Advanced Nursing Fundamentals Exam 4 Practice
UPDATED ACTUAL Questions and CORRECT Answers
1. A patient’s arterial blood gas results show a pH of 7.30, a PaCO2 of 52 mmHg,
and an HCO3 of 25 mEq/L. Which acid-base imbalance is occurring?
A. Metabolic Acidosis
B. Respiratory Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Answer: B
Rationale: The pH is low (acidosis), the PaCO2 is high (respiratory cause), and the HCO3 is
normal, indicating respiratory acidosis.
2. Which clinical manifestation is most characteristic of hypocalcemia?
A. Positive Trousseau sign
B. Absent deep tendon reflexes
C. Polyuria
D. Constipation
Answer: A
Rationale: Hypocalcemia increases neuromuscular excitability, leading to signs like
Trousseau’s and Chvostek’s signs.
,3. When administering a hypertonic IV solution, the nurse should monitor for
which complication?
A. Cellular dehydration
B. Fluid volume deficit
C. Cerebral edema
D. Pulmonary edema
Answer: D
Rationale: Hypertonic solutions pull fluid into the vascular space, increasing the risk of
fluid volume overload and pulmonary edema.
4. A nurse is caring for a patient who is 1 day postoperative. The patient reports
sudden shortness of breath and chest pain. What is the priority action?
A. Obtain an EKG
B. Administer pain medication
C. Apply oxygen and notify the provider
D. Encourage the use of the incentive spirometer
Answer: C
Rationale: Sudden respiratory distress post-op suggests a pulmonary embolism; airway
and oxygenation are the immediate priorities.
5. The nurse identifies that a surgical wound is healing by primary intention
when which of the following is observed?
A. The wound edges are approximated with staples
B. The wound is left open to heal from the bottom up
C. There is extensive tissue loss
D. The wound is contaminated and requires debridement
Answer: A
Rationale: Primary intention involves clean surgical incisions where edges are closely
approximated with sutures or staples.
, 6. Which electrolyte imbalance is a patient at risk for when taking a non-
potassium-sparing diuretic like Furosemide?
A. Hyperkalemia
B. Hyponatremia
C. Hypercalcemia
D. Hypokalemia
Answer: D
Rationale: Loop diuretics like furosemide cause the excretion of potassium in the urine,
leading to low serum potassium levels.
7. In the preoperative phase, who is primarily responsible for obtaining the
patient’s informed consent?
A. The registered nurse
B. The anesthesiologist
C. The surgical technician
D. The surgeon
Answer: D
Rationale: The physician or surgeon performing the procedure is legally responsible for
explaining the risks and benefits to obtain consent.
8. A patient has a serum sodium level of 128 mEq/L. Which nursing intervention
is a priority?
A. Encourage increased water intake
B. Administer a loop diuretic
C. Initiate seizure precautions
D. Place the patient on a low-salt diet
Answer: C
Rationale: Hyponatremia (sodium < 135) can cause cerebral swelling, placing the patient
at high risk for seizures.
UPDATED ACTUAL Questions and CORRECT Answers
1. A patient’s arterial blood gas results show a pH of 7.30, a PaCO2 of 52 mmHg,
and an HCO3 of 25 mEq/L. Which acid-base imbalance is occurring?
A. Metabolic Acidosis
B. Respiratory Acidosis
C. Metabolic Alkalosis
D. Respiratory Alkalosis
Answer: B
Rationale: The pH is low (acidosis), the PaCO2 is high (respiratory cause), and the HCO3 is
normal, indicating respiratory acidosis.
2. Which clinical manifestation is most characteristic of hypocalcemia?
A. Positive Trousseau sign
B. Absent deep tendon reflexes
C. Polyuria
D. Constipation
Answer: A
Rationale: Hypocalcemia increases neuromuscular excitability, leading to signs like
Trousseau’s and Chvostek’s signs.
,3. When administering a hypertonic IV solution, the nurse should monitor for
which complication?
A. Cellular dehydration
B. Fluid volume deficit
C. Cerebral edema
D. Pulmonary edema
Answer: D
Rationale: Hypertonic solutions pull fluid into the vascular space, increasing the risk of
fluid volume overload and pulmonary edema.
4. A nurse is caring for a patient who is 1 day postoperative. The patient reports
sudden shortness of breath and chest pain. What is the priority action?
A. Obtain an EKG
B. Administer pain medication
C. Apply oxygen and notify the provider
D. Encourage the use of the incentive spirometer
Answer: C
Rationale: Sudden respiratory distress post-op suggests a pulmonary embolism; airway
and oxygenation are the immediate priorities.
5. The nurse identifies that a surgical wound is healing by primary intention
when which of the following is observed?
A. The wound edges are approximated with staples
B. The wound is left open to heal from the bottom up
C. There is extensive tissue loss
D. The wound is contaminated and requires debridement
Answer: A
Rationale: Primary intention involves clean surgical incisions where edges are closely
approximated with sutures or staples.
, 6. Which electrolyte imbalance is a patient at risk for when taking a non-
potassium-sparing diuretic like Furosemide?
A. Hyperkalemia
B. Hyponatremia
C. Hypercalcemia
D. Hypokalemia
Answer: D
Rationale: Loop diuretics like furosemide cause the excretion of potassium in the urine,
leading to low serum potassium levels.
7. In the preoperative phase, who is primarily responsible for obtaining the
patient’s informed consent?
A. The registered nurse
B. The anesthesiologist
C. The surgical technician
D. The surgeon
Answer: D
Rationale: The physician or surgeon performing the procedure is legally responsible for
explaining the risks and benefits to obtain consent.
8. A patient has a serum sodium level of 128 mEq/L. Which nursing intervention
is a priority?
A. Encourage increased water intake
B. Administer a loop diuretic
C. Initiate seizure precautions
D. Place the patient on a low-salt diet
Answer: C
Rationale: Hyponatremia (sodium < 135) can cause cerebral swelling, placing the patient
at high risk for seizures.
