NUR 445 EXAM 1
WITH ANSWERS AND
RATIONALES GUARENTEED PASS
1. A patient with chronic COPD becomes increasingly confused and
has an SpO₂ of 85% on 2 L/min via nasal cannula. Nurse’s first
action: A. Increase oxygen to 6 L/min.
B. Encourage pursed-lip breathing and position upright.
C. Administer a sedative for anxiety.
D.Obtain a sputum culture.
Answer: B
Rationale: Positioning upright and pursed-lip breathing improve
ventilation and oxygenation immediately. High-flow O₂ can blunt
hypoxic drive in some COPD patients — titrate carefully after
assessment.
2. A postoperative patient’s dressing is saturated and BP falls from
120/78 to 86/52.
Priority nursing
action: A. Call the
surgeon.
B. Reinforce dressing and apply direct pressure.
C. Increase IV maintenance fluids.
D.Elevate legs and monitor.
Answer: B
Rationale: Control external hemorrhage immediately by applying
pressure/reinforcing dressing; then notify surgeon and initiate fluid
resuscitation as needed.
3. A patient on heparin develops sudden platelet drop from 250k to
80k. Nurse suspects:
A. Heparin-induced thrombocytopenia (HIT).
B. Lab error only.
C. Heparin overdose.
D.Immune thrombocytopenic purpura.
Answer: A
Rationale: A significant platelet drop after heparin suggests HIT;
stop heparin, notify provider, and prepare for alternative
anticoagulation per protocol.
4. Which ECG change is most characteristic of hyperkalemia? A.
Peaked T waves.
NUR 445
,NUR 445 EXAM 1
WITH ANSWERS AND
RATIONALES GUARENTEED PASS
B. U waves.
C. Short PR interval.
D.ST elevation.
Answer: A
Rationale: Tall, peaked T waves are an early ECG sign of elevated
potassium and may progress to widened QRS and ventricular
arrhythmias.
5. A patient with congestive heart failure has new crackles, orthopnea,
and 3+ peripheral edema. Best immediate medication class: A.
Beta-blocker.
B. Loop diuretic.
C. ACE inhibitor.
D.Statin.
Answer: B
Rationale: Loop diuretics reduce pulmonary and peripheral fluid
overload quickly, relieving congestion and dyspnea.
6. A diabetic on insulin has diaphoresis, tremors, and confusion. Best
immediate action:
A. Administer 10–20 g fast-acting carbohydrate orally.
B. Give insulin per sliding scale.
C. Check A1c.
D.Give long-acting carbohydrate only.
Answer: A
Rationale: These reflect hypoglycemia—administer a fast-acting
carb (juice, glucose gel). If patient cannot swallow, give IV dextrose
or IM glucagon.
7. After thyroidectomy the patient reports perioral tingling and positive
Chvostek sign. Nurse priority:
A. Call provider and assess calcium level.
B. Encourage deep breathing.
C. Give acetaminophen.
D.Start levothyroxine.
Answer: A
Rationale: Signs suggest hypocalcemia (parathyroid compromise).
Assess, notify provider, and prepare calcium replacement if ordered.
NUR 445
,NUR 445 EXAM 1
WITH ANSWERS AND
RATIONALES GUARENTEED PASS
8. A patient with DKA: ABC priorities show tachypnea, dehydration, and
blood glucose 480 mg/dL. First intervention: A. IV isotonic fluid
bolus.
B. Immediate IV insulin infusion.
C. Give oral glucose.
D.Administer sodium bicarbonate.
Answer: A
Rationale: Correct dehydration first with isotonic fluids to restore
perfusion; insulin started after initial fluids and after potassium
assessment due to risk of hypokalemia.
9. In a patient with suspected stroke, what is the first diagnostic test to
differentiate ischemic from hemorrhagic stroke? A. CT head without
contrast.
B. MRI brain.
C. Carotid doppler.
D.Lumbar puncture.
Answer: A
Rationale: Noncontrast CT quickly identifies hemorrhage and
guides acute management decisions (e.g., thrombolytics).
10. A patient on warfarin has INR of 6.2 and is asymptomatic. Best
nursing action: A. Hold warfarin and notify provider for vitamin K
orders.
B. Give fresh frozen plasma immediately.
C. Administer protamine.
D.Increase warfarin dose.
Answer: A
Rationale: Elevated INR requires holding warfarin and consulting
provider; vitamin K may be given depending on bleeding risk. FFP is
for major bleeding or urgent reversal.
11. A patient with pneumonia and sepsis shows low BP 82/48 and
cool extremities.
According to sepsis bundle, nurse should
first: A. Start rapid IV crystalloid bolus
(30 mL/kg).
B. Obtain wound cultures.
C. Administer PRN antipyretic.
D.Begin enteral nutrition.
NUR 445
, NUR 445 EXAM 1
WITH ANSWERS AND
RATIONALES GUARENTEED PASS
Answer: A
Rationale: Early aggressive fluid resuscitation is key to restore
perfusion in sepsis/septic shock before or while antibiotics are
started.
12. A patient with chest tube has continuous bubbling in the water
seal chamber.
Nurse action:
A. Check for an air leak in tubing and connections.
B. Decrease suction.
C. Strip the chest tube.
D.Clamp the tube.
Answer: A
Rationale: Continuous bubbling in water-seal suggests an air leak—
assess tubing, connections, and dressing for leak source.
Clamping/trimming can be dangerous without orders.
13. A patient scheduled for surgery receives preoperative beta-
blocker. On arrival, pulse is 48 bpm and systolic BP 90. Nurse
should: A. Hold beta-blocker and notify provider.
B. Give atropine.
C. Proceed to OR.
D.Administer IV fluids only.
Answer: A
Rationale: Bradycardia and hypotension require holding the med
and notifying provider; proceeding could risk intraoperative
instability.
14. A patient in hypovolemic shock has narrow pulse pressure,
tachycardia, and cool, clammy skin. Priority interventions include:
A. Rapid IV fluid resuscitation and blood products as needed.
B. High-dose vasopressors only.
C. Immediate diuretics.
D.NPO and oxygen only.
Answer: A
Rationale: Restore circulating volume quickly with crystalloids and
blood as indicated; vasopressors may be used after volume
resuscitation if needed.
NUR 445
WITH ANSWERS AND
RATIONALES GUARENTEED PASS
1. A patient with chronic COPD becomes increasingly confused and
has an SpO₂ of 85% on 2 L/min via nasal cannula. Nurse’s first
action: A. Increase oxygen to 6 L/min.
B. Encourage pursed-lip breathing and position upright.
C. Administer a sedative for anxiety.
D.Obtain a sputum culture.
Answer: B
Rationale: Positioning upright and pursed-lip breathing improve
ventilation and oxygenation immediately. High-flow O₂ can blunt
hypoxic drive in some COPD patients — titrate carefully after
assessment.
2. A postoperative patient’s dressing is saturated and BP falls from
120/78 to 86/52.
Priority nursing
action: A. Call the
surgeon.
B. Reinforce dressing and apply direct pressure.
C. Increase IV maintenance fluids.
D.Elevate legs and monitor.
Answer: B
Rationale: Control external hemorrhage immediately by applying
pressure/reinforcing dressing; then notify surgeon and initiate fluid
resuscitation as needed.
3. A patient on heparin develops sudden platelet drop from 250k to
80k. Nurse suspects:
A. Heparin-induced thrombocytopenia (HIT).
B. Lab error only.
C. Heparin overdose.
D.Immune thrombocytopenic purpura.
Answer: A
Rationale: A significant platelet drop after heparin suggests HIT;
stop heparin, notify provider, and prepare for alternative
anticoagulation per protocol.
4. Which ECG change is most characteristic of hyperkalemia? A.
Peaked T waves.
NUR 445
,NUR 445 EXAM 1
WITH ANSWERS AND
RATIONALES GUARENTEED PASS
B. U waves.
C. Short PR interval.
D.ST elevation.
Answer: A
Rationale: Tall, peaked T waves are an early ECG sign of elevated
potassium and may progress to widened QRS and ventricular
arrhythmias.
5. A patient with congestive heart failure has new crackles, orthopnea,
and 3+ peripheral edema. Best immediate medication class: A.
Beta-blocker.
B. Loop diuretic.
C. ACE inhibitor.
D.Statin.
Answer: B
Rationale: Loop diuretics reduce pulmonary and peripheral fluid
overload quickly, relieving congestion and dyspnea.
6. A diabetic on insulin has diaphoresis, tremors, and confusion. Best
immediate action:
A. Administer 10–20 g fast-acting carbohydrate orally.
B. Give insulin per sliding scale.
C. Check A1c.
D.Give long-acting carbohydrate only.
Answer: A
Rationale: These reflect hypoglycemia—administer a fast-acting
carb (juice, glucose gel). If patient cannot swallow, give IV dextrose
or IM glucagon.
7. After thyroidectomy the patient reports perioral tingling and positive
Chvostek sign. Nurse priority:
A. Call provider and assess calcium level.
B. Encourage deep breathing.
C. Give acetaminophen.
D.Start levothyroxine.
Answer: A
Rationale: Signs suggest hypocalcemia (parathyroid compromise).
Assess, notify provider, and prepare calcium replacement if ordered.
NUR 445
,NUR 445 EXAM 1
WITH ANSWERS AND
RATIONALES GUARENTEED PASS
8. A patient with DKA: ABC priorities show tachypnea, dehydration, and
blood glucose 480 mg/dL. First intervention: A. IV isotonic fluid
bolus.
B. Immediate IV insulin infusion.
C. Give oral glucose.
D.Administer sodium bicarbonate.
Answer: A
Rationale: Correct dehydration first with isotonic fluids to restore
perfusion; insulin started after initial fluids and after potassium
assessment due to risk of hypokalemia.
9. In a patient with suspected stroke, what is the first diagnostic test to
differentiate ischemic from hemorrhagic stroke? A. CT head without
contrast.
B. MRI brain.
C. Carotid doppler.
D.Lumbar puncture.
Answer: A
Rationale: Noncontrast CT quickly identifies hemorrhage and
guides acute management decisions (e.g., thrombolytics).
10. A patient on warfarin has INR of 6.2 and is asymptomatic. Best
nursing action: A. Hold warfarin and notify provider for vitamin K
orders.
B. Give fresh frozen plasma immediately.
C. Administer protamine.
D.Increase warfarin dose.
Answer: A
Rationale: Elevated INR requires holding warfarin and consulting
provider; vitamin K may be given depending on bleeding risk. FFP is
for major bleeding or urgent reversal.
11. A patient with pneumonia and sepsis shows low BP 82/48 and
cool extremities.
According to sepsis bundle, nurse should
first: A. Start rapid IV crystalloid bolus
(30 mL/kg).
B. Obtain wound cultures.
C. Administer PRN antipyretic.
D.Begin enteral nutrition.
NUR 445
, NUR 445 EXAM 1
WITH ANSWERS AND
RATIONALES GUARENTEED PASS
Answer: A
Rationale: Early aggressive fluid resuscitation is key to restore
perfusion in sepsis/septic shock before or while antibiotics are
started.
12. A patient with chest tube has continuous bubbling in the water
seal chamber.
Nurse action:
A. Check for an air leak in tubing and connections.
B. Decrease suction.
C. Strip the chest tube.
D.Clamp the tube.
Answer: A
Rationale: Continuous bubbling in water-seal suggests an air leak—
assess tubing, connections, and dressing for leak source.
Clamping/trimming can be dangerous without orders.
13. A patient scheduled for surgery receives preoperative beta-
blocker. On arrival, pulse is 48 bpm and systolic BP 90. Nurse
should: A. Hold beta-blocker and notify provider.
B. Give atropine.
C. Proceed to OR.
D.Administer IV fluids only.
Answer: A
Rationale: Bradycardia and hypotension require holding the med
and notifying provider; proceeding could risk intraoperative
instability.
14. A patient in hypovolemic shock has narrow pulse pressure,
tachycardia, and cool, clammy skin. Priority interventions include:
A. Rapid IV fluid resuscitation and blood products as needed.
B. High-dose vasopressors only.
C. Immediate diuretics.
D.NPO and oxygen only.
Answer: A
Rationale: Restore circulating volume quickly with crystalloids and
blood as indicated; vasopressors may be used after volume
resuscitation if needed.
NUR 445
