NURS 280 FINAL EXAM STUDY GUIDE | TESTBANK | PRACTICE QUESTIONS &
ANSWERS | EXAM PREPARATION | COMPREHENSIVE PRACTICE EXAM | LATEST
UPDATE 2026/2027 | ADVANCED REVIEW
Examiner:
Institution-specific (NURS 280 course final examinations are administered by
individual colleges or universities and are not governed by a single national
examining organization.)
TABLE OF CONTENTS
1. Comprehensive Patient Assessment
2. Clinical Judgment and Nursing Process
3. Adult Medical-Surgical Nursing
4. Pharmacology and Medication Safety
5. Fluid, Electrolyte, and Acid-Base Balance
6. Cardiovascular Disorders
7. Respiratory Disorders
8. Endocrine Disorders
9. Neurological Disorders
10. Gastrointestinal and Renal Disorders
11. Infection Prevention and Sepsis
12. Perioperative Nursing
13. Pain Management
14. Patient Safety and Quality Improvement
15. Delegation, Prioritization, and Professional Practice
CLINICAL JUDGMENT || PRIORITIZATION || PATIENT SAFETY || PHARMACOLOGY ||
MEDICATION ADMINISTRATION || NURSING PROCESS || FLUID BALANCE ||
ELECTROLYTES || CARDIOVASCULAR CARE || RESPIRATORY MANAGEMENT ||
ENDOCRINE DISORDERS || NEUROLOGICAL ASSESSMENT || INFECTION CONTROL
|| SEPSIS || PAIN MANAGEMENT || DELEGATION || ETHICS || EVIDENCE-BASED
PRACTICE || QUALITY IMPROVEMENT || CRITICAL THINKING
,QUESTION 1.
A nurse is caring for four postoperative patients. Which patient should be assessed
first?
A. A patient reporting sudden shortness of breath and pleuritic chest pain 24 hours
after hip surgery.
B. A patient requesting pain medication for incisional pain rated 7/10.
C. A patient whose dressing has a small amount of serosanguineous drainage.
D. A patient awaiting discharge instructions.
🔴 Correct Answer: A. A patient reporting sudden shortness of breath and
pleuritic chest pain 24 hours after hip surgery.
🔵 Explanation: Sudden dyspnea and pleuritic chest pain after orthopedic surgery
strongly suggest a pulmonary embolism, which is immediately life-threatening and
requires rapid assessment and intervention. The remaining patients have stable or
expected postoperative findings that can safely wait.
QUESTION 2.
A patient with diabetic ketoacidosis is receiving intravenous insulin therapy. Which
assessment finding indicates the treatment is most effective?
A. Serum sodium increases to the upper normal limit.
B. Blood glucose decreases gradually while the anion gap narrows.
C. Urine output decreases below baseline.
D. Serum osmolality remains unchanged.
🔴 Correct Answer: B. Blood glucose decreases gradually while the anion gap
narrows.
🔵 Explanation: Successful DKA treatment is reflected by gradual glucose reduction
and resolution of metabolic acidosis, demonstrated by closure of the anion gap. Sodium
changes may occur due to fluid shifts, decreased urine output is undesirable, and
unchanged osmolality does not indicate adequate correction.
,QUESTION 3.
A nurse delegates care to an experienced unlicensed assistive personnel (UAP).
Which task is appropriate?
A. Evaluate the effectiveness of pain medication.
B. Reinforce discharge teaching regarding insulin administration.
C. Obtain routine vital signs for a clinically stable patient.
D. Interpret abnormal cardiac telemetry findings.
🔴 Correct Answer: C. Obtain routine vital signs for a clinically stable patient.
🔵 Explanation: Obtaining routine vital signs for stable patients is within the UAP
scope of practice. Evaluation, patient education, and interpretation of clinical findings
require nursing judgment and must remain the responsibility of the registered nurse.
QUESTION 4.
A patient receiving intravenous potassium replacement reports burning at the
infusion site. What is the nurse's priority action?
A. Increase the infusion rate.
B. Discontinue the infusion and assess the IV site.
C. Flush the IV rapidly with normal saline.
D. Apply heat without further assessment.
🔴 Correct Answer: B. Discontinue the infusion and assess the IV site.
🔵 Explanation: Potassium is irritating to veins and infiltration or phlebitis must be
assessed immediately. Increasing the rate or rapidly flushing may worsen tissue injury,
while heat should not be applied until the cause is determined.
QUESTION 5.
A patient develops confusion, hypotension, fever, tachycardia, and an elevated serum
lactate. Which nursing intervention should occur first?
, A. Obtain blood cultures and begin the prescribed sepsis protocol.
B. Administer acetaminophen.
C. Restrict intravenous fluids.
D. Delay antibiotics until culture results return.
🔴 Correct Answer: A. Obtain blood cultures and begin the prescribed sepsis
protocol.
🔵 Explanation: Early recognition and rapid initiation of the sepsis bundle significantly
improve outcomes. Blood cultures should be obtained before antibiotics when possible,
but antibiotic therapy should not be unnecessarily delayed. Fever management is
secondary, and fluid restriction is contraindicated.
QUESTION 6.
A nurse evaluates arterial blood gas results: pH 7.30, PaCO₂ 52 mmHg, HCO₃⁻ 26
mEq/L. Which interpretation is correct?
A. Metabolic alkalosis.
B. Respiratory alkalosis.
C. Uncompensated respiratory acidosis.
D. Fully compensated metabolic acidosis.
🔴 Correct Answer: C. Uncompensated respiratory acidosis.
🔵 Explanation: The low pH indicates acidosis, while the elevated PaCO₂ identifies the
respiratory origin. Because bicarbonate remains within the normal range, renal
compensation has not yet occurred.
QUESTION 7.
A patient with heart failure suddenly becomes increasingly dyspneic and has bilateral
crackles. Which prescription should the nurse anticipate implementing first?
A. Encourage oral fluid intake.
B. Administer prescribed intravenous loop diuretic.
ANSWERS | EXAM PREPARATION | COMPREHENSIVE PRACTICE EXAM | LATEST
UPDATE 2026/2027 | ADVANCED REVIEW
Examiner:
Institution-specific (NURS 280 course final examinations are administered by
individual colleges or universities and are not governed by a single national
examining organization.)
TABLE OF CONTENTS
1. Comprehensive Patient Assessment
2. Clinical Judgment and Nursing Process
3. Adult Medical-Surgical Nursing
4. Pharmacology and Medication Safety
5. Fluid, Electrolyte, and Acid-Base Balance
6. Cardiovascular Disorders
7. Respiratory Disorders
8. Endocrine Disorders
9. Neurological Disorders
10. Gastrointestinal and Renal Disorders
11. Infection Prevention and Sepsis
12. Perioperative Nursing
13. Pain Management
14. Patient Safety and Quality Improvement
15. Delegation, Prioritization, and Professional Practice
CLINICAL JUDGMENT || PRIORITIZATION || PATIENT SAFETY || PHARMACOLOGY ||
MEDICATION ADMINISTRATION || NURSING PROCESS || FLUID BALANCE ||
ELECTROLYTES || CARDIOVASCULAR CARE || RESPIRATORY MANAGEMENT ||
ENDOCRINE DISORDERS || NEUROLOGICAL ASSESSMENT || INFECTION CONTROL
|| SEPSIS || PAIN MANAGEMENT || DELEGATION || ETHICS || EVIDENCE-BASED
PRACTICE || QUALITY IMPROVEMENT || CRITICAL THINKING
,QUESTION 1.
A nurse is caring for four postoperative patients. Which patient should be assessed
first?
A. A patient reporting sudden shortness of breath and pleuritic chest pain 24 hours
after hip surgery.
B. A patient requesting pain medication for incisional pain rated 7/10.
C. A patient whose dressing has a small amount of serosanguineous drainage.
D. A patient awaiting discharge instructions.
🔴 Correct Answer: A. A patient reporting sudden shortness of breath and
pleuritic chest pain 24 hours after hip surgery.
🔵 Explanation: Sudden dyspnea and pleuritic chest pain after orthopedic surgery
strongly suggest a pulmonary embolism, which is immediately life-threatening and
requires rapid assessment and intervention. The remaining patients have stable or
expected postoperative findings that can safely wait.
QUESTION 2.
A patient with diabetic ketoacidosis is receiving intravenous insulin therapy. Which
assessment finding indicates the treatment is most effective?
A. Serum sodium increases to the upper normal limit.
B. Blood glucose decreases gradually while the anion gap narrows.
C. Urine output decreases below baseline.
D. Serum osmolality remains unchanged.
🔴 Correct Answer: B. Blood glucose decreases gradually while the anion gap
narrows.
🔵 Explanation: Successful DKA treatment is reflected by gradual glucose reduction
and resolution of metabolic acidosis, demonstrated by closure of the anion gap. Sodium
changes may occur due to fluid shifts, decreased urine output is undesirable, and
unchanged osmolality does not indicate adequate correction.
,QUESTION 3.
A nurse delegates care to an experienced unlicensed assistive personnel (UAP).
Which task is appropriate?
A. Evaluate the effectiveness of pain medication.
B. Reinforce discharge teaching regarding insulin administration.
C. Obtain routine vital signs for a clinically stable patient.
D. Interpret abnormal cardiac telemetry findings.
🔴 Correct Answer: C. Obtain routine vital signs for a clinically stable patient.
🔵 Explanation: Obtaining routine vital signs for stable patients is within the UAP
scope of practice. Evaluation, patient education, and interpretation of clinical findings
require nursing judgment and must remain the responsibility of the registered nurse.
QUESTION 4.
A patient receiving intravenous potassium replacement reports burning at the
infusion site. What is the nurse's priority action?
A. Increase the infusion rate.
B. Discontinue the infusion and assess the IV site.
C. Flush the IV rapidly with normal saline.
D. Apply heat without further assessment.
🔴 Correct Answer: B. Discontinue the infusion and assess the IV site.
🔵 Explanation: Potassium is irritating to veins and infiltration or phlebitis must be
assessed immediately. Increasing the rate or rapidly flushing may worsen tissue injury,
while heat should not be applied until the cause is determined.
QUESTION 5.
A patient develops confusion, hypotension, fever, tachycardia, and an elevated serum
lactate. Which nursing intervention should occur first?
, A. Obtain blood cultures and begin the prescribed sepsis protocol.
B. Administer acetaminophen.
C. Restrict intravenous fluids.
D. Delay antibiotics until culture results return.
🔴 Correct Answer: A. Obtain blood cultures and begin the prescribed sepsis
protocol.
🔵 Explanation: Early recognition and rapid initiation of the sepsis bundle significantly
improve outcomes. Blood cultures should be obtained before antibiotics when possible,
but antibiotic therapy should not be unnecessarily delayed. Fever management is
secondary, and fluid restriction is contraindicated.
QUESTION 6.
A nurse evaluates arterial blood gas results: pH 7.30, PaCO₂ 52 mmHg, HCO₃⁻ 26
mEq/L. Which interpretation is correct?
A. Metabolic alkalosis.
B. Respiratory alkalosis.
C. Uncompensated respiratory acidosis.
D. Fully compensated metabolic acidosis.
🔴 Correct Answer: C. Uncompensated respiratory acidosis.
🔵 Explanation: The low pH indicates acidosis, while the elevated PaCO₂ identifies the
respiratory origin. Because bicarbonate remains within the normal range, renal
compensation has not yet occurred.
QUESTION 7.
A patient with heart failure suddenly becomes increasingly dyspneic and has bilateral
crackles. Which prescription should the nurse anticipate implementing first?
A. Encourage oral fluid intake.
B. Administer prescribed intravenous loop diuretic.
