NUR 265 Nursing Concepts & Clinical Practice II Final Exam |
Comprehensive Practice Questions & Detailed Rationales
2026/2027
Question 1
A client is scheduled for an elective surgical procedure under general
anesthesia. In the immediate intraoperative period, the client develops
masseter muscle rigidity, a rapid spike in temperature to 105.2°F
(40.7°C), and severe metabolic acidosis. Which of the following
medications should the nurse immediately anticipate administering?
• A. Atropine sulfate
• B. Naloxone hydrochloride
• C. Dantrolene sodium
• D. Flumazenil
Correct Answer: C. Dantrolene sodium
Detailed Rationale: These clinical manifestations are classic for
malignant hyperthermia, a life-threatening, inherited hypermetabolic
complication triggered by certain volatile anesthetic agents and
succinylcholine. Dantrolene is the specific skeletal muscle relaxant used
as the primary antidote to reverse this reaction.
Question 2
A client receiving a unit of packed red blood cells begins to report chills,
lower back pain, and a feeling of tightness in the chest 10 minutes after
the infusion starts. The client's blood pressure drops from 120/80
,mmHg to 88/50 mmHg. Which of the following actions should the nurse
take first?
• A. Slow the infusion rate to keep-vein-open speed and recheck
vital signs in 15 minutes.
• B. Stop the transfusion immediately, disconnect the tubing, and
infuse 0.9% sodium chloride through a new IV line.
• C. Administer an intravenous dose of diphenhydramine as
prescribed for allergic reactions.
• D. Obtain a stat blood specimen for type and crossmatch
verification.
Correct Answer: B. Stop the transfusion immediately, disconnect the
tubing, and infuse 0.9% sodium chloride through a new IV line.
Detailed Rationale: The client is experiencing an acute hemolytic
transfusion reaction, likely due to ABO incompatibility. The immediate
priority is to stop the transfusion, disconnect the blood, and maintain
vascular access with normal saline using new tubing to support renal
perfusion and prevent vascular collapse.
Question 3
A nurse is caring for a client with a chest tube connected to a water-seal
system following a thoracotomy. The nurse observes that the fluid level
in the water-seal chamber rises during inhalation and falls during
exhalation. The nurse recognizes that this finding indicates:
• A. An air leak in the chest drainage system.
• B. Complete re-expansion of the affected lung.
, • C. Normal tidaling reflecting intrapleural pressure changes.
• D. Obstruction of the chest drainage tubing.
Correct Answer: C. Normal tidaling reflecting intrapleural pressure
changes.
Detailed Rationale: "Tidaling" is the normal fluctuation of the water
level in the water-seal chamber with respiratory effort. It rises with
inspiration (as negative pressure increases in the chest) and falls with
expiration. Absence of tidaling can indicate lung re-expansion or a
tubing obstruction.
Question 4
A client with chronic heart failure is prescribed digoxin and furosemide.
Which of the following assessment findings should alert the nurse that
the client is experiencing digoxin toxicity?
• A. Weight gain of 2 pounds in 24 hours and peripheral edema.
• B. Visual disturbances such as blurred vision and seeing yellow-
green halos.
• C. Hyperactive bowel sounds and frequent watery diarrhea.
• D. Tachycardia and hypertension.
Correct Answer: B. Visual disturbances such as blurred vision and
seeing yellow-green halos.
Detailed Rationale: Classic signs of digoxin toxicity include
gastrointestinal upset (nausea, anorexia), neurological symptoms
(fatigue, confusion), and characteristic visual disturbances such as
, blurred vision, photophobia, and yellow-green halos around objects.
Hypokalemia increases the risk of this toxicity.
Question 5
A client with end-stage renal disease is admitted for dietary counseling.
Which of the following electrolyte modifications should the nurse
instruct the client to implement in their daily meal planning?
• A. Increase dietary intake of bananas, oranges, and green leafy
vegetables.
• B. Restrict dietary intake of potassium, phosphorus, and sodium.
• C. Double daily fluid and water intake to prevent dehydration.
• D. Increase consumption of dairy products to boost serum calcium
levels.
Correct Answer: B. Restrict dietary intake of potassium, phosphorus,
and sodium.
Detailed Rationale: Failing kidneys cannot effectively excrete
potassium, phosphorus, or sodium, putting clients at risk for life-
threatening hyperkalemia, hyperphosphatemia, and fluid overload.
Therefore, dietary restriction of these elements is necessary.
Question 6
A nurse is preparing a client with massive ascites due to cirrhosis for a
therapeutic paracentesis. Which of the following nursing interventions
is essential immediately before the procedure?
• A. Administer a cleansing fleet enema.
• B. Have the client empty their urinary bladder.
Comprehensive Practice Questions & Detailed Rationales
2026/2027
Question 1
A client is scheduled for an elective surgical procedure under general
anesthesia. In the immediate intraoperative period, the client develops
masseter muscle rigidity, a rapid spike in temperature to 105.2°F
(40.7°C), and severe metabolic acidosis. Which of the following
medications should the nurse immediately anticipate administering?
• A. Atropine sulfate
• B. Naloxone hydrochloride
• C. Dantrolene sodium
• D. Flumazenil
Correct Answer: C. Dantrolene sodium
Detailed Rationale: These clinical manifestations are classic for
malignant hyperthermia, a life-threatening, inherited hypermetabolic
complication triggered by certain volatile anesthetic agents and
succinylcholine. Dantrolene is the specific skeletal muscle relaxant used
as the primary antidote to reverse this reaction.
Question 2
A client receiving a unit of packed red blood cells begins to report chills,
lower back pain, and a feeling of tightness in the chest 10 minutes after
the infusion starts. The client's blood pressure drops from 120/80
,mmHg to 88/50 mmHg. Which of the following actions should the nurse
take first?
• A. Slow the infusion rate to keep-vein-open speed and recheck
vital signs in 15 minutes.
• B. Stop the transfusion immediately, disconnect the tubing, and
infuse 0.9% sodium chloride through a new IV line.
• C. Administer an intravenous dose of diphenhydramine as
prescribed for allergic reactions.
• D. Obtain a stat blood specimen for type and crossmatch
verification.
Correct Answer: B. Stop the transfusion immediately, disconnect the
tubing, and infuse 0.9% sodium chloride through a new IV line.
Detailed Rationale: The client is experiencing an acute hemolytic
transfusion reaction, likely due to ABO incompatibility. The immediate
priority is to stop the transfusion, disconnect the blood, and maintain
vascular access with normal saline using new tubing to support renal
perfusion and prevent vascular collapse.
Question 3
A nurse is caring for a client with a chest tube connected to a water-seal
system following a thoracotomy. The nurse observes that the fluid level
in the water-seal chamber rises during inhalation and falls during
exhalation. The nurse recognizes that this finding indicates:
• A. An air leak in the chest drainage system.
• B. Complete re-expansion of the affected lung.
, • C. Normal tidaling reflecting intrapleural pressure changes.
• D. Obstruction of the chest drainage tubing.
Correct Answer: C. Normal tidaling reflecting intrapleural pressure
changes.
Detailed Rationale: "Tidaling" is the normal fluctuation of the water
level in the water-seal chamber with respiratory effort. It rises with
inspiration (as negative pressure increases in the chest) and falls with
expiration. Absence of tidaling can indicate lung re-expansion or a
tubing obstruction.
Question 4
A client with chronic heart failure is prescribed digoxin and furosemide.
Which of the following assessment findings should alert the nurse that
the client is experiencing digoxin toxicity?
• A. Weight gain of 2 pounds in 24 hours and peripheral edema.
• B. Visual disturbances such as blurred vision and seeing yellow-
green halos.
• C. Hyperactive bowel sounds and frequent watery diarrhea.
• D. Tachycardia and hypertension.
Correct Answer: B. Visual disturbances such as blurred vision and
seeing yellow-green halos.
Detailed Rationale: Classic signs of digoxin toxicity include
gastrointestinal upset (nausea, anorexia), neurological symptoms
(fatigue, confusion), and characteristic visual disturbances such as
, blurred vision, photophobia, and yellow-green halos around objects.
Hypokalemia increases the risk of this toxicity.
Question 5
A client with end-stage renal disease is admitted for dietary counseling.
Which of the following electrolyte modifications should the nurse
instruct the client to implement in their daily meal planning?
• A. Increase dietary intake of bananas, oranges, and green leafy
vegetables.
• B. Restrict dietary intake of potassium, phosphorus, and sodium.
• C. Double daily fluid and water intake to prevent dehydration.
• D. Increase consumption of dairy products to boost serum calcium
levels.
Correct Answer: B. Restrict dietary intake of potassium, phosphorus,
and sodium.
Detailed Rationale: Failing kidneys cannot effectively excrete
potassium, phosphorus, or sodium, putting clients at risk for life-
threatening hyperkalemia, hyperphosphatemia, and fluid overload.
Therefore, dietary restriction of these elements is necessary.
Question 6
A nurse is preparing a client with massive ascites due to cirrhosis for a
therapeutic paracentesis. Which of the following nursing interventions
is essential immediately before the procedure?
• A. Administer a cleansing fleet enema.
• B. Have the client empty their urinary bladder.
