NUR 176 EXAM 3 ADULT HEALTH
ULTIMATE STUDY PACK 1 to 150
SCENARIO MCQS VERIFIED ANSWERS
and FULL RATIONALES INCLUDED
NUR 176 Exam 3: Concepts of Adult Health Nursing
Practice Exam
1. A 24-year-old male is admitted to the emergency
department reporting acute, sharp pain localized in the
right lower quadrant (RLQ) of his abdomen, accompanied
by a low-grade fever, nausea, and an elevated white blood
cell (WBC) count. During an abdominal assessment, the
nurse notes severe rebound tenderness at McBurney's
point. Which client statement would require the most
immediate nursing intervention?
A. "The pain is making it really hard for me to find a
comfortable position to rest."
B. "I haven't been able to eat anything since yesterday
morning because of the nausea."
C. "The sharp pain suddenly went away, and my stomach
just feels warm and sore now."
D. "I feel like I need to urinate more frequently than I
normally do." [1]
Correct Answer: C. "The sharp pain suddenly went
away, and my stomach just feels warm and sore now."
Rationale: A sudden, spontaneous relief of localized pain in
appendicitis classically indicates that the appendix has
ruptured. This is a critical medical emergency that can rapidly
lead to peritonitis, systemic sepsis, and shock, requiring
immediate surgical escalation. [1, 2]
2. The nurse is preparing to administer the morning dose of
metoprolol, a beta-blocker, to a 62-year-old female client
, diagnosed with primary hypertension. Which baseline
clinical parameters must the nurse verify immediately
before executing this medication order?
A. Blood pressure and a 60-second auscultated apical
pulse.
B. Respiratory rate and blood urea nitrogen (BUN) levels.
C. Daily body weight and peripheral oxygen saturation.
D. Serum potassium levels and 24-hour urine output
volume. [1, 2, 3]
Correct Answer: A. Blood pressure and a 60-second
auscultated apical pulse.
Rationale: Metoprolol works by blocking beta-adrenergic
receptors, which decreases both blood pressure and heart rate.
The nurse must explicitly check the blood pressure and count
the apical pulse for a full 60 seconds to ensure parameters are
safe (typically holding if HR < 60 bpm or systolic BP < 90–100
mmHg) to avoid profound bradycardia or hypotension. [1, 2]
3. A client diagnosed with chronic heart failure has been
prescribed digoxin (Lanoxin) for home management.
During a follow-up home health visit, the client reports
loss of appetite, persistent nausea, and blurriness in their
vision with a yellowish-green tint. What is the primary
nursing interpretation of these findings?
A. The client is experiencing standard progressive
symptoms of left-sided heart failure.
B. The client's clinical presentation indicates a high
probability of acute digoxin toxicity.
C. These symptoms signify an expected therapeutic side
effect that will stabilize over time.
D. The client is experiencing an allergic hypersensitivity
reaction to a new medication block. [1]
Correct Answer: B. The client's clinical presentation
indicates a high probability of acute digoxin toxicity.
,Rationale: Gastrointestinal disturbances (anorexia, nausea,
vomiting) and visual changes—such as blurred vision, seeing
yellow-green halos, or double vision—are classic early signs of
digoxin toxicity. The drug has a narrow therapeutic range,
requiring immediate hold and lab draws. [1]
4. A nurse is reviewing the laboratory results for a client who
has been receiving oral warfarin (Coumadin) therapy for
the management of deep vein thrombosis (DVT). The
current laboratory report reveals a Prothrombin Time (PT)
and an International Normalized Ratio (INR) value of 5.5.
What is the correct immediate nursing action?
A. Document the normal therapeutic baseline and
administer the scheduled daily dose.
B. Hold the scheduled dose of warfarin and immediately
notify the primary healthcare provider.
C. Request an emergency prescription to double the
warfarin dose to achieve target stability.
D. Encourage the client to increase their dietary intake of
green, leafy vegetables immediately. [1]
Correct Answer: B. Hold the scheduled dose of
warfarin and immediately notify the primary
healthcare provider.
Rationale: The target therapeutic INR range for a client on
standard warfarin therapy is 2.0 to 3.0. An INR of 5.5 places
the client at an extremely high risk for spontaneous, severe
internal or external bleeding, requiring the dose to be held and
potential antidote (Vitamin K) administration. [1]
5. A client with a new diagnosis of celiac disease is meeting
with the clinic nurse to discuss mandatory dietary
modifications. Which of the following food groups must
the nurse teach the client to completely eliminate from
their daily meal plans to avoid intestinal damage?
A. Corn products, white rice, and wild potatoes.
, B. Wheat flour, rye bread, and barley pasta.
C. Dairy products, processed poultry, and pasteurized
eggs.
D. Fresh citrus fruits, green vegetables, and legumes. [1, 2]
Correct Answer: B. Wheat flour, rye bread, and
barley pasta.
Rationale: Celiac disease is an autoimmune malabsorption
disorder characterized by permanent intolerance to gluten, a
protein found in wheat, rye, and barley. Ingesting these grains
triggers an immune response that flattens intestinal villi,
leading to severe malabsorption. [1, 2, 3]
6. A client admitted with an acute exacerbation of Crohn's
disease is experiencing severe, chronic watery diarrhea,
passing up to 12 liquid stools per day. The nurse should
recognize that this severe loss of lower gastrointestinal
fluids places the client at a high risk for which specific
acid-base imbalance?
A. Respiratory Acidosis.
B. Respiratory Alkalosis.
C. Metabolic Acidosis.
D. Metabolic Alkalosis. [1, 2]
Correct Answer: C. Metabolic Acidosis.
Rationale: Intestinal and diarrheal fluids are highly rich in
bicarbonate ions. Chronic, severe diarrhea causes a massive
loss of base (bicarbonate) from the lower GI tract, driving the
systemic pH downward into a state of metabolic acidosis. [1]
7. A 55-year-old male client is brought to the emergency
department via ambulance with a suspected acute
myocardial infarction (MI). Which of the following
diagnostic laboratory biomarkers should the nurse
evaluate first, as it is the most sensitive and earliest
indicator of myocardial cell damage?
A. Serum Creatinine and Blood Urea Nitrogen (BUN).
ULTIMATE STUDY PACK 1 to 150
SCENARIO MCQS VERIFIED ANSWERS
and FULL RATIONALES INCLUDED
NUR 176 Exam 3: Concepts of Adult Health Nursing
Practice Exam
1. A 24-year-old male is admitted to the emergency
department reporting acute, sharp pain localized in the
right lower quadrant (RLQ) of his abdomen, accompanied
by a low-grade fever, nausea, and an elevated white blood
cell (WBC) count. During an abdominal assessment, the
nurse notes severe rebound tenderness at McBurney's
point. Which client statement would require the most
immediate nursing intervention?
A. "The pain is making it really hard for me to find a
comfortable position to rest."
B. "I haven't been able to eat anything since yesterday
morning because of the nausea."
C. "The sharp pain suddenly went away, and my stomach
just feels warm and sore now."
D. "I feel like I need to urinate more frequently than I
normally do." [1]
Correct Answer: C. "The sharp pain suddenly went
away, and my stomach just feels warm and sore now."
Rationale: A sudden, spontaneous relief of localized pain in
appendicitis classically indicates that the appendix has
ruptured. This is a critical medical emergency that can rapidly
lead to peritonitis, systemic sepsis, and shock, requiring
immediate surgical escalation. [1, 2]
2. The nurse is preparing to administer the morning dose of
metoprolol, a beta-blocker, to a 62-year-old female client
, diagnosed with primary hypertension. Which baseline
clinical parameters must the nurse verify immediately
before executing this medication order?
A. Blood pressure and a 60-second auscultated apical
pulse.
B. Respiratory rate and blood urea nitrogen (BUN) levels.
C. Daily body weight and peripheral oxygen saturation.
D. Serum potassium levels and 24-hour urine output
volume. [1, 2, 3]
Correct Answer: A. Blood pressure and a 60-second
auscultated apical pulse.
Rationale: Metoprolol works by blocking beta-adrenergic
receptors, which decreases both blood pressure and heart rate.
The nurse must explicitly check the blood pressure and count
the apical pulse for a full 60 seconds to ensure parameters are
safe (typically holding if HR < 60 bpm or systolic BP < 90–100
mmHg) to avoid profound bradycardia or hypotension. [1, 2]
3. A client diagnosed with chronic heart failure has been
prescribed digoxin (Lanoxin) for home management.
During a follow-up home health visit, the client reports
loss of appetite, persistent nausea, and blurriness in their
vision with a yellowish-green tint. What is the primary
nursing interpretation of these findings?
A. The client is experiencing standard progressive
symptoms of left-sided heart failure.
B. The client's clinical presentation indicates a high
probability of acute digoxin toxicity.
C. These symptoms signify an expected therapeutic side
effect that will stabilize over time.
D. The client is experiencing an allergic hypersensitivity
reaction to a new medication block. [1]
Correct Answer: B. The client's clinical presentation
indicates a high probability of acute digoxin toxicity.
,Rationale: Gastrointestinal disturbances (anorexia, nausea,
vomiting) and visual changes—such as blurred vision, seeing
yellow-green halos, or double vision—are classic early signs of
digoxin toxicity. The drug has a narrow therapeutic range,
requiring immediate hold and lab draws. [1]
4. A nurse is reviewing the laboratory results for a client who
has been receiving oral warfarin (Coumadin) therapy for
the management of deep vein thrombosis (DVT). The
current laboratory report reveals a Prothrombin Time (PT)
and an International Normalized Ratio (INR) value of 5.5.
What is the correct immediate nursing action?
A. Document the normal therapeutic baseline and
administer the scheduled daily dose.
B. Hold the scheduled dose of warfarin and immediately
notify the primary healthcare provider.
C. Request an emergency prescription to double the
warfarin dose to achieve target stability.
D. Encourage the client to increase their dietary intake of
green, leafy vegetables immediately. [1]
Correct Answer: B. Hold the scheduled dose of
warfarin and immediately notify the primary
healthcare provider.
Rationale: The target therapeutic INR range for a client on
standard warfarin therapy is 2.0 to 3.0. An INR of 5.5 places
the client at an extremely high risk for spontaneous, severe
internal or external bleeding, requiring the dose to be held and
potential antidote (Vitamin K) administration. [1]
5. A client with a new diagnosis of celiac disease is meeting
with the clinic nurse to discuss mandatory dietary
modifications. Which of the following food groups must
the nurse teach the client to completely eliminate from
their daily meal plans to avoid intestinal damage?
A. Corn products, white rice, and wild potatoes.
, B. Wheat flour, rye bread, and barley pasta.
C. Dairy products, processed poultry, and pasteurized
eggs.
D. Fresh citrus fruits, green vegetables, and legumes. [1, 2]
Correct Answer: B. Wheat flour, rye bread, and
barley pasta.
Rationale: Celiac disease is an autoimmune malabsorption
disorder characterized by permanent intolerance to gluten, a
protein found in wheat, rye, and barley. Ingesting these grains
triggers an immune response that flattens intestinal villi,
leading to severe malabsorption. [1, 2, 3]
6. A client admitted with an acute exacerbation of Crohn's
disease is experiencing severe, chronic watery diarrhea,
passing up to 12 liquid stools per day. The nurse should
recognize that this severe loss of lower gastrointestinal
fluids places the client at a high risk for which specific
acid-base imbalance?
A. Respiratory Acidosis.
B. Respiratory Alkalosis.
C. Metabolic Acidosis.
D. Metabolic Alkalosis. [1, 2]
Correct Answer: C. Metabolic Acidosis.
Rationale: Intestinal and diarrheal fluids are highly rich in
bicarbonate ions. Chronic, severe diarrhea causes a massive
loss of base (bicarbonate) from the lower GI tract, driving the
systemic pH downward into a state of metabolic acidosis. [1]
7. A 55-year-old male client is brought to the emergency
department via ambulance with a suspected acute
myocardial infarction (MI). Which of the following
diagnostic laboratory biomarkers should the nurse
evaluate first, as it is the most sensitive and earliest
indicator of myocardial cell damage?
A. Serum Creatinine and Blood Urea Nitrogen (BUN).
