NUR 210 | NUR210 Final Exam V2 – Updated and Latest Questions
and Correct Answers with Rationale – Galen College of Nursing
1. A nurse is preparing to administer digoxin to a patient with heart failure. Which clinical
finding would require the nurse to withhold the medication and notify the provider?
A. Apical pulse 52 beats per minute
B. Blood pressure 110/70 mmHg
C. Respiratory rate 18 breaths per minute
D. Potassium level 4.2 mEq/L
Answer: A
Rationale: Digoxin is a cardiac glycoside that slows the heart rate and increases
contractility. The nurse must assess the apical pulse for a full minute before administration.
A heart rate below 60 beats per minute in an adult is a classic contraindication for giving
digoxin. Withholding the dose prevents further bradycardia and potential digoxin toxicity.
This action ensures patient safety by preventing a dangerous decrease in cardiac output.
2. A patient is prescribed lisinopril for hypertension. The nurse should instruct the patient to
report which life-threatening adverse effect immediately?
A. Persistent dry cough
B. Occasional lightheadedness
C. Increased urinary frequency
D. Swelling of the lips and tongue
Answer: D
Rationale: Lisinopril is an ACE inhibitor commonly associated with a risk of angioedema.
Angioedema involves rapid swelling of the lips, tongue, and glottis, which can lead to
airway obstruction. While a dry cough is a common side effect, it is not life-threatening like
angioedema. The patient must be taught to seek emergency care if any facial or throat
swelling occurs. This instruction is vital for the early recognition and management of a
severe allergic-like reaction.
3. The nurse is monitoring a patient receiving intravenous heparin for a deep vein
thrombosis. Which laboratory value is most critical to evaluate for this patient?
A. Activated partial thromboplastin time (aPTT)
B. International Normalized Ratio (INR)
C. Prothrombin time (PT)
,D. Platelet count only
Answer: A
Rationale: Heparin therapy is monitored using the activated partial thromboplastin time
(aPTT) to ensure therapeutic levels. The goal is typically to maintain the aPTT between 1.5
to 2.5 times the normal reference range. If the aPTT is too high, the patient is at significant
risk for spontaneous bleeding. The nurse should also monitor platelets to check for
heparin-induced thrombocytopenia. Regular monitoring allows for precise dosage
adjustments to maintain anticoagulation without causing hemorrhage.
4. A patient with a history of chronic alcoholism is admitted for pneumonia and prescribed
acetaminophen for fever. Why should the nurse question this medication order?
A. Increased risk for renal failure
B. High risk for hepatotoxicity
C. Potential for respiratory depression
D. Interference with antibiotic absorption
Answer: B
Rationale: Acetaminophen is metabolized by the liver and can cause severe damage when
taken in high doses or by individuals with liver disease. Chronic alcohol consumption
induces liver enzymes that produce a toxic metabolite from acetaminophen. This increases
the patient’s risk for acute liver failure even at standard therapeutic doses. The nurse
should suggest an alternative analgesic that does not stress the liver. Protecting hepatic
function is a priority for patients with known alcohol misuse history.
5. Which education should the nurse provide to a patient starting a new prescription for
spironolactone?
A. Avoid salt substitutes that contain potassium
B. Increase intake of potassium-rich foods like bananas
C. Expect an increase in blood pressure initially
D. Take the medication right before bedtime
Answer: A
Rationale: Spironolactone is a potassium-sparing diuretic that blocks the action of
aldosterone. Unlike loop diuretics, it causes the body to retain potassium while excreting
sodium and water. Patients must avoid extra potassium intake from supplements or salt
substitutes to prevent hyperkalemia. Hyperkalemia is a dangerous condition that can lead
to cardiac arrhythmias. The nurse should educate the patient on recognizing symptoms of
high potassium like muscle weakness or palpitations.
, 6. A patient is diagnosed with an acute asthma attack. Which medication should the nurse
expect to administer first for rapid bronchodilation?
A. Salmeterol
B. Albuterol
C. Fluticasone
D. Montelukast
Answer: B
Rationale: Albuterol is a short-acting beta-2 agonist (SABA) used as a rescue medication
for acute bronchospasm. It works by rapidly relaxing the smooth muscles of the airway to
improve airflow. Other medications like fluticasone or salmeterol are for long-term control
and do not provide immediate relief. The nurse must prioritize fast-acting treatments
during respiratory distress. Monitoring for side effects like tachycardia and tremors is
necessary after administration.
7. A patient taking warfarin for atrial fibrillation has an INR of 5.5. Which medication does the
nurse anticipate the provider will order?
A. Protamine sulfate
B. Aspirin
C. Enoxaparin
D. Vitamin K
Answer: D
Rationale: Warfarin works by inhibiting vitamin K-dependent clotting factors, so Vitamin
K is the direct antagonist. An INR of 5.5 is significantly above the therapeutic range, posing
a high risk for bleeding. Vitamin K helps the liver synthesize clotting factors to bring the
INR back to a safe level. Protamine sulfate is the reversal agent for heparin, not warfarin.
The nurse should monitor the patient for signs of occult or overt bleeding.
8. A patient is prescribed atorvastatin. Which laboratory test should the nurse monitor most
closely during therapy?
A. Complete blood count
B. Serum amylase
C. Alanine aminotransferase (ALT)
D. Blood urea nitrogen (BUN)
Answer: C
and Correct Answers with Rationale – Galen College of Nursing
1. A nurse is preparing to administer digoxin to a patient with heart failure. Which clinical
finding would require the nurse to withhold the medication and notify the provider?
A. Apical pulse 52 beats per minute
B. Blood pressure 110/70 mmHg
C. Respiratory rate 18 breaths per minute
D. Potassium level 4.2 mEq/L
Answer: A
Rationale: Digoxin is a cardiac glycoside that slows the heart rate and increases
contractility. The nurse must assess the apical pulse for a full minute before administration.
A heart rate below 60 beats per minute in an adult is a classic contraindication for giving
digoxin. Withholding the dose prevents further bradycardia and potential digoxin toxicity.
This action ensures patient safety by preventing a dangerous decrease in cardiac output.
2. A patient is prescribed lisinopril for hypertension. The nurse should instruct the patient to
report which life-threatening adverse effect immediately?
A. Persistent dry cough
B. Occasional lightheadedness
C. Increased urinary frequency
D. Swelling of the lips and tongue
Answer: D
Rationale: Lisinopril is an ACE inhibitor commonly associated with a risk of angioedema.
Angioedema involves rapid swelling of the lips, tongue, and glottis, which can lead to
airway obstruction. While a dry cough is a common side effect, it is not life-threatening like
angioedema. The patient must be taught to seek emergency care if any facial or throat
swelling occurs. This instruction is vital for the early recognition and management of a
severe allergic-like reaction.
3. The nurse is monitoring a patient receiving intravenous heparin for a deep vein
thrombosis. Which laboratory value is most critical to evaluate for this patient?
A. Activated partial thromboplastin time (aPTT)
B. International Normalized Ratio (INR)
C. Prothrombin time (PT)
,D. Platelet count only
Answer: A
Rationale: Heparin therapy is monitored using the activated partial thromboplastin time
(aPTT) to ensure therapeutic levels. The goal is typically to maintain the aPTT between 1.5
to 2.5 times the normal reference range. If the aPTT is too high, the patient is at significant
risk for spontaneous bleeding. The nurse should also monitor platelets to check for
heparin-induced thrombocytopenia. Regular monitoring allows for precise dosage
adjustments to maintain anticoagulation without causing hemorrhage.
4. A patient with a history of chronic alcoholism is admitted for pneumonia and prescribed
acetaminophen for fever. Why should the nurse question this medication order?
A. Increased risk for renal failure
B. High risk for hepatotoxicity
C. Potential for respiratory depression
D. Interference with antibiotic absorption
Answer: B
Rationale: Acetaminophen is metabolized by the liver and can cause severe damage when
taken in high doses or by individuals with liver disease. Chronic alcohol consumption
induces liver enzymes that produce a toxic metabolite from acetaminophen. This increases
the patient’s risk for acute liver failure even at standard therapeutic doses. The nurse
should suggest an alternative analgesic that does not stress the liver. Protecting hepatic
function is a priority for patients with known alcohol misuse history.
5. Which education should the nurse provide to a patient starting a new prescription for
spironolactone?
A. Avoid salt substitutes that contain potassium
B. Increase intake of potassium-rich foods like bananas
C. Expect an increase in blood pressure initially
D. Take the medication right before bedtime
Answer: A
Rationale: Spironolactone is a potassium-sparing diuretic that blocks the action of
aldosterone. Unlike loop diuretics, it causes the body to retain potassium while excreting
sodium and water. Patients must avoid extra potassium intake from supplements or salt
substitutes to prevent hyperkalemia. Hyperkalemia is a dangerous condition that can lead
to cardiac arrhythmias. The nurse should educate the patient on recognizing symptoms of
high potassium like muscle weakness or palpitations.
, 6. A patient is diagnosed with an acute asthma attack. Which medication should the nurse
expect to administer first for rapid bronchodilation?
A. Salmeterol
B. Albuterol
C. Fluticasone
D. Montelukast
Answer: B
Rationale: Albuterol is a short-acting beta-2 agonist (SABA) used as a rescue medication
for acute bronchospasm. It works by rapidly relaxing the smooth muscles of the airway to
improve airflow. Other medications like fluticasone or salmeterol are for long-term control
and do not provide immediate relief. The nurse must prioritize fast-acting treatments
during respiratory distress. Monitoring for side effects like tachycardia and tremors is
necessary after administration.
7. A patient taking warfarin for atrial fibrillation has an INR of 5.5. Which medication does the
nurse anticipate the provider will order?
A. Protamine sulfate
B. Aspirin
C. Enoxaparin
D. Vitamin K
Answer: D
Rationale: Warfarin works by inhibiting vitamin K-dependent clotting factors, so Vitamin
K is the direct antagonist. An INR of 5.5 is significantly above the therapeutic range, posing
a high risk for bleeding. Vitamin K helps the liver synthesize clotting factors to bring the
INR back to a safe level. Protamine sulfate is the reversal agent for heparin, not warfarin.
The nurse should monitor the patient for signs of occult or overt bleeding.
8. A patient is prescribed atorvastatin. Which laboratory test should the nurse monitor most
closely during therapy?
A. Complete blood count
B. Serum amylase
C. Alanine aminotransferase (ALT)
D. Blood urea nitrogen (BUN)
Answer: C
