APUS NURS 450 Final Exam verified with correct answers plus rationales
2026/2027 version instant pdf
1. A patient with acute respiratory distress has an oxygen saturation of 84%. What should
the nurse do FIRST?
A. Obtain a complete medical history
B. Apply oxygen as prescribed and assess airway and breathing
C. Encourage oral fluids
D. Document the finding and reassess in 30 minutes
Answer: B. Apply oxygen as prescribed and assess airway and breathing.
Rationale: An oxygen saturation of 84% indicates significant hypoxemia. Airway and breathing
are immediate priorities.
2. A patient with heart failure suddenly develops severe dyspnea, crackles, and pink frothy
sputum. Which condition should the nurse suspect?
A. Pneumothorax
B. Acute pulmonary edema
C. Pleural effusion
D. Pulmonary embolism
Answer: B. Acute pulmonary edema.
Rationale: Severe dyspnea, diffuse crackles, and pink frothy sputum are classic findings of acute
pulmonary edema.
3. Which assessment finding is most concerning in a patient receiving opioid analgesics?
A. Respiratory rate of 8/min
B. Mild nausea
C. Constipation
D. Drowsiness after medication
Answer: A. Respiratory rate of 8/min.
Rationale: Opioids can cause life-threatening respiratory depression. A respiratory rate of 8/min
requires immediate assessment and intervention.
,4. A patient is receiving warfarin therapy. Which laboratory test is most important for
monitoring its therapeutic effect?
A. aPTT
B. INR
C. Troponin
D. Serum sodium
Answer: B. INR.
Rationale: INR is used to monitor the anticoagulant effect of warfarin and guide dosing.
5. Which finding in a patient receiving anticoagulant therapy should the nurse report
immediately?
A. Occasional bruising at an injection site
B. Black, tarry stool
C. Mild fatigue
D. Decreased appetite
Answer: B. Black, tarry stool.
Rationale: Melena may indicate gastrointestinal bleeding, which can be a serious complication
of anticoagulant therapy.
6. A patient with diabetes is awake, confused, diaphoretic, and has a blood glucose of 48
mg/dL. What is the priority intervention?
A. Administer rapid-acting carbohydrate if the patient can swallow safely
B. Administer long-acting insulin
C. Restrict fluids
D. Encourage exercise
Answer: A. Administer rapid-acting carbohydrate if the patient can swallow safely.
Rationale: Symptomatic hypoglycemia requires immediate glucose replacement. If the patient
cannot safely swallow, IV dextrose or glucagon may be indicated according to the situation and
protocol.
,7. Which finding is most characteristic of diabetic ketoacidosis (DKA)?
A. Severe hypoglycemia
B. Metabolic acidosis with ketone production
C. Bradycardia and hypothermia
D. Decreased respiratory effort
Answer: B. Metabolic acidosis with ketone production.
Rationale: DKA is characterized by hyperglycemia, ketone production, metabolic acidosis, and
dehydration.
8. A patient with suspected stroke arrives in the emergency department. Which
information is especially important for the nurse to determine?
A. The patient's favorite foods
B. The exact time the patient was last known well
C. The patient's childhood illnesses
D. The patient's usual bedtime
Answer: B. The exact time the patient was last known well.
Rationale: The timing of symptom onset or last-known-well time is critical when determining
eligibility for time-sensitive stroke interventions.
9. Which finding is commonly associated with increased intracranial pressure?
A. Decreased level of consciousness
B. Increased appetite
C. Increased bowel sounds
D. Hypoglycemia
Answer: A. Decreased level of consciousness.
Rationale: Changes in level of consciousness are an important early indicator of neurological
deterioration and possible increased intracranial pressure.
10. Which position is generally appropriate for a patient with increased intracranial
pressure, unless contraindicated?
, A. Flat with the neck flexed
B. Head of bed elevated with the head maintained in neutral alignment
C. Trendelenburg
D. Prone with the head turned sharply
Answer: B. Head of bed elevated with the head maintained in neutral alignment.
Rationale: Elevating the head and maintaining neutral alignment can promote venous drainage
and help limit increases in intracranial pressure.
11. A patient develops facial swelling, wheezing, and hypotension shortly after receiving an
antibiotic. What is the nurse's priority action?
A. Document the reaction
B. Administer epinephrine according to emergency protocol
C. Offer oral fluids
D. Place the patient in a quiet room
Answer: B. Administer epinephrine according to emergency protocol.
Rationale: Facial swelling, wheezing, and hypotension suggest anaphylaxis. Epinephrine is the
first-line emergency medication.
12. Which assessment finding is most consistent with hypovolemic shock?
A. Bradycardia and hypertension
B. Tachycardia and hypotension
C. Bounding pulses and hypertension
D. Warm flushed skin with slow respirations
Answer: B. Tachycardia and hypotension.
Rationale: Loss of circulating volume commonly produces compensatory tachycardia followed
by hypotension as shock progresses.
13. A patient with a suspected pulmonary embolism suddenly develops dyspnea and chest
pain. What is the priority nursing action?
A. Encourage ambulation
B. Assess airway and breathing and provide oxygen as indicated
2026/2027 version instant pdf
1. A patient with acute respiratory distress has an oxygen saturation of 84%. What should
the nurse do FIRST?
A. Obtain a complete medical history
B. Apply oxygen as prescribed and assess airway and breathing
C. Encourage oral fluids
D. Document the finding and reassess in 30 minutes
Answer: B. Apply oxygen as prescribed and assess airway and breathing.
Rationale: An oxygen saturation of 84% indicates significant hypoxemia. Airway and breathing
are immediate priorities.
2. A patient with heart failure suddenly develops severe dyspnea, crackles, and pink frothy
sputum. Which condition should the nurse suspect?
A. Pneumothorax
B. Acute pulmonary edema
C. Pleural effusion
D. Pulmonary embolism
Answer: B. Acute pulmonary edema.
Rationale: Severe dyspnea, diffuse crackles, and pink frothy sputum are classic findings of acute
pulmonary edema.
3. Which assessment finding is most concerning in a patient receiving opioid analgesics?
A. Respiratory rate of 8/min
B. Mild nausea
C. Constipation
D. Drowsiness after medication
Answer: A. Respiratory rate of 8/min.
Rationale: Opioids can cause life-threatening respiratory depression. A respiratory rate of 8/min
requires immediate assessment and intervention.
,4. A patient is receiving warfarin therapy. Which laboratory test is most important for
monitoring its therapeutic effect?
A. aPTT
B. INR
C. Troponin
D. Serum sodium
Answer: B. INR.
Rationale: INR is used to monitor the anticoagulant effect of warfarin and guide dosing.
5. Which finding in a patient receiving anticoagulant therapy should the nurse report
immediately?
A. Occasional bruising at an injection site
B. Black, tarry stool
C. Mild fatigue
D. Decreased appetite
Answer: B. Black, tarry stool.
Rationale: Melena may indicate gastrointestinal bleeding, which can be a serious complication
of anticoagulant therapy.
6. A patient with diabetes is awake, confused, diaphoretic, and has a blood glucose of 48
mg/dL. What is the priority intervention?
A. Administer rapid-acting carbohydrate if the patient can swallow safely
B. Administer long-acting insulin
C. Restrict fluids
D. Encourage exercise
Answer: A. Administer rapid-acting carbohydrate if the patient can swallow safely.
Rationale: Symptomatic hypoglycemia requires immediate glucose replacement. If the patient
cannot safely swallow, IV dextrose or glucagon may be indicated according to the situation and
protocol.
,7. Which finding is most characteristic of diabetic ketoacidosis (DKA)?
A. Severe hypoglycemia
B. Metabolic acidosis with ketone production
C. Bradycardia and hypothermia
D. Decreased respiratory effort
Answer: B. Metabolic acidosis with ketone production.
Rationale: DKA is characterized by hyperglycemia, ketone production, metabolic acidosis, and
dehydration.
8. A patient with suspected stroke arrives in the emergency department. Which
information is especially important for the nurse to determine?
A. The patient's favorite foods
B. The exact time the patient was last known well
C. The patient's childhood illnesses
D. The patient's usual bedtime
Answer: B. The exact time the patient was last known well.
Rationale: The timing of symptom onset or last-known-well time is critical when determining
eligibility for time-sensitive stroke interventions.
9. Which finding is commonly associated with increased intracranial pressure?
A. Decreased level of consciousness
B. Increased appetite
C. Increased bowel sounds
D. Hypoglycemia
Answer: A. Decreased level of consciousness.
Rationale: Changes in level of consciousness are an important early indicator of neurological
deterioration and possible increased intracranial pressure.
10. Which position is generally appropriate for a patient with increased intracranial
pressure, unless contraindicated?
, A. Flat with the neck flexed
B. Head of bed elevated with the head maintained in neutral alignment
C. Trendelenburg
D. Prone with the head turned sharply
Answer: B. Head of bed elevated with the head maintained in neutral alignment.
Rationale: Elevating the head and maintaining neutral alignment can promote venous drainage
and help limit increases in intracranial pressure.
11. A patient develops facial swelling, wheezing, and hypotension shortly after receiving an
antibiotic. What is the nurse's priority action?
A. Document the reaction
B. Administer epinephrine according to emergency protocol
C. Offer oral fluids
D. Place the patient in a quiet room
Answer: B. Administer epinephrine according to emergency protocol.
Rationale: Facial swelling, wheezing, and hypotension suggest anaphylaxis. Epinephrine is the
first-line emergency medication.
12. Which assessment finding is most consistent with hypovolemic shock?
A. Bradycardia and hypertension
B. Tachycardia and hypotension
C. Bounding pulses and hypertension
D. Warm flushed skin with slow respirations
Answer: B. Tachycardia and hypotension.
Rationale: Loss of circulating volume commonly produces compensatory tachycardia followed
by hypotension as shock progresses.
13. A patient with a suspected pulmonary embolism suddenly develops dyspnea and chest
pain. What is the priority nursing action?
A. Encourage ambulation
B. Assess airway and breathing and provide oxygen as indicated
