carbonate 800 mg orally with meals.
C. Sodium polystyrene sulfonate 15 g orally four times daily.
D. Calcium carbonate 500 mg orally once daily.
Answer: B
Rationale: Hyperphosphatemia in CKD is managed with phosphate binders. Sevelamer is a
non-calcium-based binder that reduces phosphate without contributing to calcium load. Calcium-based
binders (Option A) are avoided due to hypercalcemia risk. Cinacalcet treats secondary
hyperparathyroidism. Calcitriol increases calcium absorption.
5. A client with a history of atrial fibrillation on warfarin therapy presents with an INR of 5.8 and
minor epistaxis. Which intervention is most appropriate?
A. Administer fresh frozen plasma (FFP) immediately
B. Increase the dose of warfarin to achieve therapeutic INR
C. Hold warfarin and administer vitamin K 1 mg orally
D. Administer vitamin K 10 mg intravenously
Answer: C
Rationale: For an elevated INR >5 with minor bleeding, oral vitamin K is recommended to lower INR
within 24 hours. FFP or PCC is reserved for life-threatening bleeding. Observation alone is
inappropriate because bleeding has occurred. The risk of thrombosis from reversal must be weighed, but
in this case, minor bleeding warrants intervention.
6. A nurse is caring for a patient with acute respiratory distress syndrome (ARDS) who is receiving
volume-controlled mechanical ventilation. The ventilator alarm indicates high peak airway
pressure. Which intervention should the nurse perform first?
A. Suction the endotracheal tube
B. Increase the tidal volume setting
C. Administer a bronchodilator as prescribed
D. Check the patient for a pneumothorax
Answer: A
Rationale: High peak pressure often indicates airway obstruction, such as mucus plugging or kinked
tubing. Suctioning is the priority to clear secretions. Option B is appropriate after suctioning if
bronchospasm is suspected. Option C addresses oxygenation, not pressure. Option D is more relevant
for low pressure alarms.
7. A patient with a history of chronic heart failure presents with dyspnea, orthopnea, and bilateral
lower extremity edema. Vital signs: BP 98/62 mm Hg, HR 110/min, RR 28/min, SpO2 88% on
room air. Which combination of interventions should the nurse initiate first?
A. Administer metoprolol IV, place patient in supine position, apply oxygen via non-rebreather mask at 15
L/min.
Page 2
,B. Administer furosemide IV, place patient in high Fowler's position, apply oxygen via nasal cannula at 2 L/min.
C. Administer digoxin PO, place patient in semi-Fowler's position, apply oxygen via simple face mask at 6 L/min.
D. Administer morphine sulfate IV, place patient in Trendelenburg position, apply oxygen via nasal cannula at 4 L/min.
Answer: B
Rationale: The patient is experiencing acute decompensated heart failure with pulmonary congestion and
hypoxemia. Furosemide reduces preload through diuresis, high Fowler's position optimizes
ventilation-perfusion matching, and low-flow oxygen corrects hypoxemia without causing
vasoconstriction. The other options include inappropriate medications (e.g., metoprolol in acute
decompensation), incorrect positions (e.g., supine worsens dyspnea), or excessive oxygen delivery.
8. A nurse is evaluating a client's understanding of a low-sodium diet. Which meal selection
indicates the need for further teaching?
A. Baked salmon with quinoa and asparagus
B. Grilled chicken breast with steamed vegetables
C. Canned tomato soup with a grilled cheese sandwich
D. Fresh fruit salad with plain yogurt
Answer: C
Rationale: Canned tomato soup and processed cheese are high in sodium. A low-sodium diet requires
limiting processed and canned foods. The other options consist of fresh or minimally processed foods
that are generally lower in sodium.
9. A nurse is reviewing arterial blood gas (ABG) results for a client with diabetic ketoacidosis
(DKA) who is receiving an insulin infusion and 0.45% sodium chloride. The ABG results are: pH
7.30, PaCO2 30 mm Hg, HCO3- 15 mEq/L. Which acid-base disorder is primarily present, and
what is the most appropriate nursing intervention?
A. Metabolic acidosis with appropriate respiratory compensation; continue current therapy and monitor serum
potassium.
B. Respiratory acidosis with metabolic compensation; increase the insulin infusion rate.
C. Mixed metabolic acidosis and respiratory alkalosis; administer sodium bicarbonate.
D. Metabolic alkalosis with respiratory compensation; administer potassium chloride.
Answer: A
Rationale: The pH of 7.30 indicates acidemia. The low HCO3- (15 mEq/L) confirms primary metabolic
acidosis. The PaCO2 is low (30 mm Hg), which is an appropriate compensatory respiratory alkalosis
(expected PaCO2 = 1.5 × HCO3- + 8 ± 2 = 30.5 ± 2). Thus, compensation is adequate. Sodium
bicarbonate is not recommended in DKA unless pH < 6.9. Continuing insulin and IV fluids, with careful
potassium monitoring, is standard. Option B is incorrect because the primary disorder is metabolic, not
respiratory. Option C is wrong because compensation is adequate. Option D is wrong because there is
no respiratory acidosis component.
Page 3
, 10. A client with a history of chronic heart failure presents with acute dyspnea, jugular venous
distention, and crackles in both lung bases. The nurse notes that the client has been nonadherent
with the prescribed low-sodium diet. Which pathophysiological mechanism best explains the
exacerbation?
A. Increased preload leading to pulmonary congestion from fluid volume excess.
B. Decreased afterload causing reduced cardiac output and systemic congestion.
C. Pulmonary vasoconstriction due to hypoxia leading to right ventricular failure.
D. Increased myocardial contractility resulting in elevated oxygen demand and ischemia.
Answer: A
Rationale: Sodium retention increases intravascular volume (preload), overwhelming the failing left
ventricle and causing pulmonary congestion. Afterload is not directly increased by sodium; contractility
is not primarily affected by sodium; hypoxia is a consequence, not the mechanism.
11. A patient with cirrhosis and ascites is started on furosemide and spironolactone. After three
days, the patient develops confusion, asterixis, and a serum ammonia level of 120 mcg/dL (normal
15-45). Which laboratory finding most likely precipitated this change?
A. Serum sodium 130 mEq/L
B. Serum creatinine 1.8 mg/dL
C. Serum potassium 3.1 mEq/L
D. Serum albumin 2.5 g/dL
Answer: C
Rationale: Hypokalemia (K+ 3.1) is a common precipitant of hepatic encephalopathy in cirrhosis, as it
increases renal ammonia production and promotes ammonia diffusion into the brain. Hyponatremia
(option A) can contribute but is less directly linked. Azotemia (option C) and hypoalbuminemia (option
D) are common in cirrhosis but not acute triggers.
12. A nurse is caring for a client receiving a continuous intravenous infusion of heparin. The
client's activated partial thromboplastin time (aPTT) is 98 seconds. Which of the following actions
should the nurse anticipate?
A. Administer protamine sulfate
B. Decrease the heparin infusion rate
C. Increase the heparin infusion rate
D. Discontinue the heparin infusion immediately
Answer: B
Rationale: The therapeutic aPTT range for heparin therapy is typically 1.5 to 2.5 times the control value
(usually 30-40 seconds), so 60-100 seconds. An aPTT of 98 seconds is at the upper limit, but still within
therapeutic range. However, to avoid bleeding, the nurse should anticipate decreasing the infusion rate
if the value is near the upper limit. Option A would increase bleeding risk. Option C is for severe
bleeding or heparin overdose. Option D is incorrect because a slight decrease may be warranted.
13. A nurse is assessing a client with a serum magnesium level of 1.0 mEq/L. Which clinical finding
should the nurse anticipate?
Page 4
UP-TO-DATE ACTUAL EXAM QUESTIONS AND
100% ACCURATE SOLUTIONS | VERIFIED
1. A patient with diabetic ketoacidosis (DKA) presents with serum glucose 450 mg/dL, pH 7.1,
bicarbonate 10 mEq/L, and anion gap 20. After initiating intravenous fluids and insulin therapy,
which laboratory finding best indicates resolution of the ketoacidosis?
A. Bicarbonate >20 mEq/L
B. Anion gap <12 mEq/L
C. pH >7.35
D. Serum glucose <200 mg/dL
Answer: B
Rationale: Resolution of DKA is defined by closure of the anion gap (<12). Glucose may normalize
before acidosis resolves. Bicarbonate and pH improve but lag behind anion gap normalization. Using
glucose as endpoint risks premature insulin cessation.
2. A nurse is providing discharge teaching to a client with a new colostomy. Which statement by
the client indicates understanding of stoma care?
A. I should expect the stoma to be dark purple and dry.
B. I should expect the stoma to be blue and moist.
C. I should expect the stoma to be bright red and moist.
D. I should expect the stoma to be pale and dry.
Answer: C
Rationale: A healthy stoma is bright red and moist (like oral mucosa). Alcohol damages the stoma tissue.
Pouches are changed every 3-7 days, not daily. Heating pads can cause burns; stomas have no nerve
endings, so injury may go unnoticed.
3. A nurse is preparing to administer a blood transfusion to a patient with a history of multiple
transfusions. Which premedication order should the nurse question?
A. Furosemide 40 mg intravenously
B. Diphenhydramine 25 mg orally
C. Acetaminophen 650 mg orally
D. Hydrocortisone 100 mg intravenously
Answer: A
Rationale: Furosemide is sometimes used to prevent fluid overload, but it is not a standard premedication
for transfusion reactions. Options A, B, and C are commonly used to prevent allergic or febrile
reactions. The nurse should question the furosemide order unless there is specific indication of fluid
overload risk.
Page 1
,4. A nurse is caring for a patient with chronic kidney disease who has an elevated serum phosphate
level. Which medication order should the nurse anticipate?
A. Aluminum hydroxide 600 mg orally three times daily.
B. Sevelamer carbonate 800 mg orally with meals.
C. Sodium polystyrene sulfonate 15 g orally four times daily.
D. Calcium carbonate 500 mg orally once daily.
Answer: B
Rationale: Hyperphosphatemia in CKD is managed with phosphate binders. Sevelamer is a
non-calcium-based binder that reduces phosphate without contributing to calcium load. Calcium-based
binders (Option A) are avoided due to hypercalcemia risk. Cinacalcet treats secondary
hyperparathyroidism. Calcitriol increases calcium absorption.
5. A client with a history of atrial fibrillation on warfarin therapy presents with an INR of 5.8 and
minor epistaxis. Which intervention is most appropriate?
A. Administer fresh frozen plasma (FFP) immediately
B. Increase the dose of warfarin to achieve therapeutic INR
C. Hold warfarin and administer vitamin K 1 mg orally
D. Administer vitamin K 10 mg intravenously
Answer: C
Rationale: For an elevated INR >5 with minor bleeding, oral vitamin K is recommended to lower INR
within 24 hours. FFP or PCC is reserved for life-threatening bleeding. Observation alone is
inappropriate because bleeding has occurred. The risk of thrombosis from reversal must be weighed, but
in this case, minor bleeding warrants intervention.
6. A nurse is caring for a patient with acute respiratory distress syndrome (ARDS) who is receiving
volume-controlled mechanical ventilation. The ventilator alarm indicates high peak airway
pressure. Which intervention should the nurse perform first?
A. Suction the endotracheal tube
B. Increase the tidal volume setting
C. Administer a bronchodilator as prescribed
D. Check the patient for a pneumothorax
Answer: A
Rationale: High peak pressure often indicates airway obstruction, such as mucus plugging or kinked
tubing. Suctioning is the priority to clear secretions. Option B is appropriate after suctioning if
bronchospasm is suspected. Option C addresses oxygenation, not pressure. Option D is more relevant
for low pressure alarms.
7. A patient with a history of chronic heart failure presents with dyspnea, orthopnea, and bilateral
lower extremity edema. Vital signs: BP 98/62 mm Hg, HR 110/min, RR 28/min, SpO2 88% on
room air. Which combination of interventions should the nurse initiate first?
A. Administer metoprolol IV, place patient in supine position, apply oxygen via non-rebreather mask at 15
L/min.
Page 2
,B. Administer furosemide IV, place patient in high Fowler's position, apply oxygen via nasal cannula at 2 L/min.
C. Administer digoxin PO, place patient in semi-Fowler's position, apply oxygen via simple face mask at 6 L/min.
D. Administer morphine sulfate IV, place patient in Trendelenburg position, apply oxygen via nasal cannula at 4 L/min.
Answer: B
Rationale: The patient is experiencing acute decompensated heart failure with pulmonary congestion and
hypoxemia. Furosemide reduces preload through diuresis, high Fowler's position optimizes
ventilation-perfusion matching, and low-flow oxygen corrects hypoxemia without causing
vasoconstriction. The other options include inappropriate medications (e.g., metoprolol in acute
decompensation), incorrect positions (e.g., supine worsens dyspnea), or excessive oxygen delivery.
8. A nurse is evaluating a client's understanding of a low-sodium diet. Which meal selection
indicates the need for further teaching?
A. Baked salmon with quinoa and asparagus
B. Grilled chicken breast with steamed vegetables
C. Canned tomato soup with a grilled cheese sandwich
D. Fresh fruit salad with plain yogurt
Answer: C
Rationale: Canned tomato soup and processed cheese are high in sodium. A low-sodium diet requires
limiting processed and canned foods. The other options consist of fresh or minimally processed foods
that are generally lower in sodium.
9. A nurse is reviewing arterial blood gas (ABG) results for a client with diabetic ketoacidosis
(DKA) who is receiving an insulin infusion and 0.45% sodium chloride. The ABG results are: pH
7.30, PaCO2 30 mm Hg, HCO3- 15 mEq/L. Which acid-base disorder is primarily present, and
what is the most appropriate nursing intervention?
A. Metabolic acidosis with appropriate respiratory compensation; continue current therapy and monitor serum
potassium.
B. Respiratory acidosis with metabolic compensation; increase the insulin infusion rate.
C. Mixed metabolic acidosis and respiratory alkalosis; administer sodium bicarbonate.
D. Metabolic alkalosis with respiratory compensation; administer potassium chloride.
Answer: A
Rationale: The pH of 7.30 indicates acidemia. The low HCO3- (15 mEq/L) confirms primary metabolic
acidosis. The PaCO2 is low (30 mm Hg), which is an appropriate compensatory respiratory alkalosis
(expected PaCO2 = 1.5 × HCO3- + 8 ± 2 = 30.5 ± 2). Thus, compensation is adequate. Sodium
bicarbonate is not recommended in DKA unless pH < 6.9. Continuing insulin and IV fluids, with careful
potassium monitoring, is standard. Option B is incorrect because the primary disorder is metabolic, not
respiratory. Option C is wrong because compensation is adequate. Option D is wrong because there is
no respiratory acidosis component.
Page 3
, 10. A client with a history of chronic heart failure presents with acute dyspnea, jugular venous
distention, and crackles in both lung bases. The nurse notes that the client has been nonadherent
with the prescribed low-sodium diet. Which pathophysiological mechanism best explains the
exacerbation?
A. Increased preload leading to pulmonary congestion from fluid volume excess.
B. Decreased afterload causing reduced cardiac output and systemic congestion.
C. Pulmonary vasoconstriction due to hypoxia leading to right ventricular failure.
D. Increased myocardial contractility resulting in elevated oxygen demand and ischemia.
Answer: A
Rationale: Sodium retention increases intravascular volume (preload), overwhelming the failing left
ventricle and causing pulmonary congestion. Afterload is not directly increased by sodium; contractility
is not primarily affected by sodium; hypoxia is a consequence, not the mechanism.
11. A patient with cirrhosis and ascites is started on furosemide and spironolactone. After three
days, the patient develops confusion, asterixis, and a serum ammonia level of 120 mcg/dL (normal
15-45). Which laboratory finding most likely precipitated this change?
A. Serum sodium 130 mEq/L
B. Serum creatinine 1.8 mg/dL
C. Serum potassium 3.1 mEq/L
D. Serum albumin 2.5 g/dL
Answer: C
Rationale: Hypokalemia (K+ 3.1) is a common precipitant of hepatic encephalopathy in cirrhosis, as it
increases renal ammonia production and promotes ammonia diffusion into the brain. Hyponatremia
(option A) can contribute but is less directly linked. Azotemia (option C) and hypoalbuminemia (option
D) are common in cirrhosis but not acute triggers.
12. A nurse is caring for a client receiving a continuous intravenous infusion of heparin. The
client's activated partial thromboplastin time (aPTT) is 98 seconds. Which of the following actions
should the nurse anticipate?
A. Administer protamine sulfate
B. Decrease the heparin infusion rate
C. Increase the heparin infusion rate
D. Discontinue the heparin infusion immediately
Answer: B
Rationale: The therapeutic aPTT range for heparin therapy is typically 1.5 to 2.5 times the control value
(usually 30-40 seconds), so 60-100 seconds. An aPTT of 98 seconds is at the upper limit, but still within
therapeutic range. However, to avoid bleeding, the nurse should anticipate decreasing the infusion rate
if the value is near the upper limit. Option A would increase bleeding risk. Option C is for severe
bleeding or heparin overdose. Option D is incorrect because a slight decrease may be warranted.
13. A nurse is assessing a client with a serum magnesium level of 1.0 mEq/L. Which clinical finding
should the nurse anticipate?
Page 4
