NUR 283 Comprehensive Exam
– 170 Practice Questions
1. The nurse working in the ED has received the following prescriptions for a newly admitted
client. Which prescription should the nurse implement FIRST?
A. Initiate IV sodium for a client admitted with diarrhea and dehydration who has a serum
sodium level of 134.
B. Administer an antiemetic for a client reporting nausea.
C. Initiate IV potassium for a client admitted with diarrhea and dehydration who has a serum
potassium level of 2.9.
D. Obtain a stool culture for a client with suspected infectious diarrhea.
CORRECT ANSWER: C
RATIONALE: Potassium is a critical electrolyte for cardiac and neuromuscular function. A serum
potassium level of 2.9 mEq/L indicates severe hypokalemia, which can lead to life-threatening
dysrhythmias (e.g., ventricular tachycardia, fibrillation) and respiratory muscle weakness.
Therefore, correcting the potassium deficit takes precedence over other interventions that are
important but not immediately life-saving.
2. A nurse is caring for a male client who has deep partial-thickness and full-thickness burns
to 45% of his lower body. It would be a PRIORITY for the nurse to notify the provider if the
client has:
A. A urinary output of 100 mL over the past two hours.
B. A urinary output of 45 mL over the past two hours.
C. A heart rate of 110 beats per minute.
D. A body temperature of 37.8°C (100°F).
CORRECT ANSWER: B
RATIONALE: A urinary output of 45 mL over two hours (approximately 22.5 mL/hr) in an adult
with major burns is significantly below the minimum acceptable threshold of 30 mL/hr (or 0.5
mL/kg/hr). This suggests inadequate renal perfusion and the onset of hypovolemic shock or
acute kidney injury, requiring immediate fluid resuscitation adjustment and provider
notification.
,3. The nurse is assessing clients at the scene of a mass casualty disaster and is prioritizing care
based on the disaster triage tag system. Which of the following clients should be transported
to the health care facility FIRST?
A. A client who is unresponsive with a penetrating head injury.
B. A client with multiple compound fractures and is reporting chest pain.
C. A client with a sprained ankle who is ambulatory.
D. A client with minor lacerations and stable vital signs.
CORRECT ANSWER: B
RATIONALE: In disaster triage (e.g., START or SALT), clients are categorized by the urgency of
intervention. A client with multiple compound fractures and chest pain is classified as
"Immediate" (Red tag) because their condition is life-threatening but treatable with prompt
intervention (e.g., potential pneumothorax, internal bleeding). The unresponsive client with a
penetrating head injury would likely be categorized as "Expectant" (Black tag) due to a very poor
prognosis, while the others are "Delayed" or "Minor."
4. The charge nurse in the ED is reviewing the care provided for recently admitted clients.
Which of the following reflects implementation of an accepted standard of care?
A. Placing the client who has suspected Haemophilus influenza on airborne precautions.
B. Placing the client who has suspected Haemophilus influenza on droplet precautions.
C. Placing the client who has suspected Haemophilus influenza on contact precautions.
D. Placing the client who has suspected Haemophilus influenza in a negative-pressure room.
CORRECT ANSWER: B
RATIONALE: Haemophilus influenzae is transmitted via large respiratory droplets. The standard
of care is to implement Droplet Precautions (e.g., wearing a surgical mask when within 3 feet of
the client) until the condition is ruled out or the client has received 24 hours of appropriate
antibiotic therapy.
5. The nurse is working on a crisis hotline speaking with a client who states, "I just took an
entire bottle of amitriptyline." Which of the following responses should the nurse INITIALLY
make to the client?
A. "You should go to the nearest emergency room immediately."
B. "I'm glad you called, and I want to send an ambulance to help you."
C. "Can you tell me why you took the pills?"
D. "Amitriptyline is a dangerous medication; you need to induce vomiting."
CORRECT ANSWER: B
RATIONALE: A tricyclic antidepressant (TCA) overdose is a life-threatening medical emergency
that can cause fatal cardiac dysrhythmias and seizures. The nurse's priority is to ensure the
client's immediate safety. Sending an ambulance ensures emergency medical services are
,dispatched to the client's location while maintaining a supportive, non-judgmental therapeutic
connection.
6. The nurse is monitoring a client following a thoracentesis. It would be a priority for the
nurse to notify the primary health care provider if the client develops:
A. A blood pressure that has decreased from 130/80 to 118/70 mm Hg.
B. A heart rate that has increased from 95 to 110 BPM.
C. A respiratory rate of 18 breaths per minute.
D. A small amount of serosanguineous drainage at the puncture site.
CORRECT ANSWER: B
RATIONALE: A rising heart rate (tachycardia) following a thoracentesis is an early compensatory
sign of hypovolemia or developing shock, which could indicate a complication such as a
hemothorax or a pneumothorax with mediastinal shift. While other findings may require
monitoring, tachycardia is the most sensitive indicator requiring immediate provider
notification.
7. A nurse is caring for a client receiving chemotherapy. The client is not eating well but
denies any nausea or vomiting. Which of the following would be BEST for the nurse to suggest
to the client?
A. A bland diet of white rice and bananas.
B. A nutritional supplement shake with high protein.
C. Chicken, green beans, and cottage cheese.
D. Spicy foods to stimulate appetite.
CORRECT ANSWER: C
RATIONALE: Clients receiving chemotherapy require adequate protein and calories to promote
healing and maintain immune function. A meal of chicken (lean protein), green beans
(vegetables), and cottage cheese (protein and calcium) provides a balanced, nutrient-dense
option that is generally well tolerated. High-protein, low-odor foods are often better accepted
when nausea is a risk, even if denied.
8. Which medication should be given for the patient in V-tach (ventricular tachycardia) with a
pulse?
A. Adenosine
B. Amiodarone
C. Atropine
D. Epinephrine
CORRECT ANSWER: B
RATIONALE: Amiodarone is the first-line antiarrhythmic medication for stable ventricular
tachycardia (with a pulse). It works by prolonging the action potential and refractory period,
, helping to suppress the ventricular dysrhythmia. Adenosine is used for supraventricular
tachycardia (SVT), while atropine and epinephrine are used in bradycardia or cardiac arrest
algorithms.
9. The nurse is talking with a patient who has Multiple Sclerosis (MS). Which of the following
statements by the patient would need follow-up by the nurse?
A. "I try to take hot showers to relax my muscles."
B. "I perform range-of-motion exercises every morning."
C. "I use a cooling vest when I go outside in the summer."
D. "I drink plenty of fluids throughout the day."
CORRECT ANSWER: A
RATIONALE: Heat (e.g., from hot showers, hot tubs, or fever) can temporarily worsen
neurological symptoms in clients with MS due to increased demyelination and slowed nerve
conduction (Uhthoff's phenomenon). Clients should be educated to avoid extreme heat and use
cooling strategies instead.
10. A patient had a colostomy created 6 hours ago. The stoma appears dark red, dry, flaccid,
with a small amount of mucus drained in the bag. What is the first priority?
A. Document the finding as a normal expected outcome.
B. Apply an ostomy pouch and teach the client about care.
C. Call the provider.
D. Irrigate the stoma with sterile water.
CORRECT ANSWER: C
RATIONALE: A healthy stoma should be bright red, moist, and turgid (firm). A dark red, dry, or
flaccid stoma indicates ischemia and potential necrosis. This is a medical emergency that
requires immediate provider notification to salvage the stoma and prevent further tissue death.
11. A client who is postoperative from lumbar surgery reports a severe headache and has
clear drainage from the incision. Which action should the nurse take FIRST?
A. Place the client flat and assess the drainage.
B. Encourage the client to ambulate.
C. Administer a prescribed analgesic.
D. Change the surgical dressing.
CORRECT ANSWER: A
RATIONALE: Clear drainage combined with a severe headache after lumbar surgery is a classic
sign of a cerebrospinal fluid (CSF) leak. The nurse's first action is to position the client flat (to
reduce CSF pressure and leakage) and assess the drainage for glucose (CSF is positive for
glucose). This prevents further complications like meningitis.
– 170 Practice Questions
1. The nurse working in the ED has received the following prescriptions for a newly admitted
client. Which prescription should the nurse implement FIRST?
A. Initiate IV sodium for a client admitted with diarrhea and dehydration who has a serum
sodium level of 134.
B. Administer an antiemetic for a client reporting nausea.
C. Initiate IV potassium for a client admitted with diarrhea and dehydration who has a serum
potassium level of 2.9.
D. Obtain a stool culture for a client with suspected infectious diarrhea.
CORRECT ANSWER: C
RATIONALE: Potassium is a critical electrolyte for cardiac and neuromuscular function. A serum
potassium level of 2.9 mEq/L indicates severe hypokalemia, which can lead to life-threatening
dysrhythmias (e.g., ventricular tachycardia, fibrillation) and respiratory muscle weakness.
Therefore, correcting the potassium deficit takes precedence over other interventions that are
important but not immediately life-saving.
2. A nurse is caring for a male client who has deep partial-thickness and full-thickness burns
to 45% of his lower body. It would be a PRIORITY for the nurse to notify the provider if the
client has:
A. A urinary output of 100 mL over the past two hours.
B. A urinary output of 45 mL over the past two hours.
C. A heart rate of 110 beats per minute.
D. A body temperature of 37.8°C (100°F).
CORRECT ANSWER: B
RATIONALE: A urinary output of 45 mL over two hours (approximately 22.5 mL/hr) in an adult
with major burns is significantly below the minimum acceptable threshold of 30 mL/hr (or 0.5
mL/kg/hr). This suggests inadequate renal perfusion and the onset of hypovolemic shock or
acute kidney injury, requiring immediate fluid resuscitation adjustment and provider
notification.
,3. The nurse is assessing clients at the scene of a mass casualty disaster and is prioritizing care
based on the disaster triage tag system. Which of the following clients should be transported
to the health care facility FIRST?
A. A client who is unresponsive with a penetrating head injury.
B. A client with multiple compound fractures and is reporting chest pain.
C. A client with a sprained ankle who is ambulatory.
D. A client with minor lacerations and stable vital signs.
CORRECT ANSWER: B
RATIONALE: In disaster triage (e.g., START or SALT), clients are categorized by the urgency of
intervention. A client with multiple compound fractures and chest pain is classified as
"Immediate" (Red tag) because their condition is life-threatening but treatable with prompt
intervention (e.g., potential pneumothorax, internal bleeding). The unresponsive client with a
penetrating head injury would likely be categorized as "Expectant" (Black tag) due to a very poor
prognosis, while the others are "Delayed" or "Minor."
4. The charge nurse in the ED is reviewing the care provided for recently admitted clients.
Which of the following reflects implementation of an accepted standard of care?
A. Placing the client who has suspected Haemophilus influenza on airborne precautions.
B. Placing the client who has suspected Haemophilus influenza on droplet precautions.
C. Placing the client who has suspected Haemophilus influenza on contact precautions.
D. Placing the client who has suspected Haemophilus influenza in a negative-pressure room.
CORRECT ANSWER: B
RATIONALE: Haemophilus influenzae is transmitted via large respiratory droplets. The standard
of care is to implement Droplet Precautions (e.g., wearing a surgical mask when within 3 feet of
the client) until the condition is ruled out or the client has received 24 hours of appropriate
antibiotic therapy.
5. The nurse is working on a crisis hotline speaking with a client who states, "I just took an
entire bottle of amitriptyline." Which of the following responses should the nurse INITIALLY
make to the client?
A. "You should go to the nearest emergency room immediately."
B. "I'm glad you called, and I want to send an ambulance to help you."
C. "Can you tell me why you took the pills?"
D. "Amitriptyline is a dangerous medication; you need to induce vomiting."
CORRECT ANSWER: B
RATIONALE: A tricyclic antidepressant (TCA) overdose is a life-threatening medical emergency
that can cause fatal cardiac dysrhythmias and seizures. The nurse's priority is to ensure the
client's immediate safety. Sending an ambulance ensures emergency medical services are
,dispatched to the client's location while maintaining a supportive, non-judgmental therapeutic
connection.
6. The nurse is monitoring a client following a thoracentesis. It would be a priority for the
nurse to notify the primary health care provider if the client develops:
A. A blood pressure that has decreased from 130/80 to 118/70 mm Hg.
B. A heart rate that has increased from 95 to 110 BPM.
C. A respiratory rate of 18 breaths per minute.
D. A small amount of serosanguineous drainage at the puncture site.
CORRECT ANSWER: B
RATIONALE: A rising heart rate (tachycardia) following a thoracentesis is an early compensatory
sign of hypovolemia or developing shock, which could indicate a complication such as a
hemothorax or a pneumothorax with mediastinal shift. While other findings may require
monitoring, tachycardia is the most sensitive indicator requiring immediate provider
notification.
7. A nurse is caring for a client receiving chemotherapy. The client is not eating well but
denies any nausea or vomiting. Which of the following would be BEST for the nurse to suggest
to the client?
A. A bland diet of white rice and bananas.
B. A nutritional supplement shake with high protein.
C. Chicken, green beans, and cottage cheese.
D. Spicy foods to stimulate appetite.
CORRECT ANSWER: C
RATIONALE: Clients receiving chemotherapy require adequate protein and calories to promote
healing and maintain immune function. A meal of chicken (lean protein), green beans
(vegetables), and cottage cheese (protein and calcium) provides a balanced, nutrient-dense
option that is generally well tolerated. High-protein, low-odor foods are often better accepted
when nausea is a risk, even if denied.
8. Which medication should be given for the patient in V-tach (ventricular tachycardia) with a
pulse?
A. Adenosine
B. Amiodarone
C. Atropine
D. Epinephrine
CORRECT ANSWER: B
RATIONALE: Amiodarone is the first-line antiarrhythmic medication for stable ventricular
tachycardia (with a pulse). It works by prolonging the action potential and refractory period,
, helping to suppress the ventricular dysrhythmia. Adenosine is used for supraventricular
tachycardia (SVT), while atropine and epinephrine are used in bradycardia or cardiac arrest
algorithms.
9. The nurse is talking with a patient who has Multiple Sclerosis (MS). Which of the following
statements by the patient would need follow-up by the nurse?
A. "I try to take hot showers to relax my muscles."
B. "I perform range-of-motion exercises every morning."
C. "I use a cooling vest when I go outside in the summer."
D. "I drink plenty of fluids throughout the day."
CORRECT ANSWER: A
RATIONALE: Heat (e.g., from hot showers, hot tubs, or fever) can temporarily worsen
neurological symptoms in clients with MS due to increased demyelination and slowed nerve
conduction (Uhthoff's phenomenon). Clients should be educated to avoid extreme heat and use
cooling strategies instead.
10. A patient had a colostomy created 6 hours ago. The stoma appears dark red, dry, flaccid,
with a small amount of mucus drained in the bag. What is the first priority?
A. Document the finding as a normal expected outcome.
B. Apply an ostomy pouch and teach the client about care.
C. Call the provider.
D. Irrigate the stoma with sterile water.
CORRECT ANSWER: C
RATIONALE: A healthy stoma should be bright red, moist, and turgid (firm). A dark red, dry, or
flaccid stoma indicates ischemia and potential necrosis. This is a medical emergency that
requires immediate provider notification to salvage the stoma and prevent further tissue death.
11. A client who is postoperative from lumbar surgery reports a severe headache and has
clear drainage from the incision. Which action should the nurse take FIRST?
A. Place the client flat and assess the drainage.
B. Encourage the client to ambulate.
C. Administer a prescribed analgesic.
D. Change the surgical dressing.
CORRECT ANSWER: A
RATIONALE: Clear drainage combined with a severe headache after lumbar surgery is a classic
sign of a cerebrospinal fluid (CSF) leak. The nurse's first action is to position the client flat (to
reduce CSF pressure and leakage) and assess the drainage for glucose (CSF is positive for
glucose). This prevents further complications like meningitis.
