NUR 280 Comprehensive Review Comp 1 Exam Prep
Document | 2026/2027 Edition | 250 Verified Questions
NUR 280 Comp 1 Exam 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED A+. 100% Verified
Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive review document for the NUR 280 Comp 1 Exam contains 250 verified questions
and answers, meticulously aligned with the official Academic Board of Nursing curriculum for the
2026/2027 academic year. Designed for undergraduate nursing students, this resource covers essential
topics in medical-surgical nursing, pharmacology, and foundational nursing concepts. Each question is
accompanied by detailed rationales and evidence-based explanations to reinforce learning and exam
readiness. Updated to reflect the latest clinical guidelines and nursing standards, this document ensures
students are well-prepared for success.
Abstract:
This exam preparation document for NUR 280 Comprehensive Review Comp 1 Exam comprises 250 verified
questions and answers, developed in accordance with the Official Academic Board of Nursing standards for the
2026/2027 academic year. The content is systematically organized into core nursing domains, including
medical-surgical nursing, pharmacology, fundamentals, and critical thinking. Each question is designed to assess
higher-order cognitive skills, with detailed rationales that elucidate correct and incorrect options. The document
integrates the latest evidence-based practice guidelines, such as those from the American Heart Association and
the CDC, ensuring clinical relevance. Emphasis is placed on patient safety, ethical decision-making, and
interprofessional collaboration. This resource serves as a definitive study tool for undergraduate nursing students
seeking to excel in their comprehensive exam and develop competent clinical judgment.
Content Area Overview:
Content Area Questions Key Topics Weight
Medical-Surgical Nursing 1-80 Cardiovascular, respiratory, gastrointestinal, 32%
neurological, endocrine disorders
Pharmacology 81-140 Drug classifications, dosage calculations, 24%
adverse effects, nursing interventions
Fundamentals of Nursing 141-190 Infection control, safety, mobility, hygiene, 20%
vital signs, patient education
Critical Thinking & 191-220 Delegation, prioritization, clinical 12%
Prioritization decision-making, ethical dilemmas
Legal & Ethical Issues 221-250 Patient rights, informed consent, 12%
confidentiality, advance directives
Page 1
,Q1. A patient with a history of chronic kidney disease (CKD) stage 4 is prescribed a medication that
is primarily renally eliminated. Which pharmacokinetic parameter is most critically altered in this
patient, leading to an increased risk of toxicity?
A. Volume of distribution (Vd)
B. Bioavailability
C. Half-life (t½)
D. Protein binding
Correct Answer: C. Half-life (t½)
Rationale: In CKD, renal clearance is reduced, prolonging the half-life of renally eliminated drugs. This
leads to drug accumulation and increased risk of toxicity if dosing is not adjusted. Vd may be altered in
CKD but is not the primary concern for renally cleared drugs. Bioavailability is primarily affected by
hepatic first-pass metabolism, and protein binding changes can occur but are less critical for dosing
adjustments.
Why Wrong:
A - Volume of distribution changes in CKD (e.g., due to edema) but does not directly reflect the risk
of accumulation for renally eliminated drugs.
B - Bioavailability is a measure of fraction absorbed unchanged; it is not primarily affected by renal
impairment.
D - Protein binding can be altered in CKD, but this does not directly determine the rate of drug
elimination.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 4
Q2. A research study reports a statistically significant reduction in hospital readmission rates (p <
0.05) for patients receiving a nurse-led discharge intervention compared to usual care. The absolute
risk reduction is 2%, and the number needed to treat (NNT) is 50. Which interpretation is most
accurate?
A. The intervention is highly clinically significant because the p-value is less than 0.05.
B. The intervention reduces readmissions by 2% relative to the control group.
C. For every 50 patients receiving the intervention, one readmission is prevented.
D. The NNT of 50 indicates that the intervention is not cost-effective.
Correct Answer: C. For every 50 patients receiving the intervention, one readmission is prevented.
Rationale: The number needed to treat (NNT) is the inverse of the absolute risk reduction (1/0.02 = 50),
meaning that for every 50 patients treated with the intervention, one readmission is prevented. A p-value
< 0.05 indicates statistical significance, not clinical significance. The absolute risk reduction is 2
percentage points, not 2% relative reduction. NNT alone does not determine cost-effectiveness; it must be
weighed against costs and benefits.
Why Wrong:
A - Statistical significance (p < 0.05) does not guarantee clinical significance; the magnitude of
effect must be considered.
B - Absolute risk reduction is 2 percentage points, not 2% relative reduction; relative risk reduction
would be larger.
D - Cost-effectiveness depends on the cost of the intervention and the value of preventing a
readmission, not solely on the NNT.
Reference: Melnyk, B.M., & Fineout-Overholt, E. (2025). Evidence-Based Practice in Nursing &
Healthcare, 5th Ed., Ch. 6
Page 2
,Q3. A nurse is caring for a patient with acute respiratory distress syndrome (ARDS) on mechanical
ventilation. The ventilator settings include a tidal volume of 6 mL/kg predicted body weight and
plateau pressure of 30 cm HO. Which finding would most indicate the need to adjust ventilation
strategy?
A. Arterial pH 7.35
B. PaO 85 mmHg on FiO 0.5
C. Plateau pressure 32 cm HO
D. End-tidal CO 35 mmHg
Correct Answer: C. Plateau pressure 32 cm HO
Rationale: In ARDS, lung-protective ventilation aims to keep plateau pressure below 30 cm H ‚O to
prevent ventilator-induced lung injury. A plateau pressure of 32 cm HO exceeds this threshold, indicating
a need to reduce tidal volume or adjust settings. An arterial pH of 7.35 is acceptable (permissive
hypercapnia). PaO 85 mmHg on FiO 0.5 indicates adequate oxygenation. End-tidal CO 35 mmHg is
within normal range.
Why Wrong:
A - A pH of 7.35 is within the acceptable range for permissive hypercapnia in ARDS.
B - A PaO of 85 mmHg on FiO 0.5 indicates adequate oxygenation; no immediate adjustment
needed.
D - End-tidal CO of 35 mmHg is normal and does not indicate a problem with ventilation.
Reference: Urden, L.D., Stacy, K.M., & Lough, M.E. (2026). Critical Care Nursing: Diagnosis and
Management, 9th Ed., Ch. 15
Q4. A nurse is evaluating a patient's arterial blood gas (ABG): pH 7.30, PaCO 50 mmHg, HCO 24
mEq/L. Which acid-base disorder is present, and what is the most likely underlying cause?
A. Metabolic acidosis due to diabetic ketoacidosis
B. Respiratory acidosis due to hypoventilation
C. Metabolic alkalosis due to vomiting
D. Respiratory alkalosis due to hyperventilation
Correct Answer: B. Respiratory acidosis due to hypoventilation
Rationale: The ABG shows a low pH (acidemia) with elevated PaCO ‚ (50 mmHg) and normal HCO ƒ {
(24 mEq/L). This indicates acute respiratory acidosis, typically caused by hypoventilation (e.g., opioid
overdose, COPD exacerbation, or respiratory muscle weakness). Metabolic acidosis would show low
HCO. Metabolic alkalosis would show high pH and high HCO. Respiratory alkalosis would show low
PaCO.
Why Wrong:
A - Metabolic acidosis would present with low HCO and low pH; here HCO is normal.
C - Metabolic alkalosis would show high pH and high HCO; here pH is low.
D - Respiratory alkalosis would show low PaCO and high pH; here PaCO is high and pH low.
Reference: Ignatavicius, D.D., & Workman, M.L. (2026). Medical-Surgical Nursing: Concepts for
Interprofessional Collaborative Care, 10th Ed., Ch. 18
Page 3
, Q5. A patient with heart failure with reduced ejection fraction (HFrEF) is prescribed metoprolol
succinate. The nurse notes that the patient has a history of asthma. Which consideration is most
important regarding this medication?
A. Metoprolol is contraindicated in asthma due to risk of bronchospasm.
B. Metoprolol may cause hyperglycemia in patients with diabetes.
C. Metoprolol should be taken with food to increase absorption.
D. Metoprolol is preferred over carvedilol in patients with renal impairment.
Correct Answer: A. Metoprolol is contraindicated in asthma due to risk of bronchospasm.
Rationale: Metoprolol is a beta-1 selective blocker, but at higher doses it can lose selectivity and block
beta-2 receptors, potentially causing bronchospasm in asthmatics. Therefore, it is relatively
contraindicated or used with extreme caution in asthma. Beta-blockers can mask hypoglycemia symptoms
but do not cause hyperglycemia. Taking with food does not significantly affect absorption. Carvedilol is
non-selective and also requires caution; renal impairment is not a differentiating factor.
Why Wrong:
B - Beta-blockers can mask hypoglycemia symptoms but do not cause hyperglycemia; they may
worsen insulin resistance slightly but are not primarily associated with hyperglycemia.
C - Metoprolol absorption is not significantly affected by food; it can be taken without regard to
meals.
D - Both metoprolol and carvedilol require dose adjustment in renal impairment; carvedilol is often
preferred in HFrEF due to additional alpha-blocking effects.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 18
Q6. A nurse is assessing a patient with suspected compartment syndrome following a tibial fracture.
Which assessment finding is the earliest and most reliable indicator of this condition?
A. Absence of a palpable distal pulse
B. Pain that is out of proportion to the injury and worsens with passive stretch
C. Paresthesia in the distribution of the affected nerve
D. Pallor and coolness of the distal extremity
Correct Answer: B. Pain that is out of proportion to the injury and worsens with passive stretch
Rationale: The earliest sign of compartment syndrome is severe pain that is out of proportion to the
injury and exacerbated by passive stretching of the muscles within the compartment. This pain occurs
before neurovascular changes such as paresthesia, pallor, or pulselessness. Pulselessness is a late and
ominous sign indicating irreversible damage.
Why Wrong:
A - Absence of a distal pulse is a late sign of compartment syndrome, indicating severe ischemia and
potential necrosis.
C - Paresthesia occurs after pain due to nerve ischemia, but pain is earlier.
D - Pallor and coolness are signs of arterial insufficiency, which are late findings in compartment
syndrome.
Reference: Lewis, S.L., et al. (2026). Medical-Surgical Nursing: Assessment and Management of Clinical
Problems, 11th Ed., Ch. 67
Page 4
Document | 2026/2027 Edition | 250 Verified Questions
NUR 280 Comp 1 Exam 2026-2027 QUESTIONS AND ANSWERS ALREADY GRADED A+. 100% Verified
Solutions | Updated Per Latest Guidelines | Graded A+
This comprehensive review document for the NUR 280 Comp 1 Exam contains 250 verified questions
and answers, meticulously aligned with the official Academic Board of Nursing curriculum for the
2026/2027 academic year. Designed for undergraduate nursing students, this resource covers essential
topics in medical-surgical nursing, pharmacology, and foundational nursing concepts. Each question is
accompanied by detailed rationales and evidence-based explanations to reinforce learning and exam
readiness. Updated to reflect the latest clinical guidelines and nursing standards, this document ensures
students are well-prepared for success.
Abstract:
This exam preparation document for NUR 280 Comprehensive Review Comp 1 Exam comprises 250 verified
questions and answers, developed in accordance with the Official Academic Board of Nursing standards for the
2026/2027 academic year. The content is systematically organized into core nursing domains, including
medical-surgical nursing, pharmacology, fundamentals, and critical thinking. Each question is designed to assess
higher-order cognitive skills, with detailed rationales that elucidate correct and incorrect options. The document
integrates the latest evidence-based practice guidelines, such as those from the American Heart Association and
the CDC, ensuring clinical relevance. Emphasis is placed on patient safety, ethical decision-making, and
interprofessional collaboration. This resource serves as a definitive study tool for undergraduate nursing students
seeking to excel in their comprehensive exam and develop competent clinical judgment.
Content Area Overview:
Content Area Questions Key Topics Weight
Medical-Surgical Nursing 1-80 Cardiovascular, respiratory, gastrointestinal, 32%
neurological, endocrine disorders
Pharmacology 81-140 Drug classifications, dosage calculations, 24%
adverse effects, nursing interventions
Fundamentals of Nursing 141-190 Infection control, safety, mobility, hygiene, 20%
vital signs, patient education
Critical Thinking & 191-220 Delegation, prioritization, clinical 12%
Prioritization decision-making, ethical dilemmas
Legal & Ethical Issues 221-250 Patient rights, informed consent, 12%
confidentiality, advance directives
Page 1
,Q1. A patient with a history of chronic kidney disease (CKD) stage 4 is prescribed a medication that
is primarily renally eliminated. Which pharmacokinetic parameter is most critically altered in this
patient, leading to an increased risk of toxicity?
A. Volume of distribution (Vd)
B. Bioavailability
C. Half-life (t½)
D. Protein binding
Correct Answer: C. Half-life (t½)
Rationale: In CKD, renal clearance is reduced, prolonging the half-life of renally eliminated drugs. This
leads to drug accumulation and increased risk of toxicity if dosing is not adjusted. Vd may be altered in
CKD but is not the primary concern for renally cleared drugs. Bioavailability is primarily affected by
hepatic first-pass metabolism, and protein binding changes can occur but are less critical for dosing
adjustments.
Why Wrong:
A - Volume of distribution changes in CKD (e.g., due to edema) but does not directly reflect the risk
of accumulation for renally eliminated drugs.
B - Bioavailability is a measure of fraction absorbed unchanged; it is not primarily affected by renal
impairment.
D - Protein binding can be altered in CKD, but this does not directly determine the rate of drug
elimination.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 4
Q2. A research study reports a statistically significant reduction in hospital readmission rates (p <
0.05) for patients receiving a nurse-led discharge intervention compared to usual care. The absolute
risk reduction is 2%, and the number needed to treat (NNT) is 50. Which interpretation is most
accurate?
A. The intervention is highly clinically significant because the p-value is less than 0.05.
B. The intervention reduces readmissions by 2% relative to the control group.
C. For every 50 patients receiving the intervention, one readmission is prevented.
D. The NNT of 50 indicates that the intervention is not cost-effective.
Correct Answer: C. For every 50 patients receiving the intervention, one readmission is prevented.
Rationale: The number needed to treat (NNT) is the inverse of the absolute risk reduction (1/0.02 = 50),
meaning that for every 50 patients treated with the intervention, one readmission is prevented. A p-value
< 0.05 indicates statistical significance, not clinical significance. The absolute risk reduction is 2
percentage points, not 2% relative reduction. NNT alone does not determine cost-effectiveness; it must be
weighed against costs and benefits.
Why Wrong:
A - Statistical significance (p < 0.05) does not guarantee clinical significance; the magnitude of
effect must be considered.
B - Absolute risk reduction is 2 percentage points, not 2% relative reduction; relative risk reduction
would be larger.
D - Cost-effectiveness depends on the cost of the intervention and the value of preventing a
readmission, not solely on the NNT.
Reference: Melnyk, B.M., & Fineout-Overholt, E. (2025). Evidence-Based Practice in Nursing &
Healthcare, 5th Ed., Ch. 6
Page 2
,Q3. A nurse is caring for a patient with acute respiratory distress syndrome (ARDS) on mechanical
ventilation. The ventilator settings include a tidal volume of 6 mL/kg predicted body weight and
plateau pressure of 30 cm HO. Which finding would most indicate the need to adjust ventilation
strategy?
A. Arterial pH 7.35
B. PaO 85 mmHg on FiO 0.5
C. Plateau pressure 32 cm HO
D. End-tidal CO 35 mmHg
Correct Answer: C. Plateau pressure 32 cm HO
Rationale: In ARDS, lung-protective ventilation aims to keep plateau pressure below 30 cm H ‚O to
prevent ventilator-induced lung injury. A plateau pressure of 32 cm HO exceeds this threshold, indicating
a need to reduce tidal volume or adjust settings. An arterial pH of 7.35 is acceptable (permissive
hypercapnia). PaO 85 mmHg on FiO 0.5 indicates adequate oxygenation. End-tidal CO 35 mmHg is
within normal range.
Why Wrong:
A - A pH of 7.35 is within the acceptable range for permissive hypercapnia in ARDS.
B - A PaO of 85 mmHg on FiO 0.5 indicates adequate oxygenation; no immediate adjustment
needed.
D - End-tidal CO of 35 mmHg is normal and does not indicate a problem with ventilation.
Reference: Urden, L.D., Stacy, K.M., & Lough, M.E. (2026). Critical Care Nursing: Diagnosis and
Management, 9th Ed., Ch. 15
Q4. A nurse is evaluating a patient's arterial blood gas (ABG): pH 7.30, PaCO 50 mmHg, HCO 24
mEq/L. Which acid-base disorder is present, and what is the most likely underlying cause?
A. Metabolic acidosis due to diabetic ketoacidosis
B. Respiratory acidosis due to hypoventilation
C. Metabolic alkalosis due to vomiting
D. Respiratory alkalosis due to hyperventilation
Correct Answer: B. Respiratory acidosis due to hypoventilation
Rationale: The ABG shows a low pH (acidemia) with elevated PaCO ‚ (50 mmHg) and normal HCO ƒ {
(24 mEq/L). This indicates acute respiratory acidosis, typically caused by hypoventilation (e.g., opioid
overdose, COPD exacerbation, or respiratory muscle weakness). Metabolic acidosis would show low
HCO. Metabolic alkalosis would show high pH and high HCO. Respiratory alkalosis would show low
PaCO.
Why Wrong:
A - Metabolic acidosis would present with low HCO and low pH; here HCO is normal.
C - Metabolic alkalosis would show high pH and high HCO; here pH is low.
D - Respiratory alkalosis would show low PaCO and high pH; here PaCO is high and pH low.
Reference: Ignatavicius, D.D., & Workman, M.L. (2026). Medical-Surgical Nursing: Concepts for
Interprofessional Collaborative Care, 10th Ed., Ch. 18
Page 3
, Q5. A patient with heart failure with reduced ejection fraction (HFrEF) is prescribed metoprolol
succinate. The nurse notes that the patient has a history of asthma. Which consideration is most
important regarding this medication?
A. Metoprolol is contraindicated in asthma due to risk of bronchospasm.
B. Metoprolol may cause hyperglycemia in patients with diabetes.
C. Metoprolol should be taken with food to increase absorption.
D. Metoprolol is preferred over carvedilol in patients with renal impairment.
Correct Answer: A. Metoprolol is contraindicated in asthma due to risk of bronchospasm.
Rationale: Metoprolol is a beta-1 selective blocker, but at higher doses it can lose selectivity and block
beta-2 receptors, potentially causing bronchospasm in asthmatics. Therefore, it is relatively
contraindicated or used with extreme caution in asthma. Beta-blockers can mask hypoglycemia symptoms
but do not cause hyperglycemia. Taking with food does not significantly affect absorption. Carvedilol is
non-selective and also requires caution; renal impairment is not a differentiating factor.
Why Wrong:
B - Beta-blockers can mask hypoglycemia symptoms but do not cause hyperglycemia; they may
worsen insulin resistance slightly but are not primarily associated with hyperglycemia.
C - Metoprolol absorption is not significantly affected by food; it can be taken without regard to
meals.
D - Both metoprolol and carvedilol require dose adjustment in renal impairment; carvedilol is often
preferred in HFrEF due to additional alpha-blocking effects.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 18
Q6. A nurse is assessing a patient with suspected compartment syndrome following a tibial fracture.
Which assessment finding is the earliest and most reliable indicator of this condition?
A. Absence of a palpable distal pulse
B. Pain that is out of proportion to the injury and worsens with passive stretch
C. Paresthesia in the distribution of the affected nerve
D. Pallor and coolness of the distal extremity
Correct Answer: B. Pain that is out of proportion to the injury and worsens with passive stretch
Rationale: The earliest sign of compartment syndrome is severe pain that is out of proportion to the
injury and exacerbated by passive stretching of the muscles within the compartment. This pain occurs
before neurovascular changes such as paresthesia, pallor, or pulselessness. Pulselessness is a late and
ominous sign indicating irreversible damage.
Why Wrong:
A - Absence of a distal pulse is a late sign of compartment syndrome, indicating severe ischemia and
potential necrosis.
C - Paresthesia occurs after pain due to nerve ischemia, but pain is earlier.
D - Pallor and coolness are signs of arterial insufficiency, which are late findings in compartment
syndrome.
Reference: Lewis, S.L., et al. (2026). Medical-Surgical Nursing: Assessment and Management of Clinical
Problems, 11th Ed., Ch. 67
Page 4
