NR S07 FINAL EXAM | QUESTIONS AND ANSWERS |
VERIFIED ANSWERS PLUS RATIONALES | EXAM ALREADY
GRADED A+ | LATEST EXAM
1. A nurse is caring for a patient with heart failure. Which symptom indicates fluid
overload?
A) Weight loss
B) Dry skin
C) Shortness of breath
D) Bradycardia
Answer: C) Shortness of breath
Rationale: Shortness of breath is a classic symptom of fluid overload due to pulmonary
congestion in heart failure patients.
2. The primary purpose of performing a head-to-toe assessment is to:
A) Focus only on patient complaints
B) Establish a baseline for future comparisons
C) Replace lab tests
D) Diagnose disease
Answer: B) Establish a baseline for future comparisons
Rationale: A head-to-toe assessment provides a comprehensive baseline to identify changes in
patient status.
3. Which of the following actions should a nurse take first for a patient experiencing
anaphylaxis?
A) Administer antihistamines
B) Assess airway, breathing, and circulation
C) Apply a cold compress
D) Start IV fluids
Answer: B) Assess airway, breathing, and circulation
Rationale: ABCs (airway, breathing, circulation) take priority in emergency situations such as
anaphylaxis.
4. A patient on long-term corticosteroid therapy is at risk for:
A) Hypoglycemia
B) Hypertension and immunosuppression
C) Increased muscle mass
D) Hyperpigmentation
,Answer: B) Hypertension and immunosuppression
Rationale: Corticosteroids can increase blood pressure and suppress the immune system over
long-term use.
5. A nurse teaches a patient with diabetes about foot care. Which instruction is correct?
A) Walk barefoot indoors
B) Inspect feet daily for sores
C) Apply lotion between toes
D) Ignore minor cuts
Answer: B) Inspect feet daily for sores
Rationale: Daily inspection helps prevent infections and complications such as ulcers in diabetic
patients.
6. Which lab value indicates renal impairment?
A) Serum creatinine 2.0 mg/dL
B) Hemoglobin 14 g/dL
C) Sodium 140 mEq/L
D) Potassium 4.0 mEq/L
Answer: A) Serum creatinine 2.0 mg/dL
Rationale: Elevated serum creatinine suggests decreased kidney function.
7. The nurse is caring for a patient with a nasogastric tube. Which action is correct?
A) Irrigate with 100 mL of water every hour
B) Keep the head of the bed elevated 30–45 degrees
C) Push fluids rapidly through the tube
D) Leave the tube open to air
Answer: B) Keep the head of the bed elevated 30–45 degrees
Rationale: Elevating the head prevents aspiration in patients with NG tubes.
8. Which intervention is most important for a patient with hypovolemic shock?
A) Encourage ambulation
B) Administer IV fluids rapidly
C) Apply heat packs
D) Give high-fiber diet
Answer: B) Administer IV fluids rapidly
Rationale: Rapid IV fluid replacement restores circulating volume and improves perfusion in
hypovolemic shock.
9. Which of the following is a sign of hypoglycemia?
A) Polyuria
B) Shakiness and sweating
,C) Flushed skin
D) Weight gain
Answer: B) Shakiness and sweating
Rationale: Hypoglycemia often presents with adrenergic symptoms such as tremors and
diaphoresis.
10. A patient is prescribed morphine for pain. The nurse should monitor for:
A) Tachypnea
B) Constipation and respiratory depression
C) Hypotension only
D) Hypertension
Answer: B) Constipation and respiratory depression
Rationale: Opioids can slow GI motility and depress respiratory function, requiring monitoring.
11. Which action demonstrates proper hand hygiene?
A) Using sanitizer before touching a clean surface
B) Rinsing hands with water only
C) Wearing gloves instead of washing hands
D) Using sanitizer after touching the face only
Answer: A) Using sanitizer before touching a clean surface
Rationale: Hand hygiene prevents transmission of pathogens and is essential before patient
contact.
12. A patient with COPD is receiving oxygen at 2 L/min via nasal cannula. Which finding
requires immediate intervention?
A) O2 saturation 95%
B) Respiratory rate 28/min and confusion
C) Use of accessory muscles
D) Patient reports dyspnea on exertion
Answer: B) Respiratory rate 28/min and confusion
Rationale: Confusion and increased respiratory rate indicate hypoxia, requiring urgent
assessment.
13. A patient is scheduled for surgery. The nurse knows that obtaining informed consent is
the responsibility of:
A) The nurse
B) The surgeon
C) The anesthetist
D) The hospital administrator
, Answer: B) The surgeon
Rationale: The physician performing the procedure must explain risks, benefits, and alternatives
to the patient.
14. Which nursing intervention is most appropriate for a patient with impaired skin
integrity?
A) Massage reddened areas
B) Reposition every 2 hours
C) Keep patient in one position
D) Avoid using moisturizers
Answer: B) Reposition every 2 hours
Rationale: Frequent repositioning reduces pressure and prevents pressure ulcers.
15. Which of the following is a priority for a patient with suspected sepsis?
A) Administering IV antibiotics within 1 hour
B) Waiting for lab results
C) Giving oral fluids
D) Monitoring urine output daily
Answer: A) Administering IV antibiotics within 1 hour
Rationale: Early antibiotics reduce mortality in sepsis patients.
16. A nurse teaches a patient to use an incentive spirometer. Which instruction is correct?
A) Exhale forcefully into the device
B) Inhale slowly and deeply to raise the piston
C) Use only when short of breath
D) Sit lying down while using
Answer: B) Inhale slowly and deeply to raise the piston
Rationale: Proper technique helps prevent postoperative atelectasis.
17. A patient is on warfarin therapy. Which food should the nurse advise the patient to
monitor?
A) Foods high in vitamin K like spinach
B) High-sugar foods
C) Dairy products only
D) Low-protein foods
Answer: A) Foods high in vitamin K like spinach
Rationale: Vitamin K can counteract warfarin, affecting anticoagulation.
18. Which patient should the nurse see first?
A) Patient with controlled hypertension
B) Patient with chest pain radiating to the left arm
VERIFIED ANSWERS PLUS RATIONALES | EXAM ALREADY
GRADED A+ | LATEST EXAM
1. A nurse is caring for a patient with heart failure. Which symptom indicates fluid
overload?
A) Weight loss
B) Dry skin
C) Shortness of breath
D) Bradycardia
Answer: C) Shortness of breath
Rationale: Shortness of breath is a classic symptom of fluid overload due to pulmonary
congestion in heart failure patients.
2. The primary purpose of performing a head-to-toe assessment is to:
A) Focus only on patient complaints
B) Establish a baseline for future comparisons
C) Replace lab tests
D) Diagnose disease
Answer: B) Establish a baseline for future comparisons
Rationale: A head-to-toe assessment provides a comprehensive baseline to identify changes in
patient status.
3. Which of the following actions should a nurse take first for a patient experiencing
anaphylaxis?
A) Administer antihistamines
B) Assess airway, breathing, and circulation
C) Apply a cold compress
D) Start IV fluids
Answer: B) Assess airway, breathing, and circulation
Rationale: ABCs (airway, breathing, circulation) take priority in emergency situations such as
anaphylaxis.
4. A patient on long-term corticosteroid therapy is at risk for:
A) Hypoglycemia
B) Hypertension and immunosuppression
C) Increased muscle mass
D) Hyperpigmentation
,Answer: B) Hypertension and immunosuppression
Rationale: Corticosteroids can increase blood pressure and suppress the immune system over
long-term use.
5. A nurse teaches a patient with diabetes about foot care. Which instruction is correct?
A) Walk barefoot indoors
B) Inspect feet daily for sores
C) Apply lotion between toes
D) Ignore minor cuts
Answer: B) Inspect feet daily for sores
Rationale: Daily inspection helps prevent infections and complications such as ulcers in diabetic
patients.
6. Which lab value indicates renal impairment?
A) Serum creatinine 2.0 mg/dL
B) Hemoglobin 14 g/dL
C) Sodium 140 mEq/L
D) Potassium 4.0 mEq/L
Answer: A) Serum creatinine 2.0 mg/dL
Rationale: Elevated serum creatinine suggests decreased kidney function.
7. The nurse is caring for a patient with a nasogastric tube. Which action is correct?
A) Irrigate with 100 mL of water every hour
B) Keep the head of the bed elevated 30–45 degrees
C) Push fluids rapidly through the tube
D) Leave the tube open to air
Answer: B) Keep the head of the bed elevated 30–45 degrees
Rationale: Elevating the head prevents aspiration in patients with NG tubes.
8. Which intervention is most important for a patient with hypovolemic shock?
A) Encourage ambulation
B) Administer IV fluids rapidly
C) Apply heat packs
D) Give high-fiber diet
Answer: B) Administer IV fluids rapidly
Rationale: Rapid IV fluid replacement restores circulating volume and improves perfusion in
hypovolemic shock.
9. Which of the following is a sign of hypoglycemia?
A) Polyuria
B) Shakiness and sweating
,C) Flushed skin
D) Weight gain
Answer: B) Shakiness and sweating
Rationale: Hypoglycemia often presents with adrenergic symptoms such as tremors and
diaphoresis.
10. A patient is prescribed morphine for pain. The nurse should monitor for:
A) Tachypnea
B) Constipation and respiratory depression
C) Hypotension only
D) Hypertension
Answer: B) Constipation and respiratory depression
Rationale: Opioids can slow GI motility and depress respiratory function, requiring monitoring.
11. Which action demonstrates proper hand hygiene?
A) Using sanitizer before touching a clean surface
B) Rinsing hands with water only
C) Wearing gloves instead of washing hands
D) Using sanitizer after touching the face only
Answer: A) Using sanitizer before touching a clean surface
Rationale: Hand hygiene prevents transmission of pathogens and is essential before patient
contact.
12. A patient with COPD is receiving oxygen at 2 L/min via nasal cannula. Which finding
requires immediate intervention?
A) O2 saturation 95%
B) Respiratory rate 28/min and confusion
C) Use of accessory muscles
D) Patient reports dyspnea on exertion
Answer: B) Respiratory rate 28/min and confusion
Rationale: Confusion and increased respiratory rate indicate hypoxia, requiring urgent
assessment.
13. A patient is scheduled for surgery. The nurse knows that obtaining informed consent is
the responsibility of:
A) The nurse
B) The surgeon
C) The anesthetist
D) The hospital administrator
, Answer: B) The surgeon
Rationale: The physician performing the procedure must explain risks, benefits, and alternatives
to the patient.
14. Which nursing intervention is most appropriate for a patient with impaired skin
integrity?
A) Massage reddened areas
B) Reposition every 2 hours
C) Keep patient in one position
D) Avoid using moisturizers
Answer: B) Reposition every 2 hours
Rationale: Frequent repositioning reduces pressure and prevents pressure ulcers.
15. Which of the following is a priority for a patient with suspected sepsis?
A) Administering IV antibiotics within 1 hour
B) Waiting for lab results
C) Giving oral fluids
D) Monitoring urine output daily
Answer: A) Administering IV antibiotics within 1 hour
Rationale: Early antibiotics reduce mortality in sepsis patients.
16. A nurse teaches a patient to use an incentive spirometer. Which instruction is correct?
A) Exhale forcefully into the device
B) Inhale slowly and deeply to raise the piston
C) Use only when short of breath
D) Sit lying down while using
Answer: B) Inhale slowly and deeply to raise the piston
Rationale: Proper technique helps prevent postoperative atelectasis.
17. A patient is on warfarin therapy. Which food should the nurse advise the patient to
monitor?
A) Foods high in vitamin K like spinach
B) High-sugar foods
C) Dairy products only
D) Low-protein foods
Answer: A) Foods high in vitamin K like spinach
Rationale: Vitamin K can counteract warfarin, affecting anticoagulation.
18. Which patient should the nurse see first?
A) Patient with controlled hypertension
B) Patient with chest pain radiating to the left arm
