ESTUDYR
NUR 417 FINAL EXAM 2025 UPDATED EXAM WITH MOST
TESTED QUESTIONS AND ANSWERS | GRADED A+ | ASSURED
SUCCESS WITH DETAILED RATIONALES
Which finding indicates the nurse should discontinue active rewarming of a patient admitted
with hypothermia?
A. The patient begins to shiver.
B. The BP decreases to 86/42 mm Hg.
C. The patient develops atrial fibrillation.
D. The core temperature is 94°F (34.4°C).
Rationale: Rewarming is often stopped or slowed when core temp reaches ~94°F because
rewarming shock and dysrhythmias are risks; shivering may indicate inadequate rewarming but
is not the stopping criterion at that temp.
A patient arrives after topical exposure to powdered lime at work. Which action should the
nurse take first?
A. Obtain the patient's vital signs.
B. Obtain a baseline CBC.
C. Brush visible powder from skin and clothing.
D. Decontaminate by showering with water.
Rationale: Remove dry chemical first (brush off) before flushing with water to avoid
spreading/activating the chemical.
On admission to the burn unit, a patient with ~25% TBSA burn has Hct 58%, Hgb 18.2 g/dL, K⁺
4.9, Na⁺ 135. Which prescribed action is the nurse’s priority?
A. Monitoring urine output.
B. Scheduling additional labs.
C. Increasing the rate of the ordered IV solution.
D. Typing and crossmatching for transfusion.
Rationale: Elevated Hct/Hgb indicate hemoconcentration from fluid loss—fluid resuscitation is
urgent to restore intravascular volume.
A patient with burns of ears, head, neck, and right arm/hand — best position?
A. Place right arm flexed for comfort.
B. Elevate right arm on pillows and extend fingers.
C. Supine with small pillow under head.
D. Side-lying with rolled towel under neck.
,ESTUDYR
Rationale: Elevation reduces edema; fingers extended prevents flexion contractures; avoid
pressure on ears and neck flexion.
A patient admitted with burns over 30% TBSA 3 days ago has dramatically increased urine
output today. Interpretation:
A. Indicates AKI.
B. Reflects normalizing capillary permeability (diuresis).
C. Signals urinary infection.
D. Requires increased calorie intake.
Rationale: During the diuretic phase after resuscitation, capillary integrity returns → large urine
output; monitor but this is expected.
Electrical burn from high-voltage current — priority assessment on arrival:
A. Oral temperature.
B. Peripheral pulses.
C. Extremity movement.
D. Pupil reaction to light.
Rationale: Electrical injuries carry risk of spinal injury; assess neurologic function/movement
first.
Patient with facial and chest burns from house fire — which action to take first?
A. Auscultate for breath sounds.
B. Determine extent/depth of burns.
C. Give hydromorphone (Dilaudid).
D. Infuse lactated Ringer’s solution.
Rationale: Inhalation injury/aerosolized heat can compromise airway — assess breath
sounds/airway first.
Patient with extensive electrical burns — which prescribed intervention to implement first?
A. Assess pain level.
B. Place on heart monitor.
C. Check potassium level.
D. Assess oral temperature.
Rationale: Electrical injury → risk of dysrhythmias (arrhythmia monitoring immediate), then
labs and pain control.
Lab review 48 hr after large burn: which result requires priority action?
A. Hct 53%
B. Na⁺ 147 mEq/L
C. K⁺ 6.1 mEq/L
, ESTUDYR
D. BUN 37 mg/dL
Rationale: Hyperkalemia is life-threatening (dysrhythmia risk) and needs immediate treatment.
Four hours after initiation of mechanical ventilation ABG: pH 7.51, PaO₂ 82, PaCO₂ 26, HCO₃⁻
23. Anticipated ventilator change:
A. Increase FiO₂.
B. Increase tidal volume.
C. Increase respiratory rate.
D. Decrease respiratory rate.
Rationale: Low PaCO₂ with alkalosis indicates over-ventilation — reduce rate to raise PaCO₂ and
normalize pH.
Nurse finds patient gasping and endotracheal tube on the floor. Next action:
A. Activate rapid response team.
B. Provide reassurance.
C. Call provider to reinsert tube.
D. Manually ventilate patient with 100% O₂.
Rationale: Immediate oxygenation/ventilation via bag-valve mask is priority to prevent hypoxia.
Patient on mechanical ventilation with PEEP 15 cm H₂O — which action promotes safety?
A. Suction at least every 1–2 hr.
B. Use closed-suction technique when suctioning.
C. Change circuit tubing every 48 hr routinely.
D. Tape the connection between ET and ventilator tubing.
Rationale: High PEEP requires closed suction to avoid loss of PEEP and derecruitment; routine
circuit changes increase VAP risk.
Patient with bacterial pneumonia, coarse crackles, thick sputum — best intervention to
promote airway clearance:
A. Restrict oral fluids.
B. Encourage pursed-lip breathing.
C. Help patient splint chest when coughing.
D. Encourage wearing nasal O₂ cannula.
Rationale: Splinting reduces pain and allows effective cough to mobilize secretions; hydration
and other measures complement.
After change-of-shift, which patient should step-down nurse assess first?
A. Extubated this morning, temp 101.4°F.
B. BiPAP for OSA, RR 16.
C. Arterial pressure monitoring, 2 hr post PCI, needs to void.
NUR 417 FINAL EXAM 2025 UPDATED EXAM WITH MOST
TESTED QUESTIONS AND ANSWERS | GRADED A+ | ASSURED
SUCCESS WITH DETAILED RATIONALES
Which finding indicates the nurse should discontinue active rewarming of a patient admitted
with hypothermia?
A. The patient begins to shiver.
B. The BP decreases to 86/42 mm Hg.
C. The patient develops atrial fibrillation.
D. The core temperature is 94°F (34.4°C).
Rationale: Rewarming is often stopped or slowed when core temp reaches ~94°F because
rewarming shock and dysrhythmias are risks; shivering may indicate inadequate rewarming but
is not the stopping criterion at that temp.
A patient arrives after topical exposure to powdered lime at work. Which action should the
nurse take first?
A. Obtain the patient's vital signs.
B. Obtain a baseline CBC.
C. Brush visible powder from skin and clothing.
D. Decontaminate by showering with water.
Rationale: Remove dry chemical first (brush off) before flushing with water to avoid
spreading/activating the chemical.
On admission to the burn unit, a patient with ~25% TBSA burn has Hct 58%, Hgb 18.2 g/dL, K⁺
4.9, Na⁺ 135. Which prescribed action is the nurse’s priority?
A. Monitoring urine output.
B. Scheduling additional labs.
C. Increasing the rate of the ordered IV solution.
D. Typing and crossmatching for transfusion.
Rationale: Elevated Hct/Hgb indicate hemoconcentration from fluid loss—fluid resuscitation is
urgent to restore intravascular volume.
A patient with burns of ears, head, neck, and right arm/hand — best position?
A. Place right arm flexed for comfort.
B. Elevate right arm on pillows and extend fingers.
C. Supine with small pillow under head.
D. Side-lying with rolled towel under neck.
,ESTUDYR
Rationale: Elevation reduces edema; fingers extended prevents flexion contractures; avoid
pressure on ears and neck flexion.
A patient admitted with burns over 30% TBSA 3 days ago has dramatically increased urine
output today. Interpretation:
A. Indicates AKI.
B. Reflects normalizing capillary permeability (diuresis).
C. Signals urinary infection.
D. Requires increased calorie intake.
Rationale: During the diuretic phase after resuscitation, capillary integrity returns → large urine
output; monitor but this is expected.
Electrical burn from high-voltage current — priority assessment on arrival:
A. Oral temperature.
B. Peripheral pulses.
C. Extremity movement.
D. Pupil reaction to light.
Rationale: Electrical injuries carry risk of spinal injury; assess neurologic function/movement
first.
Patient with facial and chest burns from house fire — which action to take first?
A. Auscultate for breath sounds.
B. Determine extent/depth of burns.
C. Give hydromorphone (Dilaudid).
D. Infuse lactated Ringer’s solution.
Rationale: Inhalation injury/aerosolized heat can compromise airway — assess breath
sounds/airway first.
Patient with extensive electrical burns — which prescribed intervention to implement first?
A. Assess pain level.
B. Place on heart monitor.
C. Check potassium level.
D. Assess oral temperature.
Rationale: Electrical injury → risk of dysrhythmias (arrhythmia monitoring immediate), then
labs and pain control.
Lab review 48 hr after large burn: which result requires priority action?
A. Hct 53%
B. Na⁺ 147 mEq/L
C. K⁺ 6.1 mEq/L
, ESTUDYR
D. BUN 37 mg/dL
Rationale: Hyperkalemia is life-threatening (dysrhythmia risk) and needs immediate treatment.
Four hours after initiation of mechanical ventilation ABG: pH 7.51, PaO₂ 82, PaCO₂ 26, HCO₃⁻
23. Anticipated ventilator change:
A. Increase FiO₂.
B. Increase tidal volume.
C. Increase respiratory rate.
D. Decrease respiratory rate.
Rationale: Low PaCO₂ with alkalosis indicates over-ventilation — reduce rate to raise PaCO₂ and
normalize pH.
Nurse finds patient gasping and endotracheal tube on the floor. Next action:
A. Activate rapid response team.
B. Provide reassurance.
C. Call provider to reinsert tube.
D. Manually ventilate patient with 100% O₂.
Rationale: Immediate oxygenation/ventilation via bag-valve mask is priority to prevent hypoxia.
Patient on mechanical ventilation with PEEP 15 cm H₂O — which action promotes safety?
A. Suction at least every 1–2 hr.
B. Use closed-suction technique when suctioning.
C. Change circuit tubing every 48 hr routinely.
D. Tape the connection between ET and ventilator tubing.
Rationale: High PEEP requires closed suction to avoid loss of PEEP and derecruitment; routine
circuit changes increase VAP risk.
Patient with bacterial pneumonia, coarse crackles, thick sputum — best intervention to
promote airway clearance:
A. Restrict oral fluids.
B. Encourage pursed-lip breathing.
C. Help patient splint chest when coughing.
D. Encourage wearing nasal O₂ cannula.
Rationale: Splinting reduces pain and allows effective cough to mobilize secretions; hydration
and other measures complement.
After change-of-shift, which patient should step-down nurse assess first?
A. Extubated this morning, temp 101.4°F.
B. BiPAP for OSA, RR 16.
C. Arterial pressure monitoring, 2 hr post PCI, needs to void.
