NR 546 — Midterm/Final Practice Exam verified with correct answers 2026/2027
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1. Which assessment finding should the nurse prioritize when evaluating a patient with a
new acute illness?
A. The patient's preferred meal
B. Airway, breathing, and circulation
C. The patient's usual bedtime
D. The patient's preferred pharmacy
Answer: B. Airway, breathing, and circulation
Rationale: ABC assessment prioritizes life-threatening problems involving oxygenation and
circulation before less urgent concerns.
2. Which finding most strongly indicates impaired oxygenation?
A. SpO₂ of 88%
B. Heart rate of 72/min
C. Temperature of 98.4°F
D. Blood pressure of 118/72 mm Hg
Answer: A. SpO₂ of 88%
Rationale: An oxygen saturation of 88% indicates significant hypoxemia in most patients and
requires prompt assessment and intervention.
3. A patient suddenly develops severe shortness of breath and chest pain. What should the
nurse do first?
A. Ask the patient to complete a dietary history
B. Assess airway, breathing, circulation, and vital signs
C. Schedule a routine follow-up visit
D. Encourage the patient to ambulate
Answer: B. Assess airway, breathing, circulation, and vital signs
Rationale: Acute dyspnea and chest pain can indicate a life-threatening condition. Immediate
assessment is required.
,4. Which assessment finding is most concerning for respiratory distress?
A. Respiratory rate of 8/min with decreased responsiveness
B. Respiratory rate of 16/min
C. Clear speech
D. Normal skin color
Answer: A. Respiratory rate of 8/min with decreased responsiveness
Rationale: Bradypnea combined with decreased responsiveness suggests inadequate ventilation
and possible respiratory failure.
5. Which finding is commonly associated with hypovolemia?
A. Bounding pulse
B. Hypotension and tachycardia
C. Pulmonary crackles from fluid overload
D. Bradycardia with hypertension
Answer: B. Hypotension and tachycardia
Rationale: Reduced circulating volume commonly causes compensatory tachycardia and, when
significant, hypotension.
6. Which laboratory value is most useful when assessing renal filtration?
A. Serum creatinine
B. Hemoglobin
C. Platelet count
D. Serum amylase
Answer: A. Serum creatinine
Rationale: Serum creatinine is commonly used to assess kidney function and estimate glomerular
filtration.
7. An elevated serum creatinine most directly suggests:
A. Improved renal function
B. Possible impaired kidney function
,C. Increased platelet production
D. Improved oxygenation
Answer: B. Possible impaired kidney function
Rationale: Reduced renal filtration can cause creatinine to accumulate in the bloodstream.
8. Which electrolyte abnormality can cause dangerous cardiac dysrhythmias?
A. Severe hyperkalemia
B. Mild hypernatremia only
C. Mild hyperchloremia
D. Slightly decreased calcium without symptoms
Answer: A. Severe hyperkalemia
Rationale: Significant potassium abnormalities can alter cardiac conduction and cause life-
threatening dysrhythmias.
9. Which ECG change is classically associated with hyperkalemia?
A. Peaked T waves
B. Prominent U waves
C. ST elevation in every lead
D. Prolonged QT caused exclusively by potassium elevation
Answer: A. Peaked T waves
Rationale: Tall, peaked T waves are a classic early ECG finding associated with hyperkalemia.
10. Which finding is most consistent with hypokalemia?
A. Muscle weakness
B. Peaked T waves
C. Severe hypertension in every patient
D. Increased deep tendon reflexes in every case
Answer: A. Muscle weakness
, Rationale: Hypokalemia can cause weakness, fatigue, muscle cramps, and cardiac conduction
abnormalities.
11. Which electrolyte is primarily responsible for extracellular fluid balance?
A. Sodium
B. Potassium
C. Magnesium
D. Phosphate
Answer: A. Sodium
Rationale: Sodium is the major extracellular cation and plays a major role in extracellular fluid
volume and osmotic balance.
12. Which finding is most suggestive of hyponatremia affecting the nervous system?
A. Confusion and seizures
B. Improved mental status
C. Increased visual acuity
D. Localized ankle pain
Answer: A. Confusion and seizures
Rationale: Significant hyponatremia can cause cerebral edema and neurologic manifestations
such as confusion, seizures, and altered consciousness.
13. Which intervention is appropriate for a patient experiencing symptomatic
hypoglycemia who is awake and able to swallow?
A. Give a rapid source of glucose
B. Restrict all carbohydrates
C. Administer long-acting insulin immediately
D. Keep the patient NPO indefinitely
Answer: A. Give a rapid source of glucose
Rationale: An alert patient who can safely swallow should receive a rapid-acting carbohydrate
source to raise blood glucose.
1. Which assessment finding should the nurse prioritize when evaluating a patient with a
new acute illness?
A. The patient's preferred meal
B. Airway, breathing, and circulation
C. The patient's usual bedtime
D. The patient's preferred pharmacy
Answer: B. Airway, breathing, and circulation
Rationale: ABC assessment prioritizes life-threatening problems involving oxygenation and
circulation before less urgent concerns.
2. Which finding most strongly indicates impaired oxygenation?
A. SpO₂ of 88%
B. Heart rate of 72/min
C. Temperature of 98.4°F
D. Blood pressure of 118/72 mm Hg
Answer: A. SpO₂ of 88%
Rationale: An oxygen saturation of 88% indicates significant hypoxemia in most patients and
requires prompt assessment and intervention.
3. A patient suddenly develops severe shortness of breath and chest pain. What should the
nurse do first?
A. Ask the patient to complete a dietary history
B. Assess airway, breathing, circulation, and vital signs
C. Schedule a routine follow-up visit
D. Encourage the patient to ambulate
Answer: B. Assess airway, breathing, circulation, and vital signs
Rationale: Acute dyspnea and chest pain can indicate a life-threatening condition. Immediate
assessment is required.
,4. Which assessment finding is most concerning for respiratory distress?
A. Respiratory rate of 8/min with decreased responsiveness
B. Respiratory rate of 16/min
C. Clear speech
D. Normal skin color
Answer: A. Respiratory rate of 8/min with decreased responsiveness
Rationale: Bradypnea combined with decreased responsiveness suggests inadequate ventilation
and possible respiratory failure.
5. Which finding is commonly associated with hypovolemia?
A. Bounding pulse
B. Hypotension and tachycardia
C. Pulmonary crackles from fluid overload
D. Bradycardia with hypertension
Answer: B. Hypotension and tachycardia
Rationale: Reduced circulating volume commonly causes compensatory tachycardia and, when
significant, hypotension.
6. Which laboratory value is most useful when assessing renal filtration?
A. Serum creatinine
B. Hemoglobin
C. Platelet count
D. Serum amylase
Answer: A. Serum creatinine
Rationale: Serum creatinine is commonly used to assess kidney function and estimate glomerular
filtration.
7. An elevated serum creatinine most directly suggests:
A. Improved renal function
B. Possible impaired kidney function
,C. Increased platelet production
D. Improved oxygenation
Answer: B. Possible impaired kidney function
Rationale: Reduced renal filtration can cause creatinine to accumulate in the bloodstream.
8. Which electrolyte abnormality can cause dangerous cardiac dysrhythmias?
A. Severe hyperkalemia
B. Mild hypernatremia only
C. Mild hyperchloremia
D. Slightly decreased calcium without symptoms
Answer: A. Severe hyperkalemia
Rationale: Significant potassium abnormalities can alter cardiac conduction and cause life-
threatening dysrhythmias.
9. Which ECG change is classically associated with hyperkalemia?
A. Peaked T waves
B. Prominent U waves
C. ST elevation in every lead
D. Prolonged QT caused exclusively by potassium elevation
Answer: A. Peaked T waves
Rationale: Tall, peaked T waves are a classic early ECG finding associated with hyperkalemia.
10. Which finding is most consistent with hypokalemia?
A. Muscle weakness
B. Peaked T waves
C. Severe hypertension in every patient
D. Increased deep tendon reflexes in every case
Answer: A. Muscle weakness
, Rationale: Hypokalemia can cause weakness, fatigue, muscle cramps, and cardiac conduction
abnormalities.
11. Which electrolyte is primarily responsible for extracellular fluid balance?
A. Sodium
B. Potassium
C. Magnesium
D. Phosphate
Answer: A. Sodium
Rationale: Sodium is the major extracellular cation and plays a major role in extracellular fluid
volume and osmotic balance.
12. Which finding is most suggestive of hyponatremia affecting the nervous system?
A. Confusion and seizures
B. Improved mental status
C. Increased visual acuity
D. Localized ankle pain
Answer: A. Confusion and seizures
Rationale: Significant hyponatremia can cause cerebral edema and neurologic manifestations
such as confusion, seizures, and altered consciousness.
13. Which intervention is appropriate for a patient experiencing symptomatic
hypoglycemia who is awake and able to swallow?
A. Give a rapid source of glucose
B. Restrict all carbohydrates
C. Administer long-acting insulin immediately
D. Keep the patient NPO indefinitely
Answer: A. Give a rapid source of glucose
Rationale: An alert patient who can safely swallow should receive a rapid-acting carbohydrate
source to raise blood glucose.
