NURSING 205 EXAM 1 CONTENT QUESTIONS AND
ANSWERS A+ GRADED WITH EXPERT SOLUTIONS -
150 Questions with Answers
Page 1
,Q1. In a patient with chronic kidney disease (GFR 25 mL/min) and atrial fibrillation,
which anticoagulant strategy is most appropriate considering pharmacokinetics and
bleeding risk?
A. Warfarin with routine INR monitoring
B. Apixaban 5 mg twice daily
C. Rivaroxaban 20 mg daily
D. Heparin continuous infusion
Correct Answer: B. Apixaban 5 mg twice daily
Rationale: Apixaban is preferred in advanced CKD due to lower renal clearance
dependence and reduced bleeding risk compared to rivaroxaban. Warfarin requires
frequent monitoring and has variable effects. Heparin is short-term and not ideal for
long-term anticoagulation.
Why Wrong:
A - Warfarin is effective but requires frequent INR monitoring and has multiple
interactions, making it less optimal in CKD.
C - Rivaroxaban 20 mg daily is contraindicated in CrCl <30 mL/min; a reduced dose
or alternative is needed.
D - Heparin is typically used for acute management, not long-term outpatient
anticoagulation in CKD.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 34.
Q2. Which mechanism best explains the therapeutic effect of low-dose naloxone
infusions in a patient with refractory hypotension secondary to septic shock?
A. Antagonism of opioid receptors on immune cells, reducing cytokine release
B. Blockade of central opioid receptors, enhancing sympathetic outflow
C. Inhibition of nitric oxide synthase, increasing vascular tone
D. Stimulation of peripheral beta-2 receptors, causing vasodilation
Correct Answer: B. Blockade of central opioid receptors, enhancing sympathetic
outflow
Rationale: Low-dose naloxone is hypothesized to block central opioid receptors that are
activated by endogenous endorphins during sepsis, thereby increasing sympathetic outflow
and improving blood pressure. It does not directly affect immune cells or nitric oxide.
Why Wrong:
A - While opioid receptors exist on immune cells, the pressor effect is primarily
centrally mediated.
C - Naloxone does not inhibit nitric oxide synthase.
D - Naloxone is an antagonist, not a beta-2 agonist.
Reference: Katzung, B.G. (2025). Basic & Clinical Pharmacology, 16th Ed., Ch. 31.
Page 2
,Q3. A nurse administers a medication via IV push that is incompatible with the
current IV fluid, causing precipitation. Which immediate action is most critical to
prevent patient harm?
A. Flush the line with normal saline
B. Stop the infusion and disconnect the IV line
C. Increase the IV flow rate to dilute the precipitate
D. Administer a compatible medication to counteract the precipitate
Correct Answer: B. Stop the infusion and disconnect the IV line
Rationale: The priority is to stop the infusion and disconnect the IV line to prevent further
precipitate from entering the bloodstream. Flushing could push the precipitate into the
patient; increasing flow rate worsens the risk; counteracting medication is not indicated.
Why Wrong:
A - Flushing may dislodge the precipitate and cause embolism.
C - Increasing flow rate delivers more precipitate to the patient.
D - No antidote exists for physical incompatibility.
Reference: Phillips, L.D. (2023). Manual of IV Therapeutics, 8th Ed., Ch. 6.
Q4. Which finding most clearly indicates that a patient with type 2 diabetes is
experiencing hypoglycemia unawareness, requiring a change in management?
A. HbA1c of 6.8% with episodes of asymptomatic hypoglycemia (glucose <54 mg/dL)
B. Frequent episodes of hyperglycemia in the morning
C. Consistent glucose readings between 90-110 mg/dL
D. Presence of peripheral neuropathy
Correct Answer: A. HbA1c of 6.8% with episodes of asymptomatic hypoglycemia
(glucose <54 mg/dL)
Rationale: Hypoglycemia unawareness is characterized by loss of autonomic warning
signs, leading to asymptomatic hypoglycemia, often with tight glycemic control. This
requires treatment adjustment to raise targets and reduce hypoglycemia risk.
Why Wrong:
B - Morning hyperglycemia may indicate dawn phenomenon, not hypoglycemia
unawareness.
C - Normal glucose readings do not indicate unawareness.
D - Neuropathy is a complication but not specific to unawareness.
Reference: American Diabetes Association. (2025). Standards of Care in Diabetes-2025,
Diabetes Care, 48(Suppl 1).
Q5. A nurse is reviewing a research article with a p-value of 0.04 and a confidence
interval for the relative risk of 0.95-2.10. Which interpretation is most accurate?
Page 3
, A. The result is statistically significant but not clinically significant because the CI
includes 1
B. The result is statistically significant and clinically significant because p<0.05
C. The result is not statistically significant because the CI includes 1
D. The p-value indicates a 4% probability that the null hypothesis is true
Correct Answer: A. The result is statistically significant but not clinically significant
because the CI includes 1
Rationale: The p-value <0.05 suggests statistical significance, but the confidence interval
includes 1 (no effect), indicating imprecision and lack of clinical significance. The CI
provides more information than the p-value alone.
Why Wrong:
B - Clinical significance is not determined by p-value alone; CI crossing 1 suggests
uncertainty.
C - The p-value is significant, but CI suggests the effect may be null.
D - The p-value is not the probability of the null hypothesis being true.
Reference: Polit, D.F., & Beck, C.T. (2024). Nursing Research: Generating and Assessing
Evidence for Nursing Practice, 12th Ed., Ch. 9.
Q6. A nurse is preparing to administer a blood transfusion. Which action is most
important to prevent a transfusion-associated circulatory overload (TACO)?
A. Pre-medicate with an antihistamine
B. Verify the patient's weight to calculate transfusion volume
C. Administer a diuretic prior to transfusion
D. Transfuse at the maximum rate to minimize time
Correct Answer: B. Verify the patient's weight to calculate transfusion volume
Rationale: TACO is related to volume overload; calculating the appropriate transfusion
volume based on weight and clinical status is essential. Pre-medication does not prevent
TACO; diuretics may be used but are not the first-line preventive measure; rapid infusion
increases risk.
Why Wrong:
A - Antihistamines prevent allergic reactions, not TACO.
C - Diuretics may be used in high-risk patients but are not the most important
preventive action.
D - Rapid infusion increases the risk of TACO.
Reference: AABB. (2024). Standards for Blood Banks and Transfusion Services, 34th Ed.,
Standard 5.26.
Q7. Which intervention is most likely to reduce the risk of catheter-associated urinary
tract infection (CAUTI) in a patient with an indwelling urinary catheter?
Page 4
ANSWERS A+ GRADED WITH EXPERT SOLUTIONS -
150 Questions with Answers
Page 1
,Q1. In a patient with chronic kidney disease (GFR 25 mL/min) and atrial fibrillation,
which anticoagulant strategy is most appropriate considering pharmacokinetics and
bleeding risk?
A. Warfarin with routine INR monitoring
B. Apixaban 5 mg twice daily
C. Rivaroxaban 20 mg daily
D. Heparin continuous infusion
Correct Answer: B. Apixaban 5 mg twice daily
Rationale: Apixaban is preferred in advanced CKD due to lower renal clearance
dependence and reduced bleeding risk compared to rivaroxaban. Warfarin requires
frequent monitoring and has variable effects. Heparin is short-term and not ideal for
long-term anticoagulation.
Why Wrong:
A - Warfarin is effective but requires frequent INR monitoring and has multiple
interactions, making it less optimal in CKD.
C - Rivaroxaban 20 mg daily is contraindicated in CrCl <30 mL/min; a reduced dose
or alternative is needed.
D - Heparin is typically used for acute management, not long-term outpatient
anticoagulation in CKD.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 34.
Q2. Which mechanism best explains the therapeutic effect of low-dose naloxone
infusions in a patient with refractory hypotension secondary to septic shock?
A. Antagonism of opioid receptors on immune cells, reducing cytokine release
B. Blockade of central opioid receptors, enhancing sympathetic outflow
C. Inhibition of nitric oxide synthase, increasing vascular tone
D. Stimulation of peripheral beta-2 receptors, causing vasodilation
Correct Answer: B. Blockade of central opioid receptors, enhancing sympathetic
outflow
Rationale: Low-dose naloxone is hypothesized to block central opioid receptors that are
activated by endogenous endorphins during sepsis, thereby increasing sympathetic outflow
and improving blood pressure. It does not directly affect immune cells or nitric oxide.
Why Wrong:
A - While opioid receptors exist on immune cells, the pressor effect is primarily
centrally mediated.
C - Naloxone does not inhibit nitric oxide synthase.
D - Naloxone is an antagonist, not a beta-2 agonist.
Reference: Katzung, B.G. (2025). Basic & Clinical Pharmacology, 16th Ed., Ch. 31.
Page 2
,Q3. A nurse administers a medication via IV push that is incompatible with the
current IV fluid, causing precipitation. Which immediate action is most critical to
prevent patient harm?
A. Flush the line with normal saline
B. Stop the infusion and disconnect the IV line
C. Increase the IV flow rate to dilute the precipitate
D. Administer a compatible medication to counteract the precipitate
Correct Answer: B. Stop the infusion and disconnect the IV line
Rationale: The priority is to stop the infusion and disconnect the IV line to prevent further
precipitate from entering the bloodstream. Flushing could push the precipitate into the
patient; increasing flow rate worsens the risk; counteracting medication is not indicated.
Why Wrong:
A - Flushing may dislodge the precipitate and cause embolism.
C - Increasing flow rate delivers more precipitate to the patient.
D - No antidote exists for physical incompatibility.
Reference: Phillips, L.D. (2023). Manual of IV Therapeutics, 8th Ed., Ch. 6.
Q4. Which finding most clearly indicates that a patient with type 2 diabetes is
experiencing hypoglycemia unawareness, requiring a change in management?
A. HbA1c of 6.8% with episodes of asymptomatic hypoglycemia (glucose <54 mg/dL)
B. Frequent episodes of hyperglycemia in the morning
C. Consistent glucose readings between 90-110 mg/dL
D. Presence of peripheral neuropathy
Correct Answer: A. HbA1c of 6.8% with episodes of asymptomatic hypoglycemia
(glucose <54 mg/dL)
Rationale: Hypoglycemia unawareness is characterized by loss of autonomic warning
signs, leading to asymptomatic hypoglycemia, often with tight glycemic control. This
requires treatment adjustment to raise targets and reduce hypoglycemia risk.
Why Wrong:
B - Morning hyperglycemia may indicate dawn phenomenon, not hypoglycemia
unawareness.
C - Normal glucose readings do not indicate unawareness.
D - Neuropathy is a complication but not specific to unawareness.
Reference: American Diabetes Association. (2025). Standards of Care in Diabetes-2025,
Diabetes Care, 48(Suppl 1).
Q5. A nurse is reviewing a research article with a p-value of 0.04 and a confidence
interval for the relative risk of 0.95-2.10. Which interpretation is most accurate?
Page 3
, A. The result is statistically significant but not clinically significant because the CI
includes 1
B. The result is statistically significant and clinically significant because p<0.05
C. The result is not statistically significant because the CI includes 1
D. The p-value indicates a 4% probability that the null hypothesis is true
Correct Answer: A. The result is statistically significant but not clinically significant
because the CI includes 1
Rationale: The p-value <0.05 suggests statistical significance, but the confidence interval
includes 1 (no effect), indicating imprecision and lack of clinical significance. The CI
provides more information than the p-value alone.
Why Wrong:
B - Clinical significance is not determined by p-value alone; CI crossing 1 suggests
uncertainty.
C - The p-value is significant, but CI suggests the effect may be null.
D - The p-value is not the probability of the null hypothesis being true.
Reference: Polit, D.F., & Beck, C.T. (2024). Nursing Research: Generating and Assessing
Evidence for Nursing Practice, 12th Ed., Ch. 9.
Q6. A nurse is preparing to administer a blood transfusion. Which action is most
important to prevent a transfusion-associated circulatory overload (TACO)?
A. Pre-medicate with an antihistamine
B. Verify the patient's weight to calculate transfusion volume
C. Administer a diuretic prior to transfusion
D. Transfuse at the maximum rate to minimize time
Correct Answer: B. Verify the patient's weight to calculate transfusion volume
Rationale: TACO is related to volume overload; calculating the appropriate transfusion
volume based on weight and clinical status is essential. Pre-medication does not prevent
TACO; diuretics may be used but are not the first-line preventive measure; rapid infusion
increases risk.
Why Wrong:
A - Antihistamines prevent allergic reactions, not TACO.
C - Diuretics may be used in high-risk patients but are not the most important
preventive action.
D - Rapid infusion increases the risk of TACO.
Reference: AABB. (2024). Standards for Blood Banks and Transfusion Services, 34th Ed.,
Standard 5.26.
Q7. Which intervention is most likely to reduce the risk of catheter-associated urinary
tract infection (CAUTI) in a patient with an indwelling urinary catheter?
Page 4
