1
NUR 185 Concepts of Adult Health Nursing II
Final Exam Official Practice Exam Actual Exam
2026/2027 with Detailed Rationales | Complete
Exam-Style Questions | Pass Guaranteed – A+
Graded
TABLE OF CONTENTS
Section 1 | Gas Exchange & Respiratory Care | Q1 – Q14
Section 2 | Hormonal Regulation | Q15 – Q28
Section 3 | Tissue Integrity & Burns | Q29 – Q42
Section 4 | Fluid/Electrolytes, Shock & Sepsis | Q43 – Q56
Section 5 | Functional Ability, Community Nursing & NGN-Style Case Analysis |
Q57 – Q70
Instructions: Choose the single best answer unless otherwise indicated. Pass: 80%
in 90 minutes.
══════════════════════════════════════
SECTION 1: GAS EXCHANGE & RESPIRATORY CARE Q1 – Q14
══════════════════════════════════════
Question 1 of 70
A 68-year-old patient with COPD receiving oxygen at 4 L/min via nasal cannula
becomes increasingly lethargic with respirations dropping to 8/min and an SpO2 of
88%. The arterial blood gas reveals a PaCO2 of 78 mmHg and a pH of 7.28. What
is the most likely cause of this patient's deterioration?
,2
A. The oxygen flow rate is too low to meet tissue demands
B. The patient is experiencing an acute pulmonary embolism
C. The patient has developed a spontaneous pneumothorax
D. The oxygen delivery is suppressing the hypoxic drive, causing CO2 narcosis ✓
CORRECT
Correct Answer: D
Rationale: In COPD patients who are chronic CO2 retainers, the drive to breathe is
stimulated by low oxygen levels rather than high CO2, so administering moderate-
flow oxygen can blunt this hypoxic drive and lead to hypoventilation, rising
PaCO2, and CO2 narcosis. Option A is incorrect because the problem is not
inadequate oxygen delivery but rather excessive oxygen suppressing the
respiratory drive. The nurse should reduce the oxygen flow, encourage coughing
and deep breathing, and notify the provider for possible noninvasive ventilation.
Question 2 of 70
A 54-year-old patient on a mechanical ventilator triggers the high-pressure alarm.
The nurse enters the room and notes the patient is coughing vigorously and appears
anxious with visible accessory muscle use. What should be the nurse's first action?
A. Disconnect the patient from the ventilator and manually ventilate with a bag-
valve-mask ✓ CORRECT
B. Silence the alarm and administer a bolus dose of IV midazolam
C. Check the ventilator tubing for kinks or accumulated condensation
D. Suction the patient's airway immediately
,3
Correct Answer: A
Rationale: A high-pressure alarm with vigorous coughing and anxiety suggests the
patient is fighting the ventilator or has an acute airway obstruction, which can
rapidly lead to barotrauma, so the nurse should immediately disconnect and
manually ventilate to assess lung compliance and protect the airway. Option C,
while part of the systematic troubleshooting process, delays the priority
intervention when the patient's safety is at immediate risk. Always assess the
patient before the equipment when an alarm sounds.
Question 3 of 70
A 72-year-old patient with a tracheostomy has thick, tenacious secretions that are
difficult to clear. The patient's pre-suction SpO2 is 90% on 40% FiO2. What is the
most appropriate nursing action before performing endotracheal suctioning?
A. Increase the suction pressure to 200 mmHg to remove thick secretions
efficiently
B. Hyperoxygenate the patient with 100% FiO2 for 30–60 seconds before
suctioning ✓ CORRECT
C. Instill 10 mL of sterile normal saline into the tracheostomy to thin secretions
D. Limit suctioning to a single pass to prevent mucosal damage
Correct Answer: B
Rationale: Pre-oxygenation with 100% FiO2 for 30–60 seconds prevents
hypoxemia during suctioning, especially in a patient who is already borderline at
90% saturation. Option C is a common trap because routine saline instillation is no
longer recommended as it can disperse bacteria into the lower airway and cause
transient hypoxia. The nurse should use no more than two to three suction passes,
each lasting no longer than 10–15 seconds.
, 4
Question 4 of 70
The charge nurse is developing a care plan for a ventilator-dependent patient to
prevent ventilator-associated pneumonia (VAP). Which intervention should be
included as the highest priority in the VAP prevention bundle?
A. Administer prophylactic broad-spectrum antibiotics daily
B. Keep the head of the bed flat to prevent endotracheal tube migration
C. Perform oral care with chlorhexidine every 12 hours and maintain the head of
bed at 30–45 degrees ✓ CORRECT
D. Change the ventilator circuit tubing every 24 hours
Correct Answer: C
Rationale: The VAP prevention bundle includes elevating the head of bed to 30–45
degrees, performing regular oral care with chlorhexidine, daily sedation
interruptions, and assessment of readiness to extubate to reduce bacterial
colonization and aspiration risk. Option D is incorrect because ventilator circuits
should only be changed when visibly soiled or malfunctioning, not on a routine
daily schedule. Routine daily antibiotics (option A) contribute to resistance and are
not part of the bundle.
Question 5 of 70
A 63-year-old patient has a chest tube connected to a water-seal drainage system
after a thoracotomy. The nurse observes that the water-seal chamber has stopped
bubbling, and the fluid level in the water-seal tube is gently fluctuating with each
breath. How should the nurse interpret this finding?
NUR 185 Concepts of Adult Health Nursing II
Final Exam Official Practice Exam Actual Exam
2026/2027 with Detailed Rationales | Complete
Exam-Style Questions | Pass Guaranteed – A+
Graded
TABLE OF CONTENTS
Section 1 | Gas Exchange & Respiratory Care | Q1 – Q14
Section 2 | Hormonal Regulation | Q15 – Q28
Section 3 | Tissue Integrity & Burns | Q29 – Q42
Section 4 | Fluid/Electrolytes, Shock & Sepsis | Q43 – Q56
Section 5 | Functional Ability, Community Nursing & NGN-Style Case Analysis |
Q57 – Q70
Instructions: Choose the single best answer unless otherwise indicated. Pass: 80%
in 90 minutes.
══════════════════════════════════════
SECTION 1: GAS EXCHANGE & RESPIRATORY CARE Q1 – Q14
══════════════════════════════════════
Question 1 of 70
A 68-year-old patient with COPD receiving oxygen at 4 L/min via nasal cannula
becomes increasingly lethargic with respirations dropping to 8/min and an SpO2 of
88%. The arterial blood gas reveals a PaCO2 of 78 mmHg and a pH of 7.28. What
is the most likely cause of this patient's deterioration?
,2
A. The oxygen flow rate is too low to meet tissue demands
B. The patient is experiencing an acute pulmonary embolism
C. The patient has developed a spontaneous pneumothorax
D. The oxygen delivery is suppressing the hypoxic drive, causing CO2 narcosis ✓
CORRECT
Correct Answer: D
Rationale: In COPD patients who are chronic CO2 retainers, the drive to breathe is
stimulated by low oxygen levels rather than high CO2, so administering moderate-
flow oxygen can blunt this hypoxic drive and lead to hypoventilation, rising
PaCO2, and CO2 narcosis. Option A is incorrect because the problem is not
inadequate oxygen delivery but rather excessive oxygen suppressing the
respiratory drive. The nurse should reduce the oxygen flow, encourage coughing
and deep breathing, and notify the provider for possible noninvasive ventilation.
Question 2 of 70
A 54-year-old patient on a mechanical ventilator triggers the high-pressure alarm.
The nurse enters the room and notes the patient is coughing vigorously and appears
anxious with visible accessory muscle use. What should be the nurse's first action?
A. Disconnect the patient from the ventilator and manually ventilate with a bag-
valve-mask ✓ CORRECT
B. Silence the alarm and administer a bolus dose of IV midazolam
C. Check the ventilator tubing for kinks or accumulated condensation
D. Suction the patient's airway immediately
,3
Correct Answer: A
Rationale: A high-pressure alarm with vigorous coughing and anxiety suggests the
patient is fighting the ventilator or has an acute airway obstruction, which can
rapidly lead to barotrauma, so the nurse should immediately disconnect and
manually ventilate to assess lung compliance and protect the airway. Option C,
while part of the systematic troubleshooting process, delays the priority
intervention when the patient's safety is at immediate risk. Always assess the
patient before the equipment when an alarm sounds.
Question 3 of 70
A 72-year-old patient with a tracheostomy has thick, tenacious secretions that are
difficult to clear. The patient's pre-suction SpO2 is 90% on 40% FiO2. What is the
most appropriate nursing action before performing endotracheal suctioning?
A. Increase the suction pressure to 200 mmHg to remove thick secretions
efficiently
B. Hyperoxygenate the patient with 100% FiO2 for 30–60 seconds before
suctioning ✓ CORRECT
C. Instill 10 mL of sterile normal saline into the tracheostomy to thin secretions
D. Limit suctioning to a single pass to prevent mucosal damage
Correct Answer: B
Rationale: Pre-oxygenation with 100% FiO2 for 30–60 seconds prevents
hypoxemia during suctioning, especially in a patient who is already borderline at
90% saturation. Option C is a common trap because routine saline instillation is no
longer recommended as it can disperse bacteria into the lower airway and cause
transient hypoxia. The nurse should use no more than two to three suction passes,
each lasting no longer than 10–15 seconds.
, 4
Question 4 of 70
The charge nurse is developing a care plan for a ventilator-dependent patient to
prevent ventilator-associated pneumonia (VAP). Which intervention should be
included as the highest priority in the VAP prevention bundle?
A. Administer prophylactic broad-spectrum antibiotics daily
B. Keep the head of the bed flat to prevent endotracheal tube migration
C. Perform oral care with chlorhexidine every 12 hours and maintain the head of
bed at 30–45 degrees ✓ CORRECT
D. Change the ventilator circuit tubing every 24 hours
Correct Answer: C
Rationale: The VAP prevention bundle includes elevating the head of bed to 30–45
degrees, performing regular oral care with chlorhexidine, daily sedation
interruptions, and assessment of readiness to extubate to reduce bacterial
colonization and aspiration risk. Option D is incorrect because ventilator circuits
should only be changed when visibly soiled or malfunctioning, not on a routine
daily schedule. Routine daily antibiotics (option A) contribute to resistance and are
not part of the bundle.
Question 5 of 70
A 63-year-old patient has a chest tube connected to a water-seal drainage system
after a thoracotomy. The nurse observes that the water-seal chamber has stopped
bubbling, and the fluid level in the water-seal tube is gently fluctuating with each
breath. How should the nurse interpret this finding?
