Nursing 109 Final Exam Study Guide: Medical-Surgical
Nursing, Pharmacology, Patient Safety, Clinical Judgment,
NCLEX-Style Questions with Questions and Answers/Plus a
Rationale Updated 2026 A+/Instant Download PDF
Table of Contents
Section Subtopic Question Range
1 Foundations of Nursing Practice Q1–Q5
2 Medication Administration & Pharmacology Q6–Q10
3 Adult Medical-Surgical Nursing Q11–Q15
4 Cardiovascular & Respiratory Nursing Q16–Q20
5 Endocrine, Renal & Gastrointestinal Disorders Q21–Q25
6 Prioritization, Delegation & Patient Safety Q26–Q30
Question 1
A nurse receives report on four hospitalized patients. Which patient should the nurse assess first?
A. A postoperative patient reporting pain rated 8/10 one hour after receiving analgesia.
B. A patient with heart failure who has bilateral ankle edema and urine output of 35 mL/hr.
C. A patient receiving a blood transfusion who develops chills, dyspnea, and lower back
pain 15 minutes after initiation.
D. A patient awaiting discharge who requests additional education regarding prescribed
medications.
Rationale: The patient exhibiting chills, dyspnea, and lower back pain shortly after initiation of
a blood transfusion is demonstrating manifestations of an acute hemolytic transfusion reaction,
which requires immediate cessation of the transfusion and rapid intervention. Option A involves
pain requiring reassessment but is not immediately life-threatening. Option B indicates fluid
retention requiring evaluation but lacks signs of acute instability. Option D represents an
educational priority rather than an emergency. This follows the ABCs and acute deterioration
prioritization principles.
Question 2
A patient with sepsis becomes increasingly confused, has a blood pressure of 82/46 mmHg, heart
rate of 126/min, respiratory rate of 30/min, and lactate of 4.8 mmol/L. Which nursing
intervention should occur first?
,A. Obtain another complete blood count.
B. Administer prescribed acetaminophen.
C. Initiate rapid administration of intravenous crystalloid fluids.
D. Reassess vital signs in 30 minutes.
Rationale: The patient is experiencing septic shock with evidence of tissue hypoperfusion.
Immediate aggressive fluid resuscitation is the priority to restore circulation and organ
perfusion. Option A provides useful diagnostic information but delays treatment. Option B
addresses fever but does not correct shock. Option D dangerously postpones necessary
intervention. Current sepsis management emphasizes early fluid resuscitation and timely
treatment.
Question 3
A nurse is administering medications to a patient who states, "I don't think this pill looks
familiar." What is the nurse's best response?
A. Explain that the pharmacy occasionally substitutes medications.
B. Tell the patient that the medication is probably correct.
C. Pause medication administration and verify the medication using the medication
administration record and pharmacy label.
D. Encourage the patient to take the medication because it has already been dispensed.
Rationale: Any discrepancy identified by the patient should prompt immediate verification
before administration. Following the rights of medication administration prevents medication
errors. Option A assumes accuracy without verification. Option B dismisses the patient's
concern. Option D places the patient at unnecessary risk.
Question 4
A nurse evaluates laboratory findings for a patient receiving intravenous unfractionated heparin.
Which result indicates that the medication is achieving its intended therapeutic effect?
A. INR 2.8
B. Platelet count 420,000/mm³
C. Activated partial thromboplastin time (aPTT) 70 seconds
D. Hemoglobin 15.2 g/dL
Rationale: Therapeutic unfractionated heparin prolongs the aPTT into the target therapeutic
range, commonly 1.5 to 2.5 times normal. INR primarily monitors warfarin therapy. Platelet
count does not determine therapeutic anticoagulation and must instead be monitored for
, heparin-induced thrombocytopenia. Hemoglobin reflects oxygen-carrying capacity rather than
anticoagulant effectiveness.
Question 5
A postoperative patient suddenly develops shortness of breath, chest pain, tachycardia, and
oxygen saturation of 86%. Which action should the nurse perform first?
A. Notify the healthcare provider.
B. Prepare the patient for a chest x-ray.
C. Apply supplemental oxygen and rapidly assess airway and breathing.
D. Encourage coughing and deep breathing exercises.
Rationale: The patient's findings suggest a pulmonary embolism or other acute respiratory
compromise. Immediate support of oxygenation and airway management is the priority
according to the ABC framework. Option A is necessary after immediate stabilization measures
begin. Option B delays urgent treatment. Option D is inappropriate during acute respiratory
distress.
Question 6
A nurse prepares to administer insulin glargine and regular insulin. Which action is appropriate?
A. Mix both insulins in the same syringe.
B. Administer insulin glargine intravenously.
C. Delay insulin administration until bedtime regardless of meals.
D. Administer insulin glargine separately because it should not be mixed with other
insulins.
Rationale: Insulin glargine is a long-acting insulin that should never be mixed with other insulin
preparations because mixing alters its pharmacokinetics. Option A is contraindicated. Option B
is unsafe because glargine is not administered intravenously. Option C ignores individualized
timing and prescribed administration schedules.
Question 7
A patient receiving opioid analgesics becomes difficult to arouse and has a respiratory rate of 7
breaths/min. Which medication should the nurse anticipate administering?
Nursing, Pharmacology, Patient Safety, Clinical Judgment,
NCLEX-Style Questions with Questions and Answers/Plus a
Rationale Updated 2026 A+/Instant Download PDF
Table of Contents
Section Subtopic Question Range
1 Foundations of Nursing Practice Q1–Q5
2 Medication Administration & Pharmacology Q6–Q10
3 Adult Medical-Surgical Nursing Q11–Q15
4 Cardiovascular & Respiratory Nursing Q16–Q20
5 Endocrine, Renal & Gastrointestinal Disorders Q21–Q25
6 Prioritization, Delegation & Patient Safety Q26–Q30
Question 1
A nurse receives report on four hospitalized patients. Which patient should the nurse assess first?
A. A postoperative patient reporting pain rated 8/10 one hour after receiving analgesia.
B. A patient with heart failure who has bilateral ankle edema and urine output of 35 mL/hr.
C. A patient receiving a blood transfusion who develops chills, dyspnea, and lower back
pain 15 minutes after initiation.
D. A patient awaiting discharge who requests additional education regarding prescribed
medications.
Rationale: The patient exhibiting chills, dyspnea, and lower back pain shortly after initiation of
a blood transfusion is demonstrating manifestations of an acute hemolytic transfusion reaction,
which requires immediate cessation of the transfusion and rapid intervention. Option A involves
pain requiring reassessment but is not immediately life-threatening. Option B indicates fluid
retention requiring evaluation but lacks signs of acute instability. Option D represents an
educational priority rather than an emergency. This follows the ABCs and acute deterioration
prioritization principles.
Question 2
A patient with sepsis becomes increasingly confused, has a blood pressure of 82/46 mmHg, heart
rate of 126/min, respiratory rate of 30/min, and lactate of 4.8 mmol/L. Which nursing
intervention should occur first?
,A. Obtain another complete blood count.
B. Administer prescribed acetaminophen.
C. Initiate rapid administration of intravenous crystalloid fluids.
D. Reassess vital signs in 30 minutes.
Rationale: The patient is experiencing septic shock with evidence of tissue hypoperfusion.
Immediate aggressive fluid resuscitation is the priority to restore circulation and organ
perfusion. Option A provides useful diagnostic information but delays treatment. Option B
addresses fever but does not correct shock. Option D dangerously postpones necessary
intervention. Current sepsis management emphasizes early fluid resuscitation and timely
treatment.
Question 3
A nurse is administering medications to a patient who states, "I don't think this pill looks
familiar." What is the nurse's best response?
A. Explain that the pharmacy occasionally substitutes medications.
B. Tell the patient that the medication is probably correct.
C. Pause medication administration and verify the medication using the medication
administration record and pharmacy label.
D. Encourage the patient to take the medication because it has already been dispensed.
Rationale: Any discrepancy identified by the patient should prompt immediate verification
before administration. Following the rights of medication administration prevents medication
errors. Option A assumes accuracy without verification. Option B dismisses the patient's
concern. Option D places the patient at unnecessary risk.
Question 4
A nurse evaluates laboratory findings for a patient receiving intravenous unfractionated heparin.
Which result indicates that the medication is achieving its intended therapeutic effect?
A. INR 2.8
B. Platelet count 420,000/mm³
C. Activated partial thromboplastin time (aPTT) 70 seconds
D. Hemoglobin 15.2 g/dL
Rationale: Therapeutic unfractionated heparin prolongs the aPTT into the target therapeutic
range, commonly 1.5 to 2.5 times normal. INR primarily monitors warfarin therapy. Platelet
count does not determine therapeutic anticoagulation and must instead be monitored for
, heparin-induced thrombocytopenia. Hemoglobin reflects oxygen-carrying capacity rather than
anticoagulant effectiveness.
Question 5
A postoperative patient suddenly develops shortness of breath, chest pain, tachycardia, and
oxygen saturation of 86%. Which action should the nurse perform first?
A. Notify the healthcare provider.
B. Prepare the patient for a chest x-ray.
C. Apply supplemental oxygen and rapidly assess airway and breathing.
D. Encourage coughing and deep breathing exercises.
Rationale: The patient's findings suggest a pulmonary embolism or other acute respiratory
compromise. Immediate support of oxygenation and airway management is the priority
according to the ABC framework. Option A is necessary after immediate stabilization measures
begin. Option B delays urgent treatment. Option D is inappropriate during acute respiratory
distress.
Question 6
A nurse prepares to administer insulin glargine and regular insulin. Which action is appropriate?
A. Mix both insulins in the same syringe.
B. Administer insulin glargine intravenously.
C. Delay insulin administration until bedtime regardless of meals.
D. Administer insulin glargine separately because it should not be mixed with other
insulins.
Rationale: Insulin glargine is a long-acting insulin that should never be mixed with other insulin
preparations because mixing alters its pharmacokinetics. Option A is contraindicated. Option B
is unsafe because glargine is not administered intravenously. Option C ignores individualized
timing and prescribed administration schedules.
Question 7
A patient receiving opioid analgesics becomes difficult to arouse and has a respiratory rate of 7
breaths/min. Which medication should the nurse anticipate administering?
