NUR 257 EXAM with Questions and
Answers/Plus a Rationale Updated 2026
A+/Instant Download PDF
Table of Contents
1. Fluid and Electrolyte Imbalances and Acid-Base Disturbances
2. Care of the Client with Respiratory Disorders
3. Management of Cardiovascular and Circulatory Emergencies
4. Endocrine System Dysfunction and Hormonal Regulation
5. Neurological Assessment and Complex Patient Care
1. A patient with a history of chronic obstructive pulmonary disease (COPD) presents with an
arterial blood gas (ABG) showing pH 7.31, $PaCO_2$ 58 mmHg, $HCO_3^-$ 28 mEq/L, and
$PaO_2$ 58 mmHg. Which nursing intervention is the highest priority?
A. Administering sodium bicarbonate intravenously.
B. Initiating low-flow oxygen therapy and assessing the patient's respiratory drive.
C. Increasing the patient's intake of fluids to thin secretions.
D. Preparing the patient for immediate intubation and mechanical ventilation.
CORRECT ANSWER : B
Rationale: The ABG results indicate partially compensated respiratory acidosis with hypoxemia.
Because the patient has COPD, their respiratory drive may be dependent on low oxygen levels;
therefore, high-flow oxygen could suppress this drive. Sodium bicarbonate is contraindicated in
respiratory acidosis, and intubation is not yet indicated as the patient is showing some
compensation.
,2. A client is admitted with severe vomiting and diarrhea. Laboratory results show sodium 152
mEq/L, potassium 3.1 mEq/L, and serum osmolality 315 mOsm/kg. Which clinical manifestation
should the nurse anticipate?
A. Muscle twitching and hyperactive deep tendon reflexes.
B. Confusion, agitation, and extreme thirst.
C. Bradycardia and flattened T waves on the ECG.
D. Lethargy, bradycardia, and fluid overload.
CORRECT ANSWER : B
Rationale: The client is experiencing hypernatremia (Na > 145) and dehydration (high serum
osmolality). Hypernatremia pulls water out of brain cells, leading to neurological symptoms like
confusion and agitation, while the loss of fluid causes extreme thirst. Option A describes
hyponatremia, C describes hypokalemia, and D describes water intoxication.
3. A patient with heart failure is receiving furosemide 40 mg IV push. Prior to administration, the
nurse notes a potassium level of 2.8 mEq/L. What is the most appropriate action?
A. Administer the furosemide as ordered.
B. Hold the medication and notify the healthcare provider to request a potassium
supplement.
C. Administer half the dose of furosemide.
D. Increase the patient's dietary potassium intake immediately.
CORRECT ANSWER : B
Rationale: Furosemide is a loop diuretic that causes potassium excretion. Administering it to a
patient with hypokalemia (2.8 mEq/L) could trigger life-threatening cardiac arrhythmias. The
nurse must hold the dose to prevent further depletion and ensure safety.
4. A patient in the ICU is being mechanically ventilated. Recent ABGs show pH 7.52, $PaCO_2$
30 mmHg, $HCO_3^-$ 24 mEq/L. What adjustment should the nurse expect?
A. Increasing the ventilator tidal volume.
B. Decreasing the ventilator rate or tidal volume to allow $CO_2$ retention.
C. Administering a sedative to decrease the patient's own breathing rate.
, D. Increasing the oxygen percentage (FiO2) delivered.
CORRECT ANSWER : B
Rationale: The ABGs indicate respiratory alkalosis caused by hyperventilation (low $CO_2$
from high ventilator settings). The nurse should anticipate reducing the ventilator rate or volume
to allow the patient's $CO_2$ levels to rise back to the normal range. Increasing settings would
worsen the alkalosis.
5. A client with Addison’s disease is admitted in adrenal crisis. Which laboratory finding is the
nurse most likely to observe?
A. Hyperglycemia and hyperkalemia.
B. Hyponatremia and hyperkalemia.
C. Hypokalemia and hypernatremia.
D. Hyperglycemia and hypokalemia.
CORRECT ANSWER : B
Rationale: Addison’s disease results in a deficiency of aldosterone and cortisol. Aldosterone
deficiency causes the kidneys to excrete sodium (leading to hyponatremia) and retain potassium
(leading to hyperkalemia). The other options represent Cushing's syndrome or normal states.
6. A patient with a head injury develops polyuria (8 liters/day), low urine specific gravity, and
hypernatremia. The nurse suspects diabetes insipidus. Which assessment finding supports this?
A. Elevated blood glucose levels.
B. Excessive thirst (polydipsia) and diluted urine.
C. Hypertension and peripheral edema.
D. Weight gain and decreased serum osmolality.
CORRECT ANSWER : B
Rationale: Diabetes insipidus (DI) is caused by a deficiency of ADH, leading to an inability to
concentrate urine. This results in massive fluid loss, diluted urine (low specific gravity), and
extreme thirst as the body tries to compensate. High blood glucose relates to diabetes mellitus,
not DI.
7. A patient is prescribed spironolactone. Which teaching point is most critical for the nurse to
include?
, A. "Increase your intake of bananas and oranges."
B. "Avoid salt substitutes that contain potassium."
C. "Take this medication on an empty stomach."
D. "Monitor your weight daily to watch for rapid weight loss."
CORRECT ANSWER : B
Rationale: Spironolactone is a potassium-sparing diuretic. Unlike loop diuretics, it retains
potassium. Patients must avoid potassium-rich salt substitutes to prevent dangerous
hyperkalemia. Option A would increase the risk of hyperkalemia.
8. A client has a chest tube connected to a water-seal drainage system. Upon assessment, the nurse
notes continuous bubbling in the water-seal chamber. What should the nurse conclude?
A. This is a normal finding in a patient with a pneumothorax.
B. There is an air leak in the chest tube system.
C. The lung has fully re-expanded.
D. The suction pressure is set too low.
CORRECT ANSWER : B
Rationale: Continuous bubbling in the water-seal chamber indicates that air is entering the
system from somewhere other than the patient’s pleural space (an air leak). Occasional bubbling
is normal for a pneumothorax, but continuous bubbling indicates a breach in the system's
integrity.
9. A patient is brought to the ED after a motor vehicle accident. The nurse notes tracheal deviation
to the left, absent breath sounds on the right side, and hypotension. What is the priority
intervention?
A. Obtain a chest X-ray.
B. Prepare for immediate needle decompression followed by chest tube insertion.
C. Administer high-flow oxygen via non-rebreather mask.
D. Start two large-bore IV lines.
CORRECT ANSWER : B
Answers/Plus a Rationale Updated 2026
A+/Instant Download PDF
Table of Contents
1. Fluid and Electrolyte Imbalances and Acid-Base Disturbances
2. Care of the Client with Respiratory Disorders
3. Management of Cardiovascular and Circulatory Emergencies
4. Endocrine System Dysfunction and Hormonal Regulation
5. Neurological Assessment and Complex Patient Care
1. A patient with a history of chronic obstructive pulmonary disease (COPD) presents with an
arterial blood gas (ABG) showing pH 7.31, $PaCO_2$ 58 mmHg, $HCO_3^-$ 28 mEq/L, and
$PaO_2$ 58 mmHg. Which nursing intervention is the highest priority?
A. Administering sodium bicarbonate intravenously.
B. Initiating low-flow oxygen therapy and assessing the patient's respiratory drive.
C. Increasing the patient's intake of fluids to thin secretions.
D. Preparing the patient for immediate intubation and mechanical ventilation.
CORRECT ANSWER : B
Rationale: The ABG results indicate partially compensated respiratory acidosis with hypoxemia.
Because the patient has COPD, their respiratory drive may be dependent on low oxygen levels;
therefore, high-flow oxygen could suppress this drive. Sodium bicarbonate is contraindicated in
respiratory acidosis, and intubation is not yet indicated as the patient is showing some
compensation.
,2. A client is admitted with severe vomiting and diarrhea. Laboratory results show sodium 152
mEq/L, potassium 3.1 mEq/L, and serum osmolality 315 mOsm/kg. Which clinical manifestation
should the nurse anticipate?
A. Muscle twitching and hyperactive deep tendon reflexes.
B. Confusion, agitation, and extreme thirst.
C. Bradycardia and flattened T waves on the ECG.
D. Lethargy, bradycardia, and fluid overload.
CORRECT ANSWER : B
Rationale: The client is experiencing hypernatremia (Na > 145) and dehydration (high serum
osmolality). Hypernatremia pulls water out of brain cells, leading to neurological symptoms like
confusion and agitation, while the loss of fluid causes extreme thirst. Option A describes
hyponatremia, C describes hypokalemia, and D describes water intoxication.
3. A patient with heart failure is receiving furosemide 40 mg IV push. Prior to administration, the
nurse notes a potassium level of 2.8 mEq/L. What is the most appropriate action?
A. Administer the furosemide as ordered.
B. Hold the medication and notify the healthcare provider to request a potassium
supplement.
C. Administer half the dose of furosemide.
D. Increase the patient's dietary potassium intake immediately.
CORRECT ANSWER : B
Rationale: Furosemide is a loop diuretic that causes potassium excretion. Administering it to a
patient with hypokalemia (2.8 mEq/L) could trigger life-threatening cardiac arrhythmias. The
nurse must hold the dose to prevent further depletion and ensure safety.
4. A patient in the ICU is being mechanically ventilated. Recent ABGs show pH 7.52, $PaCO_2$
30 mmHg, $HCO_3^-$ 24 mEq/L. What adjustment should the nurse expect?
A. Increasing the ventilator tidal volume.
B. Decreasing the ventilator rate or tidal volume to allow $CO_2$ retention.
C. Administering a sedative to decrease the patient's own breathing rate.
, D. Increasing the oxygen percentage (FiO2) delivered.
CORRECT ANSWER : B
Rationale: The ABGs indicate respiratory alkalosis caused by hyperventilation (low $CO_2$
from high ventilator settings). The nurse should anticipate reducing the ventilator rate or volume
to allow the patient's $CO_2$ levels to rise back to the normal range. Increasing settings would
worsen the alkalosis.
5. A client with Addison’s disease is admitted in adrenal crisis. Which laboratory finding is the
nurse most likely to observe?
A. Hyperglycemia and hyperkalemia.
B. Hyponatremia and hyperkalemia.
C. Hypokalemia and hypernatremia.
D. Hyperglycemia and hypokalemia.
CORRECT ANSWER : B
Rationale: Addison’s disease results in a deficiency of aldosterone and cortisol. Aldosterone
deficiency causes the kidneys to excrete sodium (leading to hyponatremia) and retain potassium
(leading to hyperkalemia). The other options represent Cushing's syndrome or normal states.
6. A patient with a head injury develops polyuria (8 liters/day), low urine specific gravity, and
hypernatremia. The nurse suspects diabetes insipidus. Which assessment finding supports this?
A. Elevated blood glucose levels.
B. Excessive thirst (polydipsia) and diluted urine.
C. Hypertension and peripheral edema.
D. Weight gain and decreased serum osmolality.
CORRECT ANSWER : B
Rationale: Diabetes insipidus (DI) is caused by a deficiency of ADH, leading to an inability to
concentrate urine. This results in massive fluid loss, diluted urine (low specific gravity), and
extreme thirst as the body tries to compensate. High blood glucose relates to diabetes mellitus,
not DI.
7. A patient is prescribed spironolactone. Which teaching point is most critical for the nurse to
include?
, A. "Increase your intake of bananas and oranges."
B. "Avoid salt substitutes that contain potassium."
C. "Take this medication on an empty stomach."
D. "Monitor your weight daily to watch for rapid weight loss."
CORRECT ANSWER : B
Rationale: Spironolactone is a potassium-sparing diuretic. Unlike loop diuretics, it retains
potassium. Patients must avoid potassium-rich salt substitutes to prevent dangerous
hyperkalemia. Option A would increase the risk of hyperkalemia.
8. A client has a chest tube connected to a water-seal drainage system. Upon assessment, the nurse
notes continuous bubbling in the water-seal chamber. What should the nurse conclude?
A. This is a normal finding in a patient with a pneumothorax.
B. There is an air leak in the chest tube system.
C. The lung has fully re-expanded.
D. The suction pressure is set too low.
CORRECT ANSWER : B
Rationale: Continuous bubbling in the water-seal chamber indicates that air is entering the
system from somewhere other than the patient’s pleural space (an air leak). Occasional bubbling
is normal for a pneumothorax, but continuous bubbling indicates a breach in the system's
integrity.
9. A patient is brought to the ED after a motor vehicle accident. The nurse notes tracheal deviation
to the left, absent breath sounds on the right side, and hypotension. What is the priority
intervention?
A. Obtain a chest X-ray.
B. Prepare for immediate needle decompression followed by chest tube insertion.
C. Administer high-flow oxygen via non-rebreather mask.
D. Start two large-bore IV lines.
CORRECT ANSWER : B
