NUR 210 | NUR210 Exam 3 V1 – Updated and Latest Questions and
Correct Answers with Rationale – Galen College of Nursing
1. A patient is prescribed Digoxin 0.125 mg daily for heart failure. Which assessment finding
should the nurse identify as a priority to report to the healthcare provider before
administration?
A. Apical heart rate of 52 beats per minute
B. Blood pressure of 142/88 mmHg
C. Respiratory rate of 22 breaths per minute
D. Serum potassium level of 4.2 mEq/L
Answer: A
Rationale: Digoxin is a cardiac glycoside that slows the heart rate while increasing
contractility. An apical heart rate below 60 beats per minute in an adult is a sign of
potential bradycardia and digoxin toxicity. The nurse must withhold the medication and
notify the provider to prevent further cardiac suppression. While blood pressure and
respiratory rates are important, they are not the primary assessment for digoxin
administration. A potassium level of 4.2 is within the normal range, though hypokalemia
would increase toxicity risk.
2. A nurse is teaching a patient about a new prescription for Lisinopril. Which statement by
the patient indicates a need for further teaching?
A. I will avoid using salt substitutes containing potassium.
B. I will take this medication with my morning grapefruit juice.
C. I should call the doctor if I develop a persistent, dry cough.
D. I need to rise slowly from a sitting to a standing position.
Answer: B
Rationale: Lisinopril is an ACE inhibitor that does not typically interact with grapefruit
juice, but many other cardiac meds do, making this a general safety concern. More
importantly, ACE inhibitors can cause hyperkalemia, so avoiding potassium-based salt
substitutes is correct. The development of a dry cough is a common side effect due to
bradykinin accumulation and must be reported. Orthostatic hypotension is a risk, so rising
slowly is appropriate safety behavior. The nurse must clarify that while grapefruit isn’t
contraindicated for Lisinopril specifically, general dietary precautions are vital.
3. A patient with chronic kidney disease is receiving Furosemide. Which laboratory value is
the most critical for the nurse to monitor?
A. Serum Sodium
,B. Serum Potassium
C. Hemoglobin
D. Serum Calcium
Answer: B
Rationale: Furosemide is a loop diuretic that causes significant excretion of potassium in
the urine. Hypokalemia is a life-threatening adverse effect that can lead to cardiac
dysrhythmias. Patients with kidney disease are at higher risk for electrolyte imbalances
when using potent diuretics. The nurse must monitor potassium levels closely to ensure
they remain within the 3.5 to 5.0 mEq/L range. Other electrolytes like sodium are affected,
but potassium fluctuations have the most immediate impact on cardiac stability.
4. A patient is admitted with an acute asthma exacerbation. Which medication currently on
the patient’s medication administration record (MAR) should the nurse question?
A. Hydrochlorothiazide
B. Amlodipine
C. Metoprolol
D. Losartan
Answer: C
Rationale: Metoprolol is a beta-blocker which, while cardioselective, can still cause
bronchoconstriction in high doses or sensitive patients. For patients with a history of
asthma or COPD, beta-blockers are used with extreme caution or avoided during
exacerbations. Amlodipine is a calcium channel blocker and does not affect the airway.
Hydrochlorothiazide and Losartan do not typically cause bronchospasm. The nurse must
ensure the patient’s respiratory status is not compromised by adrenergic antagonists.
5. A patient is receiving Warfarin for the treatment of deep vein thrombosis (DVT). The nurse
notes an International Normalized Ratio (INR) of 5.2. What is the priority nursing action?
A. Administer the next scheduled dose of Warfarin.
B. Assess the patient for signs of pulmonary embolism.
C. Encourage the patient to eat more leafy green vegetables.
D. Prepare to administer Vitamin K.
Answer: D
Rationale: An INR of 5.2 is significantly above the therapeutic range (typically 2.0-3.0 for
DVT). This level indicates a high risk for spontaneous bleeding and hemorrhage. Vitamin K
is the pharmacological antagonist for Warfarin and is used to reverse its effects. The nurse
should withhold the next dose and prepare the antidote as ordered. While assessment is
, important, the immediate pharmacological intervention for this critical lab value is
reversal.
6. A nurse is preparing to administer Heparin subcutaneously. Which action by the nurse is
correct?
A. Aspirate for blood return before injecting.
B. Massage the site after injection to promote absorption.
C. Use a 1-inch, 21-gauge needle for administration.
D. Administer the injection in the abdominal fat pad.
Answer: D
Rationale: Subcutaneous heparin should be administered in the abdomen, at least 2 inches
away from the umbilicus. The nurse should not aspirate or massage the site, as this can
cause tissue trauma and hematoma formation. A smaller needle (25-27 gauge) is
appropriate for subcutaneous injections to minimize bleeding. Correct technique ensures
consistent absorption and reduces local complications. Monitoring the aPTT is essential for
patients on systemic heparin, though less common for low-dose prophylaxis.
7. A patient with Type 1 Diabetes is prescribed Insulin Lispro. When should the nurse instruct
the patient to take this medication?
A. 15 minutes before eating
B. Immediately after finishing a meal
C. 30 to 60 minutes before a meal
D. At bedtime with a snack
Answer: A
Rationale: Insulin Lispro is a rapid-acting insulin with an onset of 15 to 30 minutes. It
must be administered in close proximity to a meal to prevent hypoglycemia. Administering
it 15 minutes before eating ensures the insulin peak aligns with the postprandial glucose
rise. Waiting 30-60 minutes is appropriate for regular insulin, but too long for rapid-acting.
The nurse must verify that food is present on the unit before giving the injection.
8. A patient taking Metformin for Type 2 Diabetes is scheduled for a CT scan with IV contrast.
Which instruction is most important?
A. Switch to insulin glargine for the day of the procedure.
B. Take a double dose of Metformin the day after the scan.
C. Limit fluid intake for 24 hours after the contrast is given.
D. Stop Metformin 48 hours before and after the procedure.
Correct Answers with Rationale – Galen College of Nursing
1. A patient is prescribed Digoxin 0.125 mg daily for heart failure. Which assessment finding
should the nurse identify as a priority to report to the healthcare provider before
administration?
A. Apical heart rate of 52 beats per minute
B. Blood pressure of 142/88 mmHg
C. Respiratory rate of 22 breaths per minute
D. Serum potassium level of 4.2 mEq/L
Answer: A
Rationale: Digoxin is a cardiac glycoside that slows the heart rate while increasing
contractility. An apical heart rate below 60 beats per minute in an adult is a sign of
potential bradycardia and digoxin toxicity. The nurse must withhold the medication and
notify the provider to prevent further cardiac suppression. While blood pressure and
respiratory rates are important, they are not the primary assessment for digoxin
administration. A potassium level of 4.2 is within the normal range, though hypokalemia
would increase toxicity risk.
2. A nurse is teaching a patient about a new prescription for Lisinopril. Which statement by
the patient indicates a need for further teaching?
A. I will avoid using salt substitutes containing potassium.
B. I will take this medication with my morning grapefruit juice.
C. I should call the doctor if I develop a persistent, dry cough.
D. I need to rise slowly from a sitting to a standing position.
Answer: B
Rationale: Lisinopril is an ACE inhibitor that does not typically interact with grapefruit
juice, but many other cardiac meds do, making this a general safety concern. More
importantly, ACE inhibitors can cause hyperkalemia, so avoiding potassium-based salt
substitutes is correct. The development of a dry cough is a common side effect due to
bradykinin accumulation and must be reported. Orthostatic hypotension is a risk, so rising
slowly is appropriate safety behavior. The nurse must clarify that while grapefruit isn’t
contraindicated for Lisinopril specifically, general dietary precautions are vital.
3. A patient with chronic kidney disease is receiving Furosemide. Which laboratory value is
the most critical for the nurse to monitor?
A. Serum Sodium
,B. Serum Potassium
C. Hemoglobin
D. Serum Calcium
Answer: B
Rationale: Furosemide is a loop diuretic that causes significant excretion of potassium in
the urine. Hypokalemia is a life-threatening adverse effect that can lead to cardiac
dysrhythmias. Patients with kidney disease are at higher risk for electrolyte imbalances
when using potent diuretics. The nurse must monitor potassium levels closely to ensure
they remain within the 3.5 to 5.0 mEq/L range. Other electrolytes like sodium are affected,
but potassium fluctuations have the most immediate impact on cardiac stability.
4. A patient is admitted with an acute asthma exacerbation. Which medication currently on
the patient’s medication administration record (MAR) should the nurse question?
A. Hydrochlorothiazide
B. Amlodipine
C. Metoprolol
D. Losartan
Answer: C
Rationale: Metoprolol is a beta-blocker which, while cardioselective, can still cause
bronchoconstriction in high doses or sensitive patients. For patients with a history of
asthma or COPD, beta-blockers are used with extreme caution or avoided during
exacerbations. Amlodipine is a calcium channel blocker and does not affect the airway.
Hydrochlorothiazide and Losartan do not typically cause bronchospasm. The nurse must
ensure the patient’s respiratory status is not compromised by adrenergic antagonists.
5. A patient is receiving Warfarin for the treatment of deep vein thrombosis (DVT). The nurse
notes an International Normalized Ratio (INR) of 5.2. What is the priority nursing action?
A. Administer the next scheduled dose of Warfarin.
B. Assess the patient for signs of pulmonary embolism.
C. Encourage the patient to eat more leafy green vegetables.
D. Prepare to administer Vitamin K.
Answer: D
Rationale: An INR of 5.2 is significantly above the therapeutic range (typically 2.0-3.0 for
DVT). This level indicates a high risk for spontaneous bleeding and hemorrhage. Vitamin K
is the pharmacological antagonist for Warfarin and is used to reverse its effects. The nurse
should withhold the next dose and prepare the antidote as ordered. While assessment is
, important, the immediate pharmacological intervention for this critical lab value is
reversal.
6. A nurse is preparing to administer Heparin subcutaneously. Which action by the nurse is
correct?
A. Aspirate for blood return before injecting.
B. Massage the site after injection to promote absorption.
C. Use a 1-inch, 21-gauge needle for administration.
D. Administer the injection in the abdominal fat pad.
Answer: D
Rationale: Subcutaneous heparin should be administered in the abdomen, at least 2 inches
away from the umbilicus. The nurse should not aspirate or massage the site, as this can
cause tissue trauma and hematoma formation. A smaller needle (25-27 gauge) is
appropriate for subcutaneous injections to minimize bleeding. Correct technique ensures
consistent absorption and reduces local complications. Monitoring the aPTT is essential for
patients on systemic heparin, though less common for low-dose prophylaxis.
7. A patient with Type 1 Diabetes is prescribed Insulin Lispro. When should the nurse instruct
the patient to take this medication?
A. 15 minutes before eating
B. Immediately after finishing a meal
C. 30 to 60 minutes before a meal
D. At bedtime with a snack
Answer: A
Rationale: Insulin Lispro is a rapid-acting insulin with an onset of 15 to 30 minutes. It
must be administered in close proximity to a meal to prevent hypoglycemia. Administering
it 15 minutes before eating ensures the insulin peak aligns with the postprandial glucose
rise. Waiting 30-60 minutes is appropriate for regular insulin, but too long for rapid-acting.
The nurse must verify that food is present on the unit before giving the injection.
8. A patient taking Metformin for Type 2 Diabetes is scheduled for a CT scan with IV contrast.
Which instruction is most important?
A. Switch to insulin glargine for the day of the procedure.
B. Take a double dose of Metformin the day after the scan.
C. Limit fluid intake for 24 hours after the contrast is given.
D. Stop Metformin 48 hours before and after the procedure.
