NU 311 FINAL EXAM AND STUDY GUIDE NEWEST 2026
TEST BANK| NU311 CLINICAL NURSING SKILLS FINAL
EXAM PREP WITH COMPLETE REAL EXAM QUESTIONS
AND CORRECT VERIFIED ANSWERS/ ALREADY GRADED
A+ (MOST RECENT! - 180 Questions and Answers Already
Graded A+ Premium Exam Tested And Verified
Subject Area Clinical Nursing Skills
Description This exam assesses advanced clinical nursing skills including assessment,
pharmacology, critical care, and evidence-based interventions. It integrates
pathophysiology, patient safety, and interprofessional collaboration for complex
patient scenarios.
Expected Grade A+
Total Questions 180
Duration 3 hours
Learning Outcomes 1. Perform comprehensive health assessments and interpret findings.
2. Administer and manage complex medication regimens safely.
3. Implement evidence-based interventions for acute and chronic conditions.
4. Apply clinical reasoning in high-acuity situations.
Accreditation Accredited by the Commission on Collegiate Nursing Education (CCNE) and
aligns with AACN Essentials.
Page 1
,1. A patient with a history of chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 2 L/min via nasal cannula. The nurse notes the patient's
respiratory rate is 22 breaths/min and SpO2 is 89%. Which intervention should the
nurse implement first?
A. Increase oxygen to 4 L/min and reassess SpO2.
B. Place the patient in a high Fowler's position.
C. Administer a bronchodilator via nebulizer.
D. Obtain an arterial blood gas (ABG) sample.
Answer: A. Increase oxygen to 4 L/min and reassess SpO2.
The patient is hypoxemic (SpO2 <90%) and has COPD. Increasing oxygen is the
priority to correct hypoxemia. High Fowler's position may help but does not directly
address oxygenation. Bronchodilator and ABG are important but not first.
2. Which of the following electrocardiogram (ECG) findings is most consistent with
hyperkalemia?
A. Prolonged PR interval and widened QRS complex.
B. Peaked T waves and widened QRS complex.
C. ST segment elevation and inverted T waves.
D. U waves and prolonged QT interval.
Answer: B. Peaked T waves and widened QRS complex.
Hyperkalemia typically causes peaked T waves and widened QRS. Prolonged PR
interval may occur but peaked T waves are hallmark. ST elevation suggests injury, U
waves suggest hypokalemia.
3. A patient with a diagnosis of heart failure is prescribed furosemide 40 mg
intravenous push. The nurse knows that the primary mechanism of action of
furosemide is to:
A. Inhibit sodium reabsorption in the distal convoluted tubule.
B. Block sodium-potassium-chloride cotransporter in the loop of Henle.
C. Antagonize aldosterone receptors in the collecting duct.
D. Increase glomerular filtration rate by dilating afferent arterioles.
Answer: B. Block sodium-potassium-chloride cotransporter in the loop of Henle.
Furosemide is a loop diuretic that acts on the Na-K-2Cl cotransporter in the thick
ascending limb. Option A describes thiazides, C describes spironolactone, D is not a
primary mechanism.
Page 2
,4. A nurse is assessing a patient's surgical wound on postoperative day 3. Which
finding indicates possible wound infection?
A. Serosanguinous drainage and mild erythema at edges.
B. Purulent drainage and warmth surrounding the incision.
C. Ecchymosis and edema extending 2 cm from incision.
D. Wound edges well-approximated with staples intact.
Answer: B. Purulent drainage and warmth surrounding the incision.
Purulent drainage and warmth are classic signs of infection. Serosanguinous drainage
and mild erythema can be normal. Ecchymosis and edema may be from trauma.
Well-approximated edges are expected healing.
5. A patient is receiving a blood transfusion. Five minutes after initiation, the patient
reports lower back pain and appears flushed. The nurse's priority action is to:
A. Slow the transfusion rate and administer diphenhydramine.
B. Stop the transfusion immediately and maintain IV access with normal saline.
C. Increase the IV rate to dilute the blood product.
D. Obtain vital signs and notify the healthcare provider.
Answer: B. Stop the transfusion immediately and maintain IV access with normal
saline.
These symptoms suggest an acute hemolytic reaction. The priority is to stop the
transfusion immediately to prevent further reaction. Maintaining IV access with saline
is essential. Slowing or increasing rate is incorrect; notification is secondary.
6. Which of the following is a contraindication for administration of metformin?
A. Type 2 diabetes mellitus with HbA1c 8.5%.
B. Estimated glomerular filtration rate (eGFR) of 35 mL/min/1.73 m².
C. Body mass index (BMI) of 32 kg/m².
D. Concurrent use of insulin glargine.
Answer: B. Estimated glomerular filtration rate (eGFR) of 35 mL/min/1.73 m².
Metformin is contraindicated when eGFR <30 mL/min due to risk of lactic acidosis;
some guidelines also caution at <45 mL/min. Option A is an indication, C is not a
contraindication, D is acceptable combination.
Page 3
, 7. A patient with a central venous catheter has a temperature of 39.2°C and chills.
Blood cultures are drawn. Which action is most important for the nurse to take?
A. Administer acetaminophen for fever.
B. Remove the central line and culture the tip.
C. Start broad-spectrum antibiotics after cultures.
D. Change the transparent dressing and clean the site with chlorhexidine.
Answer: C. Start broad-spectrum antibiotics after cultures.
In suspected catheter-related bloodstream infection, prompt antibiotic therapy is
critical after obtaining cultures. Removing the line may be necessary but is not the first
action unless the patient is unstable. Acetaminophen treats symptom, not infection.
Dressing change is not priority.
8. Which arterial blood gas (ABG) result is consistent with compensated metabolic
alkalosis?
A. pH 7.38, PaCO2 48 mm Hg, HCO3- 30 mEq/L.
B. pH 7.46, PaCO2 42 mm Hg, HCO3- 32 mEq/L.
C. pH 7.35, PaCO2 30 mm Hg, HCO3- 18 mEq/L.
D. pH 7.48, PaCO2 50 mm Hg, HCO3- 35 mEq/L.
Answer: A. pH 7.38, PaCO2 48 mm Hg, HCO3- 30 mEq/L.
Compensated metabolic alkalosis shows elevated HCO3- with a compensatory
respiratory acidosis (elevated PaCO2) and pH toward normal. Option A has elevated
HCO3- and PaCO2 with pH near normal. Option B is uncompensated alkalosis, C is
metabolic acidosis, D is partially compensated metabolic alkalosis.
9. A nurse is evaluating a patient's readiness to wean from mechanical ventilation.
Which finding suggests a high likelihood of successful extubation?
A. Negative inspiratory force (NIF) of -15 cm H2O.
B. Rapid shallow breathing index (RSBI) of 105 breaths/min/L.
C. PaO2/FiO2 ratio of 250.
D. Spontaneous tidal volume of 4 mL/kg.
Answer: B. Rapid shallow breathing index (RSBI) of 105 breaths/min/L.
RSBI <105 indicates likely success; 105 is borderline but suggests readiness. NIF should
be more negative than -20 to -30. PaO2/FiO2 >200 is acceptable, but 250 is adequate.
Tidal volume >5 mL/kg is preferred; 4 mL/kg is low.
Page 4
TEST BANK| NU311 CLINICAL NURSING SKILLS FINAL
EXAM PREP WITH COMPLETE REAL EXAM QUESTIONS
AND CORRECT VERIFIED ANSWERS/ ALREADY GRADED
A+ (MOST RECENT! - 180 Questions and Answers Already
Graded A+ Premium Exam Tested And Verified
Subject Area Clinical Nursing Skills
Description This exam assesses advanced clinical nursing skills including assessment,
pharmacology, critical care, and evidence-based interventions. It integrates
pathophysiology, patient safety, and interprofessional collaboration for complex
patient scenarios.
Expected Grade A+
Total Questions 180
Duration 3 hours
Learning Outcomes 1. Perform comprehensive health assessments and interpret findings.
2. Administer and manage complex medication regimens safely.
3. Implement evidence-based interventions for acute and chronic conditions.
4. Apply clinical reasoning in high-acuity situations.
Accreditation Accredited by the Commission on Collegiate Nursing Education (CCNE) and
aligns with AACN Essentials.
Page 1
,1. A patient with a history of chronic obstructive pulmonary disease (COPD) is
receiving oxygen at 2 L/min via nasal cannula. The nurse notes the patient's
respiratory rate is 22 breaths/min and SpO2 is 89%. Which intervention should the
nurse implement first?
A. Increase oxygen to 4 L/min and reassess SpO2.
B. Place the patient in a high Fowler's position.
C. Administer a bronchodilator via nebulizer.
D. Obtain an arterial blood gas (ABG) sample.
Answer: A. Increase oxygen to 4 L/min and reassess SpO2.
The patient is hypoxemic (SpO2 <90%) and has COPD. Increasing oxygen is the
priority to correct hypoxemia. High Fowler's position may help but does not directly
address oxygenation. Bronchodilator and ABG are important but not first.
2. Which of the following electrocardiogram (ECG) findings is most consistent with
hyperkalemia?
A. Prolonged PR interval and widened QRS complex.
B. Peaked T waves and widened QRS complex.
C. ST segment elevation and inverted T waves.
D. U waves and prolonged QT interval.
Answer: B. Peaked T waves and widened QRS complex.
Hyperkalemia typically causes peaked T waves and widened QRS. Prolonged PR
interval may occur but peaked T waves are hallmark. ST elevation suggests injury, U
waves suggest hypokalemia.
3. A patient with a diagnosis of heart failure is prescribed furosemide 40 mg
intravenous push. The nurse knows that the primary mechanism of action of
furosemide is to:
A. Inhibit sodium reabsorption in the distal convoluted tubule.
B. Block sodium-potassium-chloride cotransporter in the loop of Henle.
C. Antagonize aldosterone receptors in the collecting duct.
D. Increase glomerular filtration rate by dilating afferent arterioles.
Answer: B. Block sodium-potassium-chloride cotransporter in the loop of Henle.
Furosemide is a loop diuretic that acts on the Na-K-2Cl cotransporter in the thick
ascending limb. Option A describes thiazides, C describes spironolactone, D is not a
primary mechanism.
Page 2
,4. A nurse is assessing a patient's surgical wound on postoperative day 3. Which
finding indicates possible wound infection?
A. Serosanguinous drainage and mild erythema at edges.
B. Purulent drainage and warmth surrounding the incision.
C. Ecchymosis and edema extending 2 cm from incision.
D. Wound edges well-approximated with staples intact.
Answer: B. Purulent drainage and warmth surrounding the incision.
Purulent drainage and warmth are classic signs of infection. Serosanguinous drainage
and mild erythema can be normal. Ecchymosis and edema may be from trauma.
Well-approximated edges are expected healing.
5. A patient is receiving a blood transfusion. Five minutes after initiation, the patient
reports lower back pain and appears flushed. The nurse's priority action is to:
A. Slow the transfusion rate and administer diphenhydramine.
B. Stop the transfusion immediately and maintain IV access with normal saline.
C. Increase the IV rate to dilute the blood product.
D. Obtain vital signs and notify the healthcare provider.
Answer: B. Stop the transfusion immediately and maintain IV access with normal
saline.
These symptoms suggest an acute hemolytic reaction. The priority is to stop the
transfusion immediately to prevent further reaction. Maintaining IV access with saline
is essential. Slowing or increasing rate is incorrect; notification is secondary.
6. Which of the following is a contraindication for administration of metformin?
A. Type 2 diabetes mellitus with HbA1c 8.5%.
B. Estimated glomerular filtration rate (eGFR) of 35 mL/min/1.73 m².
C. Body mass index (BMI) of 32 kg/m².
D. Concurrent use of insulin glargine.
Answer: B. Estimated glomerular filtration rate (eGFR) of 35 mL/min/1.73 m².
Metformin is contraindicated when eGFR <30 mL/min due to risk of lactic acidosis;
some guidelines also caution at <45 mL/min. Option A is an indication, C is not a
contraindication, D is acceptable combination.
Page 3
, 7. A patient with a central venous catheter has a temperature of 39.2°C and chills.
Blood cultures are drawn. Which action is most important for the nurse to take?
A. Administer acetaminophen for fever.
B. Remove the central line and culture the tip.
C. Start broad-spectrum antibiotics after cultures.
D. Change the transparent dressing and clean the site with chlorhexidine.
Answer: C. Start broad-spectrum antibiotics after cultures.
In suspected catheter-related bloodstream infection, prompt antibiotic therapy is
critical after obtaining cultures. Removing the line may be necessary but is not the first
action unless the patient is unstable. Acetaminophen treats symptom, not infection.
Dressing change is not priority.
8. Which arterial blood gas (ABG) result is consistent with compensated metabolic
alkalosis?
A. pH 7.38, PaCO2 48 mm Hg, HCO3- 30 mEq/L.
B. pH 7.46, PaCO2 42 mm Hg, HCO3- 32 mEq/L.
C. pH 7.35, PaCO2 30 mm Hg, HCO3- 18 mEq/L.
D. pH 7.48, PaCO2 50 mm Hg, HCO3- 35 mEq/L.
Answer: A. pH 7.38, PaCO2 48 mm Hg, HCO3- 30 mEq/L.
Compensated metabolic alkalosis shows elevated HCO3- with a compensatory
respiratory acidosis (elevated PaCO2) and pH toward normal. Option A has elevated
HCO3- and PaCO2 with pH near normal. Option B is uncompensated alkalosis, C is
metabolic acidosis, D is partially compensated metabolic alkalosis.
9. A nurse is evaluating a patient's readiness to wean from mechanical ventilation.
Which finding suggests a high likelihood of successful extubation?
A. Negative inspiratory force (NIF) of -15 cm H2O.
B. Rapid shallow breathing index (RSBI) of 105 breaths/min/L.
C. PaO2/FiO2 ratio of 250.
D. Spontaneous tidal volume of 4 mL/kg.
Answer: B. Rapid shallow breathing index (RSBI) of 105 breaths/min/L.
RSBI <105 indicates likely success; 105 is borderline but suggests readiness. NIF should
be more negative than -20 to -30. PaO2/FiO2 >200 is acceptable, but 250 is adequate.
Tidal volume >5 mL/kg is preferred; 4 mL/kg is low.
Page 4
