NUR 274/NURS 274 EXAM 2 (MIDTERM)
— QUESTIONS 1–100 AND ANSWERS
UPDATED 2026/2027
Medgar Evers College | Advanced Nursing Practice Questions with Detailed
Rationales
Continuation of the original exam-style practice bank. These questions are for study
and revision and are not official examination questions. Check your course syllabus
and instructor-provided objectives for the exact midterm coverage.
QUESTIONS 1–100
Advanced clinical judgment and patient prioritization
Q1: A nurse is caring for a patient admitted with pneumonia. The patient initially
responded to treatment but now has a respiratory rate of 32/min, oxygen saturation of
85%, and new agitation. Which action is the priority?
A) Encourage the patient to use an incentive spirometer independently B) Obtain a
sputum specimen before initiating further assessment C) Assess airway and breathing
immediately, provide appropriate respiratory support, and activate urgent clinical
assistance D) Administer the next scheduled oral antibiotic and reassess in one hour
Rationale: Option C is correct because hypoxemia, tachypnea, and agitation suggest
acute respiratory deterioration. Immediate assessment and support take precedence.
Option A is insufficient for severe hypoxemia. Option B delays stabilization. Option
D delays emergency assessment and treatment.
Q2: A patient with heart failure reports worsening shortness of breath when lying flat.
The nurse notes crackles, bilateral edema, and a weight gain of 2.5 kg over three days.
Which intervention is most appropriate?
A) Encourage unrestricted fluid intake B) Discontinue prescribed diuretics because
edema is present C) Place the patient flat and elevate the legs without assessing
breathing D) Assess respiratory status, notify the clinical team of worsening
congestion, and implement the prescribed fluid-management plan
Rationale: Option D is correct because rapid weight gain, orthopnea, crackles, and
edema suggest worsening fluid overload. The nurse should assess oxygenation, report
deterioration, and implement prescribed interventions. Option A may worsen
congestion. Option B is not justified by edema. Option C may aggravate respiratory
distress.
,Q3: A nurse notices that a patient receiving oxygen has become cyanotic and is using
accessory muscles to breathe. What should the nurse do first?
A) Finish documenting the previous assessment B) Immediately assess airway and
breathing, summon emergency assistance, and provide appropriate respiratory support
C) Offer the patient oral fluids D) Wait for the next scheduled oxygen-saturation
measurement
Rationale: Option B is correct because cyanosis and increased work of breathing
indicate potentially life-threatening respiratory compromise. Option A delays care.
Option C may create aspiration risk. Option D is inappropriate because the patient is
already showing signs of deterioration.
Q4: A patient with suspected gastrointestinal bleeding has a blood pressure of 86/50
mmHg, heart rate of 132/min, and black stools. Which action should the nurse
prioritize?
A) Administer a prescribed stool softener B) Encourage the patient to walk to the
bathroom C) Initiate urgent escalation, assess perfusion, and prepare for prescribed
resuscitation and diagnostic evaluation D) Provide a high-fiber meal
Rationale: Option C is correct because hypotension and tachycardia with possible
gastrointestinal bleeding suggest significant blood loss and shock. Option A does not
address the emergency. Option B increases fall and collapse risk. Option D is
inappropriate during acute instability.
Q5: A patient who recently underwent surgery suddenly becomes restless and reports
severe shortness of breath. The patient has a heart rate of 126/min and oxygen
saturation of 87%. Which action is most appropriate?
A) Encourage the patient to sleep B) Administer a sedative before assessing
respiratory status C) Ask the patient to walk to improve circulation D) Initiate an
urgent cardiopulmonary assessment and escalate care for possible pulmonary
embolism or another acute complication
Rationale: Option D is correct because sudden postoperative dyspnea, tachycardia,
and hypoxemia may indicate pulmonary embolism or another serious complication.
Option A delays evaluation. Option B may worsen respiratory depression. Option C
increases physiological demand and is unsafe.
Q6: A patient with diabetes is sweating, shaking, and confused. The blood glucose is
44 mg/dL. The patient is awake but cannot swallow safely. What should the nurse do?
A) Give glucose tablets by mouth B) Administer the patient's scheduled insulin C)
Activate emergency assistance and administer glucagon or intravenous dextrose as
appropriate to access, orders, and protocol D) Delay treatment until the next meal
Rationale: Option C is correct because severe hypoglycemia with impaired
swallowing requires rapid treatment without oral intake. Glucagon or intravenous
dextrose may be appropriate depending on access and protocol. Option A creates an
, aspiration risk. Option B worsens hypoglycemia. Option D allows further
deterioration.
Q7: A patient with acute kidney injury has a potassium level of 6.7 mmol/L and
widening QRS complexes on the ECG. Which action is the priority?
A) Encourage potassium-rich foods B) Repeat the laboratory test tomorrow C)
Administer a potassium supplement D) Activate emergency assistance and prepare for
immediate hyperkalemia treatment with continuous cardiac monitoring
Rationale: Option D is correct because severe hyperkalemia with ECG changes can
cause cardiac arrest. Urgent treatment may include intravenous calcium for cardiac
membrane stabilization and therapies that shift potassium intracellularly, followed by
measures to remove potassium. Option A and C worsen the problem. Option B
dangerously delays intervention.
Q8: A patient develops sudden facial drooping, difficulty speaking, and unilateral arm
weakness. What information should the nurse obtain immediately while activating the
stroke pathway?
A) The patient's favorite foods B) The date of the patient's last dental appointment C)
The exact time symptoms began or the last time the patient was known to be at their
baseline D) The patient's preferred discharge destination
Rationale: Option C is correct because the last-known-well time helps determine
eligibility for time-sensitive stroke treatment. Option A is unrelated to immediate
management. Option B is not a priority. Option D is premature during an emergency.
Q9: A patient with sepsis remains hypotensive after initial prescribed fluid
resuscitation. Which intervention should the nurse anticipate?
A) Discontinuing all monitoring B) Administering an unprescribed sedative C)
Encouraging oral fluids as the sole treatment D) Urgent reassessment and possible
vasopressor therapy under the prescribed sepsis-management protocol
Rationale: Option D is correct because persistent hypotension despite appropriate
fluid resuscitation may require vasopressor support and higher-level monitoring.
Option A removes essential surveillance. Option B does not address circulatory
failure. Option C is inadequate for persistent shock.
Q10: A nurse receives handoff for four patients. Which patient should be assessed
first?
A) A patient requesting assistance with routine hygiene B) A patient with chronic
arthritis reporting unchanged joint stiffness C) A patient awaiting discharge
instructions for a stable condition D) A patient with new stridor and difficulty
speaking after receiving a medication
— QUESTIONS 1–100 AND ANSWERS
UPDATED 2026/2027
Medgar Evers College | Advanced Nursing Practice Questions with Detailed
Rationales
Continuation of the original exam-style practice bank. These questions are for study
and revision and are not official examination questions. Check your course syllabus
and instructor-provided objectives for the exact midterm coverage.
QUESTIONS 1–100
Advanced clinical judgment and patient prioritization
Q1: A nurse is caring for a patient admitted with pneumonia. The patient initially
responded to treatment but now has a respiratory rate of 32/min, oxygen saturation of
85%, and new agitation. Which action is the priority?
A) Encourage the patient to use an incentive spirometer independently B) Obtain a
sputum specimen before initiating further assessment C) Assess airway and breathing
immediately, provide appropriate respiratory support, and activate urgent clinical
assistance D) Administer the next scheduled oral antibiotic and reassess in one hour
Rationale: Option C is correct because hypoxemia, tachypnea, and agitation suggest
acute respiratory deterioration. Immediate assessment and support take precedence.
Option A is insufficient for severe hypoxemia. Option B delays stabilization. Option
D delays emergency assessment and treatment.
Q2: A patient with heart failure reports worsening shortness of breath when lying flat.
The nurse notes crackles, bilateral edema, and a weight gain of 2.5 kg over three days.
Which intervention is most appropriate?
A) Encourage unrestricted fluid intake B) Discontinue prescribed diuretics because
edema is present C) Place the patient flat and elevate the legs without assessing
breathing D) Assess respiratory status, notify the clinical team of worsening
congestion, and implement the prescribed fluid-management plan
Rationale: Option D is correct because rapid weight gain, orthopnea, crackles, and
edema suggest worsening fluid overload. The nurse should assess oxygenation, report
deterioration, and implement prescribed interventions. Option A may worsen
congestion. Option B is not justified by edema. Option C may aggravate respiratory
distress.
,Q3: A nurse notices that a patient receiving oxygen has become cyanotic and is using
accessory muscles to breathe. What should the nurse do first?
A) Finish documenting the previous assessment B) Immediately assess airway and
breathing, summon emergency assistance, and provide appropriate respiratory support
C) Offer the patient oral fluids D) Wait for the next scheduled oxygen-saturation
measurement
Rationale: Option B is correct because cyanosis and increased work of breathing
indicate potentially life-threatening respiratory compromise. Option A delays care.
Option C may create aspiration risk. Option D is inappropriate because the patient is
already showing signs of deterioration.
Q4: A patient with suspected gastrointestinal bleeding has a blood pressure of 86/50
mmHg, heart rate of 132/min, and black stools. Which action should the nurse
prioritize?
A) Administer a prescribed stool softener B) Encourage the patient to walk to the
bathroom C) Initiate urgent escalation, assess perfusion, and prepare for prescribed
resuscitation and diagnostic evaluation D) Provide a high-fiber meal
Rationale: Option C is correct because hypotension and tachycardia with possible
gastrointestinal bleeding suggest significant blood loss and shock. Option A does not
address the emergency. Option B increases fall and collapse risk. Option D is
inappropriate during acute instability.
Q5: A patient who recently underwent surgery suddenly becomes restless and reports
severe shortness of breath. The patient has a heart rate of 126/min and oxygen
saturation of 87%. Which action is most appropriate?
A) Encourage the patient to sleep B) Administer a sedative before assessing
respiratory status C) Ask the patient to walk to improve circulation D) Initiate an
urgent cardiopulmonary assessment and escalate care for possible pulmonary
embolism or another acute complication
Rationale: Option D is correct because sudden postoperative dyspnea, tachycardia,
and hypoxemia may indicate pulmonary embolism or another serious complication.
Option A delays evaluation. Option B may worsen respiratory depression. Option C
increases physiological demand and is unsafe.
Q6: A patient with diabetes is sweating, shaking, and confused. The blood glucose is
44 mg/dL. The patient is awake but cannot swallow safely. What should the nurse do?
A) Give glucose tablets by mouth B) Administer the patient's scheduled insulin C)
Activate emergency assistance and administer glucagon or intravenous dextrose as
appropriate to access, orders, and protocol D) Delay treatment until the next meal
Rationale: Option C is correct because severe hypoglycemia with impaired
swallowing requires rapid treatment without oral intake. Glucagon or intravenous
dextrose may be appropriate depending on access and protocol. Option A creates an
, aspiration risk. Option B worsens hypoglycemia. Option D allows further
deterioration.
Q7: A patient with acute kidney injury has a potassium level of 6.7 mmol/L and
widening QRS complexes on the ECG. Which action is the priority?
A) Encourage potassium-rich foods B) Repeat the laboratory test tomorrow C)
Administer a potassium supplement D) Activate emergency assistance and prepare for
immediate hyperkalemia treatment with continuous cardiac monitoring
Rationale: Option D is correct because severe hyperkalemia with ECG changes can
cause cardiac arrest. Urgent treatment may include intravenous calcium for cardiac
membrane stabilization and therapies that shift potassium intracellularly, followed by
measures to remove potassium. Option A and C worsen the problem. Option B
dangerously delays intervention.
Q8: A patient develops sudden facial drooping, difficulty speaking, and unilateral arm
weakness. What information should the nurse obtain immediately while activating the
stroke pathway?
A) The patient's favorite foods B) The date of the patient's last dental appointment C)
The exact time symptoms began or the last time the patient was known to be at their
baseline D) The patient's preferred discharge destination
Rationale: Option C is correct because the last-known-well time helps determine
eligibility for time-sensitive stroke treatment. Option A is unrelated to immediate
management. Option B is not a priority. Option D is premature during an emergency.
Q9: A patient with sepsis remains hypotensive after initial prescribed fluid
resuscitation. Which intervention should the nurse anticipate?
A) Discontinuing all monitoring B) Administering an unprescribed sedative C)
Encouraging oral fluids as the sole treatment D) Urgent reassessment and possible
vasopressor therapy under the prescribed sepsis-management protocol
Rationale: Option D is correct because persistent hypotension despite appropriate
fluid resuscitation may require vasopressor support and higher-level monitoring.
Option A removes essential surveillance. Option B does not address circulatory
failure. Option C is inadequate for persistent shock.
Q10: A nurse receives handoff for four patients. Which patient should be assessed
first?
A) A patient requesting assistance with routine hygiene B) A patient with chronic
arthritis reporting unchanged joint stiffness C) A patient awaiting discharge
instructions for a stable condition D) A patient with new stridor and difficulty
speaking after receiving a medication
