Master exam practice with these nursing
revision notes and practice questions for
student success.
## 📘 NR-224 / NR-226 / NR-283 / NR-293 /
NR-324 / NR-446 – Ultimate Med-Surg,
Fundamentals, and Pharmacology Prep
Guide for 2025/2026 Nursing Success 🏆
---
1. A nurse is assessing a patient with chronic obstructive pulmonary disease (COPD) who is receiving
oxygen at 2 L/min via nasal cannula. Which finding indicates that the oxygen therapy is effective?
A) Respiratory rate of 28 breaths/min
B) Oxygen saturation of 92% on pulse oximetry
C) Use of accessory muscles during inspiration
D) Arterial partial pressure of carbon dioxide (PaCO2) of 52 mmHg
💫ANSWER✔️✔️: B
,💫RATIONALE✔️✔️: An oxygen saturation of 92% indicates adequate oxygenation and is a sign that
the therapy is effective. A respiratory rate of 28 is tachypneic, accessory muscle use indicates respiratory
distress, and a PaCO2 of 52 suggests hypercapnia and possible impending respiratory failure. This
nursing exam prep question reinforces that target SpO2 for COPD is 88-92% to avoid suppressing the
hypoxic drive. For student success, these nursing revision notes emphasize monitoring for respiratory
depression and carbon dioxide retention in COPD patients receiving supplemental oxygen.
2. A patient prescribed digoxin (Lanoxin) for heart failure complains of nausea, vomiting, and visual
disturbances. Which laboratory value should the nurse check first?
A) Serum potassium level
B) Serum digoxin level
C) Serum sodium level
D) Serum calcium level
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: Nausea, vomiting, and visual disturbances are classic signs of digoxin toxicity.
The priority action is to check the serum digoxin level. While hypokalemia can predispose patients to
digoxin toxicity, the immediate concern is determining the drug level. This practice question highlights
the importance of monitoring therapeutic drug levels, a key concept in nursing exam prep. These
revision notes for student success underscore that digoxin toxicity is more common in elderly patients
and those with renal impairment.
3. A nurse is performing a sterile dressing change for a patient with a central venous catheter (CVC).
Which action is correct?
A) Clean the insertion site with a circular motion from the outer edges toward the center
B) Use clean gloves to remove the old dressing and sterile gloves for the new one
C) Apply the new transparent dressing directly over the catheter hub
D) Position the patient in a prone position during the dressing change
💫ANSWER✔️✔️: B
,💫RATIONALE✔️✔️: Using clean gloves to remove the old dressing and sterile gloves for the new one
is correct. Cleaning should be from the center outward in a circular motion to avoid contaminating the
site. Dressing should not cover the hub, and the patient should be supine or slightly tilted. This is a
common NCLEX-style prep question on infection control. This study guide emphasizes that sterile
technique is critical to prevent catheter-related bloodstream infections, a key learning point for nursing
exam prep.
4. A mother brings her 4-month-old infant to the clinic for a well-baby checkup. Which developmental
milestone should the nurse expect the infant to have achieved?
A) Sitting without support
B) Rolling from back to abdomen
C) Holding a rattle and transferring it from hand to hand
D) Crawling on hands and knees
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: Rolling from back to abdomen typically occurs around 4 to 6 months of age.
Sitting without support occurs around 6 to 8 months, transferring objects between hands occurs around
6 to 7 months, and crawling occurs around 7 to 10 months. This pediatric nursing practice question
helps in understanding developmental milestones. These nursing revision notes for student success
emphasize the need for accurate developmental assessment to identify early delays.
5. A patient with a diagnosis of major depressive disorder is prescribed fluoxetine (Prozac). The nurse
should provide which instruction regarding this medication?
A) Take the medication on an empty stomach to enhance absorption
B) Avoid foods high in tyramine, such as aged cheese and red wine
C) Expect to see full therapeutic effects within 24 to 48 hours
D) Report any new or worsening suicidal thoughts, especially in the first few weeks
💫ANSWER✔️✔️: D
, 💫RATIONALE✔️✔️: Fluoxetine, an SSRI, can increase the risk of suicidal ideation, particularly in
children, adolescents, and young adults. Patients and families should be educated to report any new or
worsening suicidal thoughts. It can be taken with or without food, does not require a low-tyramine diet
(this is for MAOIs), and typically takes 2-6 weeks for full therapeutic effect. This nursing exam prep
question is vital for mental health nursing. These study guide practice questions reinforce safe
prescribing and monitoring practices for student success.
6. A nurse is calculating the intravenous (IV) flow rate for a patient who needs 1000 mL of normal saline
over 8 hours. The IV tubing has a drop factor of 15 gtt/mL. What is the correct flow rate in drops per
minute?
A) 31 gtt/min
B) 125 gtt/min
C) 20 gtt/min
D) 100 gtt/min
💫ANSWER✔️✔️: A
💫RATIONALE✔️✔️: The formula is: (Total volume in mL / Total time in minutes) × Drop factor. 1000
mL / 480 minutes = 2.083 mL/min. 2.083 mL/min × 15 gtt/mL = 31.25 gtt/min, rounded to 31 gtt/min.
This dosage calculation question is a core component of nursing exam prep. These practice questions
help student success by reinforcing critical medication administration skills.
7. A patient with an adrenal insufficiency is at risk for an Addisonian crisis. Which symptom should the
nurse monitor for?
A) Hypernatremia and weight gain
B) Hypoglycemia and hypotension
C) Hyperkalemia and hypertension
D) Hyperglycemia and bradycardia
💫ANSWER✔️✔️: B
revision notes and practice questions for
student success.
## 📘 NR-224 / NR-226 / NR-283 / NR-293 /
NR-324 / NR-446 – Ultimate Med-Surg,
Fundamentals, and Pharmacology Prep
Guide for 2025/2026 Nursing Success 🏆
---
1. A nurse is assessing a patient with chronic obstructive pulmonary disease (COPD) who is receiving
oxygen at 2 L/min via nasal cannula. Which finding indicates that the oxygen therapy is effective?
A) Respiratory rate of 28 breaths/min
B) Oxygen saturation of 92% on pulse oximetry
C) Use of accessory muscles during inspiration
D) Arterial partial pressure of carbon dioxide (PaCO2) of 52 mmHg
💫ANSWER✔️✔️: B
,💫RATIONALE✔️✔️: An oxygen saturation of 92% indicates adequate oxygenation and is a sign that
the therapy is effective. A respiratory rate of 28 is tachypneic, accessory muscle use indicates respiratory
distress, and a PaCO2 of 52 suggests hypercapnia and possible impending respiratory failure. This
nursing exam prep question reinforces that target SpO2 for COPD is 88-92% to avoid suppressing the
hypoxic drive. For student success, these nursing revision notes emphasize monitoring for respiratory
depression and carbon dioxide retention in COPD patients receiving supplemental oxygen.
2. A patient prescribed digoxin (Lanoxin) for heart failure complains of nausea, vomiting, and visual
disturbances. Which laboratory value should the nurse check first?
A) Serum potassium level
B) Serum digoxin level
C) Serum sodium level
D) Serum calcium level
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: Nausea, vomiting, and visual disturbances are classic signs of digoxin toxicity.
The priority action is to check the serum digoxin level. While hypokalemia can predispose patients to
digoxin toxicity, the immediate concern is determining the drug level. This practice question highlights
the importance of monitoring therapeutic drug levels, a key concept in nursing exam prep. These
revision notes for student success underscore that digoxin toxicity is more common in elderly patients
and those with renal impairment.
3. A nurse is performing a sterile dressing change for a patient with a central venous catheter (CVC).
Which action is correct?
A) Clean the insertion site with a circular motion from the outer edges toward the center
B) Use clean gloves to remove the old dressing and sterile gloves for the new one
C) Apply the new transparent dressing directly over the catheter hub
D) Position the patient in a prone position during the dressing change
💫ANSWER✔️✔️: B
,💫RATIONALE✔️✔️: Using clean gloves to remove the old dressing and sterile gloves for the new one
is correct. Cleaning should be from the center outward in a circular motion to avoid contaminating the
site. Dressing should not cover the hub, and the patient should be supine or slightly tilted. This is a
common NCLEX-style prep question on infection control. This study guide emphasizes that sterile
technique is critical to prevent catheter-related bloodstream infections, a key learning point for nursing
exam prep.
4. A mother brings her 4-month-old infant to the clinic for a well-baby checkup. Which developmental
milestone should the nurse expect the infant to have achieved?
A) Sitting without support
B) Rolling from back to abdomen
C) Holding a rattle and transferring it from hand to hand
D) Crawling on hands and knees
💫ANSWER✔️✔️: B
💫RATIONALE✔️✔️: Rolling from back to abdomen typically occurs around 4 to 6 months of age.
Sitting without support occurs around 6 to 8 months, transferring objects between hands occurs around
6 to 7 months, and crawling occurs around 7 to 10 months. This pediatric nursing practice question
helps in understanding developmental milestones. These nursing revision notes for student success
emphasize the need for accurate developmental assessment to identify early delays.
5. A patient with a diagnosis of major depressive disorder is prescribed fluoxetine (Prozac). The nurse
should provide which instruction regarding this medication?
A) Take the medication on an empty stomach to enhance absorption
B) Avoid foods high in tyramine, such as aged cheese and red wine
C) Expect to see full therapeutic effects within 24 to 48 hours
D) Report any new or worsening suicidal thoughts, especially in the first few weeks
💫ANSWER✔️✔️: D
, 💫RATIONALE✔️✔️: Fluoxetine, an SSRI, can increase the risk of suicidal ideation, particularly in
children, adolescents, and young adults. Patients and families should be educated to report any new or
worsening suicidal thoughts. It can be taken with or without food, does not require a low-tyramine diet
(this is for MAOIs), and typically takes 2-6 weeks for full therapeutic effect. This nursing exam prep
question is vital for mental health nursing. These study guide practice questions reinforce safe
prescribing and monitoring practices for student success.
6. A nurse is calculating the intravenous (IV) flow rate for a patient who needs 1000 mL of normal saline
over 8 hours. The IV tubing has a drop factor of 15 gtt/mL. What is the correct flow rate in drops per
minute?
A) 31 gtt/min
B) 125 gtt/min
C) 20 gtt/min
D) 100 gtt/min
💫ANSWER✔️✔️: A
💫RATIONALE✔️✔️: The formula is: (Total volume in mL / Total time in minutes) × Drop factor. 1000
mL / 480 minutes = 2.083 mL/min. 2.083 mL/min × 15 gtt/mL = 31.25 gtt/min, rounded to 31 gtt/min.
This dosage calculation question is a core component of nursing exam prep. These practice questions
help student success by reinforcing critical medication administration skills.
7. A patient with an adrenal insufficiency is at risk for an Addisonian crisis. Which symptom should the
nurse monitor for?
A) Hypernatremia and weight gain
B) Hypoglycemia and hypotension
C) Hyperkalemia and hypertension
D) Hyperglycemia and bradycardia
💫ANSWER✔️✔️: B
