NSG 3280 Exam Questions and Correct
Answers (Verified Answers) Plus Rationale
2027 Q&A| Instant Download Pdf
1. A nurse is assessing a patient who reports sudden onset of
shortness of breath and chest pain. Which assessment finding
requires the nurse's immediate attention?
A. Respiratory rate of 22/min
B. Oxygen saturation of 97%
C. New onset of cyanosis
D. Mild anxiety
Answer: C. New onset of cyanosis
Rationale: Cyanosis indicates inadequate oxygenation and may reflect
significant hypoxemia. The nurse should immediately assess airway
and breathing, administer oxygen as indicated, and initiate
appropriate interventions. Mild tachypnea and anxiety may occur
with respiratory distress but are less immediately concerning than
visible cyanosis.
, 2. Which nursing action is most appropriate when assessing a
patient's level of consciousness?
A. Ask the patient to rate pain on a 0-to-10 scale
B. Determine the patient's ability to respond appropriately to questions
C. Measure the patient's blood pressure
D. Inspect the patient's skin for edema
Answer: B. Determine the patient's ability to respond appropriately to
questions
Rationale: Level of consciousness is evaluated by observing the
patient's alertness and ability to respond appropriately to verbal or
tactile stimuli. Changes in consciousness can indicate neurological
deterioration, metabolic abnormalities, medication effects, or other
serious conditions.
3. A patient with a fever is prescribed acetaminophen. Which finding
should the nurse recognize as the most important reason for
caution before administering the medication?
A. History of seasonal allergies
B. History of liver disease
C. Occasional headaches
D. Mild constipation
,Answer: B. History of liver disease
Rationale: Acetaminophen is metabolized primarily by the liver.
Patients with significant liver disease may be at increased risk for
hepatotoxicity. The nurse should review the patient's medical history,
dosage, and other medications containing acetaminophen before
administration.
4. Which intervention is most effective for preventing pressure
injuries in an immobile patient?
A. Restricting fluid intake
B. Repositioning the patient regularly
C. Massaging reddened areas
D. Keeping the head of the bed elevated continuously
Answer: B. Repositioning the patient regularly
Rationale: Regular repositioning reduces prolonged pressure over
bony prominences and promotes tissue perfusion. Reddened areas
should not be vigorously massaged because massage can further
damage compromised tissue.
5. A nurse is caring for a patient receiving oxygen through a nasal
cannula. Which assessment finding requires intervention?
, A. Dry nasal passages
B. Oxygen saturation of 96%
C. Respiratory rate of 16/min
D. Patient breathing comfortably
Answer: A. Dry nasal passages
Rationale: Oxygen therapy can dry the nasal and respiratory mucosa.
Humidification may be appropriate depending on the oxygen flow
rate and clinical situation. The other findings indicate adequate
oxygenation and respiratory status.
6. Which patient statement demonstrates correct understanding of
infection prevention?
A. “I only need to wash my hands after touching a patient.”
B. “Hand hygiene is important before and after patient contact.”
C. “Gloves eliminate the need for hand hygiene.”
D. “Alcohol-based hand sanitizer should never be used.”
Answer: B. “Hand hygiene is important before and after patient
contact.”
Rationale: Hand hygiene is one of the most important measures for
preventing transmission of infection. Gloves do not replace hand
Answers (Verified Answers) Plus Rationale
2027 Q&A| Instant Download Pdf
1. A nurse is assessing a patient who reports sudden onset of
shortness of breath and chest pain. Which assessment finding
requires the nurse's immediate attention?
A. Respiratory rate of 22/min
B. Oxygen saturation of 97%
C. New onset of cyanosis
D. Mild anxiety
Answer: C. New onset of cyanosis
Rationale: Cyanosis indicates inadequate oxygenation and may reflect
significant hypoxemia. The nurse should immediately assess airway
and breathing, administer oxygen as indicated, and initiate
appropriate interventions. Mild tachypnea and anxiety may occur
with respiratory distress but are less immediately concerning than
visible cyanosis.
, 2. Which nursing action is most appropriate when assessing a
patient's level of consciousness?
A. Ask the patient to rate pain on a 0-to-10 scale
B. Determine the patient's ability to respond appropriately to questions
C. Measure the patient's blood pressure
D. Inspect the patient's skin for edema
Answer: B. Determine the patient's ability to respond appropriately to
questions
Rationale: Level of consciousness is evaluated by observing the
patient's alertness and ability to respond appropriately to verbal or
tactile stimuli. Changes in consciousness can indicate neurological
deterioration, metabolic abnormalities, medication effects, or other
serious conditions.
3. A patient with a fever is prescribed acetaminophen. Which finding
should the nurse recognize as the most important reason for
caution before administering the medication?
A. History of seasonal allergies
B. History of liver disease
C. Occasional headaches
D. Mild constipation
,Answer: B. History of liver disease
Rationale: Acetaminophen is metabolized primarily by the liver.
Patients with significant liver disease may be at increased risk for
hepatotoxicity. The nurse should review the patient's medical history,
dosage, and other medications containing acetaminophen before
administration.
4. Which intervention is most effective for preventing pressure
injuries in an immobile patient?
A. Restricting fluid intake
B. Repositioning the patient regularly
C. Massaging reddened areas
D. Keeping the head of the bed elevated continuously
Answer: B. Repositioning the patient regularly
Rationale: Regular repositioning reduces prolonged pressure over
bony prominences and promotes tissue perfusion. Reddened areas
should not be vigorously massaged because massage can further
damage compromised tissue.
5. A nurse is caring for a patient receiving oxygen through a nasal
cannula. Which assessment finding requires intervention?
, A. Dry nasal passages
B. Oxygen saturation of 96%
C. Respiratory rate of 16/min
D. Patient breathing comfortably
Answer: A. Dry nasal passages
Rationale: Oxygen therapy can dry the nasal and respiratory mucosa.
Humidification may be appropriate depending on the oxygen flow
rate and clinical situation. The other findings indicate adequate
oxygenation and respiratory status.
6. Which patient statement demonstrates correct understanding of
infection prevention?
A. “I only need to wash my hands after touching a patient.”
B. “Hand hygiene is important before and after patient contact.”
C. “Gloves eliminate the need for hand hygiene.”
D. “Alcohol-based hand sanitizer should never be used.”
Answer: B. “Hand hygiene is important before and after patient
contact.”
Rationale: Hand hygiene is one of the most important measures for
preventing transmission of infection. Gloves do not replace hand
