NUR 185 Final Exam Actual Exam Style Questions with
Verified Answers & Detailed Rationales | Fundamentals of Nursing
& NCLEX-RN Prep Guide (Grade A Guaranteed)
Question 1
A client with chronic heart failure is admitted to the medical-surgical unit presenting with
severe orthopnea, a respiratory rate of 30 breaths/minute, bilateral jugular venous distention
(JVD), and fine crackles throughout the lower lung bases. The nurse notes an audible S3
heart sound. Which prescription should the nurse implement first?
A. Administer intravenous Bumetanide 1 mg over 2 minutes.
B. Obtain an immediate 12-lead electrocardiogram (ECG).
C. Draw a brain natriuretic peptide (BNP) level and basic metabolic panel.
D. Apply oxygen at 2 L/min via nasal cannula.
,VERIFIED ANSWER: A. Administer intravenous Bumetanide 1 mg over 2 minutes.
EXPLANATION: The client is exhibiting clinical manifestations of acute decompensated
heart failure (ADHF) with severe pulmonary congestion and fluid volume excess
(orthopnea, crackles, tachypnea, JVD, S3 sound). The immediate physiological priority is
reducing preload and relieving fluid accumulation in the alveoli to improve oxygenation.
Loop diuretics, such as Bumetanide or Furosemide administered intravenously, work
rapidly to promote diuresis and venodilation, directly addressing the underlying fluid
overload. While oxygen application, drawing lab values (BNP), and obtaining an ECG are
necessary components of care, they do not resolve the mechanical fluid compromise as
efficiently as loop diuretics.
Question 2
The nurse is preparing to administer the morning dose of Digoxin 0.125 mg orally to a client
with chronic atrial fibrillation. Upon assessment, the client reports mild nausea and an
unusual "yellowish haze" around the room's light fixtures. The client’s apical heart rate is 54
beats/minute. Which action should the nurse take next?
A. Administer the Digoxin and re-evaluate the client's vital signs in one hour.
B. Hold the dose, document the heart rate, and reassess the client at noon.
C. Hold the dose, check the client's serum potassium and digoxin levels, and notify the health
care provider.
D. Administer the dose and request an immediate prescription for an antiemetic.
VERIFIED ANSWER: C. Hold the dose, check the client's serum potassium and digoxin
levels, and notify the health care provider.
EXPLANATION: Nausea, vomiting, anorexia, bradycardia (apical pulse less than 60
beats/minute), and visual disturbances (such as a yellow-green halo or haze) are classic,
hallmark signs of digoxin toxicity. Digoxin has a narrow therapeutic index (0.5–2.0
ng/mL). Hypokalemia intensifies digoxin toxicity because potassium and digoxin compete
for the same binding sites on the ATPase pump. Therefore, the nurse must hold the
medication to prevent further toxicity, assess serum digoxin and potassium levels, and
,immediately notify the primary provider. Administering the dose could lead to life-
threatening dysrhythmias or severe heart block.
Question 3
A nurse on a telemetry unit receives a laboratory report indicating that an assigned client has
a serum potassium level of 6.2 mEq/L (6.2 mmol/L). Which electrocardiogram (ECG) change
is most critical for the nurse to anticipate when checking the client's monitor?
A. Prominent U waves and ST-segment depression.
B. Prolonged QT intervals and widened P waves.
C. Tall, peaked T waves and a widened QRS complex.
D. Shortened PR intervals and inverted T waves.
VERIFIED ANSWER: C. Tall, peaked T waves and a widened QRS complex.
EXPLANATION: A serum potassium level of 6.2 mEq/L indicates severe hyperkalemia
(normal range: 3.5–5.0 mEq/L). Hyperkalemia alters the myocardial cell membrane
potential, affecting cardiac conduction. The earliest ECG changes associated with
hyperkalemia are narrow, tall, and peaked T waves. As potassium levels continue to rise,
conduction slows further, leading to a prolonged PR interval, loss of P waves, and a
widened QRS complex, which can rapidly degenerate into ventricular fibrillation or
asystole. Prominent U waves and ST depression are classic features instead of
hypokalemia.
Question 4
The nurse is caring for an adult client diagnosed with Type 1 Diabetes Mellitus who was
admitted to the emergency department in Diabetic Ketoacidosis (DKA). An intravenous
infusion of Regular insulin has been running for 4 hours. The client's blood glucose has
decreased from 560 mg/dL to 230 mg/dL. Which action should the nurse expect to implement
next?
, A. Stop the insulin infusion completely to prevent profound hypoglycemia.
B. Transition the client to subcutaneous Long-Acting Glargine insulin immediately.
C. Change the intravenous maintenance fluid to a dextrose-containing solution while
maintaining the insulin infusion.
D. Increase the hourly rate of the Regular insulin infusion to rapidly clear any remaining
serum ketones.
VERIFIED ANSWER: C. Change the intravenous maintenance fluid to a dextrose-
containing solution while maintaining the insulin infusion.
EXPLANATION: During the treatment of Diabetic Ketoacidosis (DKA), when the serum
glucose drops to approximately 250–300 mg/dL, the intravenous fluid should be changed to
include 5% to 10% dextrose (e.g., 5% dextrose in 0.45% normal saline). This is done while
continuing the continuous intravenous insulin infusion. The purpose is twofold: it prevents
a rapid drop in blood glucose that could induce cerebral edema, and it provides the glucose
necessary to allow continued insulin administration, which is required to completely halt
ketogenesis and clear serum ketones. The insulin infusion must never be stopped abruptly
until the metabolic acidosis is resolved and the anion gap closes.
Question 5
An orthopedic nurse is performing a neurovascular assessment on a client who underwent a
left total knee arthroplasty 6 hours ago. Which finding is considered the earliest indicator of
potential compartment syndrome?
A. Complete absence of the left dorsalis pedis and posterior tibial pulses.
B. Unrelieving, deep, throbbing pain in the left leg that is disproportionate to the injury and
increases with passive stretching.
C. Paresthesia and numbness localized strictly between the first and second toes of the left
foot.
D. Cool, pale, and cyanotic skin below the level of the left knee incision.
VERIFIED ANSWER: B. Unrelieving, deep, throbbing pain in the left leg that is
disproportionate to the injury and increases with passive stretching.
Verified Answers & Detailed Rationales | Fundamentals of Nursing
& NCLEX-RN Prep Guide (Grade A Guaranteed)
Question 1
A client with chronic heart failure is admitted to the medical-surgical unit presenting with
severe orthopnea, a respiratory rate of 30 breaths/minute, bilateral jugular venous distention
(JVD), and fine crackles throughout the lower lung bases. The nurse notes an audible S3
heart sound. Which prescription should the nurse implement first?
A. Administer intravenous Bumetanide 1 mg over 2 minutes.
B. Obtain an immediate 12-lead electrocardiogram (ECG).
C. Draw a brain natriuretic peptide (BNP) level and basic metabolic panel.
D. Apply oxygen at 2 L/min via nasal cannula.
,VERIFIED ANSWER: A. Administer intravenous Bumetanide 1 mg over 2 minutes.
EXPLANATION: The client is exhibiting clinical manifestations of acute decompensated
heart failure (ADHF) with severe pulmonary congestion and fluid volume excess
(orthopnea, crackles, tachypnea, JVD, S3 sound). The immediate physiological priority is
reducing preload and relieving fluid accumulation in the alveoli to improve oxygenation.
Loop diuretics, such as Bumetanide or Furosemide administered intravenously, work
rapidly to promote diuresis and venodilation, directly addressing the underlying fluid
overload. While oxygen application, drawing lab values (BNP), and obtaining an ECG are
necessary components of care, they do not resolve the mechanical fluid compromise as
efficiently as loop diuretics.
Question 2
The nurse is preparing to administer the morning dose of Digoxin 0.125 mg orally to a client
with chronic atrial fibrillation. Upon assessment, the client reports mild nausea and an
unusual "yellowish haze" around the room's light fixtures. The client’s apical heart rate is 54
beats/minute. Which action should the nurse take next?
A. Administer the Digoxin and re-evaluate the client's vital signs in one hour.
B. Hold the dose, document the heart rate, and reassess the client at noon.
C. Hold the dose, check the client's serum potassium and digoxin levels, and notify the health
care provider.
D. Administer the dose and request an immediate prescription for an antiemetic.
VERIFIED ANSWER: C. Hold the dose, check the client's serum potassium and digoxin
levels, and notify the health care provider.
EXPLANATION: Nausea, vomiting, anorexia, bradycardia (apical pulse less than 60
beats/minute), and visual disturbances (such as a yellow-green halo or haze) are classic,
hallmark signs of digoxin toxicity. Digoxin has a narrow therapeutic index (0.5–2.0
ng/mL). Hypokalemia intensifies digoxin toxicity because potassium and digoxin compete
for the same binding sites on the ATPase pump. Therefore, the nurse must hold the
medication to prevent further toxicity, assess serum digoxin and potassium levels, and
,immediately notify the primary provider. Administering the dose could lead to life-
threatening dysrhythmias or severe heart block.
Question 3
A nurse on a telemetry unit receives a laboratory report indicating that an assigned client has
a serum potassium level of 6.2 mEq/L (6.2 mmol/L). Which electrocardiogram (ECG) change
is most critical for the nurse to anticipate when checking the client's monitor?
A. Prominent U waves and ST-segment depression.
B. Prolonged QT intervals and widened P waves.
C. Tall, peaked T waves and a widened QRS complex.
D. Shortened PR intervals and inverted T waves.
VERIFIED ANSWER: C. Tall, peaked T waves and a widened QRS complex.
EXPLANATION: A serum potassium level of 6.2 mEq/L indicates severe hyperkalemia
(normal range: 3.5–5.0 mEq/L). Hyperkalemia alters the myocardial cell membrane
potential, affecting cardiac conduction. The earliest ECG changes associated with
hyperkalemia are narrow, tall, and peaked T waves. As potassium levels continue to rise,
conduction slows further, leading to a prolonged PR interval, loss of P waves, and a
widened QRS complex, which can rapidly degenerate into ventricular fibrillation or
asystole. Prominent U waves and ST depression are classic features instead of
hypokalemia.
Question 4
The nurse is caring for an adult client diagnosed with Type 1 Diabetes Mellitus who was
admitted to the emergency department in Diabetic Ketoacidosis (DKA). An intravenous
infusion of Regular insulin has been running for 4 hours. The client's blood glucose has
decreased from 560 mg/dL to 230 mg/dL. Which action should the nurse expect to implement
next?
, A. Stop the insulin infusion completely to prevent profound hypoglycemia.
B. Transition the client to subcutaneous Long-Acting Glargine insulin immediately.
C. Change the intravenous maintenance fluid to a dextrose-containing solution while
maintaining the insulin infusion.
D. Increase the hourly rate of the Regular insulin infusion to rapidly clear any remaining
serum ketones.
VERIFIED ANSWER: C. Change the intravenous maintenance fluid to a dextrose-
containing solution while maintaining the insulin infusion.
EXPLANATION: During the treatment of Diabetic Ketoacidosis (DKA), when the serum
glucose drops to approximately 250–300 mg/dL, the intravenous fluid should be changed to
include 5% to 10% dextrose (e.g., 5% dextrose in 0.45% normal saline). This is done while
continuing the continuous intravenous insulin infusion. The purpose is twofold: it prevents
a rapid drop in blood glucose that could induce cerebral edema, and it provides the glucose
necessary to allow continued insulin administration, which is required to completely halt
ketogenesis and clear serum ketones. The insulin infusion must never be stopped abruptly
until the metabolic acidosis is resolved and the anion gap closes.
Question 5
An orthopedic nurse is performing a neurovascular assessment on a client who underwent a
left total knee arthroplasty 6 hours ago. Which finding is considered the earliest indicator of
potential compartment syndrome?
A. Complete absence of the left dorsalis pedis and posterior tibial pulses.
B. Unrelieving, deep, throbbing pain in the left leg that is disproportionate to the injury and
increases with passive stretching.
C. Paresthesia and numbness localized strictly between the first and second toes of the left
foot.
D. Cool, pale, and cyanotic skin below the level of the left knee incision.
VERIFIED ANSWER: B. Unrelieving, deep, throbbing pain in the left leg that is
disproportionate to the injury and increases with passive stretching.
