NR 567 FINAL EXAM 300 TESTBANK QUESTIONS AND
CORRECT ANSWERS WITH RATIONALE LATEST 2026
ALREADY GRADED A+ ASSURED PASS
This comprehensive collection of 300 unique, non-repeating, multiple-choice
questions is specifically designed to mirror the clinical rigour and format of
advanced nursing examinations such as NR 567 and the NZ NCAP. Each
question presents a distinct, real-world clinical scenario that tests critical
nursing competencies across pharmacology, pathophysiology, and priority-
setting. The questions cover a wide spectrum of conditions, medications, and
patient populations, ensuring broad revision coverage. Every entry includes
the correct answer and a detailed, evidence-based rationale that explains the
underlying clinical reasoning, pharmacokinetics, or nursing priority, making
this an effective self-assessment and high-yield learning tool for exam
preparation and clinical practice.
1 A patient presents with acute onset of severe, sharp chest pain that worsens with
inspiration and is relieved by leaning forward. The nurse hears a pericardial
friction rub on auscultation. What is the most likely diagnosis and initial nursing
action?
A) Acute myocardial infarction; administer aspirin and nitroglycerin
B) Pericarditis; administer NSAIDs and prepare for echocardiogram
C) Pulmonary embolism; start heparin infusion
D) Aortic dissection; prepare for emergency surgery
Answer: B
Rationale: Pericarditis presents with sharp, pleuritic chest pain that improves with
sitting forward, and a pericardial friction rub is a classic finding. Initial
management includes anti-inflammatory medications like NSAIDs, and an
echocardiogram is used to assess for pericardial effusion.
2 A patient with chronic hypertension presents with a blood pressure of 210/120
mmHg and is asymptomatic. What is the most appropriate nursing intervention?
A) Administer sublingual nifedipine immediately
B) Admit to the intensive care unit for IV antihypertensive therapy
C) Recheck the blood pressure in 5 minutes and administer oral antihypertensives
as prescribed
D) Give a STAT dose of IV hydralazine
Answer: C
,Rationale: Asymptomatic severe hypertension (hypertensive urgency) does not
require emergency IV therapy. The blood pressure should be rechecked, and oral
antihypertensives are initiated to lower pressure gradually over hours to days,
avoiding rapid drops that can cause cerebral ischaemia.
3 A patient with a history of heart failure presents with worsening dyspnoea,
orthopnoea, and peripheral oedema. The nurse notes jugular venous distension and
crackles in the lung bases. What is the priority nursing diagnosis and intervention?
A) Impaired gas exchange; position the patient in high Fowler's position and
administer oxygen
B) Fluid volume deficit; administer IV fluids
C) Anxiety; administer a benzodiazepine
D) Ineffective airway clearance; suction the airway
Answer: A
Rationale: The patient is exhibiting signs of acute decompensated heart failure with
pulmonary oedema. High Fowler's positioning reduces venous return and improves
ventilation, while oxygen therapy addresses hypoxaemia. Diuretics are the primary
medical treatment.
4 A patient with a history of atrial fibrillation is on warfarin. The INR is 5.2. The
patient has no active bleeding. What should the nurse do?
A) Administer vitamin K 10mg orally
B) Hold the warfarin and notify the prescriber
C) Continue the warfarin as prescribed
D) Administer fresh frozen plasma
Answer: B
Rationale: An INR above 5.0 without bleeding requires holding the warfarin and
notifying the prescriber for further instructions. Vitamin K is indicated for INR
>5.0 with bleeding or INR >8.0 without bleeding.
5 A patient with a new diagnosis of type 2 diabetes is prescribed metformin. The
patient asks how this medication works. What is the nurse's best response?
A) It stimulates the pancreas to release more insulin
B) It reduces glucose production in the liver and improves insulin sensitivity in
peripheral tissues
C) It slows the absorption of carbohydrates from the intestine
D) It increases the excretion of glucose in the urine
Answer: B
,Rationale: Metformin is a biguanide that decreases hepatic gluconeogenesis and
increases peripheral glucose uptake and utilisation. It does not cause
hypoglycaemia when used alone.
6 A patient with asthma is prescribed a short-acting beta-agonist (SABA) inhaler.
Which statement by the patient indicates correct understanding of this medication?
A) I will use this inhaler daily to prevent asthma attacks
B) I will use this inhaler when I feel short of breath for quick relief
C) I will take this medication with a full glass of water
D) I will stop using this inhaler once I feel better
Answer: B
Rationale: SABAs are rescue medications used for acute symptom relief. They are
not for daily prevention; that requires controller medications like inhaled
corticosteroids.
7 A patient with a history of seizures is prescribed phenytoin. The nurse notes
nystagmus, ataxia, and confusion. What is the priority action?
A) Administer the next dose of phenytoin as scheduled
B) Notify the prescriber and obtain a serum phenytoin level
C) Reassure the patient that these are expected side effects
D) Administer a benzodiazepine
Answer: B
Rationale: Nystagmus, ataxia, and confusion are signs of phenytoin toxicity. The
prescriber should be notified, and a serum level should be obtained to guide dose
adjustment.
8 A patient with chronic kidney disease has a serum potassium of 6.5 mmol/L. The
ECG shows peaked T waves. What is the priority nursing intervention?
A) Administer oral kayexalate
B) Prepare for emergent haemodialysis
C) Administer IV calcium gluconate and notify the prescriber
D) Restrict dietary potassium
Answer: C
Rationale: Hyperkalaemia with ECG changes is a medical emergency. IV calcium
gluconate stabilises the cardiac membrane, and the prescriber should be notified
for further interventions like insulin/dextrose, kayexalate, or dialysis.
9 A patient with a history of COPD is receiving oxygen at 2L/min via nasal
cannula. The patient's oxygen saturation is 89%. What is the most appropriate
nursing action?
, A) Increase oxygen to 4L/min
B) Maintain current oxygen and assess the patient's respiratory effort
C) Apply a non-rebreathing mask at 15L/min
D) Prepare for intubation
Answer: B
Rationale: In COPD, the target SpO2 is 88-92% to avoid suppressing the hypoxic
drive. Maintaining current oxygen and assessing the patient's work of breathing is
appropriate.
10 A patient with a history of heart failure is prescribed furosemide. Which
laboratory value should the nurse monitor most closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting, leading to
hypokalaemia. This can precipitate cardiac arrhythmias, especially in patients on
digoxin.
11 A patient with a history of schizophrenia is prescribed clozapine. The nurse
should monitor which laboratory parameter weekly for the first 6 months?
A) Liver function tests
B) Absolute neutrophil count
C) Serum glucose
D) Serum prolactin
Answer: B
Rationale: Clozapine carries a risk of agranulocytosis. Absolute neutrophil count
must be monitored weekly for the first 6 months and then fortnightly.
12 A patient with a history of hypertension is prescribed lisinopril. The patient
develops a persistent dry cough. What is the most appropriate nursing action?
A) Advise the patient to stop the medication immediately
B) Notify the prescriber to consider switching to an ARB
C) Administer an antitussive
D) Reassure the patient that this will resolve with continued use
Answer: B
Rationale: A persistent dry cough is a common side effect of ACE inhibitors due to
bradykinin accumulation. Switching to an ARB, which does not cause cough, is an
appropriate option.
CORRECT ANSWERS WITH RATIONALE LATEST 2026
ALREADY GRADED A+ ASSURED PASS
This comprehensive collection of 300 unique, non-repeating, multiple-choice
questions is specifically designed to mirror the clinical rigour and format of
advanced nursing examinations such as NR 567 and the NZ NCAP. Each
question presents a distinct, real-world clinical scenario that tests critical
nursing competencies across pharmacology, pathophysiology, and priority-
setting. The questions cover a wide spectrum of conditions, medications, and
patient populations, ensuring broad revision coverage. Every entry includes
the correct answer and a detailed, evidence-based rationale that explains the
underlying clinical reasoning, pharmacokinetics, or nursing priority, making
this an effective self-assessment and high-yield learning tool for exam
preparation and clinical practice.
1 A patient presents with acute onset of severe, sharp chest pain that worsens with
inspiration and is relieved by leaning forward. The nurse hears a pericardial
friction rub on auscultation. What is the most likely diagnosis and initial nursing
action?
A) Acute myocardial infarction; administer aspirin and nitroglycerin
B) Pericarditis; administer NSAIDs and prepare for echocardiogram
C) Pulmonary embolism; start heparin infusion
D) Aortic dissection; prepare for emergency surgery
Answer: B
Rationale: Pericarditis presents with sharp, pleuritic chest pain that improves with
sitting forward, and a pericardial friction rub is a classic finding. Initial
management includes anti-inflammatory medications like NSAIDs, and an
echocardiogram is used to assess for pericardial effusion.
2 A patient with chronic hypertension presents with a blood pressure of 210/120
mmHg and is asymptomatic. What is the most appropriate nursing intervention?
A) Administer sublingual nifedipine immediately
B) Admit to the intensive care unit for IV antihypertensive therapy
C) Recheck the blood pressure in 5 minutes and administer oral antihypertensives
as prescribed
D) Give a STAT dose of IV hydralazine
Answer: C
,Rationale: Asymptomatic severe hypertension (hypertensive urgency) does not
require emergency IV therapy. The blood pressure should be rechecked, and oral
antihypertensives are initiated to lower pressure gradually over hours to days,
avoiding rapid drops that can cause cerebral ischaemia.
3 A patient with a history of heart failure presents with worsening dyspnoea,
orthopnoea, and peripheral oedema. The nurse notes jugular venous distension and
crackles in the lung bases. What is the priority nursing diagnosis and intervention?
A) Impaired gas exchange; position the patient in high Fowler's position and
administer oxygen
B) Fluid volume deficit; administer IV fluids
C) Anxiety; administer a benzodiazepine
D) Ineffective airway clearance; suction the airway
Answer: A
Rationale: The patient is exhibiting signs of acute decompensated heart failure with
pulmonary oedema. High Fowler's positioning reduces venous return and improves
ventilation, while oxygen therapy addresses hypoxaemia. Diuretics are the primary
medical treatment.
4 A patient with a history of atrial fibrillation is on warfarin. The INR is 5.2. The
patient has no active bleeding. What should the nurse do?
A) Administer vitamin K 10mg orally
B) Hold the warfarin and notify the prescriber
C) Continue the warfarin as prescribed
D) Administer fresh frozen plasma
Answer: B
Rationale: An INR above 5.0 without bleeding requires holding the warfarin and
notifying the prescriber for further instructions. Vitamin K is indicated for INR
>5.0 with bleeding or INR >8.0 without bleeding.
5 A patient with a new diagnosis of type 2 diabetes is prescribed metformin. The
patient asks how this medication works. What is the nurse's best response?
A) It stimulates the pancreas to release more insulin
B) It reduces glucose production in the liver and improves insulin sensitivity in
peripheral tissues
C) It slows the absorption of carbohydrates from the intestine
D) It increases the excretion of glucose in the urine
Answer: B
,Rationale: Metformin is a biguanide that decreases hepatic gluconeogenesis and
increases peripheral glucose uptake and utilisation. It does not cause
hypoglycaemia when used alone.
6 A patient with asthma is prescribed a short-acting beta-agonist (SABA) inhaler.
Which statement by the patient indicates correct understanding of this medication?
A) I will use this inhaler daily to prevent asthma attacks
B) I will use this inhaler when I feel short of breath for quick relief
C) I will take this medication with a full glass of water
D) I will stop using this inhaler once I feel better
Answer: B
Rationale: SABAs are rescue medications used for acute symptom relief. They are
not for daily prevention; that requires controller medications like inhaled
corticosteroids.
7 A patient with a history of seizures is prescribed phenytoin. The nurse notes
nystagmus, ataxia, and confusion. What is the priority action?
A) Administer the next dose of phenytoin as scheduled
B) Notify the prescriber and obtain a serum phenytoin level
C) Reassure the patient that these are expected side effects
D) Administer a benzodiazepine
Answer: B
Rationale: Nystagmus, ataxia, and confusion are signs of phenytoin toxicity. The
prescriber should be notified, and a serum level should be obtained to guide dose
adjustment.
8 A patient with chronic kidney disease has a serum potassium of 6.5 mmol/L. The
ECG shows peaked T waves. What is the priority nursing intervention?
A) Administer oral kayexalate
B) Prepare for emergent haemodialysis
C) Administer IV calcium gluconate and notify the prescriber
D) Restrict dietary potassium
Answer: C
Rationale: Hyperkalaemia with ECG changes is a medical emergency. IV calcium
gluconate stabilises the cardiac membrane, and the prescriber should be notified
for further interventions like insulin/dextrose, kayexalate, or dialysis.
9 A patient with a history of COPD is receiving oxygen at 2L/min via nasal
cannula. The patient's oxygen saturation is 89%. What is the most appropriate
nursing action?
, A) Increase oxygen to 4L/min
B) Maintain current oxygen and assess the patient's respiratory effort
C) Apply a non-rebreathing mask at 15L/min
D) Prepare for intubation
Answer: B
Rationale: In COPD, the target SpO2 is 88-92% to avoid suppressing the hypoxic
drive. Maintaining current oxygen and assessing the patient's work of breathing is
appropriate.
10 A patient with a history of heart failure is prescribed furosemide. Which
laboratory value should the nurse monitor most closely?
A) Serum sodium
B) Serum potassium
C) Serum calcium
D) Serum magnesium
Answer: B
Rationale: Furosemide is a loop diuretic that causes potassium wasting, leading to
hypokalaemia. This can precipitate cardiac arrhythmias, especially in patients on
digoxin.
11 A patient with a history of schizophrenia is prescribed clozapine. The nurse
should monitor which laboratory parameter weekly for the first 6 months?
A) Liver function tests
B) Absolute neutrophil count
C) Serum glucose
D) Serum prolactin
Answer: B
Rationale: Clozapine carries a risk of agranulocytosis. Absolute neutrophil count
must be monitored weekly for the first 6 months and then fortnightly.
12 A patient with a history of hypertension is prescribed lisinopril. The patient
develops a persistent dry cough. What is the most appropriate nursing action?
A) Advise the patient to stop the medication immediately
B) Notify the prescriber to consider switching to an ARB
C) Administer an antitussive
D) Reassure the patient that this will resolve with continued use
Answer: B
Rationale: A persistent dry cough is a common side effect of ACE inhibitors due to
bradykinin accumulation. Switching to an ARB, which does not cause cough, is an
appropriate option.
