NURSING 474 Nursing Management of
the Adult Patient with Health Problems
Final Exam Review
(Questions & Solutions)
2025
1
,1. A 65-year-old patient with community-acquired pneumonia is at risk
for sepsis. Which vital sign change is the most sensitive early indicator of
sepsis?
A. Hypotension
B. Tachycardia
C. Hypothermia
D. Bradycardia
ANS: B. Tachycardia
Rationale: Tachycardia is one of the earliest physiologic responses in
sepsis as the body attempts to compensate for an infection, even before
blood pressure drops.
2. An adult patient with congestive heart failure (CHF) is admitted for
management. Which fluid management strategy is most effective in
controlling pulmonary edema?
A. Aggressive intravenous fluid replacement
B. Fluid restriction combined with diuretic therapy
C. Rapid infusion of isotonic fluids
D. A high-sodium diet to maintain circulation
ANS: B. Fluid restriction combined with diuretic therapy
Rationale: For CHF patients, reducing excess fluid through restriction
and using diuretics helps prevent pulmonary edema and lowers cardiac
workload.
3. A patient with chronic obstructive pulmonary disease (COPD) is
experiencing an acute exacerbation. What is the most critical nursing
intervention to improve oxygenation?
A. Encouraging deep breathing and coughing exercises
B. Administering opioid analgesics
C. Promoting prolonged bed rest
D. Withholding oxygen therapy
ANS: A. Encouraging deep breathing and coughing exercises
Rationale: Deep breathing exercises (including techniques such as
2
,pursed-lip breathing) and coughing help clear secretions and enhance
ventilation, which are crucial for maintaining oxygenation during acute
COPD exacerbations.
4. In managing an adult patient with diabetes mellitus who is
hyperglycemic, which nursing action is paramount to prevent diabetic
ketoacidosis?
A. Immediate administration of insulin according to a sliding scale
B. Continuous blood glucose monitoring
C. Providing carbohydrate-heavy meals
D. Elevating the head of the bed
ANS: A. Immediate administration of insulin according to a sliding
scale
Rationale: Prompt insulin administration helps reduce blood glucose
levels and prevents the progression to diabetic ketoacidosis, which is life-
threatening if not managed quickly.
5. A patient presenting with an acute myocardial infarction (AMI)
requires immediate nursing intervention. Which action is prioritized to
optimize myocardial oxygen supply?
A. Administering sublingual nitroglycerin as prescribed
B. Delaying pain management until diagnostics are complete
C. Encouraging increased physical activity
D. Serving a high-energy, high-fat meal
ANS: A. Administering sublingual nitroglycerin as prescribed
Rationale: Nitroglycerin helps dilate coronary vessels, decreases
myocardial oxygen demand, and provides rapid relief from chest pain,
making it a first-line treatment in AMI management.
6. In the acute phase of a cerebrovascular accident (stroke), which
clinical assessment is most critical to evaluate early neurological
changes?
A. Pupillary response examination
B. Urine output measurement
C. Blood pressure monitoring
3
, D. Oxygen saturation measurement
ANS: A. Pupillary response examination
Rationale: Regular assessment of pupillary response is essential for
early detection of neurological deterioration and increased intracranial
pressure in stroke patients.
7. For a post-operative adult patient, which measure is most effective in
preventing deep vein thrombosis (DVT)?
A. Early ambulation and the use of compression devices
B. Strict bed rest
C. Administering high-dose anticoagulants without evaluation
D. Encouraging fluid restriction
ANS: A. Early ambulation and the use of compression devices
Rationale: Early mobilization combined with mechanical prophylaxis
(such as elastic compression stockings) is proven to reduce the risk of
venous thromboembolism in post-operative patients.
8. During the management of an adult patient with a gastrointestinal
bleed, which nursing intervention is most critical to stabilize the patient?
A. Maintaining a constant IV infusion rate
B. Frequent assessment of hemodynamic stability and monitoring for
shock
C. Delaying fluid replacement until diagnostic results are available
D. Withholding communication with the interprofessional team
ANS: B. Frequent assessment of hemodynamic stability and
monitoring for shock
Rationale: Continuous monitoring of vital signs and signs of shock is
paramount in patients with gastrointestinal bleeding to detect
deterioration and ensure timely interventions.
9. A middle-aged patient with a history of renal insufficiency is admitted
with signs of fluid overload. Which nursing intervention should be
initiated first?
A. Rapid fluid administration
B. Initiation of fluid restriction and diuretic therapy as ordered
4
the Adult Patient with Health Problems
Final Exam Review
(Questions & Solutions)
2025
1
,1. A 65-year-old patient with community-acquired pneumonia is at risk
for sepsis. Which vital sign change is the most sensitive early indicator of
sepsis?
A. Hypotension
B. Tachycardia
C. Hypothermia
D. Bradycardia
ANS: B. Tachycardia
Rationale: Tachycardia is one of the earliest physiologic responses in
sepsis as the body attempts to compensate for an infection, even before
blood pressure drops.
2. An adult patient with congestive heart failure (CHF) is admitted for
management. Which fluid management strategy is most effective in
controlling pulmonary edema?
A. Aggressive intravenous fluid replacement
B. Fluid restriction combined with diuretic therapy
C. Rapid infusion of isotonic fluids
D. A high-sodium diet to maintain circulation
ANS: B. Fluid restriction combined with diuretic therapy
Rationale: For CHF patients, reducing excess fluid through restriction
and using diuretics helps prevent pulmonary edema and lowers cardiac
workload.
3. A patient with chronic obstructive pulmonary disease (COPD) is
experiencing an acute exacerbation. What is the most critical nursing
intervention to improve oxygenation?
A. Encouraging deep breathing and coughing exercises
B. Administering opioid analgesics
C. Promoting prolonged bed rest
D. Withholding oxygen therapy
ANS: A. Encouraging deep breathing and coughing exercises
Rationale: Deep breathing exercises (including techniques such as
2
,pursed-lip breathing) and coughing help clear secretions and enhance
ventilation, which are crucial for maintaining oxygenation during acute
COPD exacerbations.
4. In managing an adult patient with diabetes mellitus who is
hyperglycemic, which nursing action is paramount to prevent diabetic
ketoacidosis?
A. Immediate administration of insulin according to a sliding scale
B. Continuous blood glucose monitoring
C. Providing carbohydrate-heavy meals
D. Elevating the head of the bed
ANS: A. Immediate administration of insulin according to a sliding
scale
Rationale: Prompt insulin administration helps reduce blood glucose
levels and prevents the progression to diabetic ketoacidosis, which is life-
threatening if not managed quickly.
5. A patient presenting with an acute myocardial infarction (AMI)
requires immediate nursing intervention. Which action is prioritized to
optimize myocardial oxygen supply?
A. Administering sublingual nitroglycerin as prescribed
B. Delaying pain management until diagnostics are complete
C. Encouraging increased physical activity
D. Serving a high-energy, high-fat meal
ANS: A. Administering sublingual nitroglycerin as prescribed
Rationale: Nitroglycerin helps dilate coronary vessels, decreases
myocardial oxygen demand, and provides rapid relief from chest pain,
making it a first-line treatment in AMI management.
6. In the acute phase of a cerebrovascular accident (stroke), which
clinical assessment is most critical to evaluate early neurological
changes?
A. Pupillary response examination
B. Urine output measurement
C. Blood pressure monitoring
3
, D. Oxygen saturation measurement
ANS: A. Pupillary response examination
Rationale: Regular assessment of pupillary response is essential for
early detection of neurological deterioration and increased intracranial
pressure in stroke patients.
7. For a post-operative adult patient, which measure is most effective in
preventing deep vein thrombosis (DVT)?
A. Early ambulation and the use of compression devices
B. Strict bed rest
C. Administering high-dose anticoagulants without evaluation
D. Encouraging fluid restriction
ANS: A. Early ambulation and the use of compression devices
Rationale: Early mobilization combined with mechanical prophylaxis
(such as elastic compression stockings) is proven to reduce the risk of
venous thromboembolism in post-operative patients.
8. During the management of an adult patient with a gastrointestinal
bleed, which nursing intervention is most critical to stabilize the patient?
A. Maintaining a constant IV infusion rate
B. Frequent assessment of hemodynamic stability and monitoring for
shock
C. Delaying fluid replacement until diagnostic results are available
D. Withholding communication with the interprofessional team
ANS: B. Frequent assessment of hemodynamic stability and
monitoring for shock
Rationale: Continuous monitoring of vital signs and signs of shock is
paramount in patients with gastrointestinal bleeding to detect
deterioration and ensure timely interventions.
9. A middle-aged patient with a history of renal insufficiency is admitted
with signs of fluid overload. Which nursing intervention should be
initiated first?
A. Rapid fluid administration
B. Initiation of fluid restriction and diuretic therapy as ordered
4
