NRSG 2350 NORTH EASTERN UNIVERSITY FINAL EXAM –
QUESTIONS AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS LATEST EXAM UPDATE | EXAM
PREP | STUDY GUIDE | PRACTICE TEST (2026 EDITION)
1. A nurse is caring for a client admitted with an acute exacerbation of chronic obstructive pulmonary
disease (COPD). The client is restless, confused, and has a respiratory rate of 28/min with an oxygen
saturation of 84% on room air. Which action should the nurse take first?
A. Administer the prescribed oral bronchodilator
B. Initiate low-flow oxygen via nasal cannula
C. Draw arterial blood gases (ABGs) immediately
D. Place the client in a high-Fowler position
Rationales:
A — Oral medications take too long during acute distress.
B — Oxygen is vital, but positioning is the fastest first step.
C — ABGs are diagnostic and do not treat the problem.
D — Correct: high-Fowler position uses gravity to decrease work of breathing and expand thoracic
capacity before oxygen or diagnostics.
2. A nurse reviews discharge teaching with a client newly prescribed lisinopril for hypertension. Which
statement by the client indicates understanding?
A. "I will take a potassium supplement daily while on this drug."
B. "I will rise slowly from a sitting or lying position to avoid dizziness."
C. "I can stop this medication once my blood pressure is normal for a week."
D. "A persistent dry cough is harmless and does not need reporting."
Rationales:
A — ACE inhibitors retain potassium; supplements cause hyperkalemia.
B — Correct: orthostatic hypotension is common, so slow position changes prevent falls.
,C — Hypertension is lifelong; stopping causes rebound elevation.
D — A persistent dry cough is a known ACE inhibitor effect that must be reported.
3. An unlicensed assistive personnel (UAP) reports that a client receiving continuous nasogastric tube
feedings has vomited and has abdominal distention. What is the priority nursing action?
A. Stop the enteral feeding immediately
B. Advance the nasogastric tube by 5 centimeters
C. Increase the rate of the infusion pump
D. Irrigate the tube with 30 mL of sterile water
Rationales:
A — Correct: vomiting and distention signal intolerance/obstruction; stopping the feeding prevents
aspiration.
B — Advancing the tube does not address aspiration risk and may cause injury.
C — Increasing the rate worsens distention and vomiting.
D — Irrigation may be done later but is not the priority during aspiration risk.
4. A client is 4 hours post-thyroidectomy and reports throat tightness with high-pitched crowing sounds
on inspiration. Which item is most critical to keep at the bedside?
A. Suction canister and tubing
B. Emergency tracheostomy insertion kit
C. Incentive spirometer
D. Nasal cannula with humidifier
Rationales:
A — Suction clears secretions but cannot open an obstructed airway.
B — Correct: stridor and tightness indicate laryngeal edema/hematoma requiring emergency surgical
airway access.
C — Incentive spirometry prevents atelectasis, not obstruction.
D — Humidified oxygen does not relieve mechanical airway obstruction.
5. A client with type 1 diabetes arrives unresponsive with deep rapid respirations, fruity breath, glucose
480 mg/dL, and pH 7.22. Which IV fluid should the nurse anticipate administering first?
A. 5% Dextrose in 0.45% Normal Saline
B. 0.9% Normal Saline
,C. 0.45% Normal Saline
D. 5% Dextrose in Water
Rationales:
A — Dextrose is added only after glucose falls near 250 mg/dL.
B — Correct: DKA requires rapid isotonic volume expansion to restore perfusion before other solutions.
C — Hypotonic solutions are not the initial resuscitation fluid.
D — D5W worsens hyperglycemia and lacks needed sodium/chloride.
6. A client receives a continuous IV heparin infusion for deep vein thrombosis. Which laboratory value
should the nurse monitor to evaluate therapy effectiveness?
A. Prothrombin time (PT) and INR
B. Activated partial thromboplastin time (aPTT)
C. Platelet count only
D. Bleeding time
Rationales:
A — PT/INR monitors warfarin, not heparin.
B — Correct: aPTT (therapeutic ~1.5–2.5× control) evaluates heparin effectiveness.
C — Platelets screen for HIT but not therapeutic effect.
D — Bleeding time is not used for heparin monitoring.
7. A client on warfarin has an INR of 6.5 with bleeding gums. The nurse should anticipate administering
which antidote?
A. Protamine sulfate
B. Vitamin K
C. Calcium gluconate
D. Acetylcysteine
Rationales:
A — Protamine reverses heparin.
B — Correct: vitamin K reverses warfarin by restoring clotting factor synthesis.
C — Calcium gluconate treats hypocalcemia/hyperkalemia cardiac effects.
D — Acetylcysteine reverses acetaminophen toxicity.
, 8. Before giving digoxin, the nurse notes an apical pulse of 52/min. What is the best action?
A. Give the dose and document the pulse
B. Give half the prescribed dose
C. Hold the dose and notify the provider
D. Recheck the radial pulse in 15 minutes
Rationales:
A — Giving digoxin with bradycardia risks toxicity and heart block.
B — Dose reduction without an order is unsafe and unauthorized.
C — Correct: hold for apical pulse <60/min and report; bradycardia signals possible toxicity.
D — The apical pulse is the accurate measure; rechecking radially delays proper action.
9. A client taking metformin is scheduled for a CT scan with IV iodinated contrast. Which instruction is
correct?
A. Take the medication with a small sip of water before the scan
B. Withhold metformin at the time of the procedure and for 48 hours after
C. Double the dose the day before the procedure
D. Substitute insulin automatically for 1 week
Rationales:
A — Taking it with contrast increases lactic acidosis risk if kidney injury occurs.
B — Correct: contrast can impair renal function, so metformin is held to prevent lactic acidosis.
C — Doubling increases toxicity risk.
D — Insulin substitution is not automatic and requires a provider order.
10. A client receives NPH insulin at 7:00 AM. When is the client at greatest risk for hypoglycemia?
A. 7:30 AM
B. 9:00 AM
C. 4:00 PM
D. 7:00 AM the next day
Rationales:
A — NPH onset is 1–2 hours, not 30 minutes.
B — 9 AM is near onset, not peak.
QUESTIONS AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS LATEST EXAM UPDATE | EXAM
PREP | STUDY GUIDE | PRACTICE TEST (2026 EDITION)
1. A nurse is caring for a client admitted with an acute exacerbation of chronic obstructive pulmonary
disease (COPD). The client is restless, confused, and has a respiratory rate of 28/min with an oxygen
saturation of 84% on room air. Which action should the nurse take first?
A. Administer the prescribed oral bronchodilator
B. Initiate low-flow oxygen via nasal cannula
C. Draw arterial blood gases (ABGs) immediately
D. Place the client in a high-Fowler position
Rationales:
A — Oral medications take too long during acute distress.
B — Oxygen is vital, but positioning is the fastest first step.
C — ABGs are diagnostic and do not treat the problem.
D — Correct: high-Fowler position uses gravity to decrease work of breathing and expand thoracic
capacity before oxygen or diagnostics.
2. A nurse reviews discharge teaching with a client newly prescribed lisinopril for hypertension. Which
statement by the client indicates understanding?
A. "I will take a potassium supplement daily while on this drug."
B. "I will rise slowly from a sitting or lying position to avoid dizziness."
C. "I can stop this medication once my blood pressure is normal for a week."
D. "A persistent dry cough is harmless and does not need reporting."
Rationales:
A — ACE inhibitors retain potassium; supplements cause hyperkalemia.
B — Correct: orthostatic hypotension is common, so slow position changes prevent falls.
,C — Hypertension is lifelong; stopping causes rebound elevation.
D — A persistent dry cough is a known ACE inhibitor effect that must be reported.
3. An unlicensed assistive personnel (UAP) reports that a client receiving continuous nasogastric tube
feedings has vomited and has abdominal distention. What is the priority nursing action?
A. Stop the enteral feeding immediately
B. Advance the nasogastric tube by 5 centimeters
C. Increase the rate of the infusion pump
D. Irrigate the tube with 30 mL of sterile water
Rationales:
A — Correct: vomiting and distention signal intolerance/obstruction; stopping the feeding prevents
aspiration.
B — Advancing the tube does not address aspiration risk and may cause injury.
C — Increasing the rate worsens distention and vomiting.
D — Irrigation may be done later but is not the priority during aspiration risk.
4. A client is 4 hours post-thyroidectomy and reports throat tightness with high-pitched crowing sounds
on inspiration. Which item is most critical to keep at the bedside?
A. Suction canister and tubing
B. Emergency tracheostomy insertion kit
C. Incentive spirometer
D. Nasal cannula with humidifier
Rationales:
A — Suction clears secretions but cannot open an obstructed airway.
B — Correct: stridor and tightness indicate laryngeal edema/hematoma requiring emergency surgical
airway access.
C — Incentive spirometry prevents atelectasis, not obstruction.
D — Humidified oxygen does not relieve mechanical airway obstruction.
5. A client with type 1 diabetes arrives unresponsive with deep rapid respirations, fruity breath, glucose
480 mg/dL, and pH 7.22. Which IV fluid should the nurse anticipate administering first?
A. 5% Dextrose in 0.45% Normal Saline
B. 0.9% Normal Saline
,C. 0.45% Normal Saline
D. 5% Dextrose in Water
Rationales:
A — Dextrose is added only after glucose falls near 250 mg/dL.
B — Correct: DKA requires rapid isotonic volume expansion to restore perfusion before other solutions.
C — Hypotonic solutions are not the initial resuscitation fluid.
D — D5W worsens hyperglycemia and lacks needed sodium/chloride.
6. A client receives a continuous IV heparin infusion for deep vein thrombosis. Which laboratory value
should the nurse monitor to evaluate therapy effectiveness?
A. Prothrombin time (PT) and INR
B. Activated partial thromboplastin time (aPTT)
C. Platelet count only
D. Bleeding time
Rationales:
A — PT/INR monitors warfarin, not heparin.
B — Correct: aPTT (therapeutic ~1.5–2.5× control) evaluates heparin effectiveness.
C — Platelets screen for HIT but not therapeutic effect.
D — Bleeding time is not used for heparin monitoring.
7. A client on warfarin has an INR of 6.5 with bleeding gums. The nurse should anticipate administering
which antidote?
A. Protamine sulfate
B. Vitamin K
C. Calcium gluconate
D. Acetylcysteine
Rationales:
A — Protamine reverses heparin.
B — Correct: vitamin K reverses warfarin by restoring clotting factor synthesis.
C — Calcium gluconate treats hypocalcemia/hyperkalemia cardiac effects.
D — Acetylcysteine reverses acetaminophen toxicity.
, 8. Before giving digoxin, the nurse notes an apical pulse of 52/min. What is the best action?
A. Give the dose and document the pulse
B. Give half the prescribed dose
C. Hold the dose and notify the provider
D. Recheck the radial pulse in 15 minutes
Rationales:
A — Giving digoxin with bradycardia risks toxicity and heart block.
B — Dose reduction without an order is unsafe and unauthorized.
C — Correct: hold for apical pulse <60/min and report; bradycardia signals possible toxicity.
D — The apical pulse is the accurate measure; rechecking radially delays proper action.
9. A client taking metformin is scheduled for a CT scan with IV iodinated contrast. Which instruction is
correct?
A. Take the medication with a small sip of water before the scan
B. Withhold metformin at the time of the procedure and for 48 hours after
C. Double the dose the day before the procedure
D. Substitute insulin automatically for 1 week
Rationales:
A — Taking it with contrast increases lactic acidosis risk if kidney injury occurs.
B — Correct: contrast can impair renal function, so metformin is held to prevent lactic acidosis.
C — Doubling increases toxicity risk.
D — Insulin substitution is not automatic and requires a provider order.
10. A client receives NPH insulin at 7:00 AM. When is the client at greatest risk for hypoglycemia?
A. 7:30 AM
B. 9:00 AM
C. 4:00 PM
D. 7:00 AM the next day
Rationales:
A — NPH onset is 1–2 hours, not 30 minutes.
B — 9 AM is near onset, not peak.
