NURSING SCHOOL COMPREHENSIVE FINAL
EXAMINATION 2026–2027 — STUDY GUIDE | LATEST
UPDATE 2026/2027 | ACTUAL EXAM PRACTICE
QUESTIONS AND ANSWERS | EXAM REVIEW | 100%
CORRECT ANSWERS | VERIFIED SOLUTIONS
1. A nurse is assessing a client with acute pancreatitis. Which laboratory result
requires immediate reporting?
A) Serum amylase 300 U/L
B) Blood glucose 140 mg/dL
C) Serum calcium 6.9 mg/dL
D) Serum lipase 200 U/L
Correct Answer: C
Hypocalcemia is a hallmark of severe acute pancreatitis due to calcium
saponification in fat necrosis and indicates a poor prognosis; a level of 6.9 mg/dL
requires urgent intervention. Elevated amylase and lipase are expected in
pancreatitis, and mild hyperglycemia is common.
2. A client with major depressive disorder suddenly becomes more energetic,
gives away personal belongings, and states, “I finally have a plan to stop the
pain.” What is the priority nursing intervention?
A) Place the client on continuous one-to-one observation
B) Encourage the client to attend group therapy
C) Ask the client to sign a no-suicide contract
D) Administer an as-needed anxiolytic
Correct Answer: A
Sudden mood elevation and giving away possessions are warning signs of
imminent suicide; ensuring safety through continuous observation is the
immediate priority. A no-suicide contract does not replace direct supervision.
Group therapy and anxiolytics do not address acute risk.
, 3. A nurse is interpreting a rhythm strip showing a PR interval that
progressively lengthens until a QRS complex is dropped. The pattern
repeats. What rhythm is present?
A) Type I second-degree AV block (Wenckebach)
B) Type II second-degree AV block (Mobitz II)
C) Third-degree AV block
D) Sinus arrhythmia with first-degree AV block
Correct Answer: A
Mobitz I features progressive PR prolongation until a non-conducted P wave.
Mobitz II has constant PR intervals with sudden dropped QRS complexes. Third-
degree block has AV dissociation. Sinus arrhythmia has varying R-R intervals but
no dropped beats.
4. A postpartum client who delivered a 9-pound infant 2 hours ago has a
boggy uterus displaced to the right, heavy lochia rubra, and perineal pad
saturation in 15 minutes. Which nursing intervention is the priority?
A) Perform fundal massage after ensuring the bladder is empty
B) Administer methylergonovine intramuscularly
C) Place the client in Trendelenburg position
D) Measure vital signs and apply an ice pack
Correct Answer: A
A displaced, boggy uterus suggests uterine atony likely due to bladder distention.
The first step is to empty the bladder, then perform fundal massage to stimulate
contraction. Methylergonovine may be given if massage fails and after checking
blood pressure. Trendelenburg is not the immediate action.
5. A client with a history of heart failure presents with new-onset confusion,
jugular venous distention, and a productive cough with pink, frothy sputum.
Lung sounds reveal bilateral crackles. Which pathophysiological process
best explains these findings?
A) Decreased systemic vascular resistance
B) Acute left ventricular failure leading to pulmonary interstitial edema
, C) Right ventricular hypertrophy reducing venous return
D) Increased oncotic pressure drawing fluid into alveoli
Correct Answer: B
Pink, frothy sputum and crackles indicate fluid in the alveoli secondary to acute left
ventricular failure, which elevates pulmonary capillary hydrostatic pressure and
forces fluid into the interstitium and alveoli. Right ventricular failure would
primarily cause peripheral edema. Decreased SVR and increased oncotic pressure
do not cause pulmonary congestion.
6. A nurse is preparing to administer an intradermal injection for a tuberculin
skin test. Which needle gauge and length is most appropriate?
A) 18-gauge, 1.5-inch
B) 22-gauge, 1-inch
C) 25-gauge, 5/8-inch
D) 27-gauge, 1/2-inch
Correct Answer: D
Intradermal injections require a fine, short needle (26- or 27-gauge, 1/4 to 1/2
inch) to deposit medication just below the epidermis. 18-gauge is for large-bore IV.
22-gauge is for IM. 25-gauge 5/8-inch is for subcutaneous.
7. A client with COPD is receiving oxygen at 2 L/min via nasal cannula. The
nurse notes respirations have decreased to 8 breaths per minute and the
client is drowsy. What is the best initial action?
A) Increase oxygen flow to 4 L/min
B) Decrease oxygen flow to 1 L/min and notify the provider
C) Administer prescribed methylxanthine bronchodilator
D) Place the client in high Fowler’s position and administer naloxone
Correct Answer: B
In COPD with chronic CO₂ retention, excessive oxygen can suppress the hypoxic
drive. The appropriate initial action is to lower oxygen to the minimum necessary
to maintain SpO₂ 88–92% and notify the provider. Increasing oxygen worsens
respiratory depression. Naloxone is for opioid overdose.
, 8. A client with cirrhosis develops increasing ascites, oliguria, and a serum
creatinine of 2.8 mg/dL. Urine sodium is 8 mEq/L. Which condition do these
findings most likely represent?
A) Acute tubular necrosis
B) Hepatorenal syndrome
C) Prerenal acute kidney injury from diuretic overuse
D) Postrenal obstruction
Correct Answer: B
Hepatorenal syndrome is characterized by progressive renal failure in advanced
liver disease with very low urine sodium due to intense renal vasoconstriction.
Acute tubular necrosis would have higher urine sodium. The clinical picture of
cirrhosis with ascites suggests hepatorenal pathophysiology.
9. A nurse is teaching a client with Ménière’s disease about dietary
modifications. Which statement indicates a need for further teaching?
A) “I should distribute my fluid intake evenly throughout the day.”
B) “I will limit my intake of canned soups and processed meats.”
C) “I can drink coffee in the morning as long as I reduce salt.”
D) “I need to avoid alcohol and tobacco to help reduce vertigo attacks.”
Correct Answer: C
Caffeine is a stimulant that can exacerbate tinnitus and vertigo in Ménière’s
disease and should be avoided, not compensated by salt reduction. Even fluid
distribution, low-sodium diet, and avoiding alcohol and tobacco are appropriate.
10.A client with a history of schizophrenia is being discharged on clozapine.
Which laboratory result must the nurse verify before the client can receive
the next supply?
A) Absolute neutrophil count (ANC) ≥1500/mm³
B) Hemoglobin A1C less than 7%
C) Serum lithium level 0.8–1.2 mEq/L
D) Thyroid-stimulating hormone within normal limits
EXAMINATION 2026–2027 — STUDY GUIDE | LATEST
UPDATE 2026/2027 | ACTUAL EXAM PRACTICE
QUESTIONS AND ANSWERS | EXAM REVIEW | 100%
CORRECT ANSWERS | VERIFIED SOLUTIONS
1. A nurse is assessing a client with acute pancreatitis. Which laboratory result
requires immediate reporting?
A) Serum amylase 300 U/L
B) Blood glucose 140 mg/dL
C) Serum calcium 6.9 mg/dL
D) Serum lipase 200 U/L
Correct Answer: C
Hypocalcemia is a hallmark of severe acute pancreatitis due to calcium
saponification in fat necrosis and indicates a poor prognosis; a level of 6.9 mg/dL
requires urgent intervention. Elevated amylase and lipase are expected in
pancreatitis, and mild hyperglycemia is common.
2. A client with major depressive disorder suddenly becomes more energetic,
gives away personal belongings, and states, “I finally have a plan to stop the
pain.” What is the priority nursing intervention?
A) Place the client on continuous one-to-one observation
B) Encourage the client to attend group therapy
C) Ask the client to sign a no-suicide contract
D) Administer an as-needed anxiolytic
Correct Answer: A
Sudden mood elevation and giving away possessions are warning signs of
imminent suicide; ensuring safety through continuous observation is the
immediate priority. A no-suicide contract does not replace direct supervision.
Group therapy and anxiolytics do not address acute risk.
, 3. A nurse is interpreting a rhythm strip showing a PR interval that
progressively lengthens until a QRS complex is dropped. The pattern
repeats. What rhythm is present?
A) Type I second-degree AV block (Wenckebach)
B) Type II second-degree AV block (Mobitz II)
C) Third-degree AV block
D) Sinus arrhythmia with first-degree AV block
Correct Answer: A
Mobitz I features progressive PR prolongation until a non-conducted P wave.
Mobitz II has constant PR intervals with sudden dropped QRS complexes. Third-
degree block has AV dissociation. Sinus arrhythmia has varying R-R intervals but
no dropped beats.
4. A postpartum client who delivered a 9-pound infant 2 hours ago has a
boggy uterus displaced to the right, heavy lochia rubra, and perineal pad
saturation in 15 minutes. Which nursing intervention is the priority?
A) Perform fundal massage after ensuring the bladder is empty
B) Administer methylergonovine intramuscularly
C) Place the client in Trendelenburg position
D) Measure vital signs and apply an ice pack
Correct Answer: A
A displaced, boggy uterus suggests uterine atony likely due to bladder distention.
The first step is to empty the bladder, then perform fundal massage to stimulate
contraction. Methylergonovine may be given if massage fails and after checking
blood pressure. Trendelenburg is not the immediate action.
5. A client with a history of heart failure presents with new-onset confusion,
jugular venous distention, and a productive cough with pink, frothy sputum.
Lung sounds reveal bilateral crackles. Which pathophysiological process
best explains these findings?
A) Decreased systemic vascular resistance
B) Acute left ventricular failure leading to pulmonary interstitial edema
, C) Right ventricular hypertrophy reducing venous return
D) Increased oncotic pressure drawing fluid into alveoli
Correct Answer: B
Pink, frothy sputum and crackles indicate fluid in the alveoli secondary to acute left
ventricular failure, which elevates pulmonary capillary hydrostatic pressure and
forces fluid into the interstitium and alveoli. Right ventricular failure would
primarily cause peripheral edema. Decreased SVR and increased oncotic pressure
do not cause pulmonary congestion.
6. A nurse is preparing to administer an intradermal injection for a tuberculin
skin test. Which needle gauge and length is most appropriate?
A) 18-gauge, 1.5-inch
B) 22-gauge, 1-inch
C) 25-gauge, 5/8-inch
D) 27-gauge, 1/2-inch
Correct Answer: D
Intradermal injections require a fine, short needle (26- or 27-gauge, 1/4 to 1/2
inch) to deposit medication just below the epidermis. 18-gauge is for large-bore IV.
22-gauge is for IM. 25-gauge 5/8-inch is for subcutaneous.
7. A client with COPD is receiving oxygen at 2 L/min via nasal cannula. The
nurse notes respirations have decreased to 8 breaths per minute and the
client is drowsy. What is the best initial action?
A) Increase oxygen flow to 4 L/min
B) Decrease oxygen flow to 1 L/min and notify the provider
C) Administer prescribed methylxanthine bronchodilator
D) Place the client in high Fowler’s position and administer naloxone
Correct Answer: B
In COPD with chronic CO₂ retention, excessive oxygen can suppress the hypoxic
drive. The appropriate initial action is to lower oxygen to the minimum necessary
to maintain SpO₂ 88–92% and notify the provider. Increasing oxygen worsens
respiratory depression. Naloxone is for opioid overdose.
, 8. A client with cirrhosis develops increasing ascites, oliguria, and a serum
creatinine of 2.8 mg/dL. Urine sodium is 8 mEq/L. Which condition do these
findings most likely represent?
A) Acute tubular necrosis
B) Hepatorenal syndrome
C) Prerenal acute kidney injury from diuretic overuse
D) Postrenal obstruction
Correct Answer: B
Hepatorenal syndrome is characterized by progressive renal failure in advanced
liver disease with very low urine sodium due to intense renal vasoconstriction.
Acute tubular necrosis would have higher urine sodium. The clinical picture of
cirrhosis with ascites suggests hepatorenal pathophysiology.
9. A nurse is teaching a client with Ménière’s disease about dietary
modifications. Which statement indicates a need for further teaching?
A) “I should distribute my fluid intake evenly throughout the day.”
B) “I will limit my intake of canned soups and processed meats.”
C) “I can drink coffee in the morning as long as I reduce salt.”
D) “I need to avoid alcohol and tobacco to help reduce vertigo attacks.”
Correct Answer: C
Caffeine is a stimulant that can exacerbate tinnitus and vertigo in Ménière’s
disease and should be avoided, not compensated by salt reduction. Even fluid
distribution, low-sodium diet, and avoiding alcohol and tobacco are appropriate.
10.A client with a history of schizophrenia is being discharged on clozapine.
Which laboratory result must the nurse verify before the client can receive
the next supply?
A) Absolute neutrophil count (ANC) ≥1500/mm³
B) Hemoglobin A1C less than 7%
C) Serum lithium level 0.8–1.2 mEq/L
D) Thyroid-stimulating hormone within normal limits
