NUR 283 Comprehensive Exam Review 2026
| Nursing Practice Questions and Answers
SECTION I: PRIORITIZATION, DELEGATION & CLINICAL
JUDGMENT
1. The nurse is prioritizing patient care after change-of-shift report. Which
patient should the nurse assess FIRST?
A. A patient scheduled for discharge who needs final medication teaching
B. A patient who had a knee arthroscopy yesterday reporting pain at 4/10
C. A patient who had an ERCP 30 minutes ago and is reporting difficulty
swallowing
D. A patient who is NPO for an abdominal ultrasound this morning
Correct Answer: C
Rationale: The ABC framework dictates that airway is the priority. Difficulty
swallowing after an ERCP indicates risk of a depressed gag reflex and potential
aspiration. This patient requires immediate bedside assessment for airway patency
and swallowing ability. Pain at 4/10 is expected post-operatively, discharge
teaching and NPO status are not urgent.
2. A nurse working on a medical-surgical unit has just received handoff
report. The nurse should FIRST assess the patient who has:
A. COPD on 2 L/min oxygen with SpO₂ of 93%
B. Type 2 diabetes with blood glucose of 220 mg/dL before dinner
C. A stage II pressure injury needing a dressing change
D. Acute pancreatitis who reports new pain on deep inspiration
Correct Answer: D
Rationale: New pain on deep inspiration in acute pancreatitis may indicate
pleural effusion, atelectasis, or worsening inflammation that could progress to
,ARDS or respiratory failure. Acute changes in respiratory status require immediate
assessment. The other findings are stable or chronic.
3. The emergency department receives four patients simultaneously. Which
patient should the triage nurse see FIRST?
A. A patient with chest pain radiating to the left arm, diaphoretic
B. A patient with a simple arm laceration and controlled bleeding
C. A patient with a closed tibia fracture and intact pulses
D. A patient with minor abrasions and mild anxiety
Correct Answer: A
Rationale: Chest pain radiating to the left arm with diaphoresis is highly
suspicious for acute myocardial infarction. This patient is unstable and requires
immediate ECG and intervention. The other patients have stable or minor
conditions.
4. A nurse is caring for four patients. Which patient should the nurse assess
FIRST?
A. A patient with COPD who has SpO₂ of 88% on 2 L/min oxygen
B. A patient with heart failure who has 2+ pitting edema and crackles
C. A patient who had a hip replacement 2 days ago requesting pain medication
D. A patient with new onset of slurred speech and unilateral facial drooping
Correct Answer: D
Rationale: New onset slurred speech and facial drooping indicate an acute
cerebrovascular accident (stroke). This is a time-sensitive emergency requiring
immediate assessment and intervention for potential thrombolytic therapy. The
"new onset" nature makes this the highest priority.
,5. A nurse is caring for a patient with a tracheostomy. Which finding requires
IMMEDIATE intervention?
A. Small amount of bloody secretions
B. Patient requesting suctioning every 4 hours
C. Respiratory rate of 28 breaths per minute
D. Thick, yellow secretions extending from the stoma
Correct Answer: D
Rationale: Thick, yellow secretions can indicate infection and may obstruct
the airway. The presence of thick secretions poses an imminent risk of complete
airway obstruction and requires immediate suctioning and assessment. While RR
of 28 is elevated, airway obstruction is the more immediate threat.
6. The nurse is caring for four postoperative patients, all 24 hours post-op.
Which change in condition is the PRIORITY?
A. Patient reporting increased pain of 8/10 after receiving opioid analgesic
B. Patient reporting nausea after receiving antibiotics
C. Patient whose dressing has a small amount of new serosanguineous drainage
D. Patient who has voided 200 mL in the last 4 hours
Correct Answer: A
Rationale: Unrelieved or increasing pain after opioids may signal serious
complications such as hemorrhage, compartment syndrome, or anastomotic leak.
This change from baseline is most concerning. Nausea and small amounts of
drainage are expected findings.
7. A charge nurse is preparing assignments. One nurse requests not to be
assigned to a particular patient due to a previous difficult interaction. Which
response best balances fairness, patient needs, and team dynamics?
A. Discuss the concern privately, assess patient acuity needs, and make the
assignment based on overall unit safety
, B. Automatically honor the request to avoid conflict and maintain staff morale
C. Assign the nurse to the patient and document the refusal as insubordination
D. Reassign the patient to a float nurse without discussing the issue with either
nurse
Correct Answer: A
Rationale: Effective leadership requires balancing staff concerns with patient
safety. A private discussion allows the charge nurse to understand the concern
while making an assignment based on unit acuity and safety rather than personal
preference. Automatically honoring or disregarding requests without discussion
undermines team trust and patient care.
8. Which task can the RN safely delegate to unlicensed assistive personnel
(UAP)?
A. Performing an initial assessment on a new admission
B. Ambulating a stable patient
C. Developing a plan of care
D. Evaluating the effectiveness of pain medication
Correct Answer: B
Rationale: Ambulating a stable patient is within the UAP's scope of practice.
Initial assessments, developing care plans, and evaluating medication effectiveness
require licensed nursing judgment and cannot be delegated. The RN retains
accountability for all delegated tasks.
9. A nurse is prioritizing care after receiving handoff report on a pediatric
unit. Which patient should the nurse see FIRST?
A. A toddler with bronchiolitis on room air and mild wheezing
B. An infant with pertussis receiving oxygen via nasal cannula
C. A preschooler with otitis media awaiting discharge
D. A school-age child with a simple fracture in a cast
| Nursing Practice Questions and Answers
SECTION I: PRIORITIZATION, DELEGATION & CLINICAL
JUDGMENT
1. The nurse is prioritizing patient care after change-of-shift report. Which
patient should the nurse assess FIRST?
A. A patient scheduled for discharge who needs final medication teaching
B. A patient who had a knee arthroscopy yesterday reporting pain at 4/10
C. A patient who had an ERCP 30 minutes ago and is reporting difficulty
swallowing
D. A patient who is NPO for an abdominal ultrasound this morning
Correct Answer: C
Rationale: The ABC framework dictates that airway is the priority. Difficulty
swallowing after an ERCP indicates risk of a depressed gag reflex and potential
aspiration. This patient requires immediate bedside assessment for airway patency
and swallowing ability. Pain at 4/10 is expected post-operatively, discharge
teaching and NPO status are not urgent.
2. A nurse working on a medical-surgical unit has just received handoff
report. The nurse should FIRST assess the patient who has:
A. COPD on 2 L/min oxygen with SpO₂ of 93%
B. Type 2 diabetes with blood glucose of 220 mg/dL before dinner
C. A stage II pressure injury needing a dressing change
D. Acute pancreatitis who reports new pain on deep inspiration
Correct Answer: D
Rationale: New pain on deep inspiration in acute pancreatitis may indicate
pleural effusion, atelectasis, or worsening inflammation that could progress to
,ARDS or respiratory failure. Acute changes in respiratory status require immediate
assessment. The other findings are stable or chronic.
3. The emergency department receives four patients simultaneously. Which
patient should the triage nurse see FIRST?
A. A patient with chest pain radiating to the left arm, diaphoretic
B. A patient with a simple arm laceration and controlled bleeding
C. A patient with a closed tibia fracture and intact pulses
D. A patient with minor abrasions and mild anxiety
Correct Answer: A
Rationale: Chest pain radiating to the left arm with diaphoresis is highly
suspicious for acute myocardial infarction. This patient is unstable and requires
immediate ECG and intervention. The other patients have stable or minor
conditions.
4. A nurse is caring for four patients. Which patient should the nurse assess
FIRST?
A. A patient with COPD who has SpO₂ of 88% on 2 L/min oxygen
B. A patient with heart failure who has 2+ pitting edema and crackles
C. A patient who had a hip replacement 2 days ago requesting pain medication
D. A patient with new onset of slurred speech and unilateral facial drooping
Correct Answer: D
Rationale: New onset slurred speech and facial drooping indicate an acute
cerebrovascular accident (stroke). This is a time-sensitive emergency requiring
immediate assessment and intervention for potential thrombolytic therapy. The
"new onset" nature makes this the highest priority.
,5. A nurse is caring for a patient with a tracheostomy. Which finding requires
IMMEDIATE intervention?
A. Small amount of bloody secretions
B. Patient requesting suctioning every 4 hours
C. Respiratory rate of 28 breaths per minute
D. Thick, yellow secretions extending from the stoma
Correct Answer: D
Rationale: Thick, yellow secretions can indicate infection and may obstruct
the airway. The presence of thick secretions poses an imminent risk of complete
airway obstruction and requires immediate suctioning and assessment. While RR
of 28 is elevated, airway obstruction is the more immediate threat.
6. The nurse is caring for four postoperative patients, all 24 hours post-op.
Which change in condition is the PRIORITY?
A. Patient reporting increased pain of 8/10 after receiving opioid analgesic
B. Patient reporting nausea after receiving antibiotics
C. Patient whose dressing has a small amount of new serosanguineous drainage
D. Patient who has voided 200 mL in the last 4 hours
Correct Answer: A
Rationale: Unrelieved or increasing pain after opioids may signal serious
complications such as hemorrhage, compartment syndrome, or anastomotic leak.
This change from baseline is most concerning. Nausea and small amounts of
drainage are expected findings.
7. A charge nurse is preparing assignments. One nurse requests not to be
assigned to a particular patient due to a previous difficult interaction. Which
response best balances fairness, patient needs, and team dynamics?
A. Discuss the concern privately, assess patient acuity needs, and make the
assignment based on overall unit safety
, B. Automatically honor the request to avoid conflict and maintain staff morale
C. Assign the nurse to the patient and document the refusal as insubordination
D. Reassign the patient to a float nurse without discussing the issue with either
nurse
Correct Answer: A
Rationale: Effective leadership requires balancing staff concerns with patient
safety. A private discussion allows the charge nurse to understand the concern
while making an assignment based on unit acuity and safety rather than personal
preference. Automatically honoring or disregarding requests without discussion
undermines team trust and patient care.
8. Which task can the RN safely delegate to unlicensed assistive personnel
(UAP)?
A. Performing an initial assessment on a new admission
B. Ambulating a stable patient
C. Developing a plan of care
D. Evaluating the effectiveness of pain medication
Correct Answer: B
Rationale: Ambulating a stable patient is within the UAP's scope of practice.
Initial assessments, developing care plans, and evaluating medication effectiveness
require licensed nursing judgment and cannot be delegated. The RN retains
accountability for all delegated tasks.
9. A nurse is prioritizing care after receiving handoff report on a pediatric
unit. Which patient should the nurse see FIRST?
A. A toddler with bronchiolitis on room air and mild wheezing
B. An infant with pertussis receiving oxygen via nasal cannula
C. A preschooler with otitis media awaiting discharge
D. A school-age child with a simple fracture in a cast
