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Nursing 354 Final Exam Comprehensive
Practice Exam Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
Pdf
___________________________________________________________________
1. A patient with acute heart failure develops severe dyspnea and pink, frothy
sputum. Which finding requires the nurse's immediate intervention?
A. Bilateral ankle edema
B. Orthopnea
C. Crackles throughout both lung fields
D. Weight gain of 2 kilograms in 2 days
Answer: C. Crackles throughout both lung fields
Rationale: Diffuse crackles with severe dyspnea and pink, frothy sputum indicate
acute pulmonary edema, which threatens oxygenation and requires immediate
intervention.
2. Which assessment finding is most consistent with hypovolemic shock?
A. Bounding peripheral pulses
B. Warm, flushed skin
,C. Bradycardia
D. Cool, clammy skin with tachycardia
Answer: D. Cool, clammy skin with tachycardia
Rationale: Hypovolemia decreases circulating volume and tissue perfusion,
producing compensatory tachycardia and peripheral vasoconstriction that
causes cool, clammy skin.
3. A patient with increased intracranial pressure is being monitored. Which
finding is most concerning?
A. Headache
B. Decreased level of consciousness
C. Mild nausea
D. Photophobia
Answer: B. Decreased level of consciousness
Rationale: A declining level of consciousness is an important early indicator of
worsening cerebral dysfunction and increasing intracranial pressure.
4. Which electrolyte imbalance places a patient at greatest risk for life-
threatening cardiac dysrhythmias?
A. Hyperkalemia
B. Hypernatremia
C. Mild hypocalcemia
D. Mild hypermagnesemia
Answer: A. Hyperkalemia
Rationale: Elevated potassium can significantly alter cardiac conduction and
cause potentially fatal dysrhythmias.
5. A patient with chronic obstructive pulmonary disease is receiving oxygen.
Which nursing action is appropriate?
A. Maintain oxygen at the highest possible flow rate
B. Use oxygen as prescribed and monitor respiratory status closely
,C. Withhold oxygen because it suppresses all respiratory drive
D. Encourage the patient to breathe rapidly
Answer: B. Use oxygen as prescribed and monitor respiratory status closely
Rationale: Patients with chronic obstructive pulmonary disease may require
carefully titrated oxygen. Oxygen should not be withheld when hypoxemia is
present.
6. Which finding is characteristic of diabetic ketoacidosis?
A. Severe hypoglycemia with bradycardia
B. Metabolic alkalosis
C. Kussmaul respirations
D. Decreased serum ketones
Answer: C. Kussmaul respirations
Rationale: Kussmaul respirations are deep, rapid respirations that develop as
the body attempts to compensate for metabolic acidosis caused by diabetic
ketoacidosis.
7. Which assessment finding is most characteristic of hypothyroidism?
A. Heat intolerance
B. Tachycardia
C. Weight loss
D. Cold intolerance and fatigue
Answer: D. Cold intolerance and fatigue
Rationale: Reduced thyroid hormone activity slows metabolism, commonly
causing fatigue, cold intolerance, weight gain, and bradycardia.
8. A patient is admitted with suspected bacterial meningitis. Which nursing
action is the priority?
A. Place the patient on appropriate isolation precautions
B. Encourage frequent ambulation
, C. Limit neurological assessments
D. Place the patient in a brightly lit room
Answer: A. Place the patient on appropriate isolation precautions
Rationale: Suspected bacterial meningitis requires prompt infection-control
measures, including appropriate transmission-based precautions, while
diagnostic and treatment measures are initiated.
9. Which finding is commonly associated with acute kidney injury?
A. Increased urine output in all cases
B. Elevated serum creatinine
C. Decreased blood urea nitrogen
D. Persistent hypokalemia
Answer: B. Elevated serum creatinine
Rationale: Acute kidney injury reduces renal filtration, commonly resulting in
rising serum creatinine and blood urea nitrogen levels.
10. A patient with gastrointestinal bleeding has a blood pressure of 84/50 mmHg
and a heart rate of 126/min. What is the priority nursing concern?
A. Nutritional deficiency
B. Constipation
C. Impaired tissue perfusion
D. Activity intolerance
Answer: C. Impaired tissue perfusion
Rationale: Hypotension and tachycardia in a patient with significant bleeding
suggest inadequate circulating volume and compromised tissue perfusion.
11. Which finding is most consistent with left-sided heart failure?
A. Pulmonary crackles
B. Ascites only
C. Enlarged liver
D. Dependent peripheral edema only
Nursing 354 Final Exam Comprehensive
Practice Exam Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
___________________________________________________________________
1. A patient with acute heart failure develops severe dyspnea and pink, frothy
sputum. Which finding requires the nurse's immediate intervention?
A. Bilateral ankle edema
B. Orthopnea
C. Crackles throughout both lung fields
D. Weight gain of 2 kilograms in 2 days
Answer: C. Crackles throughout both lung fields
Rationale: Diffuse crackles with severe dyspnea and pink, frothy sputum indicate
acute pulmonary edema, which threatens oxygenation and requires immediate
intervention.
2. Which assessment finding is most consistent with hypovolemic shock?
A. Bounding peripheral pulses
B. Warm, flushed skin
,C. Bradycardia
D. Cool, clammy skin with tachycardia
Answer: D. Cool, clammy skin with tachycardia
Rationale: Hypovolemia decreases circulating volume and tissue perfusion,
producing compensatory tachycardia and peripheral vasoconstriction that
causes cool, clammy skin.
3. A patient with increased intracranial pressure is being monitored. Which
finding is most concerning?
A. Headache
B. Decreased level of consciousness
C. Mild nausea
D. Photophobia
Answer: B. Decreased level of consciousness
Rationale: A declining level of consciousness is an important early indicator of
worsening cerebral dysfunction and increasing intracranial pressure.
4. Which electrolyte imbalance places a patient at greatest risk for life-
threatening cardiac dysrhythmias?
A. Hyperkalemia
B. Hypernatremia
C. Mild hypocalcemia
D. Mild hypermagnesemia
Answer: A. Hyperkalemia
Rationale: Elevated potassium can significantly alter cardiac conduction and
cause potentially fatal dysrhythmias.
5. A patient with chronic obstructive pulmonary disease is receiving oxygen.
Which nursing action is appropriate?
A. Maintain oxygen at the highest possible flow rate
B. Use oxygen as prescribed and monitor respiratory status closely
,C. Withhold oxygen because it suppresses all respiratory drive
D. Encourage the patient to breathe rapidly
Answer: B. Use oxygen as prescribed and monitor respiratory status closely
Rationale: Patients with chronic obstructive pulmonary disease may require
carefully titrated oxygen. Oxygen should not be withheld when hypoxemia is
present.
6. Which finding is characteristic of diabetic ketoacidosis?
A. Severe hypoglycemia with bradycardia
B. Metabolic alkalosis
C. Kussmaul respirations
D. Decreased serum ketones
Answer: C. Kussmaul respirations
Rationale: Kussmaul respirations are deep, rapid respirations that develop as
the body attempts to compensate for metabolic acidosis caused by diabetic
ketoacidosis.
7. Which assessment finding is most characteristic of hypothyroidism?
A. Heat intolerance
B. Tachycardia
C. Weight loss
D. Cold intolerance and fatigue
Answer: D. Cold intolerance and fatigue
Rationale: Reduced thyroid hormone activity slows metabolism, commonly
causing fatigue, cold intolerance, weight gain, and bradycardia.
8. A patient is admitted with suspected bacterial meningitis. Which nursing
action is the priority?
A. Place the patient on appropriate isolation precautions
B. Encourage frequent ambulation
, C. Limit neurological assessments
D. Place the patient in a brightly lit room
Answer: A. Place the patient on appropriate isolation precautions
Rationale: Suspected bacterial meningitis requires prompt infection-control
measures, including appropriate transmission-based precautions, while
diagnostic and treatment measures are initiated.
9. Which finding is commonly associated with acute kidney injury?
A. Increased urine output in all cases
B. Elevated serum creatinine
C. Decreased blood urea nitrogen
D. Persistent hypokalemia
Answer: B. Elevated serum creatinine
Rationale: Acute kidney injury reduces renal filtration, commonly resulting in
rising serum creatinine and blood urea nitrogen levels.
10. A patient with gastrointestinal bleeding has a blood pressure of 84/50 mmHg
and a heart rate of 126/min. What is the priority nursing concern?
A. Nutritional deficiency
B. Constipation
C. Impaired tissue perfusion
D. Activity intolerance
Answer: C. Impaired tissue perfusion
Rationale: Hypotension and tachycardia in a patient with significant bleeding
suggest inadequate circulating volume and compromised tissue perfusion.
11. Which finding is most consistent with left-sided heart failure?
A. Pulmonary crackles
B. Ascites only
C. Enlarged liver
D. Dependent peripheral edema only
