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NUR 445 FINAL EXAM 2026/2027 Complete
Final Examination | Actual Questions & Verified
Answers | Nursing Leadership & Management
Comprehensive Assessment | Pass Guarantee
NUR 445 FINAL EXAM 2026/2027
Section 1: Advanced Clinical Decision-Making
Q1: A 71-year-old with COPD, heart failure with EF 30 %, and stage 4 CKD arrives in the ED
with acute dyspnea and new-onset confusion. The nurse’s first clinical reasoning step is to:
A. Review the patient’s home medication list for nephrotoxic drugs.
B. Assess airway patency, breathing effort, and circulation status.
C. Obtain a 12-lead ECG to rule out acute MI.
D. Insert a Foley catheter to monitor hourly urine output.
Answer: B
Verified Rationale: The ABC framework always precedes all other assessments because
unrecognized airway or circulatory compromise is immediately life-threatening.
Q2: Using the “SBAR” hand-off tool, the “Assessment” portion must include:
A. The nurse’s clinical interpretation of current vital signs and trends.
B. A complete list of the patient’s allergies.
C. The physician’s most recent progress note.
D. The patient’s insurance authorization status.
Answer: A
Verified Rationale: SBAR’s Assessment section requires the nurse to synthesize data and
communicate professional clinical judgment, not raw or administrative data.
Q3: A patient with sepsis has a lactate of 5.2 mmol/L, BP 78/42 mmHg, and HR 124. Which
diagnostic finding best supports the nurse’s decision to initiate the sepsis bundle?
A. PaO₂ 98 mmHg on 2 L NC.
B. WBC 28 000/mm³ with 12 % bands.
C. Serum creatinine 0.9 mg/dL.
D. BNP 350 pg/mL.
Answer: B
Verified Rationale: Marked leukocytosis with bandemia indicates severe systemic infection,
satisfying bundle criteria for immediate antibiotic and fluid resuscitation.
,2
Q4: A nurse is triaging four patients during a mass-casualty event. Which patient should be
assigned the highest priority (red tag)?
A. 25-year-old with isolated ankle fracture, distal pulses intact.
B. 40-year-old with 2 cm superficial scalp laceration, walking.
C. 60-year-old with respiratory rate 32, absent radial pulses, altered mental status.
D. 8-year-old with bruised knee, crying but alert.
Answer: C
Verified Rationale: Respiratory compromise, poor perfusion, and altered level of consciousness
meet immediate (red-tag) criteria under START triage.
Q5: A patient post-thyroidectomy develops stridor and tactile fremitus 2 hours after surgery. The
nurse’s immediate action is to:
A. Administer IV furosemide.
B. Place the patient supine and call for emergency airway equipment.
C. Check serum calcium level.
D. Offer sips of water to assess swallowing.
Answer: B
Verified Rationale: Stridor after thyroidectomy signals airway obstruction from hematoma or
laryngeal edema, requiring immediate airway preparation and semi-Fowler’s or upright
positioning.
Q6: A nurse is validating a new clinical decision rule for DVT. Which statistical term best
reflects the rule’s ability to correctly identify patients who actually have a DVT?
A. Sensitivity.
B. Specificity.
C. Positive predictive value.
D. Negative predictive value.
Answer: A
Verified Rationale: Sensitivity measures the proportion of true positives correctly identified by
the screening tool.
Q7: During rapid sequence intubation the nurse notes EtCO₂ waveform suddenly flat-line. The
most likely cause is:
A. Esophageal intubation.
B. Bronchospasm.
C. Pulmonary embolism.
D. Oversedation.
Answer: A
Verified Rationale: An abrupt loss of exhaled CO₂ strongly indicates the endotracheal tube is in
the esophagus rather than the trachea.
, 3
Q8: A patient with acute ischemic stroke receives alteplase; 30 minutes later the nurse notes
orolingual angioedema. The priority intervention is to:
A. Administer subcutaneous epinephrine 0.3 mg.
B. Stop the alteplase infusion and prepare for airway management.
C. Increase alteplase rate to finish within 60 minutes.
D. Apply cold compresses to the tongue.
Answer: B
Verified Rationale: Angioedema during alteplase can rapidly obstruct the airway; stopping the
drug and preparing for intubation are critical.
Q9: A nurse is using the Modified Early Warning Score (MEWS). Which parameter is weighted
most heavily in predicting ICU transfer?
A. Systolic BP 90 mmHg.
B. Respiratory rate 28/min.
C. Temperature 38 °C.
D. Urine output 40 mL/hr.
Answer: A
Verified Rationale: Hypotension (systolic <100 mmHg) carries the highest single MEWS point
value, reflecting shock risk.
Q10: A patient with acute MI develops ventricular tachycardia with a pulse. The nurse prepares
to administer:
A. Adenosine 6 mg IV push.
B. Amiodarone 150 mg IV over 10 min.
C. Atropine 0.5 mg IV.
D. Lidocaine 1 mg IV.
Answer: B
Verified Rationale: Stable VT is treated with amiodarone per ACLS guidelines to restore
perfusing rhythm.
Section 2: Complex Patient Management
Case Study 1 (Q11–Q14): Mr. H, 68, with HFpEF, COPD on 3 L home O₂, diabetes, and CKD
stage 4, is admitted with pneumonia and acute on chronic hypercapnic respiratory failure.
Q11: His ABG on 3 L NC shows pH 7.28, PaCO₂ 72 mmHg, PaO₂ 58 mmHg, HCO₃ 34 mEq/L.
The nurse interprets this as:
A. Acute respiratory acidosis with acute metabolic alkalosis.
B. Acute respiratory acidosis with partial metabolic compensation.
C. Chronic respiratory acidosis with acute decompensation.
D. Metabolic acidosis with respiratory compensation.
Answer: C
NUR 445 FINAL EXAM 2026/2027 Complete
Final Examination | Actual Questions & Verified
Answers | Nursing Leadership & Management
Comprehensive Assessment | Pass Guarantee
NUR 445 FINAL EXAM 2026/2027
Section 1: Advanced Clinical Decision-Making
Q1: A 71-year-old with COPD, heart failure with EF 30 %, and stage 4 CKD arrives in the ED
with acute dyspnea and new-onset confusion. The nurse’s first clinical reasoning step is to:
A. Review the patient’s home medication list for nephrotoxic drugs.
B. Assess airway patency, breathing effort, and circulation status.
C. Obtain a 12-lead ECG to rule out acute MI.
D. Insert a Foley catheter to monitor hourly urine output.
Answer: B
Verified Rationale: The ABC framework always precedes all other assessments because
unrecognized airway or circulatory compromise is immediately life-threatening.
Q2: Using the “SBAR” hand-off tool, the “Assessment” portion must include:
A. The nurse’s clinical interpretation of current vital signs and trends.
B. A complete list of the patient’s allergies.
C. The physician’s most recent progress note.
D. The patient’s insurance authorization status.
Answer: A
Verified Rationale: SBAR’s Assessment section requires the nurse to synthesize data and
communicate professional clinical judgment, not raw or administrative data.
Q3: A patient with sepsis has a lactate of 5.2 mmol/L, BP 78/42 mmHg, and HR 124. Which
diagnostic finding best supports the nurse’s decision to initiate the sepsis bundle?
A. PaO₂ 98 mmHg on 2 L NC.
B. WBC 28 000/mm³ with 12 % bands.
C. Serum creatinine 0.9 mg/dL.
D. BNP 350 pg/mL.
Answer: B
Verified Rationale: Marked leukocytosis with bandemia indicates severe systemic infection,
satisfying bundle criteria for immediate antibiotic and fluid resuscitation.
,2
Q4: A nurse is triaging four patients during a mass-casualty event. Which patient should be
assigned the highest priority (red tag)?
A. 25-year-old with isolated ankle fracture, distal pulses intact.
B. 40-year-old with 2 cm superficial scalp laceration, walking.
C. 60-year-old with respiratory rate 32, absent radial pulses, altered mental status.
D. 8-year-old with bruised knee, crying but alert.
Answer: C
Verified Rationale: Respiratory compromise, poor perfusion, and altered level of consciousness
meet immediate (red-tag) criteria under START triage.
Q5: A patient post-thyroidectomy develops stridor and tactile fremitus 2 hours after surgery. The
nurse’s immediate action is to:
A. Administer IV furosemide.
B. Place the patient supine and call for emergency airway equipment.
C. Check serum calcium level.
D. Offer sips of water to assess swallowing.
Answer: B
Verified Rationale: Stridor after thyroidectomy signals airway obstruction from hematoma or
laryngeal edema, requiring immediate airway preparation and semi-Fowler’s or upright
positioning.
Q6: A nurse is validating a new clinical decision rule for DVT. Which statistical term best
reflects the rule’s ability to correctly identify patients who actually have a DVT?
A. Sensitivity.
B. Specificity.
C. Positive predictive value.
D. Negative predictive value.
Answer: A
Verified Rationale: Sensitivity measures the proportion of true positives correctly identified by
the screening tool.
Q7: During rapid sequence intubation the nurse notes EtCO₂ waveform suddenly flat-line. The
most likely cause is:
A. Esophageal intubation.
B. Bronchospasm.
C. Pulmonary embolism.
D. Oversedation.
Answer: A
Verified Rationale: An abrupt loss of exhaled CO₂ strongly indicates the endotracheal tube is in
the esophagus rather than the trachea.
, 3
Q8: A patient with acute ischemic stroke receives alteplase; 30 minutes later the nurse notes
orolingual angioedema. The priority intervention is to:
A. Administer subcutaneous epinephrine 0.3 mg.
B. Stop the alteplase infusion and prepare for airway management.
C. Increase alteplase rate to finish within 60 minutes.
D. Apply cold compresses to the tongue.
Answer: B
Verified Rationale: Angioedema during alteplase can rapidly obstruct the airway; stopping the
drug and preparing for intubation are critical.
Q9: A nurse is using the Modified Early Warning Score (MEWS). Which parameter is weighted
most heavily in predicting ICU transfer?
A. Systolic BP 90 mmHg.
B. Respiratory rate 28/min.
C. Temperature 38 °C.
D. Urine output 40 mL/hr.
Answer: A
Verified Rationale: Hypotension (systolic <100 mmHg) carries the highest single MEWS point
value, reflecting shock risk.
Q10: A patient with acute MI develops ventricular tachycardia with a pulse. The nurse prepares
to administer:
A. Adenosine 6 mg IV push.
B. Amiodarone 150 mg IV over 10 min.
C. Atropine 0.5 mg IV.
D. Lidocaine 1 mg IV.
Answer: B
Verified Rationale: Stable VT is treated with amiodarone per ACLS guidelines to restore
perfusing rhythm.
Section 2: Complex Patient Management
Case Study 1 (Q11–Q14): Mr. H, 68, with HFpEF, COPD on 3 L home O₂, diabetes, and CKD
stage 4, is admitted with pneumonia and acute on chronic hypercapnic respiratory failure.
Q11: His ABG on 3 L NC shows pH 7.28, PaCO₂ 72 mmHg, PaO₂ 58 mmHg, HCO₃ 34 mEq/L.
The nurse interprets this as:
A. Acute respiratory acidosis with acute metabolic alkalosis.
B. Acute respiratory acidosis with partial metabolic compensation.
C. Chronic respiratory acidosis with acute decompensation.
D. Metabolic acidosis with respiratory compensation.
Answer: C
