NU 155
FINAL EXAM
Tested Questions with Rationales
Medical-Surgical Nursing I
Galen College of Nursing
This Document Description:
This document contains a collection of tested and
verified questions with accurate answers from Final
Exam of NU 155 at the Galen College of Nursing. It
covers core topics assessed in the course and
reflects the actual exam format and question style. Ideal for exam
preparation and concept reinforcement.
,1.) The nurse had just finished preparing a pain medication injection
for an assigned client when a code blue is called for another assigned
client. The nurse asks a newly hired nurse on the floor to give the
pain medication to the client. Which of the following actions by the
newly hired nurse is appropriate?
a. Do not give the medication as prepared. Check the medication
administration record (MAR) and prepare new medication to be
administered.
b. Administer the medication if the client is rating pain at an 8 or above on
the 0 (no pain) to 10 (severe pain) pain scale.
c. Hold on to the medication until the experienced nurse is finished running
the code blue.
d. Administer the medication since the experienced nurse had just prepared
it for the client.
Correct Answer: a
Expert Rationale: Nurses must adhere to the “five rights” of medication
administration. Since the newly hired nurse did not prepare the medication
themselves, they must verify the order with the MAR and prepare
medication accordingly to ensure accuracy and safety. Delegation without
verification violates medication administration standards and risks client
safety.
---
2.) The nurse has administered an intramuscular (IM) medication to a
client. Approximately 15 minutes after administration, the client
develops an itchy rash all over and reports feeling very “uneasy” to
the nurse. Which of the following actions should the nurse take first?
a. Obtain an order for hydrocortisone cream to relieve the itching.
,b. Document the reaction in the client’s chart as a side effect.
c. Determine if the client is having any difficulty breathing.
d. Report the findings to the primary health care provider (PHCP) and the
pharmacist.
Correct Answer: c
Expert Rationale: Signs of an allergic or anaphylactic reaction include
rash, itching, and feeling uneasy, which can rapidly progress to respiratory
distress. Assessing airway, breathing, and circulation (ABCs) is the nurse’s
priority to identify potential respiratory compromise and initiate emergency
interventions if needed.
---
3.) The nurse has been assigned a group of 8 clients on a very busy
medical-surgical unit. While passing medications, the nurse realizes a
medication error has been made. Which of the following actions
should the nurse take first?
a. Document the medication given, how the client responded, and reassess
1 hour later.
b. Prepare an incident report so that the facility can determine the cause of
the error.
c. Assess the client for any adverse reactions and notify the primary health
care provider (PHCP).
d. Find the nurse manager, explain the medication error, and prepare to
leave for the day.
Correct Answer: c
, Expert Rationale: The priority after discovering a medication error is to
assess the client for adverse effects and notify the PHCP promptly to
address any complications that could arise. Incident reports and
documentation are important but secondary to client safety.
---
4.) The nurse is caring for a client who has a prescription for
acetaminophen 325 mg 2 tablets by mouth (PO) every 4 hours as
needed for temperature over 101° F. The client requests something for
a headache. Which of the following actions by the nurse is
appropriate?
a. Explain to the client that the only thing they have prescribed is for a
fever.
b. Check the last set of vital signs to see if the client was running a
temperature.
c. Administer the acetaminophen since it can be used for fever and
headache.
d. Contact the primary health care provider (PHCP) to get an order for pain
control.
Correct Answer: b
Expert Rationale: The order specifies administration “as needed for
temperature over 101° F,” so the nurse should first verify the client’s
temperature before administering acetaminophen, even though the
medication can reduce fever and relieve pain.
---
FINAL EXAM
Tested Questions with Rationales
Medical-Surgical Nursing I
Galen College of Nursing
This Document Description:
This document contains a collection of tested and
verified questions with accurate answers from Final
Exam of NU 155 at the Galen College of Nursing. It
covers core topics assessed in the course and
reflects the actual exam format and question style. Ideal for exam
preparation and concept reinforcement.
,1.) The nurse had just finished preparing a pain medication injection
for an assigned client when a code blue is called for another assigned
client. The nurse asks a newly hired nurse on the floor to give the
pain medication to the client. Which of the following actions by the
newly hired nurse is appropriate?
a. Do not give the medication as prepared. Check the medication
administration record (MAR) and prepare new medication to be
administered.
b. Administer the medication if the client is rating pain at an 8 or above on
the 0 (no pain) to 10 (severe pain) pain scale.
c. Hold on to the medication until the experienced nurse is finished running
the code blue.
d. Administer the medication since the experienced nurse had just prepared
it for the client.
Correct Answer: a
Expert Rationale: Nurses must adhere to the “five rights” of medication
administration. Since the newly hired nurse did not prepare the medication
themselves, they must verify the order with the MAR and prepare
medication accordingly to ensure accuracy and safety. Delegation without
verification violates medication administration standards and risks client
safety.
---
2.) The nurse has administered an intramuscular (IM) medication to a
client. Approximately 15 minutes after administration, the client
develops an itchy rash all over and reports feeling very “uneasy” to
the nurse. Which of the following actions should the nurse take first?
a. Obtain an order for hydrocortisone cream to relieve the itching.
,b. Document the reaction in the client’s chart as a side effect.
c. Determine if the client is having any difficulty breathing.
d. Report the findings to the primary health care provider (PHCP) and the
pharmacist.
Correct Answer: c
Expert Rationale: Signs of an allergic or anaphylactic reaction include
rash, itching, and feeling uneasy, which can rapidly progress to respiratory
distress. Assessing airway, breathing, and circulation (ABCs) is the nurse’s
priority to identify potential respiratory compromise and initiate emergency
interventions if needed.
---
3.) The nurse has been assigned a group of 8 clients on a very busy
medical-surgical unit. While passing medications, the nurse realizes a
medication error has been made. Which of the following actions
should the nurse take first?
a. Document the medication given, how the client responded, and reassess
1 hour later.
b. Prepare an incident report so that the facility can determine the cause of
the error.
c. Assess the client for any adverse reactions and notify the primary health
care provider (PHCP).
d. Find the nurse manager, explain the medication error, and prepare to
leave for the day.
Correct Answer: c
, Expert Rationale: The priority after discovering a medication error is to
assess the client for adverse effects and notify the PHCP promptly to
address any complications that could arise. Incident reports and
documentation are important but secondary to client safety.
---
4.) The nurse is caring for a client who has a prescription for
acetaminophen 325 mg 2 tablets by mouth (PO) every 4 hours as
needed for temperature over 101° F. The client requests something for
a headache. Which of the following actions by the nurse is
appropriate?
a. Explain to the client that the only thing they have prescribed is for a
fever.
b. Check the last set of vital signs to see if the client was running a
temperature.
c. Administer the acetaminophen since it can be used for fever and
headache.
d. Contact the primary health care provider (PHCP) to get an order for pain
control.
Correct Answer: b
Expert Rationale: The order specifies administration “as needed for
temperature over 101° F,” so the nurse should first verify the client’s
temperature before administering acetaminophen, even though the
medication can reduce fever and relieve pain.
---
