Page 1 of 120
NUR 283 COMPREHENSIVE EXAM LATEST VERSION
QUESTIONS AND ANSWERS 2026 EDITION
NUR 283 COMPREHENSIVE EXAM - 250 QUESTIONS WITH RATIONALES
SECTION 1: PRIORITIZATION & CLINICAL JUDGMENT (Questions 1-40)
1. The nurse is caring for four patients on a busy medical-surgical unit. Which
patient should the nurse assess first after receiving the morning shift report?
A. A 68-year-old patient with pneumonia who has an oxygen saturation of 91% on room
air and is requesting pain medication for a headache.
B. A 45-year-old patient with diabetes who is scheduled for a wound debridement later
this morning and has a blood glucose level of 145 mg/dL.
C. A 72-year-old patient who is 24 hours post-total knee replacement and is reporting a
pain level of 6 out of 10 despite receiving prescribed analgesics.
D. A 55-year-old patient admitted with dehydration who has a potassium level of 3.2
mEq/L and is receiving IV fluids at 125 mL per hour.
Correct Answer: A
Rationale: The patient with pneumonia and an oxygen saturation of 91% on room air
presents the most immediate threat to airway and breathing, which takes priority
according to the ABC framework. A saturation below 92% indicates inadequate
oxygenation requiring prompt intervention such as supplemental oxygen administration
and further respiratory assessment. The other patients have stable conditions that,
while requiring attention, are not immediately life-threatening and can be addressed
after the patient with compromised oxygenation has been stabilized .
2. The nurse is caring for a patient who begins to experience acute shortness of
breath with audible wheezing and a non-productive cough. What is the nurse's
priority action?
A. Administer a scheduled bronchodilator as ordered by the healthcare provider.
B. Place the patient in a high-Fowler's position to maximize lung expansion.
C. Assess the patient's oxygen saturation using a pulse oximetry device.
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D. Notify the healthcare provider immediately about the change in status.
Correct Answer: B
Rationale: The priority action is to position the patient in high-Fowler's position to
facilitate maximum lung expansion and ease the work of breathing. This intervention
directly addresses the airway and breathing priority without delay. While assessment
and medication administration are important, positioning the patient first provides
immediate physiological support and can be performed simultaneously with other
interventions such as applying pulse oximetry and preparing medications .
3. The nurse is assessing a patient who was admitted with abdominal pain and
notes the patient's blood pressure is 88/52 mm Hg, heart rate is 118 beats per
minute, skin is cool and clammy, and the patient reports dizziness upon sitting up.
Which action should the nurse take first?
A. Recheck the blood pressure in the opposite arm to confirm the reading.
B. Notify the healthcare provider of the patient's unstable vital signs.
C. Place the patient in a supine position with legs elevated above heart level.
D. Administer an IV fluid bolus as prescribed for suspected hypovolemia.
Correct Answer: C
Rationale: The patient is exhibiting signs of hypotension and possible shock with a
systolic blood pressure below 90 mm Hg, tachycardia, and signs of poor perfusion.
Placing the patient in a supine position with legs elevated promotes venous return and
improves cardiac output, which is the priority intervention to stabilize the patient. This
non-invasive intervention addresses the immediate problem while further assessment
and provider notification occur simultaneously .
4. The nurse is caring for a patient who is 4 hours post-operative following
abdominal surgery. The patient's vital signs show a blood pressure of 98/64 mm Hg,
pulse of 58 beats per minute with thready peripheral pulses, and shallow
respirations at 26 breaths per minute. Arterial blood gas results show pH 7.20,
PaCO2 54 mm Hg, and HCO3 26 mEq/L. Based on these findings, what is the nurse's
priority intervention?
A. Administer an IV fluid bolus to address the low blood pressure.
B. Encourage the patient to take deep breaths and use an incentive spirometer.
C. Notify the healthcare provider of the ABG results indicating respiratory acidosis.
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D. Assess the patient's level of consciousness and orientation to person, place, and
time.
Correct Answer: C
Rationale: The ABG results reveal respiratory acidosis with a pH below 7.35, elevated
PaCO2 above 45 mm Hg, and a normal HCO3 indicating the kidneys have not yet
compensated. The shallow respirations (26/min) and history of general anesthesia
suggest hypoventilation as the cause. The healthcare provider must be notified
immediately because this patient requires prompt intervention to address the
underlying respiratory issue, which may include oxygen therapy, bronchodilators, or
potentially mechanical ventilation if the condition worsens .
5. The nurse is caring for a client who was recently diagnosed with a brain tumor
and has become increasingly difficult to arouse over the past hour. Which of the
following actions should the nurse take immediately?
A. Notify the healthcare provider of the change in neurological status.
B. Elevate the head of the patient's bed to 30 degrees to reduce intracranial pressure.
C. Perform a complete neurological assessment including pupillary response.
D. Administer prescribed dexamethasone to reduce cerebral edema.
Correct Answer: B
Rationale: A change in level of consciousness is a critical finding in a patient with a
brain tumor, suggesting increased intracranial pressure. Elevating the head of the bed to
30 degrees promotes venous drainage from the brain and helps reduce intracranial
pressure, which is the priority intervention to prevent further neurological deterioration.
This immediate action addresses the underlying pathophysiology before completing
further assessments or notifying the provider .
6. The nurse is assigned to care for five patients on a medical-surgical unit. Which
patient should the nurse assess first following an incident report regarding a
medication error that occurred on the previous shift?
A. A patient with a hip fracture who is scheduled for surgery in two hours.
B. A patient with type 1 diabetes who has a blood glucose reading of 52 mg/dL.
C. A patient who is complaining of nausea and vomiting following chemotherapy.
D. A patient who is requesting help with ambulating to the bathroom for the first time.
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Correct Answer: B
Rationale: The patient with a blood glucose of 52 mg/dL is experiencing hypoglycemia,
which is a life-threatening emergency that requires immediate intervention. Blood
glucose below 60 mg/dL can lead to seizures, loss of consciousness, and brain damage
if not treated promptly. The nurse must check this patient immediately, provide a fast-
acting carbohydrate source or IV dextrose as appropriate, and reassess blood glucose
in 15 minutes. All other patients have stable conditions that can wait for assessment .
7. The nurse is caring for a patient who is receiving a blood transfusion and 30
minutes into the infusion reports severe low back pain and chills. What is the
nurse's priority action?
A. Slow the infusion rate to 50 mL per hour to observe for further symptoms.
B. Stop the transfusion immediately and disconnect the blood tubing from the IV site.
C. Notify the healthcare provider about the patient's symptoms and vital signs.
D. Administer prescribed acetaminophen for the chills and fever.
Correct Answer: B
Rationale: Low back pain and chills are classic signs of an acute hemolytic transfusion
reaction, which is a life-threatening emergency. The priority action is to stop the
transfusion immediately to prevent further infusion of incompatible blood. The blood
tubing should be disconnected and the IV line kept open with normal saline. The
healthcare provider must be notified after stopping the transfusion, and the blood bag
and tubing should be returned to the blood bank for investigation. Acetaminophen may
mask symptoms and is not the priority .
8. The nurse is caring for a pediatric patient who is post-operative following a
ventriculoperitoneal shunt placement. The nurse notes the child has become
difficult to arouse and lethargic. What is the most appropriate initial nursing
action?
A. Stimulate the child to assess for any response to painful stimuli.
B. Elevate the head of the bed to 30 degrees to reduce intracranial pressure.
C. Notify the healthcare provider of the child's decreased level of consciousness.
D. Assess the child's pupillary response and vital signs.
Correct Answer: B
NUR 283 COMPREHENSIVE EXAM LATEST VERSION
QUESTIONS AND ANSWERS 2026 EDITION
NUR 283 COMPREHENSIVE EXAM - 250 QUESTIONS WITH RATIONALES
SECTION 1: PRIORITIZATION & CLINICAL JUDGMENT (Questions 1-40)
1. The nurse is caring for four patients on a busy medical-surgical unit. Which
patient should the nurse assess first after receiving the morning shift report?
A. A 68-year-old patient with pneumonia who has an oxygen saturation of 91% on room
air and is requesting pain medication for a headache.
B. A 45-year-old patient with diabetes who is scheduled for a wound debridement later
this morning and has a blood glucose level of 145 mg/dL.
C. A 72-year-old patient who is 24 hours post-total knee replacement and is reporting a
pain level of 6 out of 10 despite receiving prescribed analgesics.
D. A 55-year-old patient admitted with dehydration who has a potassium level of 3.2
mEq/L and is receiving IV fluids at 125 mL per hour.
Correct Answer: A
Rationale: The patient with pneumonia and an oxygen saturation of 91% on room air
presents the most immediate threat to airway and breathing, which takes priority
according to the ABC framework. A saturation below 92% indicates inadequate
oxygenation requiring prompt intervention such as supplemental oxygen administration
and further respiratory assessment. The other patients have stable conditions that,
while requiring attention, are not immediately life-threatening and can be addressed
after the patient with compromised oxygenation has been stabilized .
2. The nurse is caring for a patient who begins to experience acute shortness of
breath with audible wheezing and a non-productive cough. What is the nurse's
priority action?
A. Administer a scheduled bronchodilator as ordered by the healthcare provider.
B. Place the patient in a high-Fowler's position to maximize lung expansion.
C. Assess the patient's oxygen saturation using a pulse oximetry device.
, Page 2 of 120
D. Notify the healthcare provider immediately about the change in status.
Correct Answer: B
Rationale: The priority action is to position the patient in high-Fowler's position to
facilitate maximum lung expansion and ease the work of breathing. This intervention
directly addresses the airway and breathing priority without delay. While assessment
and medication administration are important, positioning the patient first provides
immediate physiological support and can be performed simultaneously with other
interventions such as applying pulse oximetry and preparing medications .
3. The nurse is assessing a patient who was admitted with abdominal pain and
notes the patient's blood pressure is 88/52 mm Hg, heart rate is 118 beats per
minute, skin is cool and clammy, and the patient reports dizziness upon sitting up.
Which action should the nurse take first?
A. Recheck the blood pressure in the opposite arm to confirm the reading.
B. Notify the healthcare provider of the patient's unstable vital signs.
C. Place the patient in a supine position with legs elevated above heart level.
D. Administer an IV fluid bolus as prescribed for suspected hypovolemia.
Correct Answer: C
Rationale: The patient is exhibiting signs of hypotension and possible shock with a
systolic blood pressure below 90 mm Hg, tachycardia, and signs of poor perfusion.
Placing the patient in a supine position with legs elevated promotes venous return and
improves cardiac output, which is the priority intervention to stabilize the patient. This
non-invasive intervention addresses the immediate problem while further assessment
and provider notification occur simultaneously .
4. The nurse is caring for a patient who is 4 hours post-operative following
abdominal surgery. The patient's vital signs show a blood pressure of 98/64 mm Hg,
pulse of 58 beats per minute with thready peripheral pulses, and shallow
respirations at 26 breaths per minute. Arterial blood gas results show pH 7.20,
PaCO2 54 mm Hg, and HCO3 26 mEq/L. Based on these findings, what is the nurse's
priority intervention?
A. Administer an IV fluid bolus to address the low blood pressure.
B. Encourage the patient to take deep breaths and use an incentive spirometer.
C. Notify the healthcare provider of the ABG results indicating respiratory acidosis.
, Page 3 of 120
D. Assess the patient's level of consciousness and orientation to person, place, and
time.
Correct Answer: C
Rationale: The ABG results reveal respiratory acidosis with a pH below 7.35, elevated
PaCO2 above 45 mm Hg, and a normal HCO3 indicating the kidneys have not yet
compensated. The shallow respirations (26/min) and history of general anesthesia
suggest hypoventilation as the cause. The healthcare provider must be notified
immediately because this patient requires prompt intervention to address the
underlying respiratory issue, which may include oxygen therapy, bronchodilators, or
potentially mechanical ventilation if the condition worsens .
5. The nurse is caring for a client who was recently diagnosed with a brain tumor
and has become increasingly difficult to arouse over the past hour. Which of the
following actions should the nurse take immediately?
A. Notify the healthcare provider of the change in neurological status.
B. Elevate the head of the patient's bed to 30 degrees to reduce intracranial pressure.
C. Perform a complete neurological assessment including pupillary response.
D. Administer prescribed dexamethasone to reduce cerebral edema.
Correct Answer: B
Rationale: A change in level of consciousness is a critical finding in a patient with a
brain tumor, suggesting increased intracranial pressure. Elevating the head of the bed to
30 degrees promotes venous drainage from the brain and helps reduce intracranial
pressure, which is the priority intervention to prevent further neurological deterioration.
This immediate action addresses the underlying pathophysiology before completing
further assessments or notifying the provider .
6. The nurse is assigned to care for five patients on a medical-surgical unit. Which
patient should the nurse assess first following an incident report regarding a
medication error that occurred on the previous shift?
A. A patient with a hip fracture who is scheduled for surgery in two hours.
B. A patient with type 1 diabetes who has a blood glucose reading of 52 mg/dL.
C. A patient who is complaining of nausea and vomiting following chemotherapy.
D. A patient who is requesting help with ambulating to the bathroom for the first time.
, Page 4 of 120
Correct Answer: B
Rationale: The patient with a blood glucose of 52 mg/dL is experiencing hypoglycemia,
which is a life-threatening emergency that requires immediate intervention. Blood
glucose below 60 mg/dL can lead to seizures, loss of consciousness, and brain damage
if not treated promptly. The nurse must check this patient immediately, provide a fast-
acting carbohydrate source or IV dextrose as appropriate, and reassess blood glucose
in 15 minutes. All other patients have stable conditions that can wait for assessment .
7. The nurse is caring for a patient who is receiving a blood transfusion and 30
minutes into the infusion reports severe low back pain and chills. What is the
nurse's priority action?
A. Slow the infusion rate to 50 mL per hour to observe for further symptoms.
B. Stop the transfusion immediately and disconnect the blood tubing from the IV site.
C. Notify the healthcare provider about the patient's symptoms and vital signs.
D. Administer prescribed acetaminophen for the chills and fever.
Correct Answer: B
Rationale: Low back pain and chills are classic signs of an acute hemolytic transfusion
reaction, which is a life-threatening emergency. The priority action is to stop the
transfusion immediately to prevent further infusion of incompatible blood. The blood
tubing should be disconnected and the IV line kept open with normal saline. The
healthcare provider must be notified after stopping the transfusion, and the blood bag
and tubing should be returned to the blood bank for investigation. Acetaminophen may
mask symptoms and is not the priority .
8. The nurse is caring for a pediatric patient who is post-operative following a
ventriculoperitoneal shunt placement. The nurse notes the child has become
difficult to arouse and lethargic. What is the most appropriate initial nursing
action?
A. Stimulate the child to assess for any response to painful stimuli.
B. Elevate the head of the bed to 30 degrees to reduce intracranial pressure.
C. Notify the healthcare provider of the child's decreased level of consciousness.
D. Assess the child's pupillary response and vital signs.
Correct Answer: B
