NUR 155 COMPREHENSIVE REVIEW:
EXAMS 2, 3, AND 4 QUESTIONS AND
ANSWERS
1. A nurse is caring for a patient with a suspected diagnosis of pulmonary tuberculosis. Which
type of isolation precautions should be implemented?
A. Contact Precautions
B. Droplet Precautions
C. Protective Environment
D. Airborne Precautions
E.
Answer: D
Conceptual Explanation: Tuberculosis is transmitted through small droplets that remain
suspended in the air. Airborne precautions require a private, negative-pressure room and
the use of an N95 respirator.
2. When assessing a pressure injury, the nurse notes full-thickness skin loss with visible
subcutaneous fat, but no bone or muscle is exposed. How should this be staged?
A. Stage 3
,B. Stage 2
C. Stage 1
D. Stage 4
Answer: A
Conceptual Explanation: Stage 3 involves full-thickness skin loss involving damage to or
necrosis of subcutaneous tissue that may extend down to, but not through, underlying
fascia.
3. Which clinical manifestation is most characteristic of hypokalemia?
A. Hyperactive bowel sounds
B. Tall, peaked T-waves on ECG
C. Positive Chvostek’s sign
D. Muscle weakness and cardiac arrhythmias
Answer: D
Conceptual Explanation: Low potassium levels significantly affect neuromuscular and
cardiac function, leading to weakness and dangerous heart rhythms.
4. A patient has an arterial blood gas (ABG) result showing pH 7.30, PaCO2 52, and HCO3 24.
What is the interpretation?
A. Respiratory Acidosis
B. Metabolic Acidosis
, C. Respiratory Alkalosis
D. Metabolic Alkalosis
Answer: A
Conceptual Explanation: A pH below 7.35 indicates acidosis. A high PaCO2 (greater than
45) indicates the cause is respiratory.
5. Which of the following is the priority nursing intervention for a patient immediately
returning from surgery?
A. Maintaining a patent airway
B. Assessing the surgical site for drainage
C. Administering prescribed pain medication
D. Encouraging the use of an incentive spirometer
Answer: A
Conceptual Explanation: According to the ABC (Airway, Breathing, Circulation) priority
framework, ensuring a patent airway is the highest priority in the immediate postoperative
period.
6. A nurse is preparing to administer an enteral feeding. What is the most reliable method for
confirming placement of a nasogastric tube before the first use?
A. Aspirating gastric contents and checking pH
B. Radiographic (X-ray) verification
EXAMS 2, 3, AND 4 QUESTIONS AND
ANSWERS
1. A nurse is caring for a patient with a suspected diagnosis of pulmonary tuberculosis. Which
type of isolation precautions should be implemented?
A. Contact Precautions
B. Droplet Precautions
C. Protective Environment
D. Airborne Precautions
E.
Answer: D
Conceptual Explanation: Tuberculosis is transmitted through small droplets that remain
suspended in the air. Airborne precautions require a private, negative-pressure room and
the use of an N95 respirator.
2. When assessing a pressure injury, the nurse notes full-thickness skin loss with visible
subcutaneous fat, but no bone or muscle is exposed. How should this be staged?
A. Stage 3
,B. Stage 2
C. Stage 1
D. Stage 4
Answer: A
Conceptual Explanation: Stage 3 involves full-thickness skin loss involving damage to or
necrosis of subcutaneous tissue that may extend down to, but not through, underlying
fascia.
3. Which clinical manifestation is most characteristic of hypokalemia?
A. Hyperactive bowel sounds
B. Tall, peaked T-waves on ECG
C. Positive Chvostek’s sign
D. Muscle weakness and cardiac arrhythmias
Answer: D
Conceptual Explanation: Low potassium levels significantly affect neuromuscular and
cardiac function, leading to weakness and dangerous heart rhythms.
4. A patient has an arterial blood gas (ABG) result showing pH 7.30, PaCO2 52, and HCO3 24.
What is the interpretation?
A. Respiratory Acidosis
B. Metabolic Acidosis
, C. Respiratory Alkalosis
D. Metabolic Alkalosis
Answer: A
Conceptual Explanation: A pH below 7.35 indicates acidosis. A high PaCO2 (greater than
45) indicates the cause is respiratory.
5. Which of the following is the priority nursing intervention for a patient immediately
returning from surgery?
A. Maintaining a patent airway
B. Assessing the surgical site for drainage
C. Administering prescribed pain medication
D. Encouraging the use of an incentive spirometer
Answer: A
Conceptual Explanation: According to the ABC (Airway, Breathing, Circulation) priority
framework, ensuring a patent airway is the highest priority in the immediate postoperative
period.
6. A nurse is preparing to administer an enteral feeding. What is the most reliable method for
confirming placement of a nasogastric tube before the first use?
A. Aspirating gastric contents and checking pH
B. Radiographic (X-ray) verification
