NUR 245 Final Exam Review Questions and 100% Answers with
Rationales 2026/27 Latest
TABLE OF CONTENTS
1. Cardiovascular Disorders
2. Respiratory Disorders
3. Renal and Urinary Disorders
4. Gastrointestinal and Hepatobiliary Disorders
5. Neurologic Disorders
6. Hematologic and Coagulation Disorders
7. Endocrine and Metabolic Disorders
8. Oncology and Immune Disorders
9. Critical Care, Shock, Sepsis and Emergency Nursing
10.Perioperative, Gerontologic, Cultural and Patient-Centered Care
11.Pharmacology, Safety, Delegation and Clinical Judgment
SECTION 1 — CARDIOVASCULAR DISORDERS
1.
A client with acute chest pain reports pressure radiating to the left arm. Which
action should the nurse take first?
A. Obtain a 12-lead ECG
B. Encourage ambulation
C. Offer a high-fat meal
D. Place the client in Trendelenburg position
Answer: A
Rationale: A 12-lead ECG should be obtained rapidly in suspected acute
coronary syndrome to identify ischemic changes and guide treatment.
,2.
Which assessment finding is most consistent with left-sided heart failure?
A. Peripheral edema
B. Jugular venous distention
C. Pulmonary crackles
D. Ascites
Answer: C
Rationale: Left-sided heart failure causes pulmonary congestion, producing
crackles, dyspnea, and orthopnea. Peripheral edema and ascites are more
associated with systemic venous congestion from right-sided failure.
3.
What is the most common underlying cause of right-sided heart failure?
A. Left-sided heart failure
B. Migraine
C. Peptic ulcer disease
D. Hypothyroidism
Answer: A
Rationale: Chronic left-sided failure increases pulmonary pressures and
eventually places excessive workload on the right ventricle.
4.
A client with heart failure has gained 2 kg in 2 days. What should the nurse
suspect?
A. Improved cardiac function
B. Fluid retention
C. Decreased blood volume
D. Normal aging
Answer: B
Rationale: Rapid weight gain is a sensitive indicator of fluid retention and
worsening heart failure.
5.
,Which instruction is most appropriate for a client taking furosemide?
A. Increase sodium intake
B. Monitor potassium levels
C. Avoid all fluids
D. Take potassium supplements without provider approval
Answer: B
Rationale: Furosemide can cause potassium loss. Serum electrolytes should be
monitored, and supplementation should be individualized.
6.
A client taking digoxin reports nausea and seeing yellow-green halos. What
should the nurse do?
A. Administer another dose
B. Hold the medication and notify the provider
C. Encourage increased sodium intake
D. Give an antacid and continue therapy
Answer: B
Rationale: Gastrointestinal symptoms and visual disturbances can indicate
digoxin toxicity. The medication should be withheld and the provider notified.
7.
Which electrolyte imbalance increases the risk of digoxin toxicity?
A. Hypernatremia
B. Hypokalemia
C. Hypermagnesemia
D. Hyperchloremia
Answer: B
Rationale: Low potassium increases digoxin binding to myocardial tissue and
increases toxicity risk.
8.
A client prescribed sublingual nitroglycerin asks when to use it.
A. Only at bedtime
B. At the onset of anginal chest pain
, C. After eating a large meal
D. Only when blood pressure is elevated
Answer: B
Rationale: Sublingual nitroglycerin is used at the onset of angina to rapidly
reduce myocardial oxygen demand and improve coronary blood flow.
9.
Which medication combination should concern the nurse in a client prescribed
nitroglycerin?
A. Nitroglycerin and acetaminophen
B. Nitroglycerin and sildenafil
C. Nitroglycerin and calcium
D. Nitroglycerin and multivitamins
Answer: B
Rationale: PDE-5 inhibitors such as sildenafil can cause profound hypotension
when combined with nitrates.
10.
Which finding is most characteristic of cardiogenic shock?
A. Warm dry skin with hypertension
B. Hypotension with poor cardiac output
C. Bradycardia with increased urine output
D. Increased peripheral perfusion
Answer: B
Rationale: Cardiogenic shock occurs when the heart cannot pump enough
blood to maintain tissue perfusion, resulting in hypotension and organ
dysfunction.
11.
Which client should the nurse assess first?
A. Client with stable hypertension
B. Client with chronic ankle edema
C. Client with new crushing chest pain
D. Client requesting discharge instructions
Rationales 2026/27 Latest
TABLE OF CONTENTS
1. Cardiovascular Disorders
2. Respiratory Disorders
3. Renal and Urinary Disorders
4. Gastrointestinal and Hepatobiliary Disorders
5. Neurologic Disorders
6. Hematologic and Coagulation Disorders
7. Endocrine and Metabolic Disorders
8. Oncology and Immune Disorders
9. Critical Care, Shock, Sepsis and Emergency Nursing
10.Perioperative, Gerontologic, Cultural and Patient-Centered Care
11.Pharmacology, Safety, Delegation and Clinical Judgment
SECTION 1 — CARDIOVASCULAR DISORDERS
1.
A client with acute chest pain reports pressure radiating to the left arm. Which
action should the nurse take first?
A. Obtain a 12-lead ECG
B. Encourage ambulation
C. Offer a high-fat meal
D. Place the client in Trendelenburg position
Answer: A
Rationale: A 12-lead ECG should be obtained rapidly in suspected acute
coronary syndrome to identify ischemic changes and guide treatment.
,2.
Which assessment finding is most consistent with left-sided heart failure?
A. Peripheral edema
B. Jugular venous distention
C. Pulmonary crackles
D. Ascites
Answer: C
Rationale: Left-sided heart failure causes pulmonary congestion, producing
crackles, dyspnea, and orthopnea. Peripheral edema and ascites are more
associated with systemic venous congestion from right-sided failure.
3.
What is the most common underlying cause of right-sided heart failure?
A. Left-sided heart failure
B. Migraine
C. Peptic ulcer disease
D. Hypothyroidism
Answer: A
Rationale: Chronic left-sided failure increases pulmonary pressures and
eventually places excessive workload on the right ventricle.
4.
A client with heart failure has gained 2 kg in 2 days. What should the nurse
suspect?
A. Improved cardiac function
B. Fluid retention
C. Decreased blood volume
D. Normal aging
Answer: B
Rationale: Rapid weight gain is a sensitive indicator of fluid retention and
worsening heart failure.
5.
,Which instruction is most appropriate for a client taking furosemide?
A. Increase sodium intake
B. Monitor potassium levels
C. Avoid all fluids
D. Take potassium supplements without provider approval
Answer: B
Rationale: Furosemide can cause potassium loss. Serum electrolytes should be
monitored, and supplementation should be individualized.
6.
A client taking digoxin reports nausea and seeing yellow-green halos. What
should the nurse do?
A. Administer another dose
B. Hold the medication and notify the provider
C. Encourage increased sodium intake
D. Give an antacid and continue therapy
Answer: B
Rationale: Gastrointestinal symptoms and visual disturbances can indicate
digoxin toxicity. The medication should be withheld and the provider notified.
7.
Which electrolyte imbalance increases the risk of digoxin toxicity?
A. Hypernatremia
B. Hypokalemia
C. Hypermagnesemia
D. Hyperchloremia
Answer: B
Rationale: Low potassium increases digoxin binding to myocardial tissue and
increases toxicity risk.
8.
A client prescribed sublingual nitroglycerin asks when to use it.
A. Only at bedtime
B. At the onset of anginal chest pain
, C. After eating a large meal
D. Only when blood pressure is elevated
Answer: B
Rationale: Sublingual nitroglycerin is used at the onset of angina to rapidly
reduce myocardial oxygen demand and improve coronary blood flow.
9.
Which medication combination should concern the nurse in a client prescribed
nitroglycerin?
A. Nitroglycerin and acetaminophen
B. Nitroglycerin and sildenafil
C. Nitroglycerin and calcium
D. Nitroglycerin and multivitamins
Answer: B
Rationale: PDE-5 inhibitors such as sildenafil can cause profound hypotension
when combined with nitrates.
10.
Which finding is most characteristic of cardiogenic shock?
A. Warm dry skin with hypertension
B. Hypotension with poor cardiac output
C. Bradycardia with increased urine output
D. Increased peripheral perfusion
Answer: B
Rationale: Cardiogenic shock occurs when the heart cannot pump enough
blood to maintain tissue perfusion, resulting in hypotension and organ
dysfunction.
11.
Which client should the nurse assess first?
A. Client with stable hypertension
B. Client with chronic ankle edema
C. Client with new crushing chest pain
D. Client requesting discharge instructions
