NUR 283 Comp 1,2 and 3 EXAM TEST |
Comprehensive All Topics Overview | 2026
Update with complete solutions.
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
147 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This comprehensive examination spans the three NUR 283 competencies: nursing process and clinical
judgment, pharmacological and parenteral therapies, and physiological integrity with safe, evidence-based
management of complex adult health conditions. Items require application of current guidelines, prioritization,
and data interpretation at the level expected of third-year BSN students preparing for NCLEX-RN.
STUDY GUIDE
Recommended duration: 3 hours. Passing target: 75%.
HIGHP - Page 1 of 46
,1. A patient receiving continuous IV heparin for venous thromboembolism has an aPTT of
98 seconds (therapeutic range 60-80 seconds) and new hematuria. Which action should
the nurse anticipate?
[ ] A. Administer vitamin K 10 mg IV push
[ ] B. Hold the heparin infusion and prepare to administer protamine sulfate
[ ] C. Increase the heparin rate to achieve a higher therapeutic level
[ ] D. Continue the infusion and recheck aPTT in 6 hours
CORRECT: B. Hold the heparin infusion and prepare to administer protamine sulfate
An aPTT above therapeutic range with bleeding indicates heparin excess; the infusion is held and protamine
sulfate is the antidote. Vitamin K reverses warfarin, not heparin. Increasing the rate or continuing the infusion
worsens bleeding risk.
2. A patient with type 1 diabetes has a blood glucose of 52 mg/dL, is diaphoretic and
confused but able to swallow. Which action should the nurse take first?
[ ] A. Administer 1 mg glucagon IM
[ ] B. Give 15 g of a fast-acting carbohydrate orally
[ ] C. Start an IV and administer 50% dextrose
[ ] D. Recheck blood glucose in 15 minutes before treating
CORRECT: B. Give 15 g of a fast-acting carbohydrate orally
For conscious hypoglycemia, the rule of 15 applies: give 15 g oral fast-acting carbohydrate, recheck in 15
minutes. Glucagon and IV dextrose are for unconscious or unable-to-swallow patients. Delaying treatment to
recheck is unsafe.
3. Which assessment finding is most concerning in a patient receiving IV vancomycin for
MRSA pneumonia?
[ ] A. Trough level of 12 mcg/mL
[ ] B. Flushing of the face and neck during infusion
[ ] C. Serum creatinine increase from 0.9 to 1.8 mg/dL
[ ] D. Complaint of mild nausea after the first dose
CORRECT: C. Serum creatinine increase from 0.9 to 1.8 mg/dL
Vancomycin is nephrotoxic; a doubling of serum creatinine indicates acute kidney injury and requires
immediate provider notification and possible dose adjustment. Flushing suggests infusion reaction
(rate-related) but is not as urgent as renal injury. A trough of 12 is within therapeutic range for serious
infections.
HIGHP - Page 2 of 46
,4. A patient with a new colostomy has liquid stool and skin excoriation around the stoma.
Which intervention should the nurse implement?
[ ] A. Apply a pectin-based skin barrier and ensure the wafer opening is no more than 1/8 inch larger
than the stoma
[ ] B. Cleanse the skin with alcohol and apply a hydrocolloid dressing
[ ] C. Use a convex wafer with belt to increase pouch adherence
[ ] D. Restrict oral fluids to thicken the stool
CORRECT: A. Apply a pectin-based skin barrier and ensure the wafer opening is no more than 1/8
inch larger than the stoma
Liquid stool is caustic; a correctly sized wafer (1/8 inch larger than stoma) with pectin barrier protects skin.
Alcohol is drying and damaging. Convexity may be used for retracted stomas but does not address the
primary skin protection issue. Fluid restriction is unsafe and ineffective.
5. Which laboratory value is most important to monitor in a patient receiving furosemide
for heart failure?
[ ] A. Serum potassium
[ ] B. Serum calcium
[ ] C. Serum magnesium
[ ] D. Serum phosphorus
CORRECT: A. Serum potassium
Loop diuretics cause potassium loss, increasing risk of hypokalemia and dysrhythmias, so potassium is the
priority. While magnesium and calcium can be affected, potassium is the most critical and commonly
monitored electrolyte. Phosphorus is not primarily affected.
6. A patient is admitted with an acute exacerbation of COPD. Which order should the
nurse question?
[ ] A. Administer albuterol via nebulizer every 4 hours as needed
[ ] B. Administer oxygen to maintain SpO2 at 88-92%
[ ] C. Administer high-flow oxygen at 10 L/min via non-rebreather
[ ] D. Administer prednisone 40 mg PO daily
CORRECT: C. Administer high-flow oxygen at 10 L/min via non-rebreather
In COPD, target SpO2 is 88-92% to avoid oxygen-induced hypercapnia; high-flow 10 L/min can cause
respiratory depression. Albuterol, controlled oxygen, and corticosteroids are appropriate. The nurse should
question the high-flow oxygen order.
HIGHP - Page 3 of 46
, 7. A patient with a traumatic brain injury has an ICP of 22 mm Hg. Which position should
the nurse maintain?
[ ] A. Flat, supine with head neutral
[ ] B. Head of bed elevated 30 degrees with head midline
[ ] C. Trendelenburg position
[ ] D. Prone position with head turned to the side
CORRECT: B. Head of bed elevated 30 degrees with head midline
Elevating the head of bed 30 degrees with head midline promotes venous drainage and reduces ICP. Flat or
Trendelenburg positions increase ICP. Prone with head turned impedes venous return and raises ICP.
8. A patient receiving total parenteral nutrition (TPN) has a sudden onset of diaphoresis,
tremors, and confusion. Which action should the nurse take first?
[ ] A. Check the blood glucose level
[ ] B. Administer a bolus of regular insulin
[ ] C. Increase the TPN infusion rate
[ ] D. Obtain a serum potassium level
CORRECT: A. Check the blood glucose level
These signs suggest hypoglycemia, a complication of abrupt TPN interruption or excess insulin; immediate
glucose check is the priority. Insulin would worsen hypoglycemia. Increasing TPN rate without knowing
glucose is unsafe. Potassium is not the first concern.
9. A patient with acute pancreatitis is receiving IV fluids and pain management. Which
assessment finding indicates a potential complication requiring immediate intervention?
[ ] A. Serum lipase 350 U/L
[ ] B. Heart rate 110/min and blood pressure 88/50 mm Hg
[ ] C. Complaint of severe epigastric pain
[ ] D. Serum amylase 200 U/L
CORRECT: B. Heart rate 110/min and blood pressure 88/50 mm Hg
Tachycardia and hypotension suggest hypovolemic shock or pancreatic hemorrhage, a life-threatening
complication. Elevated lipase and amylase are expected in pancreatitis. Pain is also expected but less urgent
than hemodynamic instability.
10. A patient with heart failure is prescribed furosemide. Which laboratory value should
the nurse monitor most closely to detect a common adverse effect of this medication?
[ ] A. Serum potassium
[ ] B. Serum calcium
[ ] C. Serum magnesium
HIGHP - Page 4 of 46
Comprehensive All Topics Overview | 2026
Update with complete solutions.
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
147 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This comprehensive examination spans the three NUR 283 competencies: nursing process and clinical
judgment, pharmacological and parenteral therapies, and physiological integrity with safe, evidence-based
management of complex adult health conditions. Items require application of current guidelines, prioritization,
and data interpretation at the level expected of third-year BSN students preparing for NCLEX-RN.
STUDY GUIDE
Recommended duration: 3 hours. Passing target: 75%.
HIGHP - Page 1 of 46
,1. A patient receiving continuous IV heparin for venous thromboembolism has an aPTT of
98 seconds (therapeutic range 60-80 seconds) and new hematuria. Which action should
the nurse anticipate?
[ ] A. Administer vitamin K 10 mg IV push
[ ] B. Hold the heparin infusion and prepare to administer protamine sulfate
[ ] C. Increase the heparin rate to achieve a higher therapeutic level
[ ] D. Continue the infusion and recheck aPTT in 6 hours
CORRECT: B. Hold the heparin infusion and prepare to administer protamine sulfate
An aPTT above therapeutic range with bleeding indicates heparin excess; the infusion is held and protamine
sulfate is the antidote. Vitamin K reverses warfarin, not heparin. Increasing the rate or continuing the infusion
worsens bleeding risk.
2. A patient with type 1 diabetes has a blood glucose of 52 mg/dL, is diaphoretic and
confused but able to swallow. Which action should the nurse take first?
[ ] A. Administer 1 mg glucagon IM
[ ] B. Give 15 g of a fast-acting carbohydrate orally
[ ] C. Start an IV and administer 50% dextrose
[ ] D. Recheck blood glucose in 15 minutes before treating
CORRECT: B. Give 15 g of a fast-acting carbohydrate orally
For conscious hypoglycemia, the rule of 15 applies: give 15 g oral fast-acting carbohydrate, recheck in 15
minutes. Glucagon and IV dextrose are for unconscious or unable-to-swallow patients. Delaying treatment to
recheck is unsafe.
3. Which assessment finding is most concerning in a patient receiving IV vancomycin for
MRSA pneumonia?
[ ] A. Trough level of 12 mcg/mL
[ ] B. Flushing of the face and neck during infusion
[ ] C. Serum creatinine increase from 0.9 to 1.8 mg/dL
[ ] D. Complaint of mild nausea after the first dose
CORRECT: C. Serum creatinine increase from 0.9 to 1.8 mg/dL
Vancomycin is nephrotoxic; a doubling of serum creatinine indicates acute kidney injury and requires
immediate provider notification and possible dose adjustment. Flushing suggests infusion reaction
(rate-related) but is not as urgent as renal injury. A trough of 12 is within therapeutic range for serious
infections.
HIGHP - Page 2 of 46
,4. A patient with a new colostomy has liquid stool and skin excoriation around the stoma.
Which intervention should the nurse implement?
[ ] A. Apply a pectin-based skin barrier and ensure the wafer opening is no more than 1/8 inch larger
than the stoma
[ ] B. Cleanse the skin with alcohol and apply a hydrocolloid dressing
[ ] C. Use a convex wafer with belt to increase pouch adherence
[ ] D. Restrict oral fluids to thicken the stool
CORRECT: A. Apply a pectin-based skin barrier and ensure the wafer opening is no more than 1/8
inch larger than the stoma
Liquid stool is caustic; a correctly sized wafer (1/8 inch larger than stoma) with pectin barrier protects skin.
Alcohol is drying and damaging. Convexity may be used for retracted stomas but does not address the
primary skin protection issue. Fluid restriction is unsafe and ineffective.
5. Which laboratory value is most important to monitor in a patient receiving furosemide
for heart failure?
[ ] A. Serum potassium
[ ] B. Serum calcium
[ ] C. Serum magnesium
[ ] D. Serum phosphorus
CORRECT: A. Serum potassium
Loop diuretics cause potassium loss, increasing risk of hypokalemia and dysrhythmias, so potassium is the
priority. While magnesium and calcium can be affected, potassium is the most critical and commonly
monitored electrolyte. Phosphorus is not primarily affected.
6. A patient is admitted with an acute exacerbation of COPD. Which order should the
nurse question?
[ ] A. Administer albuterol via nebulizer every 4 hours as needed
[ ] B. Administer oxygen to maintain SpO2 at 88-92%
[ ] C. Administer high-flow oxygen at 10 L/min via non-rebreather
[ ] D. Administer prednisone 40 mg PO daily
CORRECT: C. Administer high-flow oxygen at 10 L/min via non-rebreather
In COPD, target SpO2 is 88-92% to avoid oxygen-induced hypercapnia; high-flow 10 L/min can cause
respiratory depression. Albuterol, controlled oxygen, and corticosteroids are appropriate. The nurse should
question the high-flow oxygen order.
HIGHP - Page 3 of 46
, 7. A patient with a traumatic brain injury has an ICP of 22 mm Hg. Which position should
the nurse maintain?
[ ] A. Flat, supine with head neutral
[ ] B. Head of bed elevated 30 degrees with head midline
[ ] C. Trendelenburg position
[ ] D. Prone position with head turned to the side
CORRECT: B. Head of bed elevated 30 degrees with head midline
Elevating the head of bed 30 degrees with head midline promotes venous drainage and reduces ICP. Flat or
Trendelenburg positions increase ICP. Prone with head turned impedes venous return and raises ICP.
8. A patient receiving total parenteral nutrition (TPN) has a sudden onset of diaphoresis,
tremors, and confusion. Which action should the nurse take first?
[ ] A. Check the blood glucose level
[ ] B. Administer a bolus of regular insulin
[ ] C. Increase the TPN infusion rate
[ ] D. Obtain a serum potassium level
CORRECT: A. Check the blood glucose level
These signs suggest hypoglycemia, a complication of abrupt TPN interruption or excess insulin; immediate
glucose check is the priority. Insulin would worsen hypoglycemia. Increasing TPN rate without knowing
glucose is unsafe. Potassium is not the first concern.
9. A patient with acute pancreatitis is receiving IV fluids and pain management. Which
assessment finding indicates a potential complication requiring immediate intervention?
[ ] A. Serum lipase 350 U/L
[ ] B. Heart rate 110/min and blood pressure 88/50 mm Hg
[ ] C. Complaint of severe epigastric pain
[ ] D. Serum amylase 200 U/L
CORRECT: B. Heart rate 110/min and blood pressure 88/50 mm Hg
Tachycardia and hypotension suggest hypovolemic shock or pancreatic hemorrhage, a life-threatening
complication. Elevated lipase and amylase are expected in pancreatitis. Pain is also expected but less urgent
than hemodynamic instability.
10. A patient with heart failure is prescribed furosemide. Which laboratory value should
the nurse monitor most closely to detect a common adverse effect of this medication?
[ ] A. Serum potassium
[ ] B. Serum calcium
[ ] C. Serum magnesium
HIGHP - Page 4 of 46
