NEW ZEALAND NURSING STATE FINAL EXAM PREP | PRACTICE QUESTIONS AND
COMPLETE STUDY GUIDE
1. A registered nurse in a New Zealand acute-care setting is caring for an older
adult who has become suddenly confused, restless, and disoriented several
hours after admission for pneumonia. The patient was previously
independent and oriented. Which assessment finding would most strongly
support delirium rather than dementia?
A. Gradual memory decline occurring over several years
B. Long-standing difficulty managing finances and medications
C. Progressive loss of familiar skills over several months
D. Acute onset with fluctuating attention and altered level of awareness
Answer: D
2. A nurse is caring for a patient with suspected sepsis who has a temperature
of 39.2°C, respiratory rate of 30/min, blood pressure of 86/52 mmHg, and
new confusion. Which nursing action should receive the highest priority?
A. Initiate urgent assessment and management for possible septic shock
B. Encourage the patient to ambulate to improve circulation
C. Delay intervention until the next scheduled set of observations
D. Offer a large meal before initiating treatment
Answer: A
3. A patient admitted with acute respiratory distress has an oxygen saturation
of 82% on room air and is using accessory muscles to breathe. Which
intervention should the nurse prioritize while continuing assessment and
escalation?
A. Place the patient flat in bed
B. Provide prescribed oxygen and position the patient to optimize
ventilation
C. Encourage oral fluids before providing oxygen
D. Ask the patient to walk to assess exercise tolerance
Answer: B
pg. 1
, 4. A patient with heart failure has increasing bilateral lower-limb edema, a
rapid weight gain, and new shortness of breath when lying flat. Which
assessment finding would most strongly indicate worsening fluid overload?
A. Dry oral mucosa
B. Decreased jugular venous pressure
C. Increasing crackles with worsening orthopnea
D. Increased urine output
Answer: C
5. A patient receiving intravenous furosemide for acute pulmonary edema has
produced substantial urine output but now reports weakness and
palpitations. Which laboratory abnormality should the nurse suspect?
A. Hypernatremia
B. Hypercalcemia
C. Hypermagnesemia
D. Hypokalemia
Answer: D
6. A patient with chronic obstructive pulmonary disease is receiving oxygen
therapy and becomes increasingly drowsy while respiratory effort
decreases. Which nursing action is most appropriate?
A. Reassess respiratory status urgently and escalate because worsening
ventilation may be occurring
B. Increase oxygen flow without reassessment
C. Encourage the patient to sleep undisturbed
D. Remove all monitoring equipment
Answer: A
7. A patient develops sudden facial drooping, unilateral arm weakness, and
difficulty speaking while eating breakfast. Which action should the nurse
take first?
A. Ask the patient to walk to determine whether balance is affected
B. Activate the appropriate acute stroke response and establish the time
symptoms began
pg. 2
, C. Give oral fluids to determine whether swallowing is intact
D. Wait for the symptoms to resolve before notifying the medical team
Answer: B
8. A patient receiving anticoagulation develops sudden severe headache,
vomiting, and decreasing level of consciousness after falling. Which
complication should the nurse consider most urgently?
A. Hypoglycemia
B. Gastroenteritis
C. Intracranial bleeding
D. Mild dehydration
Answer: C
9. A patient with diabetes becomes sweaty, tremulous, confused, and unable
to concentrate shortly after receiving insulin. Which condition should the
nurse suspect?
A. Hypoglycemia
B. Hypernatremia
C. Hypercalcemia
D. Metabolic alkalosis
Answer: A
10. A patient with diabetic ketoacidosis is receiving intravenous fluids and
insulin. Which finding would indicate that treatment is moving in the
expected direction?
A. Increasing ketone production
B. Worsening acidosis
C. Progressive dehydration
D. Improving glucose level with closure of the anion gap
Answer: D
11. A patient with type 2 diabetes is prescribed metformin and is scheduled for
a procedure involving iodinated contrast. Which nursing action is most
appropriate?
A. Administer an additional metformin dose immediately before contrast
pg. 3
, B. Verify renal function and follow the prescribed instructions regarding
metformin around the procedure
C. Tell the patient renal function has no relevance to metformin
D. Encourage the patient to take the medication with alcohol
Answer: B
12. A patient taking warfarin reports black, tarry stools and dizziness when
standing. Which nursing action is the priority?
A. Encourage increased physical activity
B. Reassure the patient that dark stools are always expected
C. Assess for significant bleeding and escalate promptly
D. Recommend taking an additional warfarin dose
Answer: C
13. A patient receiving unfractionated heparin develops a marked platelet
decrease several days after therapy begins and develops a new painful
swollen leg. Which complication should the nurse suspect?
A. Heparin-induced thrombocytopenia
B. Iron-deficiency anemia
C. Hypoglycemia
D. Vitamin B12 deficiency
Answer: A
14. A patient with chest pain has prescribed sublingual glyceryl trinitrate and a
blood pressure of 82/50 mmHg. Which action is most appropriate?
A. Administer the medication and encourage walking
B. Give a double dose to relieve the pain
C. Assess the hypotension and follow the prescribed parameters before
administering
D. Place the patient upright and encourage rapid ambulation
Answer: C
15. A patient with atrial fibrillation is prescribed anticoagulant therapy even
though there is no current evidence of a thrombus. Which explanation best
describes the purpose of treatment?
pg. 4
COMPLETE STUDY GUIDE
1. A registered nurse in a New Zealand acute-care setting is caring for an older
adult who has become suddenly confused, restless, and disoriented several
hours after admission for pneumonia. The patient was previously
independent and oriented. Which assessment finding would most strongly
support delirium rather than dementia?
A. Gradual memory decline occurring over several years
B. Long-standing difficulty managing finances and medications
C. Progressive loss of familiar skills over several months
D. Acute onset with fluctuating attention and altered level of awareness
Answer: D
2. A nurse is caring for a patient with suspected sepsis who has a temperature
of 39.2°C, respiratory rate of 30/min, blood pressure of 86/52 mmHg, and
new confusion. Which nursing action should receive the highest priority?
A. Initiate urgent assessment and management for possible septic shock
B. Encourage the patient to ambulate to improve circulation
C. Delay intervention until the next scheduled set of observations
D. Offer a large meal before initiating treatment
Answer: A
3. A patient admitted with acute respiratory distress has an oxygen saturation
of 82% on room air and is using accessory muscles to breathe. Which
intervention should the nurse prioritize while continuing assessment and
escalation?
A. Place the patient flat in bed
B. Provide prescribed oxygen and position the patient to optimize
ventilation
C. Encourage oral fluids before providing oxygen
D. Ask the patient to walk to assess exercise tolerance
Answer: B
pg. 1
, 4. A patient with heart failure has increasing bilateral lower-limb edema, a
rapid weight gain, and new shortness of breath when lying flat. Which
assessment finding would most strongly indicate worsening fluid overload?
A. Dry oral mucosa
B. Decreased jugular venous pressure
C. Increasing crackles with worsening orthopnea
D. Increased urine output
Answer: C
5. A patient receiving intravenous furosemide for acute pulmonary edema has
produced substantial urine output but now reports weakness and
palpitations. Which laboratory abnormality should the nurse suspect?
A. Hypernatremia
B. Hypercalcemia
C. Hypermagnesemia
D. Hypokalemia
Answer: D
6. A patient with chronic obstructive pulmonary disease is receiving oxygen
therapy and becomes increasingly drowsy while respiratory effort
decreases. Which nursing action is most appropriate?
A. Reassess respiratory status urgently and escalate because worsening
ventilation may be occurring
B. Increase oxygen flow without reassessment
C. Encourage the patient to sleep undisturbed
D. Remove all monitoring equipment
Answer: A
7. A patient develops sudden facial drooping, unilateral arm weakness, and
difficulty speaking while eating breakfast. Which action should the nurse
take first?
A. Ask the patient to walk to determine whether balance is affected
B. Activate the appropriate acute stroke response and establish the time
symptoms began
pg. 2
, C. Give oral fluids to determine whether swallowing is intact
D. Wait for the symptoms to resolve before notifying the medical team
Answer: B
8. A patient receiving anticoagulation develops sudden severe headache,
vomiting, and decreasing level of consciousness after falling. Which
complication should the nurse consider most urgently?
A. Hypoglycemia
B. Gastroenteritis
C. Intracranial bleeding
D. Mild dehydration
Answer: C
9. A patient with diabetes becomes sweaty, tremulous, confused, and unable
to concentrate shortly after receiving insulin. Which condition should the
nurse suspect?
A. Hypoglycemia
B. Hypernatremia
C. Hypercalcemia
D. Metabolic alkalosis
Answer: A
10. A patient with diabetic ketoacidosis is receiving intravenous fluids and
insulin. Which finding would indicate that treatment is moving in the
expected direction?
A. Increasing ketone production
B. Worsening acidosis
C. Progressive dehydration
D. Improving glucose level with closure of the anion gap
Answer: D
11. A patient with type 2 diabetes is prescribed metformin and is scheduled for
a procedure involving iodinated contrast. Which nursing action is most
appropriate?
A. Administer an additional metformin dose immediately before contrast
pg. 3
, B. Verify renal function and follow the prescribed instructions regarding
metformin around the procedure
C. Tell the patient renal function has no relevance to metformin
D. Encourage the patient to take the medication with alcohol
Answer: B
12. A patient taking warfarin reports black, tarry stools and dizziness when
standing. Which nursing action is the priority?
A. Encourage increased physical activity
B. Reassure the patient that dark stools are always expected
C. Assess for significant bleeding and escalate promptly
D. Recommend taking an additional warfarin dose
Answer: C
13. A patient receiving unfractionated heparin develops a marked platelet
decrease several days after therapy begins and develops a new painful
swollen leg. Which complication should the nurse suspect?
A. Heparin-induced thrombocytopenia
B. Iron-deficiency anemia
C. Hypoglycemia
D. Vitamin B12 deficiency
Answer: A
14. A patient with chest pain has prescribed sublingual glyceryl trinitrate and a
blood pressure of 82/50 mmHg. Which action is most appropriate?
A. Administer the medication and encourage walking
B. Give a double dose to relieve the pain
C. Assess the hypotension and follow the prescribed parameters before
administering
D. Place the patient upright and encourage rapid ambulation
Answer: C
15. A patient with atrial fibrillation is prescribed anticoagulant therapy even
though there is no current evidence of a thrombus. Which explanation best
describes the purpose of treatment?
pg. 4
