NR-607 Final Exam Reviewer Final Exam
Practice Questions & [Verified Answers],
Plus Explained Rationales|2027 Latest
Update| Instant Download PDF
1. A patient with chronic heart failure reports increasing fatigue, a 4-
lb weight gain over 3 days, and worsening bilateral ankle edema.
Which finding should the nurse recognize as the most concerning
indicator of worsening fluid overload?
A. Heart rate of 88/min
B. Blood pressure of 128/76 mmHg
C. 4-lb weight gain over 3 days
D. Respiratory rate of 16/min
Rationale: The rapid weight gain is the strongest indicator of acute
fluid retention in a patient with heart failure. Daily weight is one of
the most sensitive methods for detecting changes in fluid status
before more severe manifestations develop.
2. A patient with type 2 diabetes has an HbA1c of 9.2% despite
taking metformin as prescribed. Which interpretation is most
appropriate?
A. The patient has achieved adequate long-term glycemic control
B. The HbA1c reflects only the patient's glucose level on the day of
testing
C. The patient's average blood glucose has remained above the
desired range
D. The result primarily reflects recent dietary intake
1|Page
,Rationale: HbA1c reflects average glycemic exposure over
approximately the previous 2–3 months. A value of 9.2% indicates
persistent hyperglycemia and inadequate long-term control.
3. A patient taking an ACE inhibitor develops persistent dry cough
but has no evidence of airway obstruction. Which medication
class may be considered as an alternative?
A. Thiazide diuretic
B. Beta blocker
C. Angiotensin II receptor blocker
D. Calcium supplement
Rationale: ACE inhibitors can cause a persistent dry cough because of
bradykinin accumulation. ARBs provide similar renin-angiotensin
system effects without typically producing this adverse effect.
4. A patient presents with crushing substernal chest pain,
diaphoresis, and nausea. Which diagnostic test should be
prioritized?
A. Abdominal ultrasound
B. 12-lead electrocardiogram
C. Colonoscopy
D. Pulmonary function testing
Rationale: A 12-lead ECG should be obtained promptly in suspected
acute coronary syndrome because it can rapidly identify ischemic
changes and ST-segment elevation requiring urgent intervention.
5. A patient with chronic kidney disease has a potassium level of 6.4
mEq/L and peaked T waves on ECG. Which intervention is the
priority?
2|Page
,A. Encourage oral potassium intake
B. Administer a potassium-sparing diuretic
C. Initiate emergency treatment for hyperkalemia
D. Restrict dietary calcium
Rationale: Severe hyperkalemia accompanied by ECG changes can
cause life-threatening cardiac dysrhythmias. Immediate treatment is
required to stabilize the myocardium and lower serum potassium.
6. A patient with COPD asks why pursed-lip breathing is
recommended. Which response is most accurate?
A. It increases respiratory rate
B. It prevents oxygen from entering the lungs
C. It helps maintain airway pressure during exhalation and reduces air
trapping
D. It eliminates the need for bronchodilator therapy
Rationale: Pursed-lip breathing creates positive pressure during
exhalation, helping prevent premature airway collapse and reducing
dynamic hyperinflation and air trapping.
7. A patient taking warfarin has an INR of 5.8 without active
bleeding. Which action is most appropriate?
A. Instruct the patient to take an additional dose
B. Hold or adjust warfarin according to the clinical protocol and
reassess INR
C. Tell the patient to discontinue all fluids
D. Administer potassium immediately
Rationale: An INR of 5.8 represents excessive anticoagulation and
increases bleeding risk. Management depends on the degree of
elevation and presence of bleeding, but holding or adjusting warfarin
and reassessing coagulation is appropriate.
3|Page
, 8. A patient with suspected bacterial meningitis is admitted to the
hospital. Which nursing intervention is most appropriate initially?
A. Place the patient on contact precautions only
B. Encourage unrestricted visitors
C. Initiate appropriate droplet precautions
D. Delay isolation until cerebrospinal fluid results are available
Rationale: Suspected meningococcal meningitis requires droplet
precautions because respiratory and oral secretions can transmit the
organism. Precautions should not be delayed while awaiting definitive
laboratory results.
9. A patient with hypothyroidism reports fatigue, cold intolerance,
constipation, and weight gain. Which laboratory finding would
support the diagnosis of primary hypothyroidism?
A. Low TSH and high free T4
B. High TSH and low free T4
C. High TSH and high free T4
D. Low TSH and low free T4
Rationale: In primary hypothyroidism, the thyroid gland produces
insufficient thyroid hormone. The pituitary responds by increasing
TSH secretion, resulting in high TSH and low free T4.
10. A patient with asthma uses a short-acting beta2 agonist
several times each day. What does this pattern suggest?
A. The asthma is completely controlled
B. The patient no longer requires assessment
C. The patient's asthma may be inadequately controlled
D. The medication should automatically be discontinued
4|Page
Practice Questions & [Verified Answers],
Plus Explained Rationales|2027 Latest
Update| Instant Download PDF
1. A patient with chronic heart failure reports increasing fatigue, a 4-
lb weight gain over 3 days, and worsening bilateral ankle edema.
Which finding should the nurse recognize as the most concerning
indicator of worsening fluid overload?
A. Heart rate of 88/min
B. Blood pressure of 128/76 mmHg
C. 4-lb weight gain over 3 days
D. Respiratory rate of 16/min
Rationale: The rapid weight gain is the strongest indicator of acute
fluid retention in a patient with heart failure. Daily weight is one of
the most sensitive methods for detecting changes in fluid status
before more severe manifestations develop.
2. A patient with type 2 diabetes has an HbA1c of 9.2% despite
taking metformin as prescribed. Which interpretation is most
appropriate?
A. The patient has achieved adequate long-term glycemic control
B. The HbA1c reflects only the patient's glucose level on the day of
testing
C. The patient's average blood glucose has remained above the
desired range
D. The result primarily reflects recent dietary intake
1|Page
,Rationale: HbA1c reflects average glycemic exposure over
approximately the previous 2–3 months. A value of 9.2% indicates
persistent hyperglycemia and inadequate long-term control.
3. A patient taking an ACE inhibitor develops persistent dry cough
but has no evidence of airway obstruction. Which medication
class may be considered as an alternative?
A. Thiazide diuretic
B. Beta blocker
C. Angiotensin II receptor blocker
D. Calcium supplement
Rationale: ACE inhibitors can cause a persistent dry cough because of
bradykinin accumulation. ARBs provide similar renin-angiotensin
system effects without typically producing this adverse effect.
4. A patient presents with crushing substernal chest pain,
diaphoresis, and nausea. Which diagnostic test should be
prioritized?
A. Abdominal ultrasound
B. 12-lead electrocardiogram
C. Colonoscopy
D. Pulmonary function testing
Rationale: A 12-lead ECG should be obtained promptly in suspected
acute coronary syndrome because it can rapidly identify ischemic
changes and ST-segment elevation requiring urgent intervention.
5. A patient with chronic kidney disease has a potassium level of 6.4
mEq/L and peaked T waves on ECG. Which intervention is the
priority?
2|Page
,A. Encourage oral potassium intake
B. Administer a potassium-sparing diuretic
C. Initiate emergency treatment for hyperkalemia
D. Restrict dietary calcium
Rationale: Severe hyperkalemia accompanied by ECG changes can
cause life-threatening cardiac dysrhythmias. Immediate treatment is
required to stabilize the myocardium and lower serum potassium.
6. A patient with COPD asks why pursed-lip breathing is
recommended. Which response is most accurate?
A. It increases respiratory rate
B. It prevents oxygen from entering the lungs
C. It helps maintain airway pressure during exhalation and reduces air
trapping
D. It eliminates the need for bronchodilator therapy
Rationale: Pursed-lip breathing creates positive pressure during
exhalation, helping prevent premature airway collapse and reducing
dynamic hyperinflation and air trapping.
7. A patient taking warfarin has an INR of 5.8 without active
bleeding. Which action is most appropriate?
A. Instruct the patient to take an additional dose
B. Hold or adjust warfarin according to the clinical protocol and
reassess INR
C. Tell the patient to discontinue all fluids
D. Administer potassium immediately
Rationale: An INR of 5.8 represents excessive anticoagulation and
increases bleeding risk. Management depends on the degree of
elevation and presence of bleeding, but holding or adjusting warfarin
and reassessing coagulation is appropriate.
3|Page
, 8. A patient with suspected bacterial meningitis is admitted to the
hospital. Which nursing intervention is most appropriate initially?
A. Place the patient on contact precautions only
B. Encourage unrestricted visitors
C. Initiate appropriate droplet precautions
D. Delay isolation until cerebrospinal fluid results are available
Rationale: Suspected meningococcal meningitis requires droplet
precautions because respiratory and oral secretions can transmit the
organism. Precautions should not be delayed while awaiting definitive
laboratory results.
9. A patient with hypothyroidism reports fatigue, cold intolerance,
constipation, and weight gain. Which laboratory finding would
support the diagnosis of primary hypothyroidism?
A. Low TSH and high free T4
B. High TSH and low free T4
C. High TSH and high free T4
D. Low TSH and low free T4
Rationale: In primary hypothyroidism, the thyroid gland produces
insufficient thyroid hormone. The pituitary responds by increasing
TSH secretion, resulting in high TSH and low free T4.
10. A patient with asthma uses a short-acting beta2 agonist
several times each day. What does this pattern suggest?
A. The asthma is completely controlled
B. The patient no longer requires assessment
C. The patient's asthma may be inadequately controlled
D. The medication should automatically be discontinued
4|Page
