,Galen NSG 3280 Exam 2 – Pathophysiology for
Nurses I (2026) Actual Q&A PDF
1. The nurse is reviewing the lab results of a patient with prolonged vomiting. Which arterial blood gas
finding is most consistent with this condition?
A) pH 7.30, PaCO₂ 40, HCO₃ 18
B) pH 7.48, PaCO₂ 42, HCO₃ 30
C) pH 7.33, PaCO₂ 50, HCO₃ 26
D) pH 7.46, PaCO₂ 30, HCO₃ 22
Correct Answer: pH 7.48, PaCO₂ 42, HCO₃ 30
Rationale: Vomiting causes loss of gastric hydrochloric acid, leading to metabolic alkalosis with an
elevated pH and elevated bicarbonate. The PaCO₂ is normal or slightly elevated as compensation
begins. This pattern is classic for metabolic alkalosis.
2. A patient with chronic kidney disease has a serum potassium of 6.5 mEq/L. Which ECG change is
most characteristic?
A) Prominent U waves
B) Peaked T waves
C) ST segment depression
D) Prolonged QT interval
Correct Answer: Peaked T waves
Rationale: Hyperkalemia causes tall, peaked T waves as the earliest ECG change, followed by loss of P
waves, widened QRS, and eventually ventricular fibrillation. U waves are seen in hypokalemia. The
nurse must recognize this pattern promptly.
3. The nurse is interpreting an ABG: pH 7.32, PaCO₂ 55, HCO₃ 28. This indicates:
A) Metabolic acidosis with partial compensation
,B) Respiratory acidosis with partial compensation
C) Metabolic alkalosis with full compensation
D) Respiratory alkalosis with no compensation
Correct Answer: Respiratory acidosis with partial compensation
Rationale: Low pH indicates acidosis. Elevated PaCO₂ (>45) points to a respiratory cause. The HCO₃ is
slightly elevated (28), indicating that the kidneys have begun to compensate, but the pH is still
abnormal, so compensation is partial.
4. Which intravenous fluid is classified as isotonic?
A) 0.45% sodium chloride
B) 5% dextrose in water (D5W) in the body
C) 0.9% sodium chloride
D) 3% sodium chloride
Correct Answer: 0.9% sodium chloride
Rationale: 0.9% normal saline has an osmolarity close to plasma (308 mOsm/L) and remains in the
extracellular space. 0.45% is hypotonic; 3% is hypertonic; D5W is isotonic in the bag but becomes
hypotonic when dextrose is metabolized.
5. A patient with syndrome of inappropriate antidiuretic hormone (SIADH) is at risk for which
electrolyte imbalance?
A) Hypernatremia
B) Hyponatremia
C) Hyperkalemia
D) Hypocalcemia
Correct Answer: Hyponatremia
, Rationale: SIADH causes excessive water reabsorption in the kidneys, leading to dilutional
hyponatremia (low serum sodium and low serum osmolality). Urine is concentrated. Treatment
includes fluid restriction and possibly hypertonic saline for severe symptoms.
6. The nurse is reviewing the lab results of a patient with acute kidney injury. The BUN is 45 mg/dL
and creatinine is 2.8 mg/dL. The BUN/creatinine ratio is approximately 16. This suggests:
A) Prerenal AKI
B) Intrarenal AKI
C) Postrenal AKI
D) Normal renal function
Correct Answer: Intrarenal AKI
Rationale: A BUN/creatinine ratio <20:1 (here 45/2.8 ≈ 16) is characteristic of intrarenal (intrinsic) AKI,
such as acute tubular necrosis. A ratio >20:1 suggests prerenal causes like dehydration. Both BUN and
creatinine are elevated, confirming injury.
7. A patient with post‑streptococcal glomerulonephritis asks why the urine looks dark. The nurse
explains that the cola‑colored urine is caused by:
A) Proteinuria
B) Hematuria
C) Bilirubinuria
D) Ketonuria
Correct Answer: Hematuria
Rationale: Acute glomerulonephritis causes inflammation of the glomeruli, allowing red blood cells to
pass into the urine, resulting in gross hematuria that appears cola‑ or tea‑colored. Red blood cell casts
may also be present on urinalysis.
8. Which finding is most characteristic of nephrotic syndrome?
Nurses I (2026) Actual Q&A PDF
1. The nurse is reviewing the lab results of a patient with prolonged vomiting. Which arterial blood gas
finding is most consistent with this condition?
A) pH 7.30, PaCO₂ 40, HCO₃ 18
B) pH 7.48, PaCO₂ 42, HCO₃ 30
C) pH 7.33, PaCO₂ 50, HCO₃ 26
D) pH 7.46, PaCO₂ 30, HCO₃ 22
Correct Answer: pH 7.48, PaCO₂ 42, HCO₃ 30
Rationale: Vomiting causes loss of gastric hydrochloric acid, leading to metabolic alkalosis with an
elevated pH and elevated bicarbonate. The PaCO₂ is normal or slightly elevated as compensation
begins. This pattern is classic for metabolic alkalosis.
2. A patient with chronic kidney disease has a serum potassium of 6.5 mEq/L. Which ECG change is
most characteristic?
A) Prominent U waves
B) Peaked T waves
C) ST segment depression
D) Prolonged QT interval
Correct Answer: Peaked T waves
Rationale: Hyperkalemia causes tall, peaked T waves as the earliest ECG change, followed by loss of P
waves, widened QRS, and eventually ventricular fibrillation. U waves are seen in hypokalemia. The
nurse must recognize this pattern promptly.
3. The nurse is interpreting an ABG: pH 7.32, PaCO₂ 55, HCO₃ 28. This indicates:
A) Metabolic acidosis with partial compensation
,B) Respiratory acidosis with partial compensation
C) Metabolic alkalosis with full compensation
D) Respiratory alkalosis with no compensation
Correct Answer: Respiratory acidosis with partial compensation
Rationale: Low pH indicates acidosis. Elevated PaCO₂ (>45) points to a respiratory cause. The HCO₃ is
slightly elevated (28), indicating that the kidneys have begun to compensate, but the pH is still
abnormal, so compensation is partial.
4. Which intravenous fluid is classified as isotonic?
A) 0.45% sodium chloride
B) 5% dextrose in water (D5W) in the body
C) 0.9% sodium chloride
D) 3% sodium chloride
Correct Answer: 0.9% sodium chloride
Rationale: 0.9% normal saline has an osmolarity close to plasma (308 mOsm/L) and remains in the
extracellular space. 0.45% is hypotonic; 3% is hypertonic; D5W is isotonic in the bag but becomes
hypotonic when dextrose is metabolized.
5. A patient with syndrome of inappropriate antidiuretic hormone (SIADH) is at risk for which
electrolyte imbalance?
A) Hypernatremia
B) Hyponatremia
C) Hyperkalemia
D) Hypocalcemia
Correct Answer: Hyponatremia
, Rationale: SIADH causes excessive water reabsorption in the kidneys, leading to dilutional
hyponatremia (low serum sodium and low serum osmolality). Urine is concentrated. Treatment
includes fluid restriction and possibly hypertonic saline for severe symptoms.
6. The nurse is reviewing the lab results of a patient with acute kidney injury. The BUN is 45 mg/dL
and creatinine is 2.8 mg/dL. The BUN/creatinine ratio is approximately 16. This suggests:
A) Prerenal AKI
B) Intrarenal AKI
C) Postrenal AKI
D) Normal renal function
Correct Answer: Intrarenal AKI
Rationale: A BUN/creatinine ratio <20:1 (here 45/2.8 ≈ 16) is characteristic of intrarenal (intrinsic) AKI,
such as acute tubular necrosis. A ratio >20:1 suggests prerenal causes like dehydration. Both BUN and
creatinine are elevated, confirming injury.
7. A patient with post‑streptococcal glomerulonephritis asks why the urine looks dark. The nurse
explains that the cola‑colored urine is caused by:
A) Proteinuria
B) Hematuria
C) Bilirubinuria
D) Ketonuria
Correct Answer: Hematuria
Rationale: Acute glomerulonephritis causes inflammation of the glomeruli, allowing red blood cells to
pass into the urine, resulting in gross hematuria that appears cola‑ or tea‑colored. Red blood cell casts
may also be present on urinalysis.
8. Which finding is most characteristic of nephrotic syndrome?
