NUR 283 Comprehensive Exam Study Guide 2026–2027
| 170 Verified Practice Questions and Answers with
Detailed Rationales | Advanced Nursing Concepts Final
Review Test Bank Packet
1. A nurse receives report on four clients. Which client should the nurse assess FIRST?
A. A client requesting pain medication for chronic arthritis.
B. A client with a new tracheostomy and an oxygen saturation of 88%.
C. A client scheduled for discharge teaching regarding warfarin.
D. A client awaiting a routine abdominal CT scan.
Answer: B
Rationale: Using the ABCs (Airway, Breathing, Circulation), a low oxygen saturation in a client with a
new tracheostomy indicates potential airway obstruction or hypoxemia. This is an immediate
physiological threat, whereas pain, teaching, and diagnostics can wait .
2. An RN is delegating tasks to an LPN/LVN. Which task is most appropriate for the RN to delegate?
A. Performing the initial assessment on a new admission.
B. Administering IV push morphine to a post-operative client.
C. Administering oral metoprolol to a stable client with hypertension.
D. Creating the initial care plan for a client with diabetes.
Answer: C
Rationale: LPNs/LVNs can administer oral medications to stable clients. Initial assessments, IV push
opioids, and care plan creation require the clinical judgment and scope of practice of an RN .
3. A charge nurse is making assignments. Which client should be assigned to the most experienced
RN?
A. A client with pneumonia on room air.
B. A client with appendicitis scheduled for surgery in 4 hours.
,C. A client with unstable atrial fibrillation on a new heparin drip.
D. A client with a urinary tract infection receiving oral antibiotics.
Answer: C
Rationale: Unstable atrial fibrillation and a new heparin drip require complex monitoring, titration,
and assessment skills. New graduates or less experienced nurses should be assigned clients with
predictable outcomes .
4. The nurse is using the SBAR tool. Which statement represents the "B" (Background) component?
A. "The patient's heart rate is 120 and blood pressure is 85/50."
B. "I think the patient is going into septic shock."
C. "The patient is post-op day 2 from a bowel resection with a history of diabetes."
D. "I recommend transferring the patient to the ICU."
Answer: C
Rationale: Background includes relevant history, admission diagnosis, and pertinent clinical
information. Situation is the current problem (A), Assessment is the nurse's opinion (B), and
Recommendation is the suggested action (D) .
5. A nurse is assessing a client with a suspected deep vein thrombosis (DVT) in the left leg. Which
finding is expected?
A. Pale, cool skin on the left leg.
B. Unilateral swelling and warmth in the left calf.
C. Bilateral edema in both legs.
D. Absence of a pedal pulse in the left foot.
Answer: B
Rationale: DVT typically presents with unilateral swelling, warmth, erythema, and tenderness in the
affected extremity due to venous congestion .
6. A nurse is caring for a client with a new colostomy. The stoma appears dark red, dry, and flaccid 6
hours post-op. What is the priority action?
A. Document the finding as a normal post-op appearance.
,B. Call the provider immediately.
C. Apply a new ostomy bag.
D. Irrigate the stoma with warm water.
Answer: B
Rationale: A healthy stoma should be beefy red and moist. A dark red, dry, or flaccid stoma indicates
ischemia and necrosis, which is a medical emergency requiring immediate provider notification .
7. A nurse is reviewing a new prescription for digoxin. Which finding should the nurse report before
administering?
A. Heart rate of 88 bpm.
B. Heart rate of 52 bpm.
C. Blood pressure of 120/70 mmHg.
D. Respiratory rate of 16/min.
Answer: B
Rationale: Digoxin slows the heart rate. The nurse should withhold the dose and notify the provider
if the adult client's apical heart rate is less than 60 bpm .
8. A client with a possible pulmonary embolism complains of chest pain and difficulty breathing. HR
142, BP 100/60, RR 42. What is the first action?
A. Administer anticoagulant therapy.
B. Notify the provider.
C. Prepare for a spiral CT.
D. Elevate the head of the bed to semi-Fowler's position.
Answer: D
Rationale: The immediate priority is to improve oxygenation and breathing. Elevating the head of
the bed facilitates breathing. Anticoagulants and CT are important but secondary to immediate
stabilization .
9. A nurse is evaluating the effectiveness of therapy for a client during an asthma attack. Which
finding is the best indicator of improvement?
, A. No wheezes are audible.
B. O2 saturation is >90%.
C. Accessory muscle use has decreased.
D. Respiratory rate is 16 breaths/minute.
Answer: B
Rationale: While all options indicate improvement, an oxygen saturation >90% is the most objective
indicator of adequate gas exchange and effective therapy. "No wheezes" could indicate a silent chest
(worsening) .
10. A client with cystic fibrosis reports increased sweating and weakness during summer. What
action is most appropriate?
A. Teach signs of hypoglycemia.
B. Have the client add dietary salt to meals.
C. Suggest decreasing dietary fat.
D. Instruct about pancreatic enzymes.
Answer: B
Rationale: Clients with CF lose excessive amounts of salt in sweat, especially in heat, leading to
hyponatremia and weakness. Adding salt to meals is the appropriate intervention .
11. A nurse is preparing a client for a CT scan with contrast. Which finding should be reported to the
provider?
A. Allergy to shellfish.
B. Claustrophobia.
C. Recent bronchodilator use.
D. Inability to remove a wedding band.
Answer: A
Rationale: Contrast media is iodine-based. An allergy to shellfish indicates a potential iodine allergy,
which can cause anaphylaxis. Elevated creatinine is also a concern, but shellfish allergy is a primary
contraindication .
| 170 Verified Practice Questions and Answers with
Detailed Rationales | Advanced Nursing Concepts Final
Review Test Bank Packet
1. A nurse receives report on four clients. Which client should the nurse assess FIRST?
A. A client requesting pain medication for chronic arthritis.
B. A client with a new tracheostomy and an oxygen saturation of 88%.
C. A client scheduled for discharge teaching regarding warfarin.
D. A client awaiting a routine abdominal CT scan.
Answer: B
Rationale: Using the ABCs (Airway, Breathing, Circulation), a low oxygen saturation in a client with a
new tracheostomy indicates potential airway obstruction or hypoxemia. This is an immediate
physiological threat, whereas pain, teaching, and diagnostics can wait .
2. An RN is delegating tasks to an LPN/LVN. Which task is most appropriate for the RN to delegate?
A. Performing the initial assessment on a new admission.
B. Administering IV push morphine to a post-operative client.
C. Administering oral metoprolol to a stable client with hypertension.
D. Creating the initial care plan for a client with diabetes.
Answer: C
Rationale: LPNs/LVNs can administer oral medications to stable clients. Initial assessments, IV push
opioids, and care plan creation require the clinical judgment and scope of practice of an RN .
3. A charge nurse is making assignments. Which client should be assigned to the most experienced
RN?
A. A client with pneumonia on room air.
B. A client with appendicitis scheduled for surgery in 4 hours.
,C. A client with unstable atrial fibrillation on a new heparin drip.
D. A client with a urinary tract infection receiving oral antibiotics.
Answer: C
Rationale: Unstable atrial fibrillation and a new heparin drip require complex monitoring, titration,
and assessment skills. New graduates or less experienced nurses should be assigned clients with
predictable outcomes .
4. The nurse is using the SBAR tool. Which statement represents the "B" (Background) component?
A. "The patient's heart rate is 120 and blood pressure is 85/50."
B. "I think the patient is going into septic shock."
C. "The patient is post-op day 2 from a bowel resection with a history of diabetes."
D. "I recommend transferring the patient to the ICU."
Answer: C
Rationale: Background includes relevant history, admission diagnosis, and pertinent clinical
information. Situation is the current problem (A), Assessment is the nurse's opinion (B), and
Recommendation is the suggested action (D) .
5. A nurse is assessing a client with a suspected deep vein thrombosis (DVT) in the left leg. Which
finding is expected?
A. Pale, cool skin on the left leg.
B. Unilateral swelling and warmth in the left calf.
C. Bilateral edema in both legs.
D. Absence of a pedal pulse in the left foot.
Answer: B
Rationale: DVT typically presents with unilateral swelling, warmth, erythema, and tenderness in the
affected extremity due to venous congestion .
6. A nurse is caring for a client with a new colostomy. The stoma appears dark red, dry, and flaccid 6
hours post-op. What is the priority action?
A. Document the finding as a normal post-op appearance.
,B. Call the provider immediately.
C. Apply a new ostomy bag.
D. Irrigate the stoma with warm water.
Answer: B
Rationale: A healthy stoma should be beefy red and moist. A dark red, dry, or flaccid stoma indicates
ischemia and necrosis, which is a medical emergency requiring immediate provider notification .
7. A nurse is reviewing a new prescription for digoxin. Which finding should the nurse report before
administering?
A. Heart rate of 88 bpm.
B. Heart rate of 52 bpm.
C. Blood pressure of 120/70 mmHg.
D. Respiratory rate of 16/min.
Answer: B
Rationale: Digoxin slows the heart rate. The nurse should withhold the dose and notify the provider
if the adult client's apical heart rate is less than 60 bpm .
8. A client with a possible pulmonary embolism complains of chest pain and difficulty breathing. HR
142, BP 100/60, RR 42. What is the first action?
A. Administer anticoagulant therapy.
B. Notify the provider.
C. Prepare for a spiral CT.
D. Elevate the head of the bed to semi-Fowler's position.
Answer: D
Rationale: The immediate priority is to improve oxygenation and breathing. Elevating the head of
the bed facilitates breathing. Anticoagulants and CT are important but secondary to immediate
stabilization .
9. A nurse is evaluating the effectiveness of therapy for a client during an asthma attack. Which
finding is the best indicator of improvement?
, A. No wheezes are audible.
B. O2 saturation is >90%.
C. Accessory muscle use has decreased.
D. Respiratory rate is 16 breaths/minute.
Answer: B
Rationale: While all options indicate improvement, an oxygen saturation >90% is the most objective
indicator of adequate gas exchange and effective therapy. "No wheezes" could indicate a silent chest
(worsening) .
10. A client with cystic fibrosis reports increased sweating and weakness during summer. What
action is most appropriate?
A. Teach signs of hypoglycemia.
B. Have the client add dietary salt to meals.
C. Suggest decreasing dietary fat.
D. Instruct about pancreatic enzymes.
Answer: B
Rationale: Clients with CF lose excessive amounts of salt in sweat, especially in heat, leading to
hyponatremia and weakness. Adding salt to meals is the appropriate intervention .
11. A nurse is preparing a client for a CT scan with contrast. Which finding should be reported to the
provider?
A. Allergy to shellfish.
B. Claustrophobia.
C. Recent bronchodilator use.
D. Inability to remove a wedding band.
Answer: A
Rationale: Contrast media is iodine-based. An allergy to shellfish indicates a potential iodine allergy,
which can cause anaphylaxis. Elevated creatinine is also a concern, but shellfish allergy is a primary
contraindication .
