NSG 527 Midterm Exam (Latest 2026 /
2027) Questions And Correct Answers
(Verified Answers) Plus Rationales
2026 Q&A | Instant Download Pdf
1. A nurse is evaluating a patient who reports progressive shortness of
breath, fatigue, and bilateral ankle swelling. Which additional
finding most strongly supports a diagnosis of heart failure?
A. Dry mucous membranes
B. Bounding peripheral pulses
C. Orthopnea and paroxysmal nocturnal dyspnea
D. Increased appetite
Answer: C. Orthopnea and paroxysmal nocturnal dyspnea
Rationale: Left-sided heart failure commonly produces pulmonary
congestion, resulting in orthopnea and paroxysmal nocturnal dyspnea.
These symptoms occur because lying flat increases venous return and
pulmonary vascular pressure. Peripheral edema may occur with right-
sided or advanced heart failure, but the combination of orthopnea and
paroxysmal nocturnal dyspnea is particularly characteristic of
pulmonary congestion.
2. A patient with diabetes mellitus reports sweating, tremors,
palpitations, and confusion. Which action should the nurse take
first if the patient is awake and able to swallow?
A. Administer a rapid-acting carbohydrate
B. Give the scheduled long-acting insulin
,C. Encourage the patient to exercise
D. Restrict oral fluids
Answer: A. Administer a rapid-acting carbohydrate
Rationale: The symptoms strongly suggest hypoglycemia. An awake
patient who can safely swallow should receive a rapidly absorbed
carbohydrate, followed by reassessment of blood glucose. Insulin
would worsen hypoglycemia, and exercise can further lower glucose.
Immediate correction is necessary because severe untreated
hypoglycemia can progress to seizures, loss of consciousness, or death.
3. Which assessment finding is most concerning in a patient with
suspected bacterial meningitis?
A. Mild nasal congestion
B. Nuchal rigidity with altered mental status
C. Increased appetite
D. Warm, dry skin
Answer: B. Nuchal rigidity with altered mental status
Rationale: Nuchal rigidity and altered mental status are classic
concerning findings associated with meningitis. Meningitis can rapidly
progress to neurologic deterioration, seizures, increased intracranial
pressure, and septic complications. The nurse should recognize this
presentation as requiring urgent medical evaluation and appropriate
infection-control precautions.
4. Which laboratory value is most directly associated with the
oxygen-carrying capacity of blood?
A. Platelet count
B. Serum sodium
,C. Hemoglobin
D. Serum creatinine
Answer: C. Hemoglobin
Rationale: Hemoglobin is the principal protein in red blood cells
responsible for transporting oxygen from the lungs to tissues. A low
hemoglobin concentration can reduce oxygen delivery and contribute
to fatigue, weakness, dyspnea, and tachycardia. Platelets participate in
clotting, sodium reflects fluid and electrolyte balance, and creatinine is
primarily used to assess renal function.
5. A patient taking warfarin has an international normalized ratio of
5.8 and reports bleeding gums. What is the nurse's priority action?
A. Encourage increased intake of vitamin K without further assessment
B. Administer another dose of warfarin
C. Notify the healthcare provider promptly
D. Encourage vigorous exercise
Answer: C. Notify the healthcare provider promptly
Rationale: An INR of 5.8 represents excessive anticoagulation for most
therapeutic indications, especially when accompanied by active
bleeding. The nurse should promptly notify the healthcare provider for
further management. Warfarin should not be administered
automatically when significant over-anticoagulation and bleeding are
present. Management depends on the degree and location of bleeding
and the patient's clinical condition.
6. Which finding is most consistent with hyperthyroidism?
A. Weight gain and cold intolerance
B. Bradycardia and lethargy
, C. Constipation and dry skin
D. Weight loss, heat intolerance, and tachycardia
Answer: D. Weight loss, heat intolerance, and tachycardia
Rationale: Hyperthyroidism increases metabolic activity and
sympathetic stimulation. Common findings include weight loss despite
appetite, heat intolerance, tachycardia, anxiety, tremors, sweating, and
increased bowel activity. Hypothyroidism produces the opposite
pattern, including weight gain, cold intolerance, bradycardia,
constipation, and fatigue.
7. A nurse is assessing a patient with chronic kidney disease. Which
laboratory abnormality is most expected?
A. Elevated serum creatinine
B. Decreased serum potassium in all cases
C. Increased glomerular filtration rate
D. Decreased blood urea nitrogen
Answer: A. Elevated serum creatinine
Rationale: Chronic kidney disease reduces the kidneys' ability to filter
metabolic waste. Serum creatinine and blood urea nitrogen commonly
increase as renal function declines. Potassium may increase because
impaired renal excretion can produce hyperkalemia. The estimated
glomerular filtration rate generally decreases as kidney disease
progresses.
8. Which intervention is most appropriate for preventing orthostatic
hypotension in an older adult taking antihypertensive medication?
A. Instruct the patient to stand rapidly
B. Encourage gradual position changes
2027) Questions And Correct Answers
(Verified Answers) Plus Rationales
2026 Q&A | Instant Download Pdf
1. A nurse is evaluating a patient who reports progressive shortness of
breath, fatigue, and bilateral ankle swelling. Which additional
finding most strongly supports a diagnosis of heart failure?
A. Dry mucous membranes
B. Bounding peripheral pulses
C. Orthopnea and paroxysmal nocturnal dyspnea
D. Increased appetite
Answer: C. Orthopnea and paroxysmal nocturnal dyspnea
Rationale: Left-sided heart failure commonly produces pulmonary
congestion, resulting in orthopnea and paroxysmal nocturnal dyspnea.
These symptoms occur because lying flat increases venous return and
pulmonary vascular pressure. Peripheral edema may occur with right-
sided or advanced heart failure, but the combination of orthopnea and
paroxysmal nocturnal dyspnea is particularly characteristic of
pulmonary congestion.
2. A patient with diabetes mellitus reports sweating, tremors,
palpitations, and confusion. Which action should the nurse take
first if the patient is awake and able to swallow?
A. Administer a rapid-acting carbohydrate
B. Give the scheduled long-acting insulin
,C. Encourage the patient to exercise
D. Restrict oral fluids
Answer: A. Administer a rapid-acting carbohydrate
Rationale: The symptoms strongly suggest hypoglycemia. An awake
patient who can safely swallow should receive a rapidly absorbed
carbohydrate, followed by reassessment of blood glucose. Insulin
would worsen hypoglycemia, and exercise can further lower glucose.
Immediate correction is necessary because severe untreated
hypoglycemia can progress to seizures, loss of consciousness, or death.
3. Which assessment finding is most concerning in a patient with
suspected bacterial meningitis?
A. Mild nasal congestion
B. Nuchal rigidity with altered mental status
C. Increased appetite
D. Warm, dry skin
Answer: B. Nuchal rigidity with altered mental status
Rationale: Nuchal rigidity and altered mental status are classic
concerning findings associated with meningitis. Meningitis can rapidly
progress to neurologic deterioration, seizures, increased intracranial
pressure, and septic complications. The nurse should recognize this
presentation as requiring urgent medical evaluation and appropriate
infection-control precautions.
4. Which laboratory value is most directly associated with the
oxygen-carrying capacity of blood?
A. Platelet count
B. Serum sodium
,C. Hemoglobin
D. Serum creatinine
Answer: C. Hemoglobin
Rationale: Hemoglobin is the principal protein in red blood cells
responsible for transporting oxygen from the lungs to tissues. A low
hemoglobin concentration can reduce oxygen delivery and contribute
to fatigue, weakness, dyspnea, and tachycardia. Platelets participate in
clotting, sodium reflects fluid and electrolyte balance, and creatinine is
primarily used to assess renal function.
5. A patient taking warfarin has an international normalized ratio of
5.8 and reports bleeding gums. What is the nurse's priority action?
A. Encourage increased intake of vitamin K without further assessment
B. Administer another dose of warfarin
C. Notify the healthcare provider promptly
D. Encourage vigorous exercise
Answer: C. Notify the healthcare provider promptly
Rationale: An INR of 5.8 represents excessive anticoagulation for most
therapeutic indications, especially when accompanied by active
bleeding. The nurse should promptly notify the healthcare provider for
further management. Warfarin should not be administered
automatically when significant over-anticoagulation and bleeding are
present. Management depends on the degree and location of bleeding
and the patient's clinical condition.
6. Which finding is most consistent with hyperthyroidism?
A. Weight gain and cold intolerance
B. Bradycardia and lethargy
, C. Constipation and dry skin
D. Weight loss, heat intolerance, and tachycardia
Answer: D. Weight loss, heat intolerance, and tachycardia
Rationale: Hyperthyroidism increases metabolic activity and
sympathetic stimulation. Common findings include weight loss despite
appetite, heat intolerance, tachycardia, anxiety, tremors, sweating, and
increased bowel activity. Hypothyroidism produces the opposite
pattern, including weight gain, cold intolerance, bradycardia,
constipation, and fatigue.
7. A nurse is assessing a patient with chronic kidney disease. Which
laboratory abnormality is most expected?
A. Elevated serum creatinine
B. Decreased serum potassium in all cases
C. Increased glomerular filtration rate
D. Decreased blood urea nitrogen
Answer: A. Elevated serum creatinine
Rationale: Chronic kidney disease reduces the kidneys' ability to filter
metabolic waste. Serum creatinine and blood urea nitrogen commonly
increase as renal function declines. Potassium may increase because
impaired renal excretion can produce hyperkalemia. The estimated
glomerular filtration rate generally decreases as kidney disease
progresses.
8. Which intervention is most appropriate for preventing orthostatic
hypotension in an older adult taking antihypertensive medication?
A. Instruct the patient to stand rapidly
B. Encourage gradual position changes
