Nursing 354 Comprehensive Exam
Questions And Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A
Instant Download Pdf
1. A client with heart failure suddenly develops severe dyspnea, crackles
throughout both lung fields, and pink, frothy sputum. Which action should
the nurse take first?
A. Encourage oral fluids
B. Place the client in a high-Fowler position
C. Obtain a daily weight
D. Administer a potassium supplement
Answer: Place the client in a high-Fowler position
Rationale: Positioning the client upright decreases venous return and improves
lung expansion, making it an immediate priority during acute pulmonary
edema.
2. Which assessment finding is most concerning in a client experiencing chest
pain?
A. Pain rated 3/10 after activity
B. Heart rate of 88 beats/minute
C. New ST-segment elevation
D. Blood pressure of 128/76 mm Hg
,Answer: New ST-segment elevation
Rationale: New ST-segment elevation can indicate acute myocardial injury and
requires immediate evaluation and treatment.
3. A client taking warfarin should be instructed to report which finding
immediately?
A. Mild hunger
B. Occasional fatigue
C. Unusual bleeding or black stools
D. Increased appetite
Answer: Unusual bleeding or black stools
Rationale: Warfarin increases bleeding risk. Unusual bleeding and melena can
indicate significant hemorrhage.
4. Which laboratory value should the nurse monitor most closely in a client
receiving heparin therapy?
A. INR
B. aPTT
C. Hemoglobin A1c
D. Serum sodium
Answer: aPTT
Rationale: Activated partial thromboplastin time is commonly monitored to
evaluate the therapeutic effect of unfractionated heparin.
5. A client with chronic obstructive pulmonary disease is receiving oxygen.
Which nursing principle is appropriate?
A. Oxygen should always be administered at the highest possible concentration
B. Oxygen should be titrated according to the prescribed target and clinical
condition
C. Oxygen is contraindicated in chronic obstructive pulmonary disease
D. The client should never receive supplemental oxygen
,Answer: Oxygen should be titrated according to the prescribed target and clinical
condition
Rationale: Clients with chronic obstructive pulmonary disease may require
controlled oxygen therapy. Oxygen should be titrated to the prescribed target
rather than withheld or unnecessarily given at high concentrations.
6. Which finding is characteristic of tension pneumothorax?
A. Bilateral equal breath sounds
B. Severe respiratory distress with hypotension and unilateral absent breath
sounds
C. Bradycardia with hypertension
D. Productive cough with green sputum
Answer: Severe respiratory distress with hypotension and unilateral absent
breath sounds
Rationale: Tension pneumothorax can cause respiratory compromise and
obstruct venous return, producing hypotension and unilateral absent breath
sounds.
7. Which intervention is appropriate for a client having an acute asthma
exacerbation?
A. Administer the prescribed short-acting bronchodilator
B. Encourage strenuous exercise
C. Restrict all fluids
D. Place the client flat in bed
Answer: Administer the prescribed short-acting bronchodilator
Rationale: Short-acting bronchodilators rapidly relax bronchial smooth muscle
and are commonly used for acute bronchospasm.
8. A client with pneumonia has a respiratory rate of 32/minute and oxygen
saturation of 86%. What is the nurse's priority?
, A. Encourage ambulation
B. Apply prescribed supplemental oxygen
C. Offer a large meal
D. Obtain a routine weight
Answer: Apply prescribed supplemental oxygen
Rationale: Significant hypoxemia is an immediate priority. Supporting
oxygenation takes precedence over routine interventions.
9. Which assessment finding is most consistent with increased intracranial
pressure?
A. Improved level of consciousness
B. Decreasing headache
C. Decreased level of consciousness with abnormal pupillary responses
D. Increased appetite
Answer: Decreased level of consciousness with abnormal pupillary responses
Rationale: Changes in consciousness and pupillary responses can indicate
worsening neurological status and increased intracranial pressure.
10.A client arrives with sudden facial drooping, arm weakness, and difficulty
speaking. What should the nurse do first?
A. Give the client food
B. Determine the exact time the symptoms began
C. Encourage the client to sleep
D. Place the client in a shower
Answer: Determine the exact time the symptoms began
Rationale: The time of symptom onset is critical in evaluating acute stroke and
determining eligibility for time-sensitive treatment.
11.Which finding is expected during a generalized tonic-clonic seizure?
A. Sustained purposeful conversation
B. Sudden loss of consciousness with involuntary movements
Questions And Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A
Instant Download Pdf
1. A client with heart failure suddenly develops severe dyspnea, crackles
throughout both lung fields, and pink, frothy sputum. Which action should
the nurse take first?
A. Encourage oral fluids
B. Place the client in a high-Fowler position
C. Obtain a daily weight
D. Administer a potassium supplement
Answer: Place the client in a high-Fowler position
Rationale: Positioning the client upright decreases venous return and improves
lung expansion, making it an immediate priority during acute pulmonary
edema.
2. Which assessment finding is most concerning in a client experiencing chest
pain?
A. Pain rated 3/10 after activity
B. Heart rate of 88 beats/minute
C. New ST-segment elevation
D. Blood pressure of 128/76 mm Hg
,Answer: New ST-segment elevation
Rationale: New ST-segment elevation can indicate acute myocardial injury and
requires immediate evaluation and treatment.
3. A client taking warfarin should be instructed to report which finding
immediately?
A. Mild hunger
B. Occasional fatigue
C. Unusual bleeding or black stools
D. Increased appetite
Answer: Unusual bleeding or black stools
Rationale: Warfarin increases bleeding risk. Unusual bleeding and melena can
indicate significant hemorrhage.
4. Which laboratory value should the nurse monitor most closely in a client
receiving heparin therapy?
A. INR
B. aPTT
C. Hemoglobin A1c
D. Serum sodium
Answer: aPTT
Rationale: Activated partial thromboplastin time is commonly monitored to
evaluate the therapeutic effect of unfractionated heparin.
5. A client with chronic obstructive pulmonary disease is receiving oxygen.
Which nursing principle is appropriate?
A. Oxygen should always be administered at the highest possible concentration
B. Oxygen should be titrated according to the prescribed target and clinical
condition
C. Oxygen is contraindicated in chronic obstructive pulmonary disease
D. The client should never receive supplemental oxygen
,Answer: Oxygen should be titrated according to the prescribed target and clinical
condition
Rationale: Clients with chronic obstructive pulmonary disease may require
controlled oxygen therapy. Oxygen should be titrated to the prescribed target
rather than withheld or unnecessarily given at high concentrations.
6. Which finding is characteristic of tension pneumothorax?
A. Bilateral equal breath sounds
B. Severe respiratory distress with hypotension and unilateral absent breath
sounds
C. Bradycardia with hypertension
D. Productive cough with green sputum
Answer: Severe respiratory distress with hypotension and unilateral absent
breath sounds
Rationale: Tension pneumothorax can cause respiratory compromise and
obstruct venous return, producing hypotension and unilateral absent breath
sounds.
7. Which intervention is appropriate for a client having an acute asthma
exacerbation?
A. Administer the prescribed short-acting bronchodilator
B. Encourage strenuous exercise
C. Restrict all fluids
D. Place the client flat in bed
Answer: Administer the prescribed short-acting bronchodilator
Rationale: Short-acting bronchodilators rapidly relax bronchial smooth muscle
and are commonly used for acute bronchospasm.
8. A client with pneumonia has a respiratory rate of 32/minute and oxygen
saturation of 86%. What is the nurse's priority?
, A. Encourage ambulation
B. Apply prescribed supplemental oxygen
C. Offer a large meal
D. Obtain a routine weight
Answer: Apply prescribed supplemental oxygen
Rationale: Significant hypoxemia is an immediate priority. Supporting
oxygenation takes precedence over routine interventions.
9. Which assessment finding is most consistent with increased intracranial
pressure?
A. Improved level of consciousness
B. Decreasing headache
C. Decreased level of consciousness with abnormal pupillary responses
D. Increased appetite
Answer: Decreased level of consciousness with abnormal pupillary responses
Rationale: Changes in consciousness and pupillary responses can indicate
worsening neurological status and increased intracranial pressure.
10.A client arrives with sudden facial drooping, arm weakness, and difficulty
speaking. What should the nurse do first?
A. Give the client food
B. Determine the exact time the symptoms began
C. Encourage the client to sleep
D. Place the client in a shower
Answer: Determine the exact time the symptoms began
Rationale: The time of symptom onset is critical in evaluating acute stroke and
determining eligibility for time-sensitive treatment.
11.Which finding is expected during a generalized tonic-clonic seizure?
A. Sustained purposeful conversation
B. Sudden loss of consciousness with involuntary movements
