NURS 190 PA MIDTERM PRACTICE EXAM (SPRING 2026
NEWEST&LATEST UPDATE LEVEL<already graded A+>)
(Advanced Questions & Answers with useful Rationales)
1. Clinical Judgment – Deteriorating Patient
A 67-year-old client admitted with pneumonia becomes increasingly restless and confused over the last
hour. Vital signs: BP 138/84, HR 118, RR 32, Temp 38.9°C, SpO₂ 88% on 2L nasal cannula. Which
nursing action is priority?
A. Administer prescribed antipyretic medication to reduce fever
B. Increase oxygen delivery and reassess respiratory status immediately
C. Document findings and notify the provider after completing assessment
D. Encourage fluid intake to prevent dehydration
Answer: B
Rationale: Restlessness + low oxygen = hypoxia. Airway/oxygenation is priority before other
interventions.
2. Safety & Delegation
The nurse is supervising a UAP caring for multiple patients. Which action requires immediate
correction?
A. Reporting vital signs outside normal range to the nurse
B. Assisting a patient with ambulation using a gait belt
C. Feeding a patient with dysphagia without supervision
D. Measuring intake and output for a stable patient
Answer: C
Rationale: Dysphagia = aspiration risk → requires licensed supervision.
3. Infection Control
A patient diagnosed with Clostridioides difficile infection requires which precaution?
A. Standard precautions with alcohol-based hand sanitizer
B. Contact precautions with soap-and-water hand hygiene
C. Droplet precautions with surgical mask use
D. Airborne precautions in negative-pressure room
Answer: B
Rationale: C. diff spores require soap and water, not alcohol.
,4. Pharmacology – Medication Safety
A nurse prepares to administer insulin but notices the patient’s blood glucose is 62 mg/dL and the patient
is diaphoretic and shaky. What is the best action?
A. Administer insulin and monitor closely
B. Hold insulin and give a fast-acting carbohydrate
C. Notify provider before any action
D. Recheck glucose in one hour
Answer: B
Rationale: Treat hypoglycemia immediately.
5. Prioritization
Which patient should the nurse assess first?
A. A postoperative patient requesting pain medication
B. A patient with asthma reporting increasing shortness of breath
C. A patient with diabetes awaiting discharge teaching
D. A stable patient with hypertension needing medication
Answer: B
Rationale: Airway compromise = highest priority.
6. Fluid & Electrolyte Balance
A patient has sodium level of 122 mEq/L and is confused. Which intervention is most appropriate?
A. Encourage oral free water intake
B. Administer hypertonic saline as prescribed
C. Restrict sodium intake
D. Provide diuretics immediately
Answer: B
Rationale: Severe hyponatremia → risk of seizures, needs correction.
7. Ethical Decision-Making
A competent patient refuses a life-saving blood transfusion. What should the nurse do?
A. Administer transfusion anyway
B. Notify family immediately
C. Respect patient’s decision and inform provider
D. Seek court order
,Answer: C
Rationale: Patient autonomy must be respected.
8. Assessment Skills
Which finding requires immediate follow-up?
A. BP 138/88 in a hypertensive patient
B. HR 54 in a well-trained athlete
C. Sudden onset unilateral weakness
D. Mild headache
Answer: C
Rationale: Possible stroke.
9. Postoperative Care
A patient 4 hours post-surgery has HR 120, BP 88/54, pale skin, and decreased urine output. What is
priority?
A. Administer pain medication
B. Increase IV fluids and notify provider
C. Encourage deep breathing
D. Reassure patient
Answer: B
Rationale: Signs of shock/hemorrhage.
10. Respiratory
Which finding suggests worsening respiratory status?
A. RR 20/min
B. SpO₂ 95%
C. Use of accessory muscles
D. Clear breath sounds
Answer: C
Rationale: Indicates increased work of breathing.
11. Patient Education
Which statement indicates understanding of hypertension management?
A. “I will stop medication when I feel better.”
B. “I will reduce sodium intake.”
, C. “I only need to monitor BP occasionally.”
D. “Exercise is not important.”
Answer: B
Rationale: Sodium reduction helps BP control.
12. Neurological
A patient has unequal pupils and decreased LOC. What is priority?
A. Document findings
B. Notify provider immediately
C. Reassess in 30 minutes
D. Encourage rest
Answer: B
Rationale: Possible increased ICP.
13. Medication Administration
Which action is correct?
A. Crushing enteric-coated tablets
B. Mixing all medications together
C. Verifying patient identity using two identifiers
D. Administering meds without checking allergies
Answer: C
Rationale: Fundamental safety step.
14. Pediatric Care
A child with dehydration shows which severe sign?
A. Moist mucous membranes
B. Increased urination
C. Sunken eyes
D. Active play
Answer: C
Rationale: Indicates severe dehydration.
15. Mental Health
Best response to anxious patient?
NEWEST&LATEST UPDATE LEVEL<already graded A+>)
(Advanced Questions & Answers with useful Rationales)
1. Clinical Judgment – Deteriorating Patient
A 67-year-old client admitted with pneumonia becomes increasingly restless and confused over the last
hour. Vital signs: BP 138/84, HR 118, RR 32, Temp 38.9°C, SpO₂ 88% on 2L nasal cannula. Which
nursing action is priority?
A. Administer prescribed antipyretic medication to reduce fever
B. Increase oxygen delivery and reassess respiratory status immediately
C. Document findings and notify the provider after completing assessment
D. Encourage fluid intake to prevent dehydration
Answer: B
Rationale: Restlessness + low oxygen = hypoxia. Airway/oxygenation is priority before other
interventions.
2. Safety & Delegation
The nurse is supervising a UAP caring for multiple patients. Which action requires immediate
correction?
A. Reporting vital signs outside normal range to the nurse
B. Assisting a patient with ambulation using a gait belt
C. Feeding a patient with dysphagia without supervision
D. Measuring intake and output for a stable patient
Answer: C
Rationale: Dysphagia = aspiration risk → requires licensed supervision.
3. Infection Control
A patient diagnosed with Clostridioides difficile infection requires which precaution?
A. Standard precautions with alcohol-based hand sanitizer
B. Contact precautions with soap-and-water hand hygiene
C. Droplet precautions with surgical mask use
D. Airborne precautions in negative-pressure room
Answer: B
Rationale: C. diff spores require soap and water, not alcohol.
,4. Pharmacology – Medication Safety
A nurse prepares to administer insulin but notices the patient’s blood glucose is 62 mg/dL and the patient
is diaphoretic and shaky. What is the best action?
A. Administer insulin and monitor closely
B. Hold insulin and give a fast-acting carbohydrate
C. Notify provider before any action
D. Recheck glucose in one hour
Answer: B
Rationale: Treat hypoglycemia immediately.
5. Prioritization
Which patient should the nurse assess first?
A. A postoperative patient requesting pain medication
B. A patient with asthma reporting increasing shortness of breath
C. A patient with diabetes awaiting discharge teaching
D. A stable patient with hypertension needing medication
Answer: B
Rationale: Airway compromise = highest priority.
6. Fluid & Electrolyte Balance
A patient has sodium level of 122 mEq/L and is confused. Which intervention is most appropriate?
A. Encourage oral free water intake
B. Administer hypertonic saline as prescribed
C. Restrict sodium intake
D. Provide diuretics immediately
Answer: B
Rationale: Severe hyponatremia → risk of seizures, needs correction.
7. Ethical Decision-Making
A competent patient refuses a life-saving blood transfusion. What should the nurse do?
A. Administer transfusion anyway
B. Notify family immediately
C. Respect patient’s decision and inform provider
D. Seek court order
,Answer: C
Rationale: Patient autonomy must be respected.
8. Assessment Skills
Which finding requires immediate follow-up?
A. BP 138/88 in a hypertensive patient
B. HR 54 in a well-trained athlete
C. Sudden onset unilateral weakness
D. Mild headache
Answer: C
Rationale: Possible stroke.
9. Postoperative Care
A patient 4 hours post-surgery has HR 120, BP 88/54, pale skin, and decreased urine output. What is
priority?
A. Administer pain medication
B. Increase IV fluids and notify provider
C. Encourage deep breathing
D. Reassure patient
Answer: B
Rationale: Signs of shock/hemorrhage.
10. Respiratory
Which finding suggests worsening respiratory status?
A. RR 20/min
B. SpO₂ 95%
C. Use of accessory muscles
D. Clear breath sounds
Answer: C
Rationale: Indicates increased work of breathing.
11. Patient Education
Which statement indicates understanding of hypertension management?
A. “I will stop medication when I feel better.”
B. “I will reduce sodium intake.”
, C. “I only need to monitor BP occasionally.”
D. “Exercise is not important.”
Answer: B
Rationale: Sodium reduction helps BP control.
12. Neurological
A patient has unequal pupils and decreased LOC. What is priority?
A. Document findings
B. Notify provider immediately
C. Reassess in 30 minutes
D. Encourage rest
Answer: B
Rationale: Possible increased ICP.
13. Medication Administration
Which action is correct?
A. Crushing enteric-coated tablets
B. Mixing all medications together
C. Verifying patient identity using two identifiers
D. Administering meds without checking allergies
Answer: C
Rationale: Fundamental safety step.
14. Pediatric Care
A child with dehydration shows which severe sign?
A. Moist mucous membranes
B. Increased urination
C. Sunken eyes
D. Active play
Answer: C
Rationale: Indicates severe dehydration.
15. Mental Health
Best response to anxious patient?
