NUR 283 EXAM 200 ACTUAL QUESTIONS AND
CORRECT ANSWERS WITH RATIONALE LATEST
UPDATE ALREADY GRADED A+
This comprehensive collection features 300 unique, single-best-answer
multiple-choice questions crafted for advanced medical-surgical nursing.
Each question presents a realistic clinical scenario followed by four plausible
options, a correct answer, and a detailed, evidence-based rationale that
explains the underlying pathophysiology and nursing reasoning. The content
spans critical care, cardiology, pulmonology, neurology, nephrology,
endocrinology, and hematology. No questions are repeated, and all formatting
is plain text for easy study. This bank is designed to strengthen clinical
judgment, reinforce pharmacological knowledge, and prepare students for
high-stakes nursing examinations through active recall and conceptual
understanding.
Question 1
A patient with acute decompensated heart failure has pulmonary edema. Which
assessment finding requires immediate intervention by the nurse?
A) Jugular venous distention
B) Crackles audible to the lung apices
C) Peripheral edema in the lower extremities
D) Weight gain of 1 kg over 24 hours
Answer: B
Rationale: Crackles that extend to the apices indicate severe pulmonary congestion
and fluid accumulation throughout the lung fields. This suggests imminent
respiratory failure and requires immediate interventions such as high-dose
diuretics, oxygen, and possibly noninvasive ventilation. Jugular venous distention,
peripheral edema, and gradual weight gain are important signs of fluid overload
but do not signal the same level of acute respiratory compromise as crackles at the
apices.
Question 2
A patient is receiving intravenous nitroglycerin for acute coronary syndrome.
Which parameter is most critical for the nurse to monitor continuously?
,A) Serum potassium level
B) Blood pressure
C) Urinary output
D) Blood glucose
Answer: B
Rationale: Intravenous nitroglycerin is a potent vasodilator that can cause
significant hypotension. Continuous blood pressure monitoring is essential to
prevent severe drops in perfusion to vital organs. Potassium, urinary output, and
glucose are important but are not the most immediate critical parameters during
this infusion.
Question 3
A patient with chronic obstructive pulmonary disease has an arterial blood gas
showing pH 7.31, PaCO2 68 mm Hg, and HCO3 32 mEq/L. The nurse interprets
this as which condition?
A) Acute respiratory acidosis with metabolic compensation
B) Chronic respiratory acidosis with renal compensation
C) Acute metabolic alkalosis with respiratory compensation
D) Mixed respiratory and metabolic acidosis
Answer: B
Rationale: The pH is low (acidemia) and PaCO2 is elevated, indicating a
respiratory acidosis. The HCO3 is elevated above 26 mEq/L, showing that the
kidneys have retained bicarbonate to compensate. Because the pH is not extremely
low despite the high PaCO2, this suggests a chronic process where renal
compensation has had time to develop.
Question 4
A patient who had a carotid endarterectomy 4 hours ago reports sudden severe
headache and difficulty swallowing. The nurse assesses a blood pressure of 154/92
mm Hg. What is the priority nursing action?
A) Administer prescribed antihypertensive medication
B) Notify the healthcare provider immediately
C) Reassure the patient and reposition the head of the bed
D) Apply ice packs to the neck incision site
Answer: B
Rationale: Sudden severe headache, hypertension, and difficulty swallowing after
carotid endarterectomy are warning signs of hyperperfusion syndrome or cerebral
hemorrhage. The provider must be notified immediately for further evaluation,
which may include imaging. Antihypertensives may be indicated but only after
,provider assessment; repositioning and ice will not address this life-threatening
complication.
Question 5
Which electrocardiogram finding is most characteristic of acute pericarditis?
A) ST-segment depression in multiple leads
B) Diffuse PR-segment depression and ST-segment elevation
C) Pathologic Q waves in leads V1 to V4
D) Tall peaked T waves in the precordial leads
Answer: B
Rationale: Acute pericarditis typically causes diffuse ST-segment elevation and
PR-segment depression across many leads due to widespread epicardial
inflammation. ST-segment depression is more common in myocardial ischemia.
Pathologic Q waves indicate prior infarction, and tall peaked T waves are seen in
hyperkalemia.
Question 6
A patient with atrial fibrillation is started on amiodarone. Which baseline
assessment is essential before this medication is administered?
A) Liver function tests
B) Pulmonary function tests
C) Thyroid function tests
D) Renal function tests
Answer: C
Rationale: Amiodarone contains iodine and can cause thyroid dysfunction,
including both hyperthyroidism and hypothyroidism. Baseline thyroid function
tests are essential to monitor for drug-induced changes. Liver and pulmonary
function are also important with long-term use, but thyroid assessment is a key
baseline requirement before starting therapy.
Question 7
A patient with severe sepsis has a central venous pressure of 3 mm Hg and a mean
arterial pressure of 55 mm Hg. According to the Surviving Sepsis Campaign, what
is the initial fluid resuscitation goal?
A) Administer 30 mL/kg of crystalloid within the first 3 hours
B) Start a vasopressor immediately before fluids
C) Administer 500 mL of normal saline over 1 hour
D) Restrict fluids to prevent pulmonary edema
Answer: A
, Rationale: The Surviving Sepsis Campaign recommends rapid administration of 30
mL/kg of crystalloid within the first 3 hours for sepsis with hypotension or lactate
≥4 mmol/L. This patient has both low CVP and low MAP, indicating hypovolemia
and inadequate perfusion. Vasopressors are added after adequate fluid resuscitation
if hypotension persists.
Question 8
A postoperative patient develops sudden onset of dyspnea, pleuritic chest pain, and
tachycardia. The nurse notes a pulse oximetry reading of 88% on room air. Which
condition should the nurse suspect first?
A) Atelectasis
B) Pulmonary embolism
C) Pneumothorax
D) Pulmonary edema
Answer: B
Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxia in a
postoperative patient are classic signs of pulmonary embolism. Atelectasis usually
develops more gradually. Pneumothorax would likely have decreased breath
sounds on one side. Pulmonary edema is more associated with crackles and a
history of heart failure.
Question 9
A patient with liver cirrhosis has developed ascites. The nurse notes that the patient
is breathing rapidly with a respiratory rate of 28 breaths per minute. Which
complication is most likely occurring?
A) Spontaneous bacterial peritonitis
B) Hepatic encephalopathy
C) Hepatorenal syndrome
D) Restrictive lung disease from abdominal distention
Answer: D
Rationale: Massive ascites causes abdominal distention that pushes upward on the
diaphragm, restricting lung expansion and leading to rapid, shallow breathing.
While spontaneous bacterial peritonitis and hepatic encephalopathy are
complications of cirrhosis, the primary cause of tachypnea in this context is
mechanical restriction from fluid accumulation.
Question 10
A patient is receiving a continuous heparin infusion for a deep vein thrombosis.
The nurse notes that the patient's activated partial thromboplastin time is 98
seconds, and the baseline was 30 seconds. What is the appropriate nursing action?
CORRECT ANSWERS WITH RATIONALE LATEST
UPDATE ALREADY GRADED A+
This comprehensive collection features 300 unique, single-best-answer
multiple-choice questions crafted for advanced medical-surgical nursing.
Each question presents a realistic clinical scenario followed by four plausible
options, a correct answer, and a detailed, evidence-based rationale that
explains the underlying pathophysiology and nursing reasoning. The content
spans critical care, cardiology, pulmonology, neurology, nephrology,
endocrinology, and hematology. No questions are repeated, and all formatting
is plain text for easy study. This bank is designed to strengthen clinical
judgment, reinforce pharmacological knowledge, and prepare students for
high-stakes nursing examinations through active recall and conceptual
understanding.
Question 1
A patient with acute decompensated heart failure has pulmonary edema. Which
assessment finding requires immediate intervention by the nurse?
A) Jugular venous distention
B) Crackles audible to the lung apices
C) Peripheral edema in the lower extremities
D) Weight gain of 1 kg over 24 hours
Answer: B
Rationale: Crackles that extend to the apices indicate severe pulmonary congestion
and fluid accumulation throughout the lung fields. This suggests imminent
respiratory failure and requires immediate interventions such as high-dose
diuretics, oxygen, and possibly noninvasive ventilation. Jugular venous distention,
peripheral edema, and gradual weight gain are important signs of fluid overload
but do not signal the same level of acute respiratory compromise as crackles at the
apices.
Question 2
A patient is receiving intravenous nitroglycerin for acute coronary syndrome.
Which parameter is most critical for the nurse to monitor continuously?
,A) Serum potassium level
B) Blood pressure
C) Urinary output
D) Blood glucose
Answer: B
Rationale: Intravenous nitroglycerin is a potent vasodilator that can cause
significant hypotension. Continuous blood pressure monitoring is essential to
prevent severe drops in perfusion to vital organs. Potassium, urinary output, and
glucose are important but are not the most immediate critical parameters during
this infusion.
Question 3
A patient with chronic obstructive pulmonary disease has an arterial blood gas
showing pH 7.31, PaCO2 68 mm Hg, and HCO3 32 mEq/L. The nurse interprets
this as which condition?
A) Acute respiratory acidosis with metabolic compensation
B) Chronic respiratory acidosis with renal compensation
C) Acute metabolic alkalosis with respiratory compensation
D) Mixed respiratory and metabolic acidosis
Answer: B
Rationale: The pH is low (acidemia) and PaCO2 is elevated, indicating a
respiratory acidosis. The HCO3 is elevated above 26 mEq/L, showing that the
kidneys have retained bicarbonate to compensate. Because the pH is not extremely
low despite the high PaCO2, this suggests a chronic process where renal
compensation has had time to develop.
Question 4
A patient who had a carotid endarterectomy 4 hours ago reports sudden severe
headache and difficulty swallowing. The nurse assesses a blood pressure of 154/92
mm Hg. What is the priority nursing action?
A) Administer prescribed antihypertensive medication
B) Notify the healthcare provider immediately
C) Reassure the patient and reposition the head of the bed
D) Apply ice packs to the neck incision site
Answer: B
Rationale: Sudden severe headache, hypertension, and difficulty swallowing after
carotid endarterectomy are warning signs of hyperperfusion syndrome or cerebral
hemorrhage. The provider must be notified immediately for further evaluation,
which may include imaging. Antihypertensives may be indicated but only after
,provider assessment; repositioning and ice will not address this life-threatening
complication.
Question 5
Which electrocardiogram finding is most characteristic of acute pericarditis?
A) ST-segment depression in multiple leads
B) Diffuse PR-segment depression and ST-segment elevation
C) Pathologic Q waves in leads V1 to V4
D) Tall peaked T waves in the precordial leads
Answer: B
Rationale: Acute pericarditis typically causes diffuse ST-segment elevation and
PR-segment depression across many leads due to widespread epicardial
inflammation. ST-segment depression is more common in myocardial ischemia.
Pathologic Q waves indicate prior infarction, and tall peaked T waves are seen in
hyperkalemia.
Question 6
A patient with atrial fibrillation is started on amiodarone. Which baseline
assessment is essential before this medication is administered?
A) Liver function tests
B) Pulmonary function tests
C) Thyroid function tests
D) Renal function tests
Answer: C
Rationale: Amiodarone contains iodine and can cause thyroid dysfunction,
including both hyperthyroidism and hypothyroidism. Baseline thyroid function
tests are essential to monitor for drug-induced changes. Liver and pulmonary
function are also important with long-term use, but thyroid assessment is a key
baseline requirement before starting therapy.
Question 7
A patient with severe sepsis has a central venous pressure of 3 mm Hg and a mean
arterial pressure of 55 mm Hg. According to the Surviving Sepsis Campaign, what
is the initial fluid resuscitation goal?
A) Administer 30 mL/kg of crystalloid within the first 3 hours
B) Start a vasopressor immediately before fluids
C) Administer 500 mL of normal saline over 1 hour
D) Restrict fluids to prevent pulmonary edema
Answer: A
, Rationale: The Surviving Sepsis Campaign recommends rapid administration of 30
mL/kg of crystalloid within the first 3 hours for sepsis with hypotension or lactate
≥4 mmol/L. This patient has both low CVP and low MAP, indicating hypovolemia
and inadequate perfusion. Vasopressors are added after adequate fluid resuscitation
if hypotension persists.
Question 8
A postoperative patient develops sudden onset of dyspnea, pleuritic chest pain, and
tachycardia. The nurse notes a pulse oximetry reading of 88% on room air. Which
condition should the nurse suspect first?
A) Atelectasis
B) Pulmonary embolism
C) Pneumothorax
D) Pulmonary edema
Answer: B
Rationale: Sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxia in a
postoperative patient are classic signs of pulmonary embolism. Atelectasis usually
develops more gradually. Pneumothorax would likely have decreased breath
sounds on one side. Pulmonary edema is more associated with crackles and a
history of heart failure.
Question 9
A patient with liver cirrhosis has developed ascites. The nurse notes that the patient
is breathing rapidly with a respiratory rate of 28 breaths per minute. Which
complication is most likely occurring?
A) Spontaneous bacterial peritonitis
B) Hepatic encephalopathy
C) Hepatorenal syndrome
D) Restrictive lung disease from abdominal distention
Answer: D
Rationale: Massive ascites causes abdominal distention that pushes upward on the
diaphragm, restricting lung expansion and leading to rapid, shallow breathing.
While spontaneous bacterial peritonitis and hepatic encephalopathy are
complications of cirrhosis, the primary cause of tachypnea in this context is
mechanical restriction from fluid accumulation.
Question 10
A patient is receiving a continuous heparin infusion for a deep vein thrombosis.
The nurse notes that the patient's activated partial thromboplastin time is 98
seconds, and the baseline was 30 seconds. What is the appropriate nursing action?
