NSG 3250 Final Exam V2 | NSG 3250 Adult
Health I | Galen College of Nursing | Q&A
with Rationale (Galen NSG3250 Final
Exam)
1. A nurse is assessing a client who is 24 hours postoperative following abdominal surgery.
Which of the following findings should the nurse report to the provider immediately?
A. Urine output of 20 mL/hr for the past 2 hours
B. Absent bowel sounds in all four quadrants
C. A blood pressure of 110/72 mmHg
D. Serosanguineous drainage on the abdominal dressing
Answer: A
Rationale: A urine output of less than 30 mL/hr can indicate decreased renal perfusion or
hypovolemia, which are critical complications following surgery. The nurse must prioritize
this finding as it suggests potential acute kidney injury or shock. While absent bowel
sounds are common immediately post-op, they should be monitored, but low urine output
requires immediate intervention.
2. A nurse is teaching a client with chronic obstructive pulmonary disease (COPD) about
pursed-lip breathing. Which of the following statements should the nurse include?
A. Inhale quickly through your mouth.
,B. Exhale through your nose while keeping your mouth open.
C. Puff out your cheeks while you exhale.
D. Exhale for twice as long as you inhale.
Answer: D
Rationale: Pursed-lip breathing helps to maintain airway pressure and keep the airways
open longer, allowing for more effective CO2 removal. The client should be instructed to
breathe in through the nose and exhale slowly through pursed lips. This technique
specifically lengthens the expiratory phase to prevent air trapping in the alveoli.
3. A client is admitted with a suspected diagnosis of pulmonary embolism. Which of the
following diagnostic tests is considered the ‘gold standard’ for confirming this condition?
A. Chest X-ray
B. Arterial Blood Gas (ABG)
C. Electrocardiogram (ECG)
D. Computed Tomography Angiography (CTA)
Answer: D
Rationale: Computed Tomography Angiography is the primary diagnostic tool used to
visualize clots in the pulmonary vasculature. While other tests like chest X-rays or ECGs can
rule out other conditions, they do not confirm a PE. The CTA provides high-resolution
images that allow for a definitive diagnosis and immediate initiation of treatment.
, 4. A nurse is reviewing the laboratory results of a client receiving heparin via continuous IV
infusion. Which of the following values should the nurse report to the provider?
A. aPTT of 75 seconds
B. Hgb of 14 g/dL
C. Platelet count of 90,000/mm3
D. INR of 1.1
Answer: C
Rationale: A platelet count below 100,000/mm3 in a client receiving heparin may indicate
heparin-induced thrombocytopenia (HIT). HIT is a serious immune-mediated reaction that
puts the client at risk for both bleeding and paradoxical clotting. The nurse must report this
immediately to stop heparin therapy and use an alternative anticoagulant.
5. A client with Type 1 Diabetes Mellitus is found unresponsive and clammy. What is the
priority nursing action?
A. Administer glucagon intramuscularly or subcutaneously.
B. Check the client’s blood glucose level.
C. Administer 15g of simple carbohydrates orally.
D. Contact the rapid response team.
Answer: A
Health I | Galen College of Nursing | Q&A
with Rationale (Galen NSG3250 Final
Exam)
1. A nurse is assessing a client who is 24 hours postoperative following abdominal surgery.
Which of the following findings should the nurse report to the provider immediately?
A. Urine output of 20 mL/hr for the past 2 hours
B. Absent bowel sounds in all four quadrants
C. A blood pressure of 110/72 mmHg
D. Serosanguineous drainage on the abdominal dressing
Answer: A
Rationale: A urine output of less than 30 mL/hr can indicate decreased renal perfusion or
hypovolemia, which are critical complications following surgery. The nurse must prioritize
this finding as it suggests potential acute kidney injury or shock. While absent bowel
sounds are common immediately post-op, they should be monitored, but low urine output
requires immediate intervention.
2. A nurse is teaching a client with chronic obstructive pulmonary disease (COPD) about
pursed-lip breathing. Which of the following statements should the nurse include?
A. Inhale quickly through your mouth.
,B. Exhale through your nose while keeping your mouth open.
C. Puff out your cheeks while you exhale.
D. Exhale for twice as long as you inhale.
Answer: D
Rationale: Pursed-lip breathing helps to maintain airway pressure and keep the airways
open longer, allowing for more effective CO2 removal. The client should be instructed to
breathe in through the nose and exhale slowly through pursed lips. This technique
specifically lengthens the expiratory phase to prevent air trapping in the alveoli.
3. A client is admitted with a suspected diagnosis of pulmonary embolism. Which of the
following diagnostic tests is considered the ‘gold standard’ for confirming this condition?
A. Chest X-ray
B. Arterial Blood Gas (ABG)
C. Electrocardiogram (ECG)
D. Computed Tomography Angiography (CTA)
Answer: D
Rationale: Computed Tomography Angiography is the primary diagnostic tool used to
visualize clots in the pulmonary vasculature. While other tests like chest X-rays or ECGs can
rule out other conditions, they do not confirm a PE. The CTA provides high-resolution
images that allow for a definitive diagnosis and immediate initiation of treatment.
, 4. A nurse is reviewing the laboratory results of a client receiving heparin via continuous IV
infusion. Which of the following values should the nurse report to the provider?
A. aPTT of 75 seconds
B. Hgb of 14 g/dL
C. Platelet count of 90,000/mm3
D. INR of 1.1
Answer: C
Rationale: A platelet count below 100,000/mm3 in a client receiving heparin may indicate
heparin-induced thrombocytopenia (HIT). HIT is a serious immune-mediated reaction that
puts the client at risk for both bleeding and paradoxical clotting. The nurse must report this
immediately to stop heparin therapy and use an alternative anticoagulant.
5. A client with Type 1 Diabetes Mellitus is found unresponsive and clammy. What is the
priority nursing action?
A. Administer glucagon intramuscularly or subcutaneously.
B. Check the client’s blood glucose level.
C. Administer 15g of simple carbohydrates orally.
D. Contact the rapid response team.
Answer: A