NUR 210 | NUR210 Final Exam V3 – Updated and Latest Questions
and Correct Answers with Rationale – Galen College of Nursing
1. A patient with heart failure is prescribed Digoxin 0.125 mg daily. Which assessment finding
should the nurse prioritize before administration?
A. Apical pulse 52 beats per minute
B. Blood pressure 110/70 mmHg
C. Serum potassium level of 4.2 mEq/L
D. Respiratory rate 18 breaths per minute
Answer: A
Rationale: Digoxin is a cardiac glycoside that increases myocardial contractility but slows
the heart rate through the AV node. The nurse must assess the apical pulse for one full
minute prior to administration. If the apical pulse is less than 60 beats per minute in an
adult, the dose should be withheld and the provider notified. This safety measure prevents
further bradycardia and potential digoxin toxicity. Monitoring for toxicity is crucial because
the drug has a very narrow therapeutic index.
2. The nurse is preparing to administer Furosemide 40 mg IV push. Which administration
technique is most appropriate to prevent adverse effects?
A. Inject the dose rapidly over 10 seconds
B. Dilute the medication in 50 mL of Normal Saline
C. Administer the dose over 1 to 2 minutes
D. Administer only via a central venous catheter
Answer: C
Rationale: Furosemide is a loop diuretic that can cause ototoxicity if administered too
rapidly via the intravenous route. The standard recommendation is to administer at a rate
of no more than 20 mg per minute to minimize this risk. Rapid bolus injection can lead to
transient or permanent hearing loss and tinnitus. The nurse must also monitor for signs of
hypokalemia and dehydration following administration. Education should focus on
reporting any changes in hearing or balance immediately.
3. A patient is receiving a continuous Heparin infusion for a deep vein thrombosis. Which
laboratory value requires immediate nursing intervention?
A. INR 2.5
B. aPTT 110 seconds
,C. Platelet count 250,000/mm3
D. Hemoglobin 14 g/dL
Answer: B
Rationale: The activated partial thromboplastin time (aPTT) is used to monitor the
therapeutic effectiveness of Heparin. A normal aPTT is typically 30 to 40 seconds, and the
therapeutic goal is usually 1.5 to 2.5 times the baseline. An aPTT of 110 seconds is
significantly above the therapeutic range and puts the patient at high risk for bleeding. The
nurse should stop the infusion and prepare the antidote, protamine sulfate, if ordered.
Monitoring for signs of active bleeding like hematuria or bruising is also essential.
4. Which dietary instruction is essential for a patient who has recently been prescribed
Warfarin?
A. Avoid all foods containing Vitamin K
B. Increase intake of dark leafy greens to boost Vitamin K
C. Maintain a consistent intake of Vitamin K-rich foods
D. Switch to a high-protein, low-carbohydrate diet
Answer: C
Rationale: Warfarin acts as a Vitamin K antagonist to prevent the synthesis of clotting
factors. Sudden changes in Vitamin K intake can cause the International Normalized Ratio
(INR) to fluctuate dangerously. Rather than avoiding Vitamin K entirely, the patient should
keep their consumption consistent to allow for stable dosing. If the patient increases
Vitamin K, the Warfarin will be less effective, increasing clot risk. Conversely, decreasing
intake can lead to an elevated INR and bleeding risk.
5. A patient receives Lispro (Humalog) insulin at 0800. At what time is the nurse most likely to
observe symptoms of hypoglycemia?
A. 0930
B. 0815
C. 1200
D. 1400
Answer: A
Rationale: Lispro is a rapid-acting insulin with an onset of 15 minutes and a peak effect
occurring between 1 and 2 hours after administration. Symptoms of hypoglycemia are
most likely to occur during the peak time when the insulin concentration is highest in the
blood. For an 0800 dose, the peak would occur between 0900 and 1000. The nurse must
ensure the patient eats immediately after the injection to prevent a rapid drop in blood
, glucose. Education should include recognizing shakiness, sweating, and confusion as signs
of low sugar.
6. A patient taking Metformin is scheduled for a CT scan with intravenous contrast dye.
Which action should the nurse take?
A. Administer the Metformin as scheduled before the scan
B. Double the dose of Metformin after the scan
C. Hold the Metformin 48 hours before and after the scan
D. Hold the Metformin on the day of and for 48 hours after the scan
Answer: D
Rationale: Metformin and iodinated contrast media can both affect renal function and
increase the risk of lactic acidosis. The medication is generally held the day of the
procedure and for 48 hours afterward to ensure renal function remains stable. Renal
function, specifically serum creatinine and GFR, should be verified before resuming the
drug. Lactic acidosis is a rare but life-threatening complication characterized by malaise
and respiratory distress. Staying hydrated is also encouraged to help flush the contrast
from the kidneys.
7. A patient taking Lisinopril for hypertension reports a persistent, dry cough. What is the
nurse’s best response?
A. Suggest the use of an over-the-counter cough suppressant
B. Explain that this is a common side effect and will resolve in a week
C. Increase fluid intake to thin the mucus causing the cough
D. Notify the provider as the medication may need to be changed
Answer: D
Rationale: Lisinopril is an ACE inhibitor that commonly causes a dry, non-productive
cough due to the accumulation of bradykinin in the lungs. This cough does not typically
respond to cough suppressants and is a frequent reason for discontinuation of the drug.
The nurse should notify the provider because the patient may need to switch to an
Angiotensin II Receptor Blocker (ARB). ARBs do not affect bradykinin and thus rarely cause
a cough. The nurse must also monitor for more severe reactions like angioedema.
8. A patient with a history of asthma is prescribed Metoprolol for hypertension. What should
the nurse monitor most closely?
A. Signs of bronchospasm or wheezing
B. Serum glucose levels
C. Heart rate and blood pressure
and Correct Answers with Rationale – Galen College of Nursing
1. A patient with heart failure is prescribed Digoxin 0.125 mg daily. Which assessment finding
should the nurse prioritize before administration?
A. Apical pulse 52 beats per minute
B. Blood pressure 110/70 mmHg
C. Serum potassium level of 4.2 mEq/L
D. Respiratory rate 18 breaths per minute
Answer: A
Rationale: Digoxin is a cardiac glycoside that increases myocardial contractility but slows
the heart rate through the AV node. The nurse must assess the apical pulse for one full
minute prior to administration. If the apical pulse is less than 60 beats per minute in an
adult, the dose should be withheld and the provider notified. This safety measure prevents
further bradycardia and potential digoxin toxicity. Monitoring for toxicity is crucial because
the drug has a very narrow therapeutic index.
2. The nurse is preparing to administer Furosemide 40 mg IV push. Which administration
technique is most appropriate to prevent adverse effects?
A. Inject the dose rapidly over 10 seconds
B. Dilute the medication in 50 mL of Normal Saline
C. Administer the dose over 1 to 2 minutes
D. Administer only via a central venous catheter
Answer: C
Rationale: Furosemide is a loop diuretic that can cause ototoxicity if administered too
rapidly via the intravenous route. The standard recommendation is to administer at a rate
of no more than 20 mg per minute to minimize this risk. Rapid bolus injection can lead to
transient or permanent hearing loss and tinnitus. The nurse must also monitor for signs of
hypokalemia and dehydration following administration. Education should focus on
reporting any changes in hearing or balance immediately.
3. A patient is receiving a continuous Heparin infusion for a deep vein thrombosis. Which
laboratory value requires immediate nursing intervention?
A. INR 2.5
B. aPTT 110 seconds
,C. Platelet count 250,000/mm3
D. Hemoglobin 14 g/dL
Answer: B
Rationale: The activated partial thromboplastin time (aPTT) is used to monitor the
therapeutic effectiveness of Heparin. A normal aPTT is typically 30 to 40 seconds, and the
therapeutic goal is usually 1.5 to 2.5 times the baseline. An aPTT of 110 seconds is
significantly above the therapeutic range and puts the patient at high risk for bleeding. The
nurse should stop the infusion and prepare the antidote, protamine sulfate, if ordered.
Monitoring for signs of active bleeding like hematuria or bruising is also essential.
4. Which dietary instruction is essential for a patient who has recently been prescribed
Warfarin?
A. Avoid all foods containing Vitamin K
B. Increase intake of dark leafy greens to boost Vitamin K
C. Maintain a consistent intake of Vitamin K-rich foods
D. Switch to a high-protein, low-carbohydrate diet
Answer: C
Rationale: Warfarin acts as a Vitamin K antagonist to prevent the synthesis of clotting
factors. Sudden changes in Vitamin K intake can cause the International Normalized Ratio
(INR) to fluctuate dangerously. Rather than avoiding Vitamin K entirely, the patient should
keep their consumption consistent to allow for stable dosing. If the patient increases
Vitamin K, the Warfarin will be less effective, increasing clot risk. Conversely, decreasing
intake can lead to an elevated INR and bleeding risk.
5. A patient receives Lispro (Humalog) insulin at 0800. At what time is the nurse most likely to
observe symptoms of hypoglycemia?
A. 0930
B. 0815
C. 1200
D. 1400
Answer: A
Rationale: Lispro is a rapid-acting insulin with an onset of 15 minutes and a peak effect
occurring between 1 and 2 hours after administration. Symptoms of hypoglycemia are
most likely to occur during the peak time when the insulin concentration is highest in the
blood. For an 0800 dose, the peak would occur between 0900 and 1000. The nurse must
ensure the patient eats immediately after the injection to prevent a rapid drop in blood
, glucose. Education should include recognizing shakiness, sweating, and confusion as signs
of low sugar.
6. A patient taking Metformin is scheduled for a CT scan with intravenous contrast dye.
Which action should the nurse take?
A. Administer the Metformin as scheduled before the scan
B. Double the dose of Metformin after the scan
C. Hold the Metformin 48 hours before and after the scan
D. Hold the Metformin on the day of and for 48 hours after the scan
Answer: D
Rationale: Metformin and iodinated contrast media can both affect renal function and
increase the risk of lactic acidosis. The medication is generally held the day of the
procedure and for 48 hours afterward to ensure renal function remains stable. Renal
function, specifically serum creatinine and GFR, should be verified before resuming the
drug. Lactic acidosis is a rare but life-threatening complication characterized by malaise
and respiratory distress. Staying hydrated is also encouraged to help flush the contrast
from the kidneys.
7. A patient taking Lisinopril for hypertension reports a persistent, dry cough. What is the
nurse’s best response?
A. Suggest the use of an over-the-counter cough suppressant
B. Explain that this is a common side effect and will resolve in a week
C. Increase fluid intake to thin the mucus causing the cough
D. Notify the provider as the medication may need to be changed
Answer: D
Rationale: Lisinopril is an ACE inhibitor that commonly causes a dry, non-productive
cough due to the accumulation of bradykinin in the lungs. This cough does not typically
respond to cough suppressants and is a frequent reason for discontinuation of the drug.
The nurse should notify the provider because the patient may need to switch to an
Angiotensin II Receptor Blocker (ARB). ARBs do not affect bradykinin and thus rarely cause
a cough. The nurse must also monitor for more severe reactions like angioedema.
8. A patient with a history of asthma is prescribed Metoprolol for hypertension. What should
the nurse monitor most closely?
A. Signs of bronchospasm or wheezing
B. Serum glucose levels
C. Heart rate and blood pressure
