PN 3001 Final Exam | Questions and
Answers | Accurate | Verified 2026 Actual
Questions and Correct Answers (Verified)
Plus Rationales | Instant Download PDF
Question 1:
A nurse is preparing to administer furosemide to a client with heart failure.
Which of the following actions should the nurse take prior to administration?
A) Administer the dose as ordered and monitor intake and output
B) Check the most recent serum potassium level and notify the provider
if low
C) Administer the medication with food to prevent GI upset
D) Hold the medication if the client reports dizziness
Rationale: Loop diuretics like furosemide cause significant potassium loss,
which can lead to life-threatening dysrhythmias. The nurse must verify
potassium levels prior to administration per the nursing process and
medication administration standards to prevent adverse effects and ensure
safe care. Hypokalemia is a common adverse effect that can precipitate
cardiac arrhythmias.
Question 2:
A client with diabetes mellitus type 1 is admitted with diabetic ketoacidosis
(DKA). Which clinical manifestation is most consistent with this condition?
A) Bradycardia and hypertension
B) Kussmaul respirations, fruity breath odor, and polyuria
C) Hypoglycemia with diaphoresis
D) Hypertension with borborygmi
Rationale: In DKA, insulin deficiency leads to hyperglycemia, ketosis, and
metabolic acidosis. The body compensates with deep, rapid Kussmaul
respirations to blow off CO2, while ketone production causes fruity breath
,(acetone). Osmotic diuresis from hyperglycemia leads to polyuria and
dehydration. This requires immediate fluid resuscitation and insulin therapy.
Question 3:
The nurse is preparing to administer insulin to a client. Which action
demonstrates correct medication administration technique?
A) Shake the insulin vial vigorously before drawing up the dose
B) Administer rapid-acting insulin 15 minutes before meals
C) Mix NPH and regular insulin together
D) Store opened insulin vials in the freezer
Rationale: Rapid-acting insulin (e.g., lispro, aspart) should be administered
15 minutes before meals to match the onset of action with postprandial
glucose rise. Insulin vials should be rolled, not shaken. NPH and regular
insulin can be mixed but require specific technique. Opened insulin vials
should be stored at room temperature, not in the freezer.
Question 4:
A postoperative client reports severe pain rated 9/10 despite receiving
morphine 4 mg IV 30 minutes ago. What is the nurse's priority action?
A) Administer another dose of morphine immediately
B) Reassess pain using a different scale and check for complications
C) Document the pain as unrelieved and continue monitoring
D) Tell the client the pain will decrease soon
Rationale: Unrelieved severe pain requires reassessment for complications
such as bleeding, infection, or compartment syndrome. The nursing process
demands thorough evaluation before additional medication to ensure patient
safety and address the underlying cause. Reassessment is essential to
determine if the pain is expected or indicates a complication.
Question 5:
A client with pneumonia is receiving oxygen at 4 L/min via nasal cannula. The
SpO2 is 88%. What is the nurse's next action?
,A) Increase oxygen to 6 L/min
B) Place the client in high Fowler's position and notify the provider
C) Suction the airway
D) Decrease oxygen flow rate
Rationale: Hypoxemia despite supplemental oxygen requires consideration
of positioning to improve ventilation-perfusion matching and immediate
notification for possible escalation of therapy such as non-rebreather mask or
mechanical ventilation. High Fowler's position improves diaphragmatic
excursion and lung expansion.
Question 6:
The nurse is teaching a client about warfarin therapy. Which statement by the
client indicates understanding of dietary considerations?
A) "I will eat large amounts of spinach daily for vitamins."
B) "I will maintain consistent vitamin K intake."
C) "I can eat whatever I want as long as I take my medication."
D) "I should avoid all green vegetables."
Rationale: Warfarin's anticoagulant effect is antagonized by vitamin K. Clients
should maintain consistent vitamin K intake rather than avoiding all sources.
Sudden changes in vitamin K intake can alter INR levels. Spinach and other
green leafy vegetables are high in vitamin K and should be eaten consistently.
Question 7:
A client with chronic obstructive pulmonary disease (COPD) has an oxygen
saturation of 89% on room air. The nurse should administer oxygen at:
A) 2 L/min via nasal cannula
B) 1-2 L/min via nasal cannula with monitoring for respiratory
depression
C) 4 L/min via nasal cannula
D) 6 L/min via non-rebreather mask
Rationale: Clients with COPD may have hypoxic drive, where the respiratory
drive is stimulated by low oxygen levels rather than high CO2. High oxygen
, concentrations can depress respiratory drive. Oxygen should be administered
at 1-2 L/min with careful monitoring of respiratory rate and mental status.
Question 8:
A client with heart failure has jugular venous distention, peripheral edema,
and crackles in the lung bases. Which of the following is the priority nursing
intervention?
A) Administer prescribed diuretic
B) Place the client in high Fowler's position
C) Restrict oral fluid intake
D) Monitor daily weights
Rationale: High Fowler's position reduces venous return and decreases
preload, helping to relieve pulmonary congestion and improve breathing. This
is the priority intervention to improve oxygenation. Diuretics, fluid restriction,
and weight monitoring are important but follow positioning.
Question 9:
A client with a new diagnosis of hypertension is prescribed lisinopril. Which
adverse effect should the nurse teach the client to report?
A) Dry cough
B) Angioedema and persistent cough
C) Hypotension
D) Hyperkalemia
Rationale: Angioedema is a serious adverse effect of ACE inhibitors
(lisinopril) that requires immediate medical attention. A persistent dry cough
is a common side effect but is not life-threatening. Hypotension and
hyperkalemia are also adverse effects but are less emergent than angioedema.
Question 10:
A client with diabetes mellitus type 2 is prescribed metformin. Which
instruction should the nurse include in client teaching?
Answers | Accurate | Verified 2026 Actual
Questions and Correct Answers (Verified)
Plus Rationales | Instant Download PDF
Question 1:
A nurse is preparing to administer furosemide to a client with heart failure.
Which of the following actions should the nurse take prior to administration?
A) Administer the dose as ordered and monitor intake and output
B) Check the most recent serum potassium level and notify the provider
if low
C) Administer the medication with food to prevent GI upset
D) Hold the medication if the client reports dizziness
Rationale: Loop diuretics like furosemide cause significant potassium loss,
which can lead to life-threatening dysrhythmias. The nurse must verify
potassium levels prior to administration per the nursing process and
medication administration standards to prevent adverse effects and ensure
safe care. Hypokalemia is a common adverse effect that can precipitate
cardiac arrhythmias.
Question 2:
A client with diabetes mellitus type 1 is admitted with diabetic ketoacidosis
(DKA). Which clinical manifestation is most consistent with this condition?
A) Bradycardia and hypertension
B) Kussmaul respirations, fruity breath odor, and polyuria
C) Hypoglycemia with diaphoresis
D) Hypertension with borborygmi
Rationale: In DKA, insulin deficiency leads to hyperglycemia, ketosis, and
metabolic acidosis. The body compensates with deep, rapid Kussmaul
respirations to blow off CO2, while ketone production causes fruity breath
,(acetone). Osmotic diuresis from hyperglycemia leads to polyuria and
dehydration. This requires immediate fluid resuscitation and insulin therapy.
Question 3:
The nurse is preparing to administer insulin to a client. Which action
demonstrates correct medication administration technique?
A) Shake the insulin vial vigorously before drawing up the dose
B) Administer rapid-acting insulin 15 minutes before meals
C) Mix NPH and regular insulin together
D) Store opened insulin vials in the freezer
Rationale: Rapid-acting insulin (e.g., lispro, aspart) should be administered
15 minutes before meals to match the onset of action with postprandial
glucose rise. Insulin vials should be rolled, not shaken. NPH and regular
insulin can be mixed but require specific technique. Opened insulin vials
should be stored at room temperature, not in the freezer.
Question 4:
A postoperative client reports severe pain rated 9/10 despite receiving
morphine 4 mg IV 30 minutes ago. What is the nurse's priority action?
A) Administer another dose of morphine immediately
B) Reassess pain using a different scale and check for complications
C) Document the pain as unrelieved and continue monitoring
D) Tell the client the pain will decrease soon
Rationale: Unrelieved severe pain requires reassessment for complications
such as bleeding, infection, or compartment syndrome. The nursing process
demands thorough evaluation before additional medication to ensure patient
safety and address the underlying cause. Reassessment is essential to
determine if the pain is expected or indicates a complication.
Question 5:
A client with pneumonia is receiving oxygen at 4 L/min via nasal cannula. The
SpO2 is 88%. What is the nurse's next action?
,A) Increase oxygen to 6 L/min
B) Place the client in high Fowler's position and notify the provider
C) Suction the airway
D) Decrease oxygen flow rate
Rationale: Hypoxemia despite supplemental oxygen requires consideration
of positioning to improve ventilation-perfusion matching and immediate
notification for possible escalation of therapy such as non-rebreather mask or
mechanical ventilation. High Fowler's position improves diaphragmatic
excursion and lung expansion.
Question 6:
The nurse is teaching a client about warfarin therapy. Which statement by the
client indicates understanding of dietary considerations?
A) "I will eat large amounts of spinach daily for vitamins."
B) "I will maintain consistent vitamin K intake."
C) "I can eat whatever I want as long as I take my medication."
D) "I should avoid all green vegetables."
Rationale: Warfarin's anticoagulant effect is antagonized by vitamin K. Clients
should maintain consistent vitamin K intake rather than avoiding all sources.
Sudden changes in vitamin K intake can alter INR levels. Spinach and other
green leafy vegetables are high in vitamin K and should be eaten consistently.
Question 7:
A client with chronic obstructive pulmonary disease (COPD) has an oxygen
saturation of 89% on room air. The nurse should administer oxygen at:
A) 2 L/min via nasal cannula
B) 1-2 L/min via nasal cannula with monitoring for respiratory
depression
C) 4 L/min via nasal cannula
D) 6 L/min via non-rebreather mask
Rationale: Clients with COPD may have hypoxic drive, where the respiratory
drive is stimulated by low oxygen levels rather than high CO2. High oxygen
, concentrations can depress respiratory drive. Oxygen should be administered
at 1-2 L/min with careful monitoring of respiratory rate and mental status.
Question 8:
A client with heart failure has jugular venous distention, peripheral edema,
and crackles in the lung bases. Which of the following is the priority nursing
intervention?
A) Administer prescribed diuretic
B) Place the client in high Fowler's position
C) Restrict oral fluid intake
D) Monitor daily weights
Rationale: High Fowler's position reduces venous return and decreases
preload, helping to relieve pulmonary congestion and improve breathing. This
is the priority intervention to improve oxygenation. Diuretics, fluid restriction,
and weight monitoring are important but follow positioning.
Question 9:
A client with a new diagnosis of hypertension is prescribed lisinopril. Which
adverse effect should the nurse teach the client to report?
A) Dry cough
B) Angioedema and persistent cough
C) Hypotension
D) Hyperkalemia
Rationale: Angioedema is a serious adverse effect of ACE inhibitors
(lisinopril) that requires immediate medical attention. A persistent dry cough
is a common side effect but is not life-threatening. Hypotension and
hyperkalemia are also adverse effects but are less emergent than angioedema.
Question 10:
A client with diabetes mellitus type 2 is prescribed metformin. Which
instruction should the nurse include in client teaching?
