PN 3004 FINAL EXAMINATION Comprehensive Nursing
Practice Assessment
With 150+ QUESTIONS,CORRECT AND VERIFIED ANSWERS WITH
ELABORATED RATIONALES ACTUAL EXAM !
SECTION A: MEDICAL-SURGICAL NURSING (Questions 1-40)
1. A patient with chronic obstructive pulmonary disease (COPD) presents with
worsening dyspnea, barrel chest, and peripheral edema. The nurse notes jugular
venous distention. Which intervention should the nurse prioritize?
A) Administer high-flow oxygen via non-rebreather mask
B) Elevate the head of the bed to 45 degrees
C) Encourage oral fluid intake of 3L/day
D) Administer bronchodilators as prescribed
CORRECT ANSWER: B) Elevate the head of the bed to 45 degrees
Rationale: Elevating the head of the bed promotes optimal diaphragmatic excursion
and lung expansion, reducing dyspnea and work of breathing. High-flow oxygen may
suppress respiratory drive in COPD patients. Fluid restriction, not encouragement, is
typically indicated due to right-sided heart failure concerns.
2. A patient with heart failure is prescribed furosemide 40mg IV push. Which laboratory
value requires immediate notification of the healthcare provider before administration?
A) Serum sodium 135 mEq/L
,B) Serum potassium 2.9 mEq/L
C) Serum creatinine 1.2 mg/dL
D) Serum glucose 110 mg/dL
CORRECT ANSWER: B) Serum potassium 2.9 mEq/L
Rationale: Furosemide is a loop diuretic that can cause significant potassium depletion.
A potassium level of 2.9 mEq/L is critically low (normal 3.5-5.0 mEq/L) and increases the
risk of cardiac arrhythmias. This value requires correction before administering the
medication.
3. A postoperative patient develops sudden-onset chest pain, dyspnea, and
hemoptysis. The nurse notes tachycardia and hypotension. Which condition should the
nurse suspect first?
A) Pneumothorax
B) Pulmonary embolism
C) Atelectasis
D) Wound infection
CORRECT ANSWER: B) Pulmonary embolism
Rationale: The classic triad of sudden chest pain, dyspnea, and hemoptysis, particularly
in a postoperative patient at risk for thromboembolism, is highly suggestive of
,pulmonary embolism. The hemodynamic instability (tachycardia, hypotension) further
supports this diagnosis as an emergency situation.
4. The nurse is caring for a patient with acute pancreatitis. Which laboratory finding is
most indicative of this condition?
A) Elevated white blood cell count
B) Elevated serum amylase and lipase
C) Decreased serum calcium
D) Elevated blood glucose
CORRECT ANSWER: B) Elevated serum amylase and lipase
Rationale: Serum amylase and lipase are the primary diagnostic markers for acute
pancreatitis. Lipase is more specific to the pancreas and remains elevated longer than
amylase. While WBC, calcium, and glucose may be affected, they are not the
definitive diagnostic indicators.
5. A patient with cirrhosis presents with ascites, jaundice, and asterixis. Which nursing
intervention is most important to prevent complications?
A) Restrict dietary sodium to 2g/day
B) Administer lactulose as prescribed
C) Measure abdominal girth daily
D) Monitor for signs of bleeding
, CORRECT ANSWER: B) Administer lactulose as prescribed
Rationale: Asterixis indicates hepatic encephalopathy, a complication of cirrhosis.
Lactulose is the first-line treatment to reduce serum ammonia levels by acidifying the
colon and promoting ammonia excretion. While all options are important, managing
encephalopathy takes priority to prevent progression to coma.
6. A patient with diabetes mellitus type 2 is admitted with hyperglycemic hyperosmolar
syndrome (HHS). Which finding is characteristic of this condition?
A) Kussmaul respirations
B) Fruity breath odor
C) Serum osmolarity >320 mOsm/L
D) Serum ketones positive
CORRECT ANSWER: C) Serum osmolarity >320 mOsm/L
Rationale: HHS is characterized by severe hyperglycemia (>600 mg/dL) and
hyperosmolarity (>320 mOsm/L) without significant ketosis. Kussmaul respirations and
fruity breath odor are associated with diabetic ketoacidosis (DKA). HHS typically
presents with more severe dehydration and neurological symptoms.
7. The nurse is assessing a patient with suspected meningitis. Which finding is a positive
Kernig's sign?
A) Pain and resistance with neck flexion
Practice Assessment
With 150+ QUESTIONS,CORRECT AND VERIFIED ANSWERS WITH
ELABORATED RATIONALES ACTUAL EXAM !
SECTION A: MEDICAL-SURGICAL NURSING (Questions 1-40)
1. A patient with chronic obstructive pulmonary disease (COPD) presents with
worsening dyspnea, barrel chest, and peripheral edema. The nurse notes jugular
venous distention. Which intervention should the nurse prioritize?
A) Administer high-flow oxygen via non-rebreather mask
B) Elevate the head of the bed to 45 degrees
C) Encourage oral fluid intake of 3L/day
D) Administer bronchodilators as prescribed
CORRECT ANSWER: B) Elevate the head of the bed to 45 degrees
Rationale: Elevating the head of the bed promotes optimal diaphragmatic excursion
and lung expansion, reducing dyspnea and work of breathing. High-flow oxygen may
suppress respiratory drive in COPD patients. Fluid restriction, not encouragement, is
typically indicated due to right-sided heart failure concerns.
2. A patient with heart failure is prescribed furosemide 40mg IV push. Which laboratory
value requires immediate notification of the healthcare provider before administration?
A) Serum sodium 135 mEq/L
,B) Serum potassium 2.9 mEq/L
C) Serum creatinine 1.2 mg/dL
D) Serum glucose 110 mg/dL
CORRECT ANSWER: B) Serum potassium 2.9 mEq/L
Rationale: Furosemide is a loop diuretic that can cause significant potassium depletion.
A potassium level of 2.9 mEq/L is critically low (normal 3.5-5.0 mEq/L) and increases the
risk of cardiac arrhythmias. This value requires correction before administering the
medication.
3. A postoperative patient develops sudden-onset chest pain, dyspnea, and
hemoptysis. The nurse notes tachycardia and hypotension. Which condition should the
nurse suspect first?
A) Pneumothorax
B) Pulmonary embolism
C) Atelectasis
D) Wound infection
CORRECT ANSWER: B) Pulmonary embolism
Rationale: The classic triad of sudden chest pain, dyspnea, and hemoptysis, particularly
in a postoperative patient at risk for thromboembolism, is highly suggestive of
,pulmonary embolism. The hemodynamic instability (tachycardia, hypotension) further
supports this diagnosis as an emergency situation.
4. The nurse is caring for a patient with acute pancreatitis. Which laboratory finding is
most indicative of this condition?
A) Elevated white blood cell count
B) Elevated serum amylase and lipase
C) Decreased serum calcium
D) Elevated blood glucose
CORRECT ANSWER: B) Elevated serum amylase and lipase
Rationale: Serum amylase and lipase are the primary diagnostic markers for acute
pancreatitis. Lipase is more specific to the pancreas and remains elevated longer than
amylase. While WBC, calcium, and glucose may be affected, they are not the
definitive diagnostic indicators.
5. A patient with cirrhosis presents with ascites, jaundice, and asterixis. Which nursing
intervention is most important to prevent complications?
A) Restrict dietary sodium to 2g/day
B) Administer lactulose as prescribed
C) Measure abdominal girth daily
D) Monitor for signs of bleeding
, CORRECT ANSWER: B) Administer lactulose as prescribed
Rationale: Asterixis indicates hepatic encephalopathy, a complication of cirrhosis.
Lactulose is the first-line treatment to reduce serum ammonia levels by acidifying the
colon and promoting ammonia excretion. While all options are important, managing
encephalopathy takes priority to prevent progression to coma.
6. A patient with diabetes mellitus type 2 is admitted with hyperglycemic hyperosmolar
syndrome (HHS). Which finding is characteristic of this condition?
A) Kussmaul respirations
B) Fruity breath odor
C) Serum osmolarity >320 mOsm/L
D) Serum ketones positive
CORRECT ANSWER: C) Serum osmolarity >320 mOsm/L
Rationale: HHS is characterized by severe hyperglycemia (>600 mg/dL) and
hyperosmolarity (>320 mOsm/L) without significant ketosis. Kussmaul respirations and
fruity breath odor are associated with diabetic ketoacidosis (DKA). HHS typically
presents with more severe dehydration and neurological symptoms.
7. The nurse is assessing a patient with suspected meningitis. Which finding is a positive
Kernig's sign?
A) Pain and resistance with neck flexion
