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NRSG 3420 NRSG3420 Ultimate Final Exam QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 202 5 Northeastern
University
The questions cover a summary-level mix of topics typically found in advanced med-surg nursing, critical care, and complex adult health, which is common for NRSG 3420
- A patient with chronic heart failure has an ejection fraction of 35%. Which medication should the nurse anticipate administering to improve cardiac contractility?
Digoxin
Digoxin increases the force of myocardial contraction, which helps improve cardiac output in patients with low ejection fraction.
- A patient is admitted with status asthmaticus. Which intervention should the nurse implement first?
Administer a short-acting beta-agonist (albuterol)
A rapid-acting bronchodilator should be given immediately to open the airways and improve oxygenation.
- A patient with cirrhosis is at risk for hepatic encephalopathy. Which lab value should the nurse monitor closely?
Ammonia
Elevated ammonia levels can lead to changes in mental status and are indicative of worsening hepatic encephalopathy.
- The nurse assesses a patient with a chest tube and notes continuous bubbling in the water-seal chamber. What does this indicate?
There is an air leak
Continuous bubbling suggests air is entering the system, which can be due to a leak that must be identified and corrected.
- Which dietary instruction is most appropriate for a patient with chronic kidney disease (CKD)?
Limit protein intake
Protein restriction helps reduce the buildup of nitrogenous waste products in CKD.
- A patient with a mechanical valve replacement must take which medication for life?
Warfarin
Patients with mechanical valves require lifelong anticoagulation to prevent thrombus formation.
11.The nurse prepares to administer rapid IV potassium chloride. What action is correct?
Clarify the order
Potassium chloride should never be given IV push because it can cause fatal arrhythmias. 12.Which complication should the nurse monitor for after a paracentesis?
Hypotension
Rapid removal of fluid can cause vascular volume shifts leading to hypotension. 13.Which symptom is most indicative of digoxin toxicity?
Visual disturbances
Blurred or yellow vision is a classic sign of digoxin toxicity. 14.A patient with DKA has K+ of 5.8 mEq/L. What should the nurse do?
Administer insulin as ordered
Insulin shifts potassium into cells, helping lower elevated serum potassium in DKA. 15.Which finding in a burn patient requires immediate action?
Urine output of 10 mL/hr
Low urine output may indicate hypovolemia and inadequate organ perfusion. 16.What should the nurse teach a patient taking prednisone long-term?
Do not stop medication abruptly
Abrupt cessation can cause adrenal insufficiency due to suppression of the hypothalamic-pituitary-adrenal axis. 17.Which patient is at greatest risk for developing hypovolemic shock?
Patient with a GI bleed
A GI bleed can cause significant blood loss leading to hypovolemia and shock. 18.Which lab result indicates improvement in a patient with acute pancreatitis?
Decreasing serum amylase
Elevated amylase is a marker of pancreatic inflammation; decreasing levels indicate improvement. 19.A patient with COPD has an oxygen saturation of 88%. What is the best nursing action?
Maintain current O2 level
24.What is the priority for a patient with an upper GI bleed?
Assess vital signs
Monitoring for signs of hypovolemia or shock is the immediate priority. 25.Which ECG finding requires immediate action?
ST elevation
ST elevation indicates myocardial infarction requiring rapid intervention. 26.A patient with HIV has a CD4 count of 190. Which complication is likely?
Opportunistic infections
A CD4 count <200 indicates AIDS, increasing infection risk. 27.A patient is receiving TPN. Which assessment is most important?
Blood glucose
Hyperglycemia is a common complication of TPN. 28.Which medication should be held before cardiac catheterization with contrast?
Metformin
Metformin increases the risk of lactic acidosis when used with IV contrast.
29.Which sign indicates hypocalcemia?
Positive Chvostek’s sign
Facial twitching when tapping the facial nerve indicates low calcium levels. 30.Which medication is used to treat adrenal crisis?
Hydrocortisone
Hydrocortisone replaces deficient cortisol levels in adrenal insufficiency. 31.Which patient is most at risk for a fat embolism?
Patient with a fractured femur
Long bone fractures can release fat droplets into circulation, causing emboli. 32.A patient with a new AV fistula should be instructed to:
Avoid carrying heavy objects with the affected arm
This prevents damage and promotes fistula patency. 33.Which condition can result from untreated hypertension?
Left ventricular hypertrophy
Chronic high blood pressure increases cardiac workload, causing hypertrophy.
Fiber softens stool and prevents diverticular complications. 39.Which test result confirms rheumatoid arthritis?
Positive rheumatoid factor
Rheumatoid factor is commonly elevated in RA. 40.Which symptom requires immediate attention in Guillain-Barré syndrome?
Dyspnea
Respiratory failure can occur due to muscle paralysis. 41.What is the priority action for a patient with suspected pulmonary embolism?
Administer oxygen
Oxygenation is the first priority while diagnostic tests are arranged. 42.Which action is appropriate after a lumbar puncture?
Keep the patient flat
Lying flat reduces headache risk from CSF leakage. 43.Which lab value should be monitored when a patient is on furosemide?
Potassium
Furosemide can cause hypokalemia due to increased excretion. 44.Which symptom indicates retinal detachment?
Flashes of light
Patients often report photopsia or floaters with detachment. 45.Which nursing action is priority for a patient with high ICP?
Keep the head midline
Neutral head positioning promotes venous drainage and lowers ICP. 46.Which dietary item should be avoided by a patient taking MAOIs?
Aged cheese
Tyramine-rich foods can cause hypertensive crisis when combined with MAOIs. 47.A patient has a potassium of 2.9. Which ECG change should the nurse expect?
Flattened T waves
Hypokalemia can cause flattened T waves and U waves.
Perform a neurological assessment
Rapid neurological evaluation is crucial to identify stroke severity and guide treatment. 53.Which electrolyte imbalance is common in patients with Addison’s disease?
Hyponatremia
Aldosterone deficiency leads to sodium loss and hyponatremia. 54.Which sign is expected in a patient with right-sided heart failure?
Jugular vein distension
Right-sided failure causes systemic venous congestion, visible as JVD. 55.Which action reduces the risk of ventilator-associated pneumonia?
Elevate the head of the bed to 30–45 degrees
This position decreases aspiration risk and pneumonia incidence. 56.Which symptom is characteristic of a patient in the hypoglycemic state?
Sweating
Hypoglycemia stimulates the sympathetic nervous system causing diaphoresis.
57.What is the first priority in managing an anaphylactic reaction?
Maintain airway patency
Airway swelling can cause obstruction; securing the airway is vital. 58.Which lab result is most concerning in a patient with chronic liver disease?
Elevated INR
Prolonged INR indicates impaired liver synthesis of clotting factors. 59.What is the earliest sign of compartment syndrome?
Pain out of proportion to injury
Severe pain disproportionate to exam findings is an early warning. 60.Which medication helps prevent osteoporosis in postmenopausal women?
Alendronate
Bisphosphonates like alendronate inhibit bone resorption. 61.What does the presence of a widened pulse pressure indicate?
Increased stroke volume or decreased vascular compliance
Conditions like aortic regurgitation or hypertension cause widened pulse pressure.
Active internal bleeding
Thrombolytics increase bleeding risk and are contraindicated in active hemorrhage. 67.What is the typical finding in a patient with multiple sclerosis?
Periods of exacerbation and remission
MS presents as relapsing-remitting neurological symptoms due to demyelination. 68.Which nursing action helps reduce risk of deep vein thrombosis (DVT)?
Encourage early ambulation
Mobilization improves venous return and reduces clot formation. 69.Which blood product is used to treat thrombocytopenia?
Platelets
Platelet transfusions increase platelet count to reduce bleeding risk. 70.What is the priority assessment after a lumbar puncture?
Check for headache
Post-lumbar puncture headache indicates CSF leakage.
71.Which acid-base imbalance is expected with prolonged vomiting?
Metabolic alkalosis
Loss of gastric acid increases blood bicarbonate leading to alkalosis. 72.Which clinical manifestation suggests a pulmonary embolism?
Sudden onset dyspnea
Acute obstruction of pulmonary arteries causes respiratory distress. 73.Which lab value is the best indicator of renal function?
Serum creatinine
Creatinine reflects glomerular filtration rate and kidney function. 74.Which electrolyte imbalance causes peaked T waves on ECG?
Hyperkalemia
High potassium alters cardiac repolarization, producing peaked T waves. 75.Which medication is used to reverse opioid overdose?
Naloxone
80.What is the typical presentation of acute pancreatitis?
Severe epigastric pain radiating to the back
Pancreatic inflammation causes characteristic upper abdominal pain. 81.Which medication is commonly used to treat hypertension in patients with diabetes?
ACE inhibitors
ACE inhibitors protect kidneys and lower blood pressure effectively in diabetics. 82.What is the action of beta-blockers in heart failure?
Decrease heart rate and myocardial oxygen demand
Reducing workload helps improve heart function. 83.Which clinical sign indicates worsening respiratory distress in COPD?
Use of accessory muscles
Accessory muscle use reflects increased work of breathing. 84.Which electrolyte imbalance can cause tetany?
Hypocalcemia
Low calcium levels increase neuromuscular excitability leading to muscle spasms. 85.What is the main risk of prolonged immobility in hospitalized patients?
Deep vein thrombosis
Venous stasis promotes clot formation in immobilized patients. 86.Which condition is a contraindication for MRI?
Pacemaker
MRI’s strong magnetic field can interfere with pacemaker function. 87.What is the normal range for serum potassium?
3.5–5.0 mEq/L
Potassium outside this range can cause serious cardiac issues. 88.Which lab test is used to monitor long-term glucose control in diabetics?
HbA1c
Glycated hemoglobin reflects average blood glucose over 2-3 months. 89.What does the presence of red, swollen, and painful joints indicate?
