,NURS 3661 Final Exam | Nursing of Adults (2026) Q&A |
University of Texas at Arlington
1. A patient with a serum potassium level of 5.9 mEq/L is prescribed spironolactone. What
is the nurse's priority action?
A) Administer the medication as prescribed and monitor urine output
B) Hold the medication and notify the provider
C) Encourage the patient to increase dietary potassium
D) Recheck the potassium level in two hours
Correct Answer: Hold the medication and notify the provider
Rationale: Spironolactone is a potassium-sparing diuretic that further increases
potassium levels and is contraindicated in hyperkalemia. The nurse must hold the
medication and notify the provider immediately. Administering it could worsen
hyperkalemia and cause cardiac dysrhythmias, while encouraging potassium-rich foods or
delaying recheck would exacerbate the danger.
2. Which acid-base disturbance is most likely in a patient with diabetic ketoacidosis?
A) Respiratory alkalosis
B) Metabolic acidosis
C) Metabolic alkalosis
D) Respiratory acidosis
Correct Answer: Metabolic acidosis
Rationale: Diabetic ketoacidosis produces ketone acids that consume bicarbonate,
leading to metabolic acidosis with a low pH and low bicarbonate. Compensatory
,hyperventilation lowers PaCO2. It does not cause respiratory alkalosis, metabolic alkalosis,
or primary respiratory acidosis.
3. Which intravenous fluid is hypertonic and used cautiously to treat severe symptomatic
hyponatremia?
A) 0.45% sodium chloride
B) 0.9% sodium chloride
C) 3% sodium chloride
D) 5% dextrose in water
Correct Answer: 3% sodium chloride
Rationale: 3% sodium chloride is hypertonic and used cautiously in severe symptomatic
hyponatremia to raise serum sodium. 0.45% sodium chloride is hypotonic, 0.9% is isotonic,
and 5% dextrose in water becomes hypotonic after dextrose metabolism.
4. Which assessment finding is most consistent with fluid volume excess?
A) Dry mucous membranes and poor skin turgor
B) Bounding pulses, crackles, and weight gain
C) Orthostatic hypotension and tachycardia
D) Decreased urine output and thirst
Correct Answer: Bounding pulses, crackles, and weight gain
Rationale: Fluid volume excess causes increased intravascular volume, leading to
bounding pulses, pulmonary crackles, edema, and weight gain. Dry mucous membranes,
poor turgor, orthostatic hypotension, tachycardia, decreased urine output, and thirst
suggest fluid volume deficit.
, 5. Which medication is most likely to cause hypokalemia in a patient receiving treatment
for heart failure?
A) Spironolactone
B) Furosemide
C) Lisinopril
D) Valsartan
Correct Answer: Furosemide
Rationale: Furosemide is a loop diuretic that increases potassium excretion, leading to
hypokalemia. Spironolactone is potassium-sparing and can cause hyperkalemia, while
lisinopril and valsartan may also raise potassium but are not primarily associated with
potassium loss.
6. Which finding is most consistent with hypocalcemia?
A) Muscle weakness and hyporeflexia
B) Tetany and a positive Trousseau sign
C) Tall peaked T waves
D) Hypertension and flushing
Correct Answer: Tetany and a positive Trousseau sign
Rationale: Hypocalcemia increases neuromuscular excitability, causing tetany,
paresthesias, and a positive Trousseau or Chvostek sign. Muscle weakness and hyporeflexia
suggest hypercalcemia, tall peaked T waves suggest hyperkalemia, and hypertension with
flushing is not characteristic of hypocalcemia.
University of Texas at Arlington
1. A patient with a serum potassium level of 5.9 mEq/L is prescribed spironolactone. What
is the nurse's priority action?
A) Administer the medication as prescribed and monitor urine output
B) Hold the medication and notify the provider
C) Encourage the patient to increase dietary potassium
D) Recheck the potassium level in two hours
Correct Answer: Hold the medication and notify the provider
Rationale: Spironolactone is a potassium-sparing diuretic that further increases
potassium levels and is contraindicated in hyperkalemia. The nurse must hold the
medication and notify the provider immediately. Administering it could worsen
hyperkalemia and cause cardiac dysrhythmias, while encouraging potassium-rich foods or
delaying recheck would exacerbate the danger.
2. Which acid-base disturbance is most likely in a patient with diabetic ketoacidosis?
A) Respiratory alkalosis
B) Metabolic acidosis
C) Metabolic alkalosis
D) Respiratory acidosis
Correct Answer: Metabolic acidosis
Rationale: Diabetic ketoacidosis produces ketone acids that consume bicarbonate,
leading to metabolic acidosis with a low pH and low bicarbonate. Compensatory
,hyperventilation lowers PaCO2. It does not cause respiratory alkalosis, metabolic alkalosis,
or primary respiratory acidosis.
3. Which intravenous fluid is hypertonic and used cautiously to treat severe symptomatic
hyponatremia?
A) 0.45% sodium chloride
B) 0.9% sodium chloride
C) 3% sodium chloride
D) 5% dextrose in water
Correct Answer: 3% sodium chloride
Rationale: 3% sodium chloride is hypertonic and used cautiously in severe symptomatic
hyponatremia to raise serum sodium. 0.45% sodium chloride is hypotonic, 0.9% is isotonic,
and 5% dextrose in water becomes hypotonic after dextrose metabolism.
4. Which assessment finding is most consistent with fluid volume excess?
A) Dry mucous membranes and poor skin turgor
B) Bounding pulses, crackles, and weight gain
C) Orthostatic hypotension and tachycardia
D) Decreased urine output and thirst
Correct Answer: Bounding pulses, crackles, and weight gain
Rationale: Fluid volume excess causes increased intravascular volume, leading to
bounding pulses, pulmonary crackles, edema, and weight gain. Dry mucous membranes,
poor turgor, orthostatic hypotension, tachycardia, decreased urine output, and thirst
suggest fluid volume deficit.
, 5. Which medication is most likely to cause hypokalemia in a patient receiving treatment
for heart failure?
A) Spironolactone
B) Furosemide
C) Lisinopril
D) Valsartan
Correct Answer: Furosemide
Rationale: Furosemide is a loop diuretic that increases potassium excretion, leading to
hypokalemia. Spironolactone is potassium-sparing and can cause hyperkalemia, while
lisinopril and valsartan may also raise potassium but are not primarily associated with
potassium loss.
6. Which finding is most consistent with hypocalcemia?
A) Muscle weakness and hyporeflexia
B) Tetany and a positive Trousseau sign
C) Tall peaked T waves
D) Hypertension and flushing
Correct Answer: Tetany and a positive Trousseau sign
Rationale: Hypocalcemia increases neuromuscular excitability, causing tetany,
paresthesias, and a positive Trousseau or Chvostek sign. Muscle weakness and hyporeflexia
suggest hypercalcemia, tall peaked T waves suggest hyperkalemia, and hypertension with
flushing is not characteristic of hypocalcemia.
