NSG 3160 ADVANCED NURSING
PRACTICE FINAL EXAM 2026/2027
QUESTIONS & VERIFIED ANSWERS
2026/2027 UPDATE
1. A patient with chronic renal failure is experiencing metabolic acidosis. Which of the
following laboratory findings is most consistent with this diagnosis?
A. pH 7.48, PaCO2 30 mmHg, HCO3 22 mEq/L
B. pH 7.30, PaCO2 55 mmHg, HCO3 28 mEq/L
C. pH 7.25, PaCO2 35 mmHg, HCO3 18 mEq/L
D. pH 7.50, PaCO2 48 mmHg, HCO3 32 mEq/L
Answer: C
Conceptual Explanation: Metabolic acidosis is characterized by a low pH (below 7.35) and
a low bicarbonate level (below 22 mEq/L). Option B shows both a low pH and low HCO3
with a normal PaCO2, indicative of an uncompensated metabolic state.
2. A client is prescribed Clozapine for treatment-resistant schizophrenia. Which laboratory
value requires immediate notification of the provider?
A. Absolute Neutrophil Count (ANC) of 900/mm3
B. Serum glucose of 110 mg/dL
,C. Platelet count of 150,000/mm3
D. Blood Urea Nitrogen (BUN) of 18 mg/dL
Answer: A
Conceptual Explanation: Clozapine carries a risk of agranulocytosis. An ANC below
1000/mm3 (mild neutropenia) or especially below 500/mm3 requires immediate
discontinuation and monitoring per REMS protocols.
3. In a patient with SIADH, which electrolyte imbalance is the primary concern for causing
neurological changes?
A. Hyperkalemia
B. Hyponatremia
C. Hypernatremia
D. Hypocalcemia
Answer: B
Conceptual Explanation: SIADH involves excessive ADH, leading to water retention and
dilutional hyponatremia. Low sodium levels cause cerebral edema, leading to confusion,
seizures, and coma.
4. Which of the following EKG changes is most characteristic of hyperkalemia?
A. Prominent U waves
B. ST-segment depression
, C. Tall, peaked T waves
D. Prolonged QT interval
Answer: C
Conceptual Explanation: Hyperkalemia causes repolarization abnormalities, most notably
tall, peaked T waves. If untreated, it can lead to QRS widening and sine wave patterns.
5. A patient presents with a ‘stiff neck’, high fever, and a positive Brudzinski sign. What is the
priority nursing intervention?
A. Administering antipyretics
B. Initiating droplet precautions
C. Obtaining a sputum culture
D. Performing a neurological assessment every 4 hours
Answer: B
Conceptual Explanation: Symptoms suggest bacterial meningitis. Droplet precautions
must be initiated immediately to prevent transmission while waiting for confirmation via
lumbar puncture.
6. When administering Lithium Carbonate, which range represents the therapeutic serum
level for acute mania?
A. 0.1 to 0.5 mEq/L
B. 2.5 to 3.5 mEq/L
PRACTICE FINAL EXAM 2026/2027
QUESTIONS & VERIFIED ANSWERS
2026/2027 UPDATE
1. A patient with chronic renal failure is experiencing metabolic acidosis. Which of the
following laboratory findings is most consistent with this diagnosis?
A. pH 7.48, PaCO2 30 mmHg, HCO3 22 mEq/L
B. pH 7.30, PaCO2 55 mmHg, HCO3 28 mEq/L
C. pH 7.25, PaCO2 35 mmHg, HCO3 18 mEq/L
D. pH 7.50, PaCO2 48 mmHg, HCO3 32 mEq/L
Answer: C
Conceptual Explanation: Metabolic acidosis is characterized by a low pH (below 7.35) and
a low bicarbonate level (below 22 mEq/L). Option B shows both a low pH and low HCO3
with a normal PaCO2, indicative of an uncompensated metabolic state.
2. A client is prescribed Clozapine for treatment-resistant schizophrenia. Which laboratory
value requires immediate notification of the provider?
A. Absolute Neutrophil Count (ANC) of 900/mm3
B. Serum glucose of 110 mg/dL
,C. Platelet count of 150,000/mm3
D. Blood Urea Nitrogen (BUN) of 18 mg/dL
Answer: A
Conceptual Explanation: Clozapine carries a risk of agranulocytosis. An ANC below
1000/mm3 (mild neutropenia) or especially below 500/mm3 requires immediate
discontinuation and monitoring per REMS protocols.
3. In a patient with SIADH, which electrolyte imbalance is the primary concern for causing
neurological changes?
A. Hyperkalemia
B. Hyponatremia
C. Hypernatremia
D. Hypocalcemia
Answer: B
Conceptual Explanation: SIADH involves excessive ADH, leading to water retention and
dilutional hyponatremia. Low sodium levels cause cerebral edema, leading to confusion,
seizures, and coma.
4. Which of the following EKG changes is most characteristic of hyperkalemia?
A. Prominent U waves
B. ST-segment depression
, C. Tall, peaked T waves
D. Prolonged QT interval
Answer: C
Conceptual Explanation: Hyperkalemia causes repolarization abnormalities, most notably
tall, peaked T waves. If untreated, it can lead to QRS widening and sine wave patterns.
5. A patient presents with a ‘stiff neck’, high fever, and a positive Brudzinski sign. What is the
priority nursing intervention?
A. Administering antipyretics
B. Initiating droplet precautions
C. Obtaining a sputum culture
D. Performing a neurological assessment every 4 hours
Answer: B
Conceptual Explanation: Symptoms suggest bacterial meningitis. Droplet precautions
must be initiated immediately to prevent transmission while waiting for confirmation via
lumbar puncture.
6. When administering Lithium Carbonate, which range represents the therapeutic serum
level for acute mania?
A. 0.1 to 0.5 mEq/L
B. 2.5 to 3.5 mEq/L
