[NUR 3300 EXAMS 1–4 – NURSING PRACTICE II]
EXAM WITH QUESTIONS AND ANSWERS/PLUS A
RATIONALE UPDATED 2026 A+/INSTANT
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Table of Contents
1. Advanced Medical-Surgical Nursing
2. Complex Pharmacological Interventions
3. Fluid and Electrolyte Homeostasis
4. Critical Care and Hemodynamic Monitoring
5. Professional Nursing Standards and Ethical Practice
1. A patient with severe acute pancreatitis exhibits a positive Trousseau’s sign and persistent
muscle tremors. Given the pathophysiology of this condition, which electrolyte imbalance is the
priority, and what is the most appropriate initial nursing intervention?
A. Hypokalemia; initiate continuous cardiac monitoring.
B. Hypocalcemia; administer calcium gluconate via slow IV push.
C. Hypermagnesemia; withhold all magnesium-containing antacids.
D. Hyponatremia; restrict free water intake to prevent cerebral edema.
Answer: B
CORRECT ANSWER : B
Rationale: Acute pancreatitis often causes calcium to precipitate into the retroperitoneal space,
leading to symptomatic hypocalcemia manifesting as tetany (Trousseau’s/Chvostek’s). Calcium
gluconate is the standard treatment to prevent life-threatening laryngeal stridor or arrhythmias,
, whereas options A, C, and D do not address the primary cause of the patient’s acute
neuromuscular symptoms.
2. A patient on mechanical ventilation with PEEP of 15 cm H2O suddenly develops hypotension
and tachycardia. Assessment reveals decreased breath sounds on the right side and tracheal
deviation to the left. What is the most immediate clinical priority?
A. Increase the tidal volume to improve oxygenation.
B. Obtain a stat portable chest X-ray to confirm placement.
C. Prepare for immediate needle thoracostomy or chest tube insertion.
D. Administer a fluid bolus to treat distributive shock.
Answer: C
CORRECT ANSWER : C
Rationale: The patient is exhibiting classic signs of a tension pneumothorax, likely exacerbated
by high PEEP. This is a medical emergency requiring immediate decompression (needle
thoracostomy) to relieve intrathoracic pressure; waiting for an X-ray (B) or providing fluids (D)
will delay life-saving intervention.
3. A patient receiving vancomycin for MRSA pneumonia develops flushing of the face, neck, and
upper chest shortly after the infusion begins. What is the most appropriate nursing action?
A. Discontinue the drug permanently and update the allergy record.
B. Slow the infusion rate and monitor the patient for respiratory distress.
C. Administer an intramuscular injection of epinephrine.
D. Request a change to a different class of antibiotic immediately.
Answer: B
CORRECT ANSWER : B
Rationale: This presentation describes "Red Man Syndrome," an infusion-related reaction
caused by rapid histamine release, not a true IgE-mediated anaphylactic allergy. Slowing the
infusion rate usually resolves symptoms, whereas stopping the drug (A) or using epinephrine (C)
is reserved for true anaphylaxis.
4. A patient with cirrhosis presents with ascites and a serum creatinine of 2.1 mg/dL. Which
medication order should the nurse question as it may exacerbate the patient’s renal status?
, A. Spironolactone 100 mg daily.
B. Ketorolac 15 mg IV every 6 hours PRN.
C. Albumin 25% infusion.
D. Lactulose 30 mL orally four times daily.
Answer: B
CORRECT ANSWER : B
Rationale: Patients with cirrhosis are at high risk for hepatorenal syndrome and have decreased
renal perfusion; NSAIDs like ketorolac inhibit prostaglandins that maintain renal blood flow,
thus worsening renal failure. Spironolactone and albumin are standard treatments for ascites,
and lactulose is standard for preventing encephalopathy.
5. A patient receiving an infusion of packed red blood cells (PRBCs) begins to report lumbar pain
and dyspnea 15 minutes after initiation. What is the nurse's primary action?
A. Notify the physician and prepare to administer furosemide.
B. Reduce the infusion rate and continue monitoring for stabilization.
C. Stop the transfusion immediately and disconnect the tubing from the IV site.
D. Flush the line with normal saline to ensure the vein remains patent.
Answer: C
CORRECT ANSWER : C
Rationale: The symptoms of flank/lumbar pain and dyspnea are cardinal signs of an acute
hemolytic transfusion reaction, requiring immediate cessation of the transfusion. Flushing the
line (D) would continue to introduce incompatible blood into the patient's system, and reducing
the rate (B) is inappropriate for a hemolytic event.
6. In evaluating a patient with SIADH, which laboratory finding and clinical presentation are most
consistent with the diagnosis?
A. High serum sodium and peripheral edema.
B. Low serum osmolality and concentrated urine.
C. Hyperkalemia and elevated blood urea nitrogen.
, D. Hypoglycemia and polyuria.
Answer: B
CORRECT ANSWER : B
Rationale: SIADH is characterized by the inappropriate release of ADH, causing water
retention; this results in dilutional hyponatremia (low serum osmolality) and concentrated urine
due to continued water reabsorption. High sodium (A) is the opposite of the dilutional effect, and
polyuria (D) is associated with Diabetes Insipidus.
7. A patient is being treated for a hypertensive crisis with a nitroprusside drip. Which nursing
intervention is essential to prevent toxicity?
A. Monitor serum potassium levels every 2 hours.
B. Assess for signs of thiocyanate toxicity, including mental status changes.
C. Keep the patient in a Trendelenburg position to maintain cerebral perfusion.
D. Titrate the infusion to keep the MAP at 110-120 mmHg.
Answer: B
CORRECT ANSWER : B
Rationale: Sodium nitroprusside is metabolized into cyanide and subsequently thiocyanate;
prolonged use or high doses can lead to toxic accumulation, manifesting as neurological
changes (confusion, psychosis). Potassium (A) is not the primary electrolyte of concern for this
medication, and the MAP goal is typically lower in crisis.
8. A patient is 48 hours post-operative from a bowel resection. The nurse notes absent bowel
sounds, abdominal distention, and tenderness. What is the most appropriate nursing intervention?
A. Encourage the patient to ambulate frequently.
B. Administer a dose of magnesium citrate to stimulate motility.
C. Maintain NPO status and continue nasogastric tube to low intermittent suction.
D. Introduce clear liquids to promote mechanical stimulation of the gut.
Answer: C
CORRECT ANSWER : C
EXAM WITH QUESTIONS AND ANSWERS/PLUS A
RATIONALE UPDATED 2026 A+/INSTANT
DOWNLOAD PDF
Table of Contents
1. Advanced Medical-Surgical Nursing
2. Complex Pharmacological Interventions
3. Fluid and Electrolyte Homeostasis
4. Critical Care and Hemodynamic Monitoring
5. Professional Nursing Standards and Ethical Practice
1. A patient with severe acute pancreatitis exhibits a positive Trousseau’s sign and persistent
muscle tremors. Given the pathophysiology of this condition, which electrolyte imbalance is the
priority, and what is the most appropriate initial nursing intervention?
A. Hypokalemia; initiate continuous cardiac monitoring.
B. Hypocalcemia; administer calcium gluconate via slow IV push.
C. Hypermagnesemia; withhold all magnesium-containing antacids.
D. Hyponatremia; restrict free water intake to prevent cerebral edema.
Answer: B
CORRECT ANSWER : B
Rationale: Acute pancreatitis often causes calcium to precipitate into the retroperitoneal space,
leading to symptomatic hypocalcemia manifesting as tetany (Trousseau’s/Chvostek’s). Calcium
gluconate is the standard treatment to prevent life-threatening laryngeal stridor or arrhythmias,
, whereas options A, C, and D do not address the primary cause of the patient’s acute
neuromuscular symptoms.
2. A patient on mechanical ventilation with PEEP of 15 cm H2O suddenly develops hypotension
and tachycardia. Assessment reveals decreased breath sounds on the right side and tracheal
deviation to the left. What is the most immediate clinical priority?
A. Increase the tidal volume to improve oxygenation.
B. Obtain a stat portable chest X-ray to confirm placement.
C. Prepare for immediate needle thoracostomy or chest tube insertion.
D. Administer a fluid bolus to treat distributive shock.
Answer: C
CORRECT ANSWER : C
Rationale: The patient is exhibiting classic signs of a tension pneumothorax, likely exacerbated
by high PEEP. This is a medical emergency requiring immediate decompression (needle
thoracostomy) to relieve intrathoracic pressure; waiting for an X-ray (B) or providing fluids (D)
will delay life-saving intervention.
3. A patient receiving vancomycin for MRSA pneumonia develops flushing of the face, neck, and
upper chest shortly after the infusion begins. What is the most appropriate nursing action?
A. Discontinue the drug permanently and update the allergy record.
B. Slow the infusion rate and monitor the patient for respiratory distress.
C. Administer an intramuscular injection of epinephrine.
D. Request a change to a different class of antibiotic immediately.
Answer: B
CORRECT ANSWER : B
Rationale: This presentation describes "Red Man Syndrome," an infusion-related reaction
caused by rapid histamine release, not a true IgE-mediated anaphylactic allergy. Slowing the
infusion rate usually resolves symptoms, whereas stopping the drug (A) or using epinephrine (C)
is reserved for true anaphylaxis.
4. A patient with cirrhosis presents with ascites and a serum creatinine of 2.1 mg/dL. Which
medication order should the nurse question as it may exacerbate the patient’s renal status?
, A. Spironolactone 100 mg daily.
B. Ketorolac 15 mg IV every 6 hours PRN.
C. Albumin 25% infusion.
D. Lactulose 30 mL orally four times daily.
Answer: B
CORRECT ANSWER : B
Rationale: Patients with cirrhosis are at high risk for hepatorenal syndrome and have decreased
renal perfusion; NSAIDs like ketorolac inhibit prostaglandins that maintain renal blood flow,
thus worsening renal failure. Spironolactone and albumin are standard treatments for ascites,
and lactulose is standard for preventing encephalopathy.
5. A patient receiving an infusion of packed red blood cells (PRBCs) begins to report lumbar pain
and dyspnea 15 minutes after initiation. What is the nurse's primary action?
A. Notify the physician and prepare to administer furosemide.
B. Reduce the infusion rate and continue monitoring for stabilization.
C. Stop the transfusion immediately and disconnect the tubing from the IV site.
D. Flush the line with normal saline to ensure the vein remains patent.
Answer: C
CORRECT ANSWER : C
Rationale: The symptoms of flank/lumbar pain and dyspnea are cardinal signs of an acute
hemolytic transfusion reaction, requiring immediate cessation of the transfusion. Flushing the
line (D) would continue to introduce incompatible blood into the patient's system, and reducing
the rate (B) is inappropriate for a hemolytic event.
6. In evaluating a patient with SIADH, which laboratory finding and clinical presentation are most
consistent with the diagnosis?
A. High serum sodium and peripheral edema.
B. Low serum osmolality and concentrated urine.
C. Hyperkalemia and elevated blood urea nitrogen.
, D. Hypoglycemia and polyuria.
Answer: B
CORRECT ANSWER : B
Rationale: SIADH is characterized by the inappropriate release of ADH, causing water
retention; this results in dilutional hyponatremia (low serum osmolality) and concentrated urine
due to continued water reabsorption. High sodium (A) is the opposite of the dilutional effect, and
polyuria (D) is associated with Diabetes Insipidus.
7. A patient is being treated for a hypertensive crisis with a nitroprusside drip. Which nursing
intervention is essential to prevent toxicity?
A. Monitor serum potassium levels every 2 hours.
B. Assess for signs of thiocyanate toxicity, including mental status changes.
C. Keep the patient in a Trendelenburg position to maintain cerebral perfusion.
D. Titrate the infusion to keep the MAP at 110-120 mmHg.
Answer: B
CORRECT ANSWER : B
Rationale: Sodium nitroprusside is metabolized into cyanide and subsequently thiocyanate;
prolonged use or high doses can lead to toxic accumulation, manifesting as neurological
changes (confusion, psychosis). Potassium (A) is not the primary electrolyte of concern for this
medication, and the MAP goal is typically lower in crisis.
8. A patient is 48 hours post-operative from a bowel resection. The nurse notes absent bowel
sounds, abdominal distention, and tenderness. What is the most appropriate nursing intervention?
A. Encourage the patient to ambulate frequently.
B. Administer a dose of magnesium citrate to stimulate motility.
C. Maintain NPO status and continue nasogastric tube to low intermittent suction.
D. Introduce clear liquids to promote mechanical stimulation of the gut.
Answer: C
CORRECT ANSWER : C
