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RNSG 1443 Exam 1- Level 2 Adult Health Nursing Master Practice
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This comprehensive nursing resource features 150 high-level practice questions specifically designed for the first exam of Adult Health I, focusing on the complex care of the medical- surgical patient. The content covers critical licensure-level topics including Fluid and Electrolytes, Acid-Base Imbalances, Perioperative Safety, and Respiratory Management , with a heavy emphasis on clinical prioritization and NCLEX-style application. Each question includes a bolded correct answer and a detailed scientific rationale to bridge the gap between textbook theory and real-world clinical judgment. Part 1: Fluid, Electrolytes, and Acid-Base A patient with a potassium level of 6.2 mEq/L is admitted. Which peaked wave on the ECG should the nurse monitor for? A) P wave B) T wave C) U wave D) ST segment Rationale: Hyperkalemia (K+ > 5.0) causes tall, peaked T waves due to rapid repolarization of the heart muscle. A patient is persistent in vomiting for 24 hours. Which acid-base imbalance is the nurse most likely to find? A) Respiratory Acidosis B) Respiratory Alkalosis C) Metabolic Alkalosis D) Metabolic Acidosis Rationale: Vomiting results in the loss of hydrochloric acid from the stomach, leading to a surplus of bicarbonate in the body ( Metabolic Alkalosis ). Which IV fluid is considered hypotonic and used to treat cellular dehydration? A) 0.9% Normal Saline B) Lactated Ringer’s C) 0.45% Normal Saline D) 5% Dextrose in 0.9% NS
Rationale: 0.45% NS has a lower osmolarity than plasma, causing fluid to shift from the vascular space into the cells. A patient has a positive Chvostek’s sign. Which electrolyte abnormality does the nurse suspect? A) Hypercalcemia B) Hypocalcemia C) Hyperkalemia D) Hypophosphatemia Rationale: Hypocalcemia increases neuromuscular excitability; tapping the facial nerve causing a twitch ( Chvostek's ) is a classic sign. The nurse is caring for a patient with a serum sodium of 115 mEq/L. Which is the priority nursing intervention? A) Encourage increased oral water intake. B) Implement seizure precautions. C) Administer a rapid bolus of 0.45% NS. D) Monitor for peaked T waves. Rationale: Severe hyponatremia (<120) causes cerebral edema, putting the patient at extreme risk for seizures and coma. An elderly patient is admitted with dehydration. Which assessment is the most reliable indicator of fluid status in the elderly? A) Skin turgor on the hand B) Daily weights C) Fluid intake records D) Presence of thirst Rationale: Skin turgor is unreliable in the elderly due to loss of elasticity. Daily weights are the gold standard for tracking fluid gain or loss. A patient’s ABG results are: pH 7.30, PaCO2 52, HCO3 24. How does the nurse interpret this? A) Respiratory Acidosis B) Respiratory Alkalosis
C) Vitamin C D) Diphenhydramine Rationale: Warfarin is an anticoagulant; continuing it before surgery increases the risk of life-threatening hemorrhage. A patient is scheduled for surgery and states, "I'm not sure what the doctor is actually doing." What is the nurse's best action? A) Explain the surgical procedure in detail. B) Notify the surgeon that the patient needs further explanation. C) Tell the patient not to worry, the surgeon is the best. D) Have the patient sign the consent form quickly. Rationale: The nurse’s role is to witness the signature. If the patient lacks understanding, the surgeon must return to provide informed consent. Which patient is at the highest risk for surgical complications? A) A 40-year-old with controlled hypertension. B) An 80-year-old with COPD and diabetes. C) A 20-year-old athlete. D) A 50-year-old who quit smoking 10 years ago. Rationale: Advanced age combined with chronic respiratory and metabolic diseases creates the highest risk for poor healing and respiratory failure. What is the primary purpose of having a patient "NPO after midnight" before surgery? A) To prevent postoperative diarrhea. B) To prevent aspiration pneumonia during anesthesia. C) To ensure the patient loses weight before surgery. D) To decrease the risk of surgical site infection. Rationale: Anesthesia relaxes the esophageal sphincter; an empty stomach reduces the risk of vomiting and aspiration into the lungs. In the OR, a "Time Out" is performed primarily to: A) Give the staff a break. B) Verify the correct patient, site, and procedure. C) Allow the anesthesia to take effect. D) Check the room temperature.
Rationale: The Time Out is a critical safety step to prevent "wrong site, wrong patient" surgeries. A patient in the PACU has a bucking of the breath and a low SpO2. What is the priority nursing action? A) Administer pain medication. B) Perform a head-tilt/chin-lift maneuver to open the airway. C) Increase the IV fluid rate. D) Call the family. Rationale: Post-op patients are at risk for tongue obstruction ; repositioning the airway is the first step in basic life support. Which postoperative finding should the nurse report immediately? A) A urine output of 15 mL/hour. B) Pain rated 6/10. C) Serosanguinous drainage on the dressing. D) Absent bowel sounds 2 hours post-op. Rationale: Urine output less than 30 mL/hour indicates poor kidney perfusion or hypovolemic shock. To prevent Deep Vein Thrombosis (DVT) post-surgery, the nurse should prioritize: A) Encouraging the patient to stay still. B) Early ambulation and sequential compression devices (SCDs). C) Restricting fluid intake. D) Massaging the calves daily. Rationale: Ambulation and SCDs promote venous return and prevent stasis. Never massage calves, as it can dislodge a clot. A patient develops high fever, muscle rigidity, and tachycardia during surgery. Which medication does the nurse prepare? A) Epinephrine B) Dantrolene C) Atropine D) Furosemide Rationale: These are signs of Malignant Hyperthermia , a life-threatening reaction to anesthesia. Dantrolene is the specific antidote.
Chronic pain is defined as pain lasting longer than: A) 1 week B) 1 month C) 3 to 6 months D) 1 year Rationale: Unlike acute pain, chronic pain persists beyond the normal healing time, usually 3-6 months. Which type of pain results from damage to the nerves themselves, often described as "burning" or "shooting"? A) Visceral pain B) Somatic pain C) Neuropathic pain D) Psychogenic pain Rationale: Neuropathic pain is caused by nerve injury (e.g., diabetic neuropathy or sciatica). For a patient with mild pain (2/10), which medication is most appropriate according to the WHO ladder? A) Morphine B) Ibuprofen C) Hydromorphone D) Fentanyl Rationale: Step 1 for mild pain involves non-opioids like NSAIDs or Acetaminophen. A common side effect of long-term opioid use that the nurse should proactively manage is: A) Diarrhea B) Constipation C) Hypertension D) Increased appetite Rationale: Opioids slow gastric motility; a bowel regimen is almost always necessary.
"Referred pain" is best described as: A) Pain that goes away with rest. B) Pain felt in an area away from the actual source. C) Pain caused by imaginary triggers. D) Pain that occurs only at night. Rationale: An example of referred pain is jaw pain during a myocardial infarction (heart attack). Before administering an opioid, the priority assessment is: A) Respiratory rate B) Blood pressure ) Temperature D) Bowel sounds Rationale: Opioids cause respiratory depression ; it is unsafe to give them if the rate is too low (usually <12). The "Gate Control Theory" suggests that: A) Pain is only in the brain. B) Non-painful stimuli can block pain signals from reaching the brain. C) Pain gates open wider as we age. D) Only surgery can close the pain gate. Rationale: Techniques like massage or TENS units use this theory to "close the gate" to pain signals. Part 4: Respiratory Care A patient with COPD has a pulse oximetry reading of 89%. What is the nurse's first action? A) Call a Code Blue. B) Assess the patient's respiratory effort and skin color. C) Increase Oxygen to 10L via simple mask. D) Administer a sedative. Rationale: For many COPD patients, 88-92% is their "normal" baseline. Always assess the patient before intervening. Which acid-base imbalance is common in patients with severe COPD? A) Respiratory Acidosis
C) Non-rebreather Mask D) Simple Face Mask Rationale: The non-rebreather has a reservoir bag that prevents room air from diluting the oxygen. A "ventilation-perfusion (V/Q) scan" is primarily used to diagnose: A) Lung Cancer B) Pulmonary Embolism C) Tuberculosis D) Bronchitis Rationale: A PE causes a mismatch where parts of the lung are ventilated (have air) but not perfused (have no blood flow due to a clot). "Orthopnea" refers to: A) Pain when breathing. B) Difficulty breathing while lying flat. C) Rapid breathing. D) Blue tint to the skin. Rationale: Patients with heart failure or COPD often need to be propped up to breathe comfortably. The most common early sign of laryngeal cancer is: A) Hoarseness lasting more than 2 weeks. B) Difficulty swallowing. C) Weight loss. D) Chronic cough. Rationale: Hoarseness occurs early because the tumor affects the vocal cords. When suctioning a tracheostomy, the nurse should apply suction for no longer than: A) 5 seconds B) 10 – 15 seconds C) 30 seconds D) 1 minute Rationale: Prolonged suctioning causes hypoxia and can damage the tracheal mucosa.
Part 5: Comprehensive Review & Safety A patient with a high risk for falls should be placed: A) At the end of the hallway. B) In a room near the nurse's station. C) In a room with the door closed. D) In a wheelchair all day. Rationale: Proximity allows for quicker response when the patient attempts to get up. Which of the following is a "Late" sign of hypoxia? A) Restlessness B) Tachycardia C) Cyanosis D) Anxiety Rationale: Restlessness and anxiety are early signs; cyanosis means the oxygen levels have been dangerously low for some time. A patient is hyperventilating due to a panic attack. Which ABG change is expected? A) Respiratory Acidosis B) Respiratory Alkalosis C) Metabolic Acidosis D) Metabolic Alkalosis Rationale: Hyperventilation "blows off" too much CO2, making the blood alkaline. Which electrolyte is the major intracellular cation? A) Sodium B) Potassium C) Chloride D) Bicarbonate Rationale: Potassium stays inside the cells; Sodium stays outside in the ECF. An isotonic solution like 0.9% NS is used to: A) Shrink cells. B) Swell cells.
Rationale: Over-breathing (anxiety, high altitudes) causes the loss of acid (CO2). The nurse is checking a surgical site and notes a small amount of bright red blood. This is documented as: A) Serous B) Sanguineous C) Purulent D) Serosanguineous Rationale: Sanguineous is bloody; Serosanguineous is pink/yellow; Purulent is pus-like (infection). Part 6: Advanced Fluid & Electrolyte Nursing A patient with Chronic Kidney Disease (CKD) has a potassium level of 6.8 mEq/L. Which medication does the nurse expect to administer for an immediate, temporary shift of potassium into the cells? A) Sodium Polystyrene Sulfonate (Kayexalate) B) Regular Insulin and 50% Dextrose (D50) C) Calcium Gluconate D) Furosemide (Lasix) Rationale: Insulin shifts potassium into the intracellular space; D50 prevents hypoglycemia. Kayexalate actually removes K+ from the body but takes hours to work. A patient is receiving a 3% Hypertonic Saline infusion. Which assessment is most critical for the nurse to perform hourly? A) Lung sounds for crackles and shortness of breath. B) Daily weights. C) Skin turgor. D) Bowel sounds. Rationale: Hypertonic solutions pull fluid into the vascular space, putting the patient at high risk for fluid volume overload and pulmonary edema. Which electrolyte imbalance is a patient at risk for after receiving multiple rapid blood transfusions? A) Hypercalcemia
B) Hypocalcemia C) Hyponatremia D) Hyperkalemia Rationale: Citrate is used as a preservative in banked blood; it binds to the patient's calcium, leading to hypocalcemia. The nurse notes a "positive Trousseau's sign" during a blood pressure check. This is an indicator of: A) Hypermagnesemia B) Hypocalcemia C) Hypokalemia D) Hypernatremia Rationale: Trousseau’s sign (carpal spasm when the BP cuff is inflated) indicates neuromuscular irritability due to low calcium. A patient with SIADH (Syndrome of Inappropriate Antidiuretic Hormone) is likely to exhibit: A) High serum osmolarity and dehydration. B) Low serum sodium and fluid retention. C) Excessive urinary output and thirst. D) Hyperkalemia and metabolic acidosis. Rationale: SIADH causes the body to keep too much water, diluting the sodium (dilutional hyponatremia ). Part 7: Acid-Base Imbalance Scenarios A patient is admitted with Diabetic Ketoacidosis (DKA). Which breathing pattern does the nurse expect to observe? A) Cheyne-Stokes B) Kussmaul respirations C) Shallow bradypnea D) Apneic periods Rationale: Kussmaul (deep, rapid) breathing is the body's attempt to blow off CO to compensate for metabolic acidosis. A patient has the following ABG: pH 7.50, PaCO2 30, HCO3 24. What is the nurse's interpretation?
B) Notify the surgical team of a possible Latex allergy. C) Tell the patient to bring their own fruit for recovery. D) Cancel the surgery immediately. Rationale: There is a known cross-sensitivity between these foods and latex. A postoperative patient has not voided for 8 hours since returning from surgery. What is the nurse's first action? A) Insert an indwelling catheter. B) Perform a bladder scan. C) Increase the IV fluid rate. D) Encourage the patient to drink 500 mL of water. Rationale: Assessment comes first; a bladder scan determines if the issue is urine production (kidneys) or retention (bladder). Which lab result must be reported to the surgeon prior to an elective procedure? A) Hemoglobin of 12.0 g/dL B) Potassium of 2.8 mEq/L C) WBC of 9,000/mm³ D) Creatinine of 1.0 mg/dL Rationale: Hypokalemia (2.8) increases the risk for life-threatening cardiac arrhythmias during anesthesia. A patient is in the PACU and becomes restless and agitated. What is the nurse's priority assessment? A) Check the surgical dressing for drainage. B) Check the oxygen saturation and airway patency. C) Administer a prescribed sedative. D) Check the patient's temperature. Rationale: In post-op patients, agitation is a primary early sign of hypoxia. What is the nurse's role in the "Informed Consent" process? A) Explaining the risks and benefits of the surgery. B) Deciding if the patient should have the surgery. C) Witnessing the patient's signature and ensuring they are competent. D) Signing for the patient if they are under 18.
Rationale: The surgeon explains; the nurse witnesses the signature and confirms the patient is not under the influence of sedatives. Part 9: Complex Pain & Pharmacological Management A patient is receiving around-the-clock opioids for cancer pain. The patient complains of a sudden increase in pain (8/10) despite the regular doses. This is known as: A) Tolerance B) Breakthrough pain C) Addiction D) Pseudoaddiction Rationale: Breakthrough pain is an acute flare-up that "breaks through" a controlled pain regimen. Which assessment finding indicates a patient is experiencing the most common side effect of NSAID therapy? A) Black, tarry stools. B) Dry mouth. C) Tachypnea. D) Decreased heart rate. Rationale: NSAIDs can cause GI bleeding and gastric ulcers by inhibiting protective prostaglandins. When assessing a patient's pain, the nurse asks the patient to describe what the pain feels like (e.g., sharp, dull, burning). Which part of the pain assessment is this? A) Intensity B) Quality C) Location D) Duration Rationale: Quality refers to the descriptors (burning, stabbing, throbbing). A patient is using a TENS unit for pain. How does the nurse explain its function? A) It destroys the nerves sending pain signals. B) It delivers low-dose opioids through the skin. C) It uses electrical impulses to block pain signals from reaching the brain. D) It prevents the muscles from moving.
C) A wet-to-dry dressing. D) No dressing, leave it open to air. Rationale: Taping on three sides allows air to escape the chest but prevents air from entering (preventing a tension pneumothorax). A patient is diagnosed with Obstructive Sleep Apnea (OSA). Which assessment finding is most characteristic of this condition? A) Morning headaches and excessive daytime sleepiness. B) Weight loss. C) Increased lung capacity. D) Bradycardia during the day. Rationale: Daytime sleepiness and headaches (from CO2 retention at night) are classic signs of OSA. Which patient should the nurse assess first? A) A patient with COPD and an SpO2 of 90%. B) A patient with a history of asthma who has become suddenly "quiet" with no audible wheezing. C) A patient with pneumonia who is coughing up green sputum. D) A patient post-thoracentesis with a small amount of bruising. Rationale: The "silent chest" in asthma is an emergency —it means the airways are so constricted that no air is moving at all. A patient is prescribed Guaifenesin. What is the primary purpose of this medication? A) To stop the cough reflex. B) To thin respiratory secretions so they can be coughed up. C) To dilate the bronchioles. D) To treat a bacterial infection. Rationale: Guaifenesin is an expectorant that reduces the viscosity of mucus. "Cor Pulmonale" is a complication of COPD defined as: A) Left-sided heart failure. B) Right-sided heart failure caused by pulmonary hypertension. C) Lung cancer. D) Infection of the pleural space.
Rationale: High pressure in the lungs (due to COPD) makes the right ventricle work too hard and eventually fail. A patient is 24 hours post-op and is reluctant to use the Incentive Spirometer (IS) due to pain. What is the nurse's best response? A) "You can wait until tomorrow to use it." B) "Let's medicate you for pain, then we will use the IS to prevent pneumonia." C) "If you don't use it, you will stay in the hospital for weeks." D) "It's not that important if you are walking." Rationale: Pain management is required to facilitate respiratory hygiene and prevent atelectasis. The nurse notes a patient's chest is moving inward during inspiration and outward during expiration. This is documented as: A) Normal breathing. B) Paradoxical chest movement (Flail Chest). C) Kussmaul breathing. D) Biot's respirations. Rationale: Paradoxical movement occurs with multiple rib fractures (Flail Chest) and indicates respiratory instability. What is the priority intervention for a patient with a suspected Pulmonary Embolism? A) Apply oxygen and notify the Rapid Response Team. B) Start an IV of Normal Saline. C) Obtain a sputum culture. D) Encourage the patient to walk to clear the clot. Rationale: A PE is a medical emergency requiring immediate oxygenation and medical intervention. Part 11: General Safety & Lab Integration Which lab value is the most sensitive indicator of nutritional status for wound healing? A) Albumin B) Prealbumin C) Hemoglobin D) Glucose
