NUR 283 Comprehensive Exam
Review 2026 | Nursing Practice
Questions and Answers with
Detailed Rationales Guaranteed
Pass (GRADED A+)
1. A nurse is caring for a client who is receiving a blood transfusion.
Which of the following findings should the nurse identify as an acute
hemolytic reaction?
A. Urticaria and itching
B. Fever and chills
C. Low back pain and dark urine
D. Low back pain and dark urine
Rationale: Acute hemolytic reactions are a severe, life-threatening
complication of blood transfusion. They occur when the client's immune
system attacks the transfused red blood cells, leading to their destruction
(hemolysis). Classic signs include fever, chills, flank or low back pain, and
hemoglobinuria (dark, reddish-brown urine) due to the excretion of
hemoglobin from destroyed cells. Urticaria and itching are signs of a mild
allergic reaction, while fever and chills can be early signs of a febrile non-
hemolytic reaction.
,2. A client with chronic kidney disease is prescribed epoetin alfa.
Which of the following laboratory values should the nurse monitor to
evaluate the effectiveness of this medication?
A. Serum potassium
B. Serum creatinine
C. Hemoglobin and hematocrit
D. Hemoglobin and hematocrit
Rationale: Epoetin alfa is an erythropoiesis-stimulating agent (ESA) that
stimulates the bone marrow to produce red blood cells. It is used to treat
anemia associated with chronic kidney disease. Therefore, the nurse should
monitor the client's hemoglobin and hematocrit levels to determine the
medication's effectiveness. An increase in these values indicates a positive
response to therapy. Serum potassium and creatinine are important to
monitor in CKD but do not directly reflect the effectiveness of epoetin alfa.
3. A nurse is assessing a client who has been taking lithium carbonate
for bipolar disorder. Which of the following findings is an early
indication of lithium toxicity?
A. Constipation
B. Tinnitus
C. Fine hand tremors
D. Fine hand tremors
Rationale: Fine hand tremors are a common and often early sign of lithium
toxicity. Other early signs include nausea, vomiting, diarrhea, and lethargy.
As toxicity worsens, tremors can become coarse, and the client may develop
,ataxia, confusion, and seizures. Constipation is not a typical sign of lithium
toxicity. Tinnitus is not a classic early sign of lithium toxicity.
4. A nurse is developing a care plan for a client with a new colostomy.
Which of the following instructions should the nurse include in the
teaching?
A. "You should change the ostomy pouch every day."
B. "Avoid eating foods that are high in fiber."
C. "Empty the pouch when it is one-third to one-half full."
D. "Empty the pouch when it is one-third to one-half full."
Rationale: An ostomy pouch should be emptied when it is one-third to one-
half full to prevent the weight of the effluent from breaking the seal and
causing a leak. The pouch system is typically changed every 3 to 7 days, not
daily. Clients with a colostomy are encouraged to eat a high-fiber diet unless
otherwise contraindicated, as it helps regulate stool consistency and prevents
constipation.
5. A client is admitted with a diagnosis of syndrome of inappropriate
antidiuretic hormone (SIADH). Which of the following findings should
the nurse expect?
A. Polyuria and dehydration
B. Hypernatremia and thirst
C. Hyponatremia and concentrated urine
D. Hyponatremia and concentrated urine
, Rationale: SIADH is characterized by the excessive release of antidiuretic
hormone (ADH), which causes the kidneys to reabsorb too much water. This
leads to dilutional hyponatremia (low serum sodium) and the production of
highly concentrated urine. Clients typically have oliguria (decreased urine
output) and may exhibit signs of fluid overload, such as weight gain and
edema. Polyuria is the opposite of what is seen in SIADH. Hypernatremia is
associated with diabetes insipidus.
6. A nurse is caring for a client in the immediate postoperative period
following a thyroidectomy. Which of the following assessment
findings is the priority?
A. A sore throat
B. A feeling of fatigue
C. Stridor and difficulty breathing
D. Stridor and difficulty breathing
Rationale: Stridor and difficulty breathing are signs of a life-threatening
complication following a thyroidectomy: tracheal compression due to
hematoma or laryngeal edema. This is a critical emergency that requires
immediate intervention (e.g., opening the surgical wound, calling for help). A
sore throat and fatigue are expected postoperative findings and are not the
priority. Airway always takes precedence.
7. A client with heart failure is prescribed furosemide. Which of the
following client statements indicates a need for further teaching?
Review 2026 | Nursing Practice
Questions and Answers with
Detailed Rationales Guaranteed
Pass (GRADED A+)
1. A nurse is caring for a client who is receiving a blood transfusion.
Which of the following findings should the nurse identify as an acute
hemolytic reaction?
A. Urticaria and itching
B. Fever and chills
C. Low back pain and dark urine
D. Low back pain and dark urine
Rationale: Acute hemolytic reactions are a severe, life-threatening
complication of blood transfusion. They occur when the client's immune
system attacks the transfused red blood cells, leading to their destruction
(hemolysis). Classic signs include fever, chills, flank or low back pain, and
hemoglobinuria (dark, reddish-brown urine) due to the excretion of
hemoglobin from destroyed cells. Urticaria and itching are signs of a mild
allergic reaction, while fever and chills can be early signs of a febrile non-
hemolytic reaction.
,2. A client with chronic kidney disease is prescribed epoetin alfa.
Which of the following laboratory values should the nurse monitor to
evaluate the effectiveness of this medication?
A. Serum potassium
B. Serum creatinine
C. Hemoglobin and hematocrit
D. Hemoglobin and hematocrit
Rationale: Epoetin alfa is an erythropoiesis-stimulating agent (ESA) that
stimulates the bone marrow to produce red blood cells. It is used to treat
anemia associated with chronic kidney disease. Therefore, the nurse should
monitor the client's hemoglobin and hematocrit levels to determine the
medication's effectiveness. An increase in these values indicates a positive
response to therapy. Serum potassium and creatinine are important to
monitor in CKD but do not directly reflect the effectiveness of epoetin alfa.
3. A nurse is assessing a client who has been taking lithium carbonate
for bipolar disorder. Which of the following findings is an early
indication of lithium toxicity?
A. Constipation
B. Tinnitus
C. Fine hand tremors
D. Fine hand tremors
Rationale: Fine hand tremors are a common and often early sign of lithium
toxicity. Other early signs include nausea, vomiting, diarrhea, and lethargy.
As toxicity worsens, tremors can become coarse, and the client may develop
,ataxia, confusion, and seizures. Constipation is not a typical sign of lithium
toxicity. Tinnitus is not a classic early sign of lithium toxicity.
4. A nurse is developing a care plan for a client with a new colostomy.
Which of the following instructions should the nurse include in the
teaching?
A. "You should change the ostomy pouch every day."
B. "Avoid eating foods that are high in fiber."
C. "Empty the pouch when it is one-third to one-half full."
D. "Empty the pouch when it is one-third to one-half full."
Rationale: An ostomy pouch should be emptied when it is one-third to one-
half full to prevent the weight of the effluent from breaking the seal and
causing a leak. The pouch system is typically changed every 3 to 7 days, not
daily. Clients with a colostomy are encouraged to eat a high-fiber diet unless
otherwise contraindicated, as it helps regulate stool consistency and prevents
constipation.
5. A client is admitted with a diagnosis of syndrome of inappropriate
antidiuretic hormone (SIADH). Which of the following findings should
the nurse expect?
A. Polyuria and dehydration
B. Hypernatremia and thirst
C. Hyponatremia and concentrated urine
D. Hyponatremia and concentrated urine
, Rationale: SIADH is characterized by the excessive release of antidiuretic
hormone (ADH), which causes the kidneys to reabsorb too much water. This
leads to dilutional hyponatremia (low serum sodium) and the production of
highly concentrated urine. Clients typically have oliguria (decreased urine
output) and may exhibit signs of fluid overload, such as weight gain and
edema. Polyuria is the opposite of what is seen in SIADH. Hypernatremia is
associated with diabetes insipidus.
6. A nurse is caring for a client in the immediate postoperative period
following a thyroidectomy. Which of the following assessment
findings is the priority?
A. A sore throat
B. A feeling of fatigue
C. Stridor and difficulty breathing
D. Stridor and difficulty breathing
Rationale: Stridor and difficulty breathing are signs of a life-threatening
complication following a thyroidectomy: tracheal compression due to
hematoma or laryngeal edema. This is a critical emergency that requires
immediate intervention (e.g., opening the surgical wound, calling for help). A
sore throat and fatigue are expected postoperative findings and are not the
priority. Airway always takes precedence.
7. A client with heart failure is prescribed furosemide. Which of the
following client statements indicates a need for further teaching?
