NUR 421 |summer exam series |June/July 2026
|questions and correct answers |already graded A+
1 A 68-year-old patient with chronic heart failure is admitted with
increased shortness of breath and peripheral edema. Which assessment
finding best indicates the need to adjust the patient's diuretic regimen?
A. Urinary output of 30 mL/hr over 4 hours
B. Weight increase of 1.0 kg since yesterday
C. Blood pressure 128/76 mm Hg
D. Peripheral pulses 2+ bilaterally
CORRECT ANSWER: A
Explanation: A urinary output of 30 mL/hr over 4 hours suggests
oliguria and inadequate diuresis requiring adjustment; a 1.0 kg
weight gain is concerning but less specific than low urine output,
normal BP is not an indication to change diuretics, and 2+ pulses
are within normal range and not an indicator for diuretic change.
2 Which mechanism best explains why loop diuretics relieve pulmonary
congestion in acute decompensated heart failure?
A. Increased renal reabsorption of sodium
B. Inhibition of Na-K-2Cl transporter in the thick ascending limb
C. Enhanced distal tubule calcium reabsorption
D. Activation of aldosterone receptors
CORRECT ANSWER: B
Explanation: Loop diuretics inhibit the Na-K-2Cl transporter in the
thick ascending limb, leading to powerful natriuresis and fluid
removal that relieves pulmonary congestion; increased
reabsorption, calcium reabsorption enhancement, and aldosterone
activation would worsen fluid retention.
,3 A patient with diabetes and a new prescription for metformin develops
acute kidney injury (AKI). What is the primary nursing concern if
metformin is continued?
A. Hypoglycemia
B. Lactic acidosis
C. Hyperkalemia
D. Thyroid dysfunction
CORRECT ANSWER: B
Explanation: Metformin accumulation in AKI increases risk of lactic
acidosis, a serious complication; metformin is less associated with
hypoglycemia, hyperkalemia, or thyroid dysfunction.
4 During a code, the nurse notes ventricular fibrillation on the monitor.
Which action should the nurse take immediately?
A. Administer intravenous amiodarone
B. Defibrillate immediately with unsynchronized shock
C. Start chest compressions without delay
D. Give synchronized cardioversion
CORRECT ANSWER: B
Explanation: VF requires immediate unsynchronized defibrillation;
while chest compressions should be started if a shock is delayed, the
priority for VF is immediate defibrillation, not synchronized
cardioversion or initial amiodarone.
5 A patient with chronic obstructive pulmonary disease (COPD) is being
discharged with home oxygen therapy. Which instruction will best
prevent oxygen-related complications?
A. Increase flow rate during sleep to prevent hypoxia
B. Use open flames near oxygen tubing if well-ventilated
C. Keep oxygen concentrator at least 1 meter from heat sources
D. Stop oxygen when performing light exercise
CORRECT ANSWER: C
,Explanation: Keeping the oxygen concentrator away from heat
sources reduces fire risk; oxygen should never be exposed to open
flames, flow rates should be prescribed (not arbitrarily increased),
and oxygen should not be stopped during exercise if prescribed.
6 A nurse is teaching a patient about INR monitoring while on warfarin.
Which statement by the patient indicates correct understanding?
A. "I can stop my medication if my INR is above 2.0."
B. "I will avoid changing any of my dietary habits."
C. "I will have my INR checked before any invasive procedure."
D. "I can take over-the-counter aspirin for headaches regularly."
CORRECT ANSWER: C
Explanation: INR should be checked before invasive procedures;
stopping warfarin based on a single value without guidance is
unsafe, dietary changes can affect INR and should be discussed with
provider, and regular aspirin increases bleeding risk with warfarin
and is not advised without provider approval.
7 A postoperative patient develops sudden confusion, aphasia, and right-
sided weakness 2 hours after arrival on the unit. What is the nurse's most
appropriate immediate action?
A. Administer prescribed opioid for pain
B. Call the rapid response team and follow stroke protocol
C. Reassess vital signs in 30 minutes
D. Encourage the patient to rest and observe for improvement
CORRECT ANSWER: B
Explanation: Sudden neurologic deficits require immediate
activation of stroke protocol/rapid response to allow timely
intervention; waiting, treating pain, or passive observation could
delay critical treatment.
, 8 A patient with suspected bacterial meningitis is admitted. Which
nursing intervention is highest priority before antibiotics are given?
A. Obtain blood cultures
B. Begin droplet isolation
C. Start IV fluids
D. Administer analgesics
CORRECT ANSWER: B
Explanation: Droplet isolation should begin immediately to prevent
spread; blood cultures are important and ideally before antibiotics if
they will not delay treatment, but isolation is highest priority for
infection control, while fluids and analgesics are secondary.
9 In a patient receiving total parenteral nutrition (TPN), which value
most directly indicates a problem with the TPN infusion?
A. Serum sodium 140 mEq/L
B. Serum glucose 320 mg/dL
C. White blood cell count 6,000/mm3
D. Total protein 7.0 g/dL
CORRECT ANSWER: B
Explanation: Hyperglycemia (glucose 320 mg/dL) is a common and
direct complication of TPN requiring adjustment; normal sodium
and WBC do not indicate TPN issues, and total protein is less
specific.
10 A nurse evaluates an arterial blood gas (ABG): pH 7.25, PaCO2 55
mm Hg, HCO3- 22 mEq/L. What is the primary acid-base disturbance?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Respiratory acidosis
D. Metabolic alkalosis
CORRECT ANSWER: C
Explanation: Low pH with elevated PaCO2 indicates primary
|questions and correct answers |already graded A+
1 A 68-year-old patient with chronic heart failure is admitted with
increased shortness of breath and peripheral edema. Which assessment
finding best indicates the need to adjust the patient's diuretic regimen?
A. Urinary output of 30 mL/hr over 4 hours
B. Weight increase of 1.0 kg since yesterday
C. Blood pressure 128/76 mm Hg
D. Peripheral pulses 2+ bilaterally
CORRECT ANSWER: A
Explanation: A urinary output of 30 mL/hr over 4 hours suggests
oliguria and inadequate diuresis requiring adjustment; a 1.0 kg
weight gain is concerning but less specific than low urine output,
normal BP is not an indication to change diuretics, and 2+ pulses
are within normal range and not an indicator for diuretic change.
2 Which mechanism best explains why loop diuretics relieve pulmonary
congestion in acute decompensated heart failure?
A. Increased renal reabsorption of sodium
B. Inhibition of Na-K-2Cl transporter in the thick ascending limb
C. Enhanced distal tubule calcium reabsorption
D. Activation of aldosterone receptors
CORRECT ANSWER: B
Explanation: Loop diuretics inhibit the Na-K-2Cl transporter in the
thick ascending limb, leading to powerful natriuresis and fluid
removal that relieves pulmonary congestion; increased
reabsorption, calcium reabsorption enhancement, and aldosterone
activation would worsen fluid retention.
,3 A patient with diabetes and a new prescription for metformin develops
acute kidney injury (AKI). What is the primary nursing concern if
metformin is continued?
A. Hypoglycemia
B. Lactic acidosis
C. Hyperkalemia
D. Thyroid dysfunction
CORRECT ANSWER: B
Explanation: Metformin accumulation in AKI increases risk of lactic
acidosis, a serious complication; metformin is less associated with
hypoglycemia, hyperkalemia, or thyroid dysfunction.
4 During a code, the nurse notes ventricular fibrillation on the monitor.
Which action should the nurse take immediately?
A. Administer intravenous amiodarone
B. Defibrillate immediately with unsynchronized shock
C. Start chest compressions without delay
D. Give synchronized cardioversion
CORRECT ANSWER: B
Explanation: VF requires immediate unsynchronized defibrillation;
while chest compressions should be started if a shock is delayed, the
priority for VF is immediate defibrillation, not synchronized
cardioversion or initial amiodarone.
5 A patient with chronic obstructive pulmonary disease (COPD) is being
discharged with home oxygen therapy. Which instruction will best
prevent oxygen-related complications?
A. Increase flow rate during sleep to prevent hypoxia
B. Use open flames near oxygen tubing if well-ventilated
C. Keep oxygen concentrator at least 1 meter from heat sources
D. Stop oxygen when performing light exercise
CORRECT ANSWER: C
,Explanation: Keeping the oxygen concentrator away from heat
sources reduces fire risk; oxygen should never be exposed to open
flames, flow rates should be prescribed (not arbitrarily increased),
and oxygen should not be stopped during exercise if prescribed.
6 A nurse is teaching a patient about INR monitoring while on warfarin.
Which statement by the patient indicates correct understanding?
A. "I can stop my medication if my INR is above 2.0."
B. "I will avoid changing any of my dietary habits."
C. "I will have my INR checked before any invasive procedure."
D. "I can take over-the-counter aspirin for headaches regularly."
CORRECT ANSWER: C
Explanation: INR should be checked before invasive procedures;
stopping warfarin based on a single value without guidance is
unsafe, dietary changes can affect INR and should be discussed with
provider, and regular aspirin increases bleeding risk with warfarin
and is not advised without provider approval.
7 A postoperative patient develops sudden confusion, aphasia, and right-
sided weakness 2 hours after arrival on the unit. What is the nurse's most
appropriate immediate action?
A. Administer prescribed opioid for pain
B. Call the rapid response team and follow stroke protocol
C. Reassess vital signs in 30 minutes
D. Encourage the patient to rest and observe for improvement
CORRECT ANSWER: B
Explanation: Sudden neurologic deficits require immediate
activation of stroke protocol/rapid response to allow timely
intervention; waiting, treating pain, or passive observation could
delay critical treatment.
, 8 A patient with suspected bacterial meningitis is admitted. Which
nursing intervention is highest priority before antibiotics are given?
A. Obtain blood cultures
B. Begin droplet isolation
C. Start IV fluids
D. Administer analgesics
CORRECT ANSWER: B
Explanation: Droplet isolation should begin immediately to prevent
spread; blood cultures are important and ideally before antibiotics if
they will not delay treatment, but isolation is highest priority for
infection control, while fluids and analgesics are secondary.
9 In a patient receiving total parenteral nutrition (TPN), which value
most directly indicates a problem with the TPN infusion?
A. Serum sodium 140 mEq/L
B. Serum glucose 320 mg/dL
C. White blood cell count 6,000/mm3
D. Total protein 7.0 g/dL
CORRECT ANSWER: B
Explanation: Hyperglycemia (glucose 320 mg/dL) is a common and
direct complication of TPN requiring adjustment; normal sodium
and WBC do not indicate TPN issues, and total protein is less
specific.
10 A nurse evaluates an arterial blood gas (ABG): pH 7.25, PaCO2 55
mm Hg, HCO3- 22 mEq/L. What is the primary acid-base disturbance?
A. Metabolic acidosis
B. Respiratory alkalosis
C. Respiratory acidosis
D. Metabolic alkalosis
CORRECT ANSWER: C
Explanation: Low pH with elevated PaCO2 indicates primary
