BSN3A Nursing Comprehensive Exam
Practice Questions & [Verified Answers],
Plus Explained Rationales|2026 Latest
Update| Instant Download PDF
1. A nurse is assessing a patient who has just returned from surgery.
Which finding requires the nurse's immediate attention?
A. Pain rated 6/10
B. Temperature of 37.4°C (99.3°F)
C. Oxygen saturation of 88%
D. Urine output of 40 mL/hr
Answer: C. Oxygen saturation of 88%
Rationale: An oxygen saturation of 88% indicates hypoxemia and
requires immediate assessment and intervention. Airway and
breathing take priority according to the ABC approach. Pain,
temperature, and urine output are important but are not the most
immediately threatening findings.
2. A patient with heart failure is receiving furosemide. Which
laboratory value should the nurse monitor most closely?
A. Sodium
B. Potassium
C. Hemoglobin
D. Platelet count
1|Page
,Answer: B. Potassium
Rationale: Furosemide is a loop diuretic that can cause significant
potassium loss. Hypokalemia can produce muscle weakness and
potentially life-threatening cardiac dysrhythmias, making potassium
monitoring essential.
3. A nurse is caring for a patient experiencing an acute asthma
exacerbation. Which medication should the nurse expect to
administer first for rapid relief?
A. Montelukast
B. Fluticasone
C. Albuterol
D. Theophylline
Answer: C. Albuterol
Rationale: Albuterol is a short-acting beta2-adrenergic agonist that
produces rapid bronchodilation and is used as a rescue medication
during acute bronchospasm. Inhaled corticosteroids such as
fluticasone are primarily controller medications.
4. A patient with diabetes mellitus is pale, diaphoretic, and confused.
The blood glucose level is 48 mg/dL. What should the nurse do first if
the patient is conscious and able to swallow?
A. Administer regular insulin
B. Give 15 g of rapid-acting carbohydrate
C. Administer glucagon intramuscularly
D. Start an intravenous insulin infusion
Answer: B. Give 15 g of rapid-acting carbohydrate
2|Page
,Rationale: A conscious patient who can safely swallow and has
symptomatic hypoglycemia should receive approximately 15 g of
rapid-acting carbohydrate, followed by reassessment of blood
glucose. Insulin would worsen hypoglycemia. Glucagon is generally
used when the patient cannot safely take oral carbohydrates.
5. A nurse is caring for a patient with suspected increased intracranial
pressure. Which assessment finding is most concerning?
A. Headache
B. Nausea
C. Decreasing level of consciousness
D. Mild photophobia
Answer: C. Decreasing level of consciousness
Rationale: A decreasing level of consciousness is a significant
neurological deterioration and may indicate worsening intracranial
pressure or cerebral compromise. It requires prompt assessment and
intervention.
6. Which assessment finding is most characteristic of left-sided heart
failure?
A. Peripheral edema
B. Jugular venous distention
C. Pulmonary crackles
D. Enlarged liver
Answer: C. Pulmonary crackles
Rationale: Left-sided heart failure causes blood to back up into the
pulmonary circulation, producing pulmonary congestion, dyspnea,
3|Page
, and crackles. Peripheral edema, jugular venous distention, and
hepatomegaly are more commonly associated with systemic venous
congestion from right-sided heart failure.
7. A patient is receiving a blood transfusion and develops chills, fever,
and low back pain. What is the nurse's priority action?
A. Slow the transfusion
B. Stop the transfusion
C. Administer acetaminophen
D. Increase the transfusion rate
Answer: B. Stop the transfusion
Rationale: Fever, chills, and back pain may indicate an acute
hemolytic transfusion reaction. The transfusion must be stopped
immediately, and the nurse should maintain IV access with
appropriate compatible fluid according to institutional protocol and
notify the provider and blood bank.
8. A patient with chronic obstructive pulmonary disease is receiving
oxygen. Which nursing intervention is appropriate?
A. Administer oxygen at the highest possible flow rate
B. Maintain oxygen according to the prescribed target saturation
C. Withhold oxygen because it suppresses respiratory drive
D. Encourage prolonged breath-holding exercises
Answer: B. Maintain oxygen according to the prescribed target
saturation
Rationale: Patients with COPD may require carefully titrated oxygen
therapy. Oxygen should not be withheld when hypoxemia is present,
4|Page
Practice Questions & [Verified Answers],
Plus Explained Rationales|2026 Latest
Update| Instant Download PDF
1. A nurse is assessing a patient who has just returned from surgery.
Which finding requires the nurse's immediate attention?
A. Pain rated 6/10
B. Temperature of 37.4°C (99.3°F)
C. Oxygen saturation of 88%
D. Urine output of 40 mL/hr
Answer: C. Oxygen saturation of 88%
Rationale: An oxygen saturation of 88% indicates hypoxemia and
requires immediate assessment and intervention. Airway and
breathing take priority according to the ABC approach. Pain,
temperature, and urine output are important but are not the most
immediately threatening findings.
2. A patient with heart failure is receiving furosemide. Which
laboratory value should the nurse monitor most closely?
A. Sodium
B. Potassium
C. Hemoglobin
D. Platelet count
1|Page
,Answer: B. Potassium
Rationale: Furosemide is a loop diuretic that can cause significant
potassium loss. Hypokalemia can produce muscle weakness and
potentially life-threatening cardiac dysrhythmias, making potassium
monitoring essential.
3. A nurse is caring for a patient experiencing an acute asthma
exacerbation. Which medication should the nurse expect to
administer first for rapid relief?
A. Montelukast
B. Fluticasone
C. Albuterol
D. Theophylline
Answer: C. Albuterol
Rationale: Albuterol is a short-acting beta2-adrenergic agonist that
produces rapid bronchodilation and is used as a rescue medication
during acute bronchospasm. Inhaled corticosteroids such as
fluticasone are primarily controller medications.
4. A patient with diabetes mellitus is pale, diaphoretic, and confused.
The blood glucose level is 48 mg/dL. What should the nurse do first if
the patient is conscious and able to swallow?
A. Administer regular insulin
B. Give 15 g of rapid-acting carbohydrate
C. Administer glucagon intramuscularly
D. Start an intravenous insulin infusion
Answer: B. Give 15 g of rapid-acting carbohydrate
2|Page
,Rationale: A conscious patient who can safely swallow and has
symptomatic hypoglycemia should receive approximately 15 g of
rapid-acting carbohydrate, followed by reassessment of blood
glucose. Insulin would worsen hypoglycemia. Glucagon is generally
used when the patient cannot safely take oral carbohydrates.
5. A nurse is caring for a patient with suspected increased intracranial
pressure. Which assessment finding is most concerning?
A. Headache
B. Nausea
C. Decreasing level of consciousness
D. Mild photophobia
Answer: C. Decreasing level of consciousness
Rationale: A decreasing level of consciousness is a significant
neurological deterioration and may indicate worsening intracranial
pressure or cerebral compromise. It requires prompt assessment and
intervention.
6. Which assessment finding is most characteristic of left-sided heart
failure?
A. Peripheral edema
B. Jugular venous distention
C. Pulmonary crackles
D. Enlarged liver
Answer: C. Pulmonary crackles
Rationale: Left-sided heart failure causes blood to back up into the
pulmonary circulation, producing pulmonary congestion, dyspnea,
3|Page
, and crackles. Peripheral edema, jugular venous distention, and
hepatomegaly are more commonly associated with systemic venous
congestion from right-sided heart failure.
7. A patient is receiving a blood transfusion and develops chills, fever,
and low back pain. What is the nurse's priority action?
A. Slow the transfusion
B. Stop the transfusion
C. Administer acetaminophen
D. Increase the transfusion rate
Answer: B. Stop the transfusion
Rationale: Fever, chills, and back pain may indicate an acute
hemolytic transfusion reaction. The transfusion must be stopped
immediately, and the nurse should maintain IV access with
appropriate compatible fluid according to institutional protocol and
notify the provider and blood bank.
8. A patient with chronic obstructive pulmonary disease is receiving
oxygen. Which nursing intervention is appropriate?
A. Administer oxygen at the highest possible flow rate
B. Maintain oxygen according to the prescribed target saturation
C. Withhold oxygen because it suppresses respiratory drive
D. Encourage prolonged breath-holding exercises
Answer: B. Maintain oxygen according to the prescribed target
saturation
Rationale: Patients with COPD may require carefully titrated oxygen
therapy. Oxygen should not be withheld when hypoxemia is present,
4|Page
