NUR 283 Comprehensive Final Exam 150+
Multiple Choice Questions with Rationales
Galen College of Nursing - 2026/2027
Edition
SECTION A: MEDICAL-SURGICAL NURSING FOUNDATIONS
(Questions 1-25)
Question 1
A nurse is caring for a patient with heart failure who has developed shortness of breath,
crackles in lung bases, and peripheral edema. Which medication should the nurse
anticipate administering FIRST?
A) Digoxin
B) Furosemide
C) Metoprolol
D) Lisinopril
Correct Answer: B) Furosemide
Rationale: Furosemide is a loop diuretic that should be administered first to reduce fluid
overload, which is causing the patient's symptoms of pulmonary congestion and
edema. Diuresis will decrease preload and alleviate respiratory symptoms quickly. While
digoxin, metoprolol, and lisinopril are important components of heart failure
management, they are not the immediate priority for acute symptom relief.
Question 2
,A postoperative patient reports sudden chest pain and shortness of breath. The nurse
notes tachycardia, tachypnea, and a drop in oxygen saturation to 88% on room air.
What is the nurse's priority action?
A) Administer PRN pain medication
B) Place the patient in high Fowler's position
C) Call the rapid response team
D) Check vital signs in 15 minutes
Correct Answer: C) Call the rapid response team
Rationale: The patient is exhibiting signs of a possible pulmonary embolism (sudden
chest pain, shortness of breath, hypoxia, tachycardia). This is a medical emergency
requiring immediate intervention. The rapid response team should be activated
immediately to provide advanced life support and diagnostic evaluation. High Fowler's
position may help with breathing but is not sufficient; pain medication would mask
symptoms; waiting 15 minutes is unsafe.
Question 3
Which assessment finding is the EARLIEST sign of hypoxemia?
A) Cyanosis
B) Restlessness
C) Bradypnea
D) Bradycardia
Correct Answer: B) Restlessness
Rationale: Restlessness and confusion are early signs of hypoxemia as the brain is highly
sensitive to oxygen deprivation. Cyanosis is a late sign of hypoxemia and indicates
significant oxygen desaturation. Bradypnea and bradycardia are also late signs;
compensatory tachycardia and tachypnea typically occur earlier.
,Question 4
A patient is prescribed enoxaparin (Lovenox) subcutaneously for deep vein thrombosis
prevention. Which action by the nurse is CORRECT when administering this medication?
A) Aspirate before injection
B) Massage the injection site after administration
C) Administer in the abdomen, 2 inches away from the umbilicus
D) Insert needle at a 90-degree angle without pinching the skin
Correct Answer: C) Administer in the abdomen, 2 inches away from the umbilicus
Rationale: Enoxaparin should be administered subcutaneously in the abdomen,
alternating sites, at least 2 inches away from the umbilicus. The skin should be pinched
to create a fold, and the needle inserted at a 45-90 degree angle. Do not aspirate (can
cause hematoma) and do not massage the site (increases bleeding risk).
Question 5
A patient with chronic obstructive pulmonary disease (COPD) has an oxygen saturation
of 88%. Which oxygen delivery method should the nurse use?
A) Non-rebreather mask at 15 L/min
B) Nasal cannula at 2 L/min
C) Simple face mask at 10 L/min
D) Venturi mask at 40%
Correct Answer: B) Nasal cannula at 2 L/min
Rationale: Patients with COPD often retain carbon dioxide and rely on hypoxic drive to
stimulate breathing. High-flow oxygen can suppress this drive, leading to respiratory
depression. The nasal cannula at 2 L/min provides low-flow oxygen that can safely
, increase saturation without suppressing the respiratory drive. Target SpO2 for COPD
patients is typically 88-92%.
Question 6
A nurse is preparing to administer digoxin to a patient with heart failure. Which vital sign
should be assessed PRIOR to administration?
A) Blood pressure
B) Respiratory rate
C) Apical pulse
D) Temperature
Correct Answer: C) Apical pulse
Rationale: Digoxin has a narrow therapeutic range and can cause bradycardia and
heart block. The apical pulse should be assessed for 1 full minute before administration.
The medication should be held if the pulse is below 60 beats per minute (or according
to facility protocol) and the healthcare provider notified.
Question 7
A patient with pneumonia is prescribed ceftriaxone IV. Which adverse effect should the
nurse monitor for related to this medication?
A) Ototoxicity
B) Nephrotoxicity
C) Hepatotoxicity
D) Pseudomembranous colitis
Correct Answer: D) Pseudomembranous colitis
Multiple Choice Questions with Rationales
Galen College of Nursing - 2026/2027
Edition
SECTION A: MEDICAL-SURGICAL NURSING FOUNDATIONS
(Questions 1-25)
Question 1
A nurse is caring for a patient with heart failure who has developed shortness of breath,
crackles in lung bases, and peripheral edema. Which medication should the nurse
anticipate administering FIRST?
A) Digoxin
B) Furosemide
C) Metoprolol
D) Lisinopril
Correct Answer: B) Furosemide
Rationale: Furosemide is a loop diuretic that should be administered first to reduce fluid
overload, which is causing the patient's symptoms of pulmonary congestion and
edema. Diuresis will decrease preload and alleviate respiratory symptoms quickly. While
digoxin, metoprolol, and lisinopril are important components of heart failure
management, they are not the immediate priority for acute symptom relief.
Question 2
,A postoperative patient reports sudden chest pain and shortness of breath. The nurse
notes tachycardia, tachypnea, and a drop in oxygen saturation to 88% on room air.
What is the nurse's priority action?
A) Administer PRN pain medication
B) Place the patient in high Fowler's position
C) Call the rapid response team
D) Check vital signs in 15 minutes
Correct Answer: C) Call the rapid response team
Rationale: The patient is exhibiting signs of a possible pulmonary embolism (sudden
chest pain, shortness of breath, hypoxia, tachycardia). This is a medical emergency
requiring immediate intervention. The rapid response team should be activated
immediately to provide advanced life support and diagnostic evaluation. High Fowler's
position may help with breathing but is not sufficient; pain medication would mask
symptoms; waiting 15 minutes is unsafe.
Question 3
Which assessment finding is the EARLIEST sign of hypoxemia?
A) Cyanosis
B) Restlessness
C) Bradypnea
D) Bradycardia
Correct Answer: B) Restlessness
Rationale: Restlessness and confusion are early signs of hypoxemia as the brain is highly
sensitive to oxygen deprivation. Cyanosis is a late sign of hypoxemia and indicates
significant oxygen desaturation. Bradypnea and bradycardia are also late signs;
compensatory tachycardia and tachypnea typically occur earlier.
,Question 4
A patient is prescribed enoxaparin (Lovenox) subcutaneously for deep vein thrombosis
prevention. Which action by the nurse is CORRECT when administering this medication?
A) Aspirate before injection
B) Massage the injection site after administration
C) Administer in the abdomen, 2 inches away from the umbilicus
D) Insert needle at a 90-degree angle without pinching the skin
Correct Answer: C) Administer in the abdomen, 2 inches away from the umbilicus
Rationale: Enoxaparin should be administered subcutaneously in the abdomen,
alternating sites, at least 2 inches away from the umbilicus. The skin should be pinched
to create a fold, and the needle inserted at a 45-90 degree angle. Do not aspirate (can
cause hematoma) and do not massage the site (increases bleeding risk).
Question 5
A patient with chronic obstructive pulmonary disease (COPD) has an oxygen saturation
of 88%. Which oxygen delivery method should the nurse use?
A) Non-rebreather mask at 15 L/min
B) Nasal cannula at 2 L/min
C) Simple face mask at 10 L/min
D) Venturi mask at 40%
Correct Answer: B) Nasal cannula at 2 L/min
Rationale: Patients with COPD often retain carbon dioxide and rely on hypoxic drive to
stimulate breathing. High-flow oxygen can suppress this drive, leading to respiratory
depression. The nasal cannula at 2 L/min provides low-flow oxygen that can safely
, increase saturation without suppressing the respiratory drive. Target SpO2 for COPD
patients is typically 88-92%.
Question 6
A nurse is preparing to administer digoxin to a patient with heart failure. Which vital sign
should be assessed PRIOR to administration?
A) Blood pressure
B) Respiratory rate
C) Apical pulse
D) Temperature
Correct Answer: C) Apical pulse
Rationale: Digoxin has a narrow therapeutic range and can cause bradycardia and
heart block. The apical pulse should be assessed for 1 full minute before administration.
The medication should be held if the pulse is below 60 beats per minute (or according
to facility protocol) and the healthcare provider notified.
Question 7
A patient with pneumonia is prescribed ceftriaxone IV. Which adverse effect should the
nurse monitor for related to this medication?
A) Ototoxicity
B) Nephrotoxicity
C) Hepatotoxicity
D) Pseudomembranous colitis
Correct Answer: D) Pseudomembranous colitis
