COMPREHENSIVE FINAL SU 2027 EXAM
7|COMPLETE ACTUAL QUESTIONS AND
REAL RELIABLE ANSWERS WITH
RATIONALES |100% GUARANTEED PASS|A
GRADE ,MOST RECENT!!!
Question 1: The nurse is caring for a client who is postoperative day 1 following a total hip
replacement. Which assessment finding requires immediate intervention?
A) Heart rate of 88 bpm
B) Blood pressure of 142/88 mmHg
C) Oxygen saturation of 89% on room air
D) Temperature of 99.2°F (37.3°C)
Answer: C
An oxygen saturation of 89% indicates hypoxemia and requires immediate intervention. This could be
a sign of atelectasis, pulmonary embolism, or other postoperative complications. The other vital signs
are within acceptable ranges for a postoperative client.
Question 2: The nurse is preparing to administer an intramuscular (IM) injection using the
ventrogluteal site. Which landmark should the nurse use to locate this site?
A) Greater trochanter and iliac crest
B) Acromion process and axilla
C) Xiphoid process and umbilicus
D) Patella and tibial tuberosity
Answer: A
The ventrogluteal site is located using the greater trochanter and the iliac crest. This site is preferred
for IM injections because it is free of major nerves and blood vessels.
,Question 3: A client with heart failure is prescribed furosemide (Lasix). Which laboratory value should
the nurse monitor most closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Answer: B
Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia can lead to cardiac
arrhythmias, especially in clients taking digoxin. Potassium levels should be monitored closely.
Question 4: The nurse is caring for a client with a new tracheostomy. Which action is most important
for maintaining airway patency?
A) Suctioning the tracheostomy tube every 2 hours
B) Providing oral care every 4 hours
C) Humidifying the inspired air
D) Changing the tracheostomy ties daily
Answer: C
Humidification of inspired air is essential for clients with a tracheostomy because the upper airway is
bypassed and normal warming and humidifying functions are lost. This prevents drying and thickening
of secretions.
Question 5: A client with diabetes mellitus type 1 is experiencing hypoglycemia. Which action should
the nurse take first?
A) Administer regular insulin
B) Give 15 grams of rapid-acting carbohydrate
C) Encourage the client to exercise
D) Check the client's urine for ketones
Answer: B
The priority intervention for hypoglycemia is administering 15 grams of rapid-acting carbohydrate
(e.g., glucose tablets, juice, or regular soda). Recheck blood glucose in 15 minutes. If still low, repeat.
Question 6: The nurse is caring for a client who is at risk for falls. Which intervention should the nurse
implement?
A) Keep the bed in the lowest position with side rails up
B) Keep the bed in the highest position for easier access
,C) Leave the call light out of reach to prevent false calls
D) Keep the room dark to promote sleep
Answer: A
Keeping the bed in the lowest position with side rails up (if appropriate) reduces fall risk. The call light
should be within reach, and the room should have adequate lighting.
Question 7: A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min
via nasal cannula. Which assessment finding indicates the client is experiencing oxygen toxicity?
A) Increased appetite
B) Bradycardia
C) Substernal chest pain and dyspnea
D) Hypothermia
Answer: C
Oxygen toxicity can cause substernal chest pain, dyspnea, and nonproductive cough. It is more
common with high concentrations of oxygen over prolonged periods.
Question 8: The nurse is teaching a client with a new colostomy about stoma care. Which statement
by the client indicates a need for further teaching?
A) "I will clean the stoma with warm water and pat it dry."
B) "I will apply a skin barrier to protect the skin around the stoma."
C) "I will measure the stoma weekly to ensure proper appliance fit."
D) "I will notify the provider if the stoma becomes dusky or purple."
Answer: C
The stoma should be measured regularly (not just weekly) to ensure proper appliance fit and prevent
skin breakdown. Dusky or purple stoma indicates ischemia and should be reported immediately.
Question 9: A client with hypertension is prescribed lisinopril. Which adverse effect should the nurse
monitor for?
A) Hyperkalemia
B) Hypokalemia
C) Tachycardia
D) Hypoglycemia
Answer: A
Lisinopril is an ACE inhibitor that can cause hyperkalemia by reducing aldosterone secretion.
Potassium levels should be monitored, especially in clients with renal impairment or those taking
potassium supplements.
, Question 10: The nurse is assessing a client who is 2 hours postoperative from a right total knee
arthroplasty. Which finding should the nurse report to the healthcare provider?
A) Pain rated 6 on a 0-10 scale
B) Cold, pale right foot with diminished pulses
C) Urine output of 60 mL over 2 hours
D) Temperature of 99.0°F (37.2°C)
Answer: B
A cold, pale extremity with diminished pulses may indicate compromised circulation, possibly due to a
hematoma, vascular injury, or compartment syndrome. This requires immediate intervention.
Question 11: The nurse is caring for a client with a chest tube following a thoracotomy. The nurse
notes continuous bubbling in the water seal chamber. Which action should the nurse take?
A) Clamp the chest tube immediately
B) Assess the chest tube system for an air leak
C) Increase the suction pressure
D) Document the finding as expected
Answer: B
Continuous bubbling in the water seal chamber indicates an air leak. The nurse should assess the
system for the source of the leak (e.g., loose connections, dislodged tube) and notify the healthcare
provider if needed.
Question 12: A client with cirrhosis is at risk for bleeding due to:
A) Increased platelet production
B) Decreased synthesis of clotting factors
C) Increased vitamin K absorption
D) Decreased capillary fragility
Answer: B
The liver synthesizes clotting factors. In cirrhosis, liver function is impaired, decreasing clotting factor
synthesis and increasing bleeding risk.
Question 13: The nurse is administering a blood transfusion to a client. Which finding indicates a
transfusion reaction and requires stopping the transfusion immediately?
A) Mild itching at the IV site
B) Temperature increase of 0.5°F (0.3°C)
C) Back pain and chills
D) Slight increase in blood pressure
7|COMPLETE ACTUAL QUESTIONS AND
REAL RELIABLE ANSWERS WITH
RATIONALES |100% GUARANTEED PASS|A
GRADE ,MOST RECENT!!!
Question 1: The nurse is caring for a client who is postoperative day 1 following a total hip
replacement. Which assessment finding requires immediate intervention?
A) Heart rate of 88 bpm
B) Blood pressure of 142/88 mmHg
C) Oxygen saturation of 89% on room air
D) Temperature of 99.2°F (37.3°C)
Answer: C
An oxygen saturation of 89% indicates hypoxemia and requires immediate intervention. This could be
a sign of atelectasis, pulmonary embolism, or other postoperative complications. The other vital signs
are within acceptable ranges for a postoperative client.
Question 2: The nurse is preparing to administer an intramuscular (IM) injection using the
ventrogluteal site. Which landmark should the nurse use to locate this site?
A) Greater trochanter and iliac crest
B) Acromion process and axilla
C) Xiphoid process and umbilicus
D) Patella and tibial tuberosity
Answer: A
The ventrogluteal site is located using the greater trochanter and the iliac crest. This site is preferred
for IM injections because it is free of major nerves and blood vessels.
,Question 3: A client with heart failure is prescribed furosemide (Lasix). Which laboratory value should
the nurse monitor most closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Answer: B
Furosemide is a loop diuretic that causes potassium wasting. Hypokalemia can lead to cardiac
arrhythmias, especially in clients taking digoxin. Potassium levels should be monitored closely.
Question 4: The nurse is caring for a client with a new tracheostomy. Which action is most important
for maintaining airway patency?
A) Suctioning the tracheostomy tube every 2 hours
B) Providing oral care every 4 hours
C) Humidifying the inspired air
D) Changing the tracheostomy ties daily
Answer: C
Humidification of inspired air is essential for clients with a tracheostomy because the upper airway is
bypassed and normal warming and humidifying functions are lost. This prevents drying and thickening
of secretions.
Question 5: A client with diabetes mellitus type 1 is experiencing hypoglycemia. Which action should
the nurse take first?
A) Administer regular insulin
B) Give 15 grams of rapid-acting carbohydrate
C) Encourage the client to exercise
D) Check the client's urine for ketones
Answer: B
The priority intervention for hypoglycemia is administering 15 grams of rapid-acting carbohydrate
(e.g., glucose tablets, juice, or regular soda). Recheck blood glucose in 15 minutes. If still low, repeat.
Question 6: The nurse is caring for a client who is at risk for falls. Which intervention should the nurse
implement?
A) Keep the bed in the lowest position with side rails up
B) Keep the bed in the highest position for easier access
,C) Leave the call light out of reach to prevent false calls
D) Keep the room dark to promote sleep
Answer: A
Keeping the bed in the lowest position with side rails up (if appropriate) reduces fall risk. The call light
should be within reach, and the room should have adequate lighting.
Question 7: A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min
via nasal cannula. Which assessment finding indicates the client is experiencing oxygen toxicity?
A) Increased appetite
B) Bradycardia
C) Substernal chest pain and dyspnea
D) Hypothermia
Answer: C
Oxygen toxicity can cause substernal chest pain, dyspnea, and nonproductive cough. It is more
common with high concentrations of oxygen over prolonged periods.
Question 8: The nurse is teaching a client with a new colostomy about stoma care. Which statement
by the client indicates a need for further teaching?
A) "I will clean the stoma with warm water and pat it dry."
B) "I will apply a skin barrier to protect the skin around the stoma."
C) "I will measure the stoma weekly to ensure proper appliance fit."
D) "I will notify the provider if the stoma becomes dusky or purple."
Answer: C
The stoma should be measured regularly (not just weekly) to ensure proper appliance fit and prevent
skin breakdown. Dusky or purple stoma indicates ischemia and should be reported immediately.
Question 9: A client with hypertension is prescribed lisinopril. Which adverse effect should the nurse
monitor for?
A) Hyperkalemia
B) Hypokalemia
C) Tachycardia
D) Hypoglycemia
Answer: A
Lisinopril is an ACE inhibitor that can cause hyperkalemia by reducing aldosterone secretion.
Potassium levels should be monitored, especially in clients with renal impairment or those taking
potassium supplements.
, Question 10: The nurse is assessing a client who is 2 hours postoperative from a right total knee
arthroplasty. Which finding should the nurse report to the healthcare provider?
A) Pain rated 6 on a 0-10 scale
B) Cold, pale right foot with diminished pulses
C) Urine output of 60 mL over 2 hours
D) Temperature of 99.0°F (37.2°C)
Answer: B
A cold, pale extremity with diminished pulses may indicate compromised circulation, possibly due to a
hematoma, vascular injury, or compartment syndrome. This requires immediate intervention.
Question 11: The nurse is caring for a client with a chest tube following a thoracotomy. The nurse
notes continuous bubbling in the water seal chamber. Which action should the nurse take?
A) Clamp the chest tube immediately
B) Assess the chest tube system for an air leak
C) Increase the suction pressure
D) Document the finding as expected
Answer: B
Continuous bubbling in the water seal chamber indicates an air leak. The nurse should assess the
system for the source of the leak (e.g., loose connections, dislodged tube) and notify the healthcare
provider if needed.
Question 12: A client with cirrhosis is at risk for bleeding due to:
A) Increased platelet production
B) Decreased synthesis of clotting factors
C) Increased vitamin K absorption
D) Decreased capillary fragility
Answer: B
The liver synthesizes clotting factors. In cirrhosis, liver function is impaired, decreasing clotting factor
synthesis and increasing bleeding risk.
Question 13: The nurse is administering a blood transfusion to a client. Which finding indicates a
transfusion reaction and requires stopping the transfusion immediately?
A) Mild itching at the IV site
B) Temperature increase of 0.5°F (0.3°C)
C) Back pain and chills
D) Slight increase in blood pressure
