NR 447 FINAL EXAM BRAND NEW VERSION 2027-2028 Q&A
EXAM | ALL QUESTIONS AND ANSWERS PLUS DETAILED
RATIONALES | COMPLETE STUDYGUIDE| GUARANTEED PASS |
DOWNLOAD INSTANT PDF 2027-2028
1. A postoperative client suddenly becomes restless and has an oxygen saturation of
86% on room air. Which action should the nurse take first?
A. Administer the prescribed oral analgesic
B. Assess airway and breathing and apply oxygen as indicated
C. Encourage the client to ambulate
D. Obtain a routine postoperative weight
Rationale: Acute restlessness with hypoxemia may indicate impaired oxygenation. Airway
and breathing must be assessed and supported immediately.
2. A client with left-sided heart failure reports worsening shortness of breath and
awakens at night gasping for air. Which finding would the nurse most likely expect?
A. Bilateral crackles
B. Increased bowel sounds
C. Dry mucous membranes
D. Warm, flushed skin
Rationale: Left-sided heart failure causes pulmonary congestion, commonly producing
crackles and worsening dyspnea, particularly when lying down.
3. A client receiving furosemide for heart failure has a potassium level of 3.0 mEq/L.
Which assessment finding is most concerning?
A. Increased appetite
B. Muscle weakness and irregular pulse
C. Mild thirst
D. Increased urinary frequency
Rationale: Hypokalemia can cause muscle weakness and potentially life-threatening cardiac
dysrhythmias, especially in clients receiving diuretics.
4. A client with COPD is receiving oxygen therapy. Which nursing intervention is most
appropriate?
A. Maintain oxygen at the highest possible flow rate
B. Titrate oxygen according to the prescribed target and clinical response
,C. Discontinue oxygen whenever the client becomes dyspneic
D. Encourage prolonged breath holding
Rationale: Oxygen should be administered carefully according to the client's prescribed target
and monitored response rather than automatically using excessive concentrations.
5. A client with diabetes is awake, diaphoretic, and trembling. The blood glucose level
is 54 mg/dL. Which intervention is appropriate?
A. Administer rapid-acting carbohydrate
B. Give scheduled long-acting insulin
C. Restrict oral intake
D. Administer metformin
Rationale: A conscious client who can safely swallow should receive a rapidly absorbed
carbohydrate for symptomatic hypoglycemia.
6. A client admitted with vomiting and diarrhea has a blood pressure of 88/54 mmHg,
heart rate of 118/min, and cool skin. Which condition should the nurse suspect?
A. Fluid volume excess
B. Hypovolemic shock
C. Hypertensive crisis
D. Increased intracranial pressure
Rationale: Hypotension, tachycardia, and cool skin in the setting of significant fluid loss
indicate inadequate circulating volume and possible hypovolemic shock.
7. A nurse is preparing to administer IV potassium chloride. Which action is essential?
A. Administer it by rapid IV push
B. Dilute it and administer it using an infusion pump as prescribed
C. Mix it with an unrelated medication at the bedside
D. Give it undiluted through a peripheral line
Rationale: IV potassium is a high-alert medication and must never be administered by IV
push. Controlled infusion and appropriate dilution are required.
8. A client with pneumonia has increasing respiratory effort and an oxygen saturation
of 88% despite prescribed oxygen. What is the nurse's priority?
A. Offer a snack
B. Reassess respiratory status and escalate the deterioration
C. Encourage the client to sleep
D. Delay intervention until the next vital-sign round
, Rationale: Worsening oxygenation despite therapy may indicate respiratory deterioration
and requires immediate reassessment and escalation.
9. A client receiving morphine after surgery has a respiratory rate of 7/min and is
difficult to arouse. Which medication should the nurse anticipate?
A. Naloxone
B. Furosemide
C. Protamine
D. Vitamin K
Rationale: Naloxone reverses opioid-induced respiratory depression and may be required
when clinically significant respiratory depression occurs.
10. A client reports crushing substernal chest pressure radiating to the left arm and is
diaphoretic. Which action has priority?
A. Encourage the client to walk
B. Initiate immediate cardiac assessment and emergency management
C. Give a routine bedtime medication
D. Ask the client to return later
Rationale: Classic ischemic symptoms require rapid assessment and treatment because acute
coronary syndrome can rapidly become life-threatening.
11. A client with hypertension asks which lifestyle change can help reduce
cardiovascular risk. Which recommendation is most appropriate?
A. Increase sodium intake
B. Follow a heart-healthy diet and maintain regular physical activity
C. Avoid all exercise
D. Stop prescribed medications when blood pressure improves
Rationale: Dietary modification, physical activity, weight management, and medication
adherence are important components of hypertension management.
12. A client with peripheral arterial disease reports calf pain when walking that resolves
with rest. How should the nurse interpret this finding?
A. Intermittent claudication
B. Venous stasis ulcer
C. Acute urinary retention
D. Neurologic tremor
EXAM | ALL QUESTIONS AND ANSWERS PLUS DETAILED
RATIONALES | COMPLETE STUDYGUIDE| GUARANTEED PASS |
DOWNLOAD INSTANT PDF 2027-2028
1. A postoperative client suddenly becomes restless and has an oxygen saturation of
86% on room air. Which action should the nurse take first?
A. Administer the prescribed oral analgesic
B. Assess airway and breathing and apply oxygen as indicated
C. Encourage the client to ambulate
D. Obtain a routine postoperative weight
Rationale: Acute restlessness with hypoxemia may indicate impaired oxygenation. Airway
and breathing must be assessed and supported immediately.
2. A client with left-sided heart failure reports worsening shortness of breath and
awakens at night gasping for air. Which finding would the nurse most likely expect?
A. Bilateral crackles
B. Increased bowel sounds
C. Dry mucous membranes
D. Warm, flushed skin
Rationale: Left-sided heart failure causes pulmonary congestion, commonly producing
crackles and worsening dyspnea, particularly when lying down.
3. A client receiving furosemide for heart failure has a potassium level of 3.0 mEq/L.
Which assessment finding is most concerning?
A. Increased appetite
B. Muscle weakness and irregular pulse
C. Mild thirst
D. Increased urinary frequency
Rationale: Hypokalemia can cause muscle weakness and potentially life-threatening cardiac
dysrhythmias, especially in clients receiving diuretics.
4. A client with COPD is receiving oxygen therapy. Which nursing intervention is most
appropriate?
A. Maintain oxygen at the highest possible flow rate
B. Titrate oxygen according to the prescribed target and clinical response
,C. Discontinue oxygen whenever the client becomes dyspneic
D. Encourage prolonged breath holding
Rationale: Oxygen should be administered carefully according to the client's prescribed target
and monitored response rather than automatically using excessive concentrations.
5. A client with diabetes is awake, diaphoretic, and trembling. The blood glucose level
is 54 mg/dL. Which intervention is appropriate?
A. Administer rapid-acting carbohydrate
B. Give scheduled long-acting insulin
C. Restrict oral intake
D. Administer metformin
Rationale: A conscious client who can safely swallow should receive a rapidly absorbed
carbohydrate for symptomatic hypoglycemia.
6. A client admitted with vomiting and diarrhea has a blood pressure of 88/54 mmHg,
heart rate of 118/min, and cool skin. Which condition should the nurse suspect?
A. Fluid volume excess
B. Hypovolemic shock
C. Hypertensive crisis
D. Increased intracranial pressure
Rationale: Hypotension, tachycardia, and cool skin in the setting of significant fluid loss
indicate inadequate circulating volume and possible hypovolemic shock.
7. A nurse is preparing to administer IV potassium chloride. Which action is essential?
A. Administer it by rapid IV push
B. Dilute it and administer it using an infusion pump as prescribed
C. Mix it with an unrelated medication at the bedside
D. Give it undiluted through a peripheral line
Rationale: IV potassium is a high-alert medication and must never be administered by IV
push. Controlled infusion and appropriate dilution are required.
8. A client with pneumonia has increasing respiratory effort and an oxygen saturation
of 88% despite prescribed oxygen. What is the nurse's priority?
A. Offer a snack
B. Reassess respiratory status and escalate the deterioration
C. Encourage the client to sleep
D. Delay intervention until the next vital-sign round
, Rationale: Worsening oxygenation despite therapy may indicate respiratory deterioration
and requires immediate reassessment and escalation.
9. A client receiving morphine after surgery has a respiratory rate of 7/min and is
difficult to arouse. Which medication should the nurse anticipate?
A. Naloxone
B. Furosemide
C. Protamine
D. Vitamin K
Rationale: Naloxone reverses opioid-induced respiratory depression and may be required
when clinically significant respiratory depression occurs.
10. A client reports crushing substernal chest pressure radiating to the left arm and is
diaphoretic. Which action has priority?
A. Encourage the client to walk
B. Initiate immediate cardiac assessment and emergency management
C. Give a routine bedtime medication
D. Ask the client to return later
Rationale: Classic ischemic symptoms require rapid assessment and treatment because acute
coronary syndrome can rapidly become life-threatening.
11. A client with hypertension asks which lifestyle change can help reduce
cardiovascular risk. Which recommendation is most appropriate?
A. Increase sodium intake
B. Follow a heart-healthy diet and maintain regular physical activity
C. Avoid all exercise
D. Stop prescribed medications when blood pressure improves
Rationale: Dietary modification, physical activity, weight management, and medication
adherence are important components of hypertension management.
12. A client with peripheral arterial disease reports calf pain when walking that resolves
with rest. How should the nurse interpret this finding?
A. Intermittent claudication
B. Venous stasis ulcer
C. Acute urinary retention
D. Neurologic tremor
