NUR 417 FINAL EXAM 2026/2027 UPDATED EXAM Actual
Exam 2026/2027 with Detailed Rationales | Complete Exam-Style
Questions | Graded A+ Pass Guaranteed
Total Questions: 50 | Time: 90 min | Pass: 80%
TABLE OF CONTENTS
Section 1 | Advanced Medical-Surgical Nursing | Q1 – Q10
Section 2 | Critical Care & Emergency Nursing | Q11 – Q20
Section 3 | Pharmacology & Parenteral Therapies | Q21 – Q30
Section 4 | Leadership, Ethics, & Patient Safety | Q31 – Q40
Section 5 | Complex Multisystem Conditions & End-of-Life Care | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
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SECTION 1: ADVANCED MEDICAL-SURGICAL NURSING Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 62-year-old patient is on postoperative day 3 after an open abdominal aortic
aneurysm repair. While ambulating in the hallway, the patient states something "gave
way" at the incision site. The nurse observes a small amount of pink, clear fluid on the
dressing and notes that the wound edges have separated with visible underlying tissue.
A. Place the patient in a supine position with knees flexed and cover the wound with a
sterile saline-moistened dressing ✓ CORRECT
B. Apply an abdominal binder tightly around the wound and encourage the patient to
continue walking to promote circulation
C. Immediately pack the wound with sterile gauze soaked in povidone-iodine and notify
the surgeon
D. Assist the patient to a high-Fowler position and apply a dry sterile dressing with
adhesive tape
Correct Answer: A
,Rationale: A supine position with knees flexed reduces intra-abdominal tension on the
dehisced wound, and a sterile saline-moistened dressing protects exposed tissue while
maintaining a moist environment conducive to healing. Tight binders or continued
ambulation increase intra-abdominal pressure and can worsen the dehiscence. In
practice, you should stay with the patient, keep them calm, and have another nurse
notify the surgeon immediately while you maintain the sterile field.
Question 2 of 50
A 54-year-old patient with type 2 diabetes presents to the wound care clinic with a 2 cm
by 3 cm ulcer on the plantar surface of the right foot over the first metatarsal head. The
ulcer is shallow with no exposed tendon or bone, and there is no gangrene or abscess
formation. The surrounding skin is warm and erythematous.
A. Stage the ulcer as Wagner Grade 2 and recommend total contact casting
B. Document the wound as Wagner Grade 1 and initiate offloading with a removable
cast walker ✓ CORRECT
C. Classify the wound as Wagner Grade 3 and arrange for surgical debridement in the
operating room
D. Grade the ulcer as Wagner Grade 0 and prescribe therapeutic footwear with custom
insoles
Correct Answer: B
Rationale: Wagner Grade 1 describes a superficial ulcer that does not penetrate to
tendon, bone, or deeper structures, which matches this presentation of a shallow
plantar ulcer without deeper involvement. Grade 2 requires tendon or capsule exposure,
while Grade 3 involves bone or joint involvement, making those choices incorrect for
this clinical picture. Offloading is the cornerstone of Wagner Grade 1 management, and
a removable cast walker is an effective, evidence-based intervention that reduces
plantar pressure.
Question 3 of 50
,A 38-year-old patient with a history of anorexia nervosa is admitted to the
medical-surgical unit after a 15% weight loss over three months. The provider orders
initiation of enteral nutrition via NG tube at 60 mL per hour. Six hours after starting the
feeds, the patient becomes lethargic, develops muscle weakness, and the cardiac
monitor shows peaked T-waves with a widened QRS complex.
A. Increase the enteral feeding rate to meet caloric goals and administer sodium
bicarbonate for the acidosis
B. Discontinue the feeding immediately and administer 50% dextrose IV push to treat
hypoglycemia
C. Stop the enteral nutrition, check serum phosphorus, and prepare to administer IV
phosphorus with cardiac monitoring ✓ CORRECT
D. Continue the current feeding rate and administer potassium chloride IV to correct the
peaked T-waves
Correct Answer: C
Rationale: This patient is exhibiting classic signs of refeeding syndrome, where rapid
carbohydrate administration in a malnourished patient drives phosphorus intracellularly,
causing severe hypophosphatemia that manifests as cardiac conduction abnormalities
and neuromuscular weakness. Stopping the feed and replacing phosphorus is the
priority, as continuing feeds or giving dextrose would worsen the shift. Refeeding
syndrome can be fatal if not recognized early, and protocols typically require starting
nutrition at roughly 10–20 kcal/kg and advancing slowly with close electrolyte
monitoring.
Question 4 of 50
A 28-year-old firefighter is brought to the emergency department after being trapped in a
house fire for approximately 8 minutes. He has partial-thickness burns covering 36% of
his total body surface area, primarily involving the anterior trunk and both upper
extremities. He weighs 82 kg. The provider asks the nurse to calculate the fluid
resuscitation for the first 24 hours using the Parkland formula.
, A. Administer 2,952 mL of lactated Ringer's over the first 8 hours and the same amount
over the next 16 hours
B. Give 5,904 mL of normal saline in the first 8 hours, then continue at 125 mL/hour for
the remaining 16 hours
C. Infuse 11,808 mL of lactated Ringer's evenly over 24 hours at 492 mL/hour
D. Give 5,904 mL of lactated Ringer's in the first 8 hours from the time of injury, with the
remainder over the next 16 hours ✓ CORRECT
Correct Answer: D
Rationale: The Parkland formula calculates 4 mL per kg per percent TBSA burned,
yielding 11,808 mL total for this patient, with half of that volume given in the first 8
hours and the remaining half in the next 16 hours. Normal saline is not the preferred
resuscitation fluid for burns, and giving the total volume evenly over 24 hours does not
account for the massive capillary leak that occurs in the first 8 hours. The clock for the
first 8 hours starts at the time of injury, not hospital arrival, so the nurse must adjust the
rate if transport was delayed.
Question 5 of 50
A 45-year-old patient is admitted with a diagnosis of Cushing syndrome secondary to a
pituitary adenoma. During the morning assessment, the nurse notes the patient has 3+
pitting edema of the lower extremities, a blood pressure of 168/102 mmHg, and reports
feeling anxious and unable to sleep.
A. Implement a low-sodium diet, monitor strict intake and output, and assess for signs
of hyperglycemia ✓ CORRECT
B. Encourage increased fluid intake to counteract the edema and administer a sedative
for sleep
C. Place the patient on a high-potassium diet and prepare for immediate surgical
removal of the adenoma
D. Elevate the legs above the level of the heart for 30 minutes and then resume normal
activity
Correct Answer: A
Exam 2026/2027 with Detailed Rationales | Complete Exam-Style
Questions | Graded A+ Pass Guaranteed
Total Questions: 50 | Time: 90 min | Pass: 80%
TABLE OF CONTENTS
Section 1 | Advanced Medical-Surgical Nursing | Q1 – Q10
Section 2 | Critical Care & Emergency Nursing | Q11 – Q20
Section 3 | Pharmacology & Parenteral Therapies | Q21 – Q30
Section 4 | Leadership, Ethics, & Patient Safety | Q31 – Q40
Section 5 | Complex Multisystem Conditions & End-of-Life Care | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: ADVANCED MEDICAL-SURGICAL NURSING Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 62-year-old patient is on postoperative day 3 after an open abdominal aortic
aneurysm repair. While ambulating in the hallway, the patient states something "gave
way" at the incision site. The nurse observes a small amount of pink, clear fluid on the
dressing and notes that the wound edges have separated with visible underlying tissue.
A. Place the patient in a supine position with knees flexed and cover the wound with a
sterile saline-moistened dressing ✓ CORRECT
B. Apply an abdominal binder tightly around the wound and encourage the patient to
continue walking to promote circulation
C. Immediately pack the wound with sterile gauze soaked in povidone-iodine and notify
the surgeon
D. Assist the patient to a high-Fowler position and apply a dry sterile dressing with
adhesive tape
Correct Answer: A
,Rationale: A supine position with knees flexed reduces intra-abdominal tension on the
dehisced wound, and a sterile saline-moistened dressing protects exposed tissue while
maintaining a moist environment conducive to healing. Tight binders or continued
ambulation increase intra-abdominal pressure and can worsen the dehiscence. In
practice, you should stay with the patient, keep them calm, and have another nurse
notify the surgeon immediately while you maintain the sterile field.
Question 2 of 50
A 54-year-old patient with type 2 diabetes presents to the wound care clinic with a 2 cm
by 3 cm ulcer on the plantar surface of the right foot over the first metatarsal head. The
ulcer is shallow with no exposed tendon or bone, and there is no gangrene or abscess
formation. The surrounding skin is warm and erythematous.
A. Stage the ulcer as Wagner Grade 2 and recommend total contact casting
B. Document the wound as Wagner Grade 1 and initiate offloading with a removable
cast walker ✓ CORRECT
C. Classify the wound as Wagner Grade 3 and arrange for surgical debridement in the
operating room
D. Grade the ulcer as Wagner Grade 0 and prescribe therapeutic footwear with custom
insoles
Correct Answer: B
Rationale: Wagner Grade 1 describes a superficial ulcer that does not penetrate to
tendon, bone, or deeper structures, which matches this presentation of a shallow
plantar ulcer without deeper involvement. Grade 2 requires tendon or capsule exposure,
while Grade 3 involves bone or joint involvement, making those choices incorrect for
this clinical picture. Offloading is the cornerstone of Wagner Grade 1 management, and
a removable cast walker is an effective, evidence-based intervention that reduces
plantar pressure.
Question 3 of 50
,A 38-year-old patient with a history of anorexia nervosa is admitted to the
medical-surgical unit after a 15% weight loss over three months. The provider orders
initiation of enteral nutrition via NG tube at 60 mL per hour. Six hours after starting the
feeds, the patient becomes lethargic, develops muscle weakness, and the cardiac
monitor shows peaked T-waves with a widened QRS complex.
A. Increase the enteral feeding rate to meet caloric goals and administer sodium
bicarbonate for the acidosis
B. Discontinue the feeding immediately and administer 50% dextrose IV push to treat
hypoglycemia
C. Stop the enteral nutrition, check serum phosphorus, and prepare to administer IV
phosphorus with cardiac monitoring ✓ CORRECT
D. Continue the current feeding rate and administer potassium chloride IV to correct the
peaked T-waves
Correct Answer: C
Rationale: This patient is exhibiting classic signs of refeeding syndrome, where rapid
carbohydrate administration in a malnourished patient drives phosphorus intracellularly,
causing severe hypophosphatemia that manifests as cardiac conduction abnormalities
and neuromuscular weakness. Stopping the feed and replacing phosphorus is the
priority, as continuing feeds or giving dextrose would worsen the shift. Refeeding
syndrome can be fatal if not recognized early, and protocols typically require starting
nutrition at roughly 10–20 kcal/kg and advancing slowly with close electrolyte
monitoring.
Question 4 of 50
A 28-year-old firefighter is brought to the emergency department after being trapped in a
house fire for approximately 8 minutes. He has partial-thickness burns covering 36% of
his total body surface area, primarily involving the anterior trunk and both upper
extremities. He weighs 82 kg. The provider asks the nurse to calculate the fluid
resuscitation for the first 24 hours using the Parkland formula.
, A. Administer 2,952 mL of lactated Ringer's over the first 8 hours and the same amount
over the next 16 hours
B. Give 5,904 mL of normal saline in the first 8 hours, then continue at 125 mL/hour for
the remaining 16 hours
C. Infuse 11,808 mL of lactated Ringer's evenly over 24 hours at 492 mL/hour
D. Give 5,904 mL of lactated Ringer's in the first 8 hours from the time of injury, with the
remainder over the next 16 hours ✓ CORRECT
Correct Answer: D
Rationale: The Parkland formula calculates 4 mL per kg per percent TBSA burned,
yielding 11,808 mL total for this patient, with half of that volume given in the first 8
hours and the remaining half in the next 16 hours. Normal saline is not the preferred
resuscitation fluid for burns, and giving the total volume evenly over 24 hours does not
account for the massive capillary leak that occurs in the first 8 hours. The clock for the
first 8 hours starts at the time of injury, not hospital arrival, so the nurse must adjust the
rate if transport was delayed.
Question 5 of 50
A 45-year-old patient is admitted with a diagnosis of Cushing syndrome secondary to a
pituitary adenoma. During the morning assessment, the nurse notes the patient has 3+
pitting edema of the lower extremities, a blood pressure of 168/102 mmHg, and reports
feeling anxious and unable to sleep.
A. Implement a low-sodium diet, monitor strict intake and output, and assess for signs
of hyperglycemia ✓ CORRECT
B. Encourage increased fluid intake to counteract the edema and administer a sedative
for sleep
C. Place the patient on a high-potassium diet and prepare for immediate surgical
removal of the adenoma
D. Elevate the legs above the level of the heart for 30 minutes and then resume normal
activity
Correct Answer: A
