NUR 445 EXAM 1
WITH ANSWERS AND RATIONALES
GUARENTEED PASS
1. A patient with chronic COPD becomes increasingly confused and has an SpO₂ of
85% on 2 L/min via nasal cannula. Nurse’s first action:
A. Increase oxygen to 6 L/min.
B. Encourage pursed-lip breathing and position upright.
C. Administer a sedative for anxiety.
D. Obtain a sputum culture.
Answer: B
Rationale: Positioning upright and pursed-lip breathing improve ventilation and
oxygenation immediately. High-flow O₂ can blunt hypoxic drive in some COPD
patients — titrate carefully after assessment.
2. A postoperative patient’s dressing is saturated and BP falls from 120/78 to 86/52.
Priority nursing action:
A. Call the surgeon.
B. Reinforce dressing and apply direct pressure.
C. Increase IV maintenance fluids.
D. Elevate legs and monitor.
Answer: B
Rationale: Control external hemorrhage immediately by applying
pressure/reinforcing dressing; then notify surgeon and initiate fluid resuscitation
as needed.
3. A patient on heparin develops sudden platelet drop from 250k to 80k. Nurse
suspects:
A. Heparin-induced thrombocytopenia (HIT).
B. Lab error only.
C. Heparin overdose.
D. Immune thrombocytopenic purpura.
Answer: A
Rationale: A significant platelet drop after heparin suggests HIT; stop heparin,
notify provider, and prepare for alternative anticoagulation per protocol.
4. Which ECG change is most characteristic of hyperkalemia?
A. Peaked T waves.
B. U waves.
C. Short PR interval.
D. ST elevation.
,NUR 445 EXAM 1
WITH ANSWERS AND RATIONALES
GUARENTEED PASS
Answer: A
Rationale: Tall, peaked T waves are an early ECG sign of elevated potassium and
may progress to widened QRS and ventricular arrhythmias.
5. A patient with congestive heart failure has new crackles, orthopnea, and 3+
peripheral edema. Best immediate medication class:
A. Beta-blocker.
B. Loop diuretic.
C. ACE inhibitor.
D. Statin.
Answer: B
Rationale: Loop diuretics reduce pulmonary and peripheral fluid overload
quickly, relieving congestion and dyspnea.
6. A diabetic on insulin has diaphoresis, tremors, and confusion. Best immediate
action:
A. Administer 10–20 g fast-acting carbohydrate orally.
B. Give insulin per sliding scale.
C. Check A1c.
D. Give long-acting carbohydrate only.
Answer: A
Rationale: These reflect hypoglycemia—administer a fast-acting carb (juice,
glucose gel). If patient cannot swallow, give IV dextrose or IM glucagon.
7. After thyroidectomy the patient reports perioral tingling and positive Chvostek
sign. Nurse priority:
A. Call provider and assess calcium level.
B. Encourage deep breathing.
C. Give acetaminophen.
D. Start levothyroxine.
Answer: A
Rationale: Signs suggest hypocalcemia (parathyroid compromise). Assess,
notify provider, and prepare calcium replacement if ordered.
8. A patient with DKA: ABC priorities show tachypnea, dehydration, and blood
glucose 480 mg/dL. First intervention:
A. IV isotonic fluid bolus.
B. Immediate IV insulin infusion.
C. Give oral glucose.
,NUR 445 EXAM 1
WITH ANSWERS AND RATIONALES
GUARENTEED PASS
D. Administer sodium bicarbonate.
Answer: A
Rationale: Correct dehydration first with isotonic fluids to restore perfusion;
insulin started after initial fluids and after potassium assessment due to risk of
hypokalemia.
9. In a patient with suspected stroke, what is the first diagnostic test to differentiate
ischemic from hemorrhagic stroke?
A. CT head without contrast.
B. MRI brain.
C. Carotid doppler.
D. Lumbar puncture.
Answer: A
Rationale: Noncontrast CT quickly identifies hemorrhage and guides acute
management decisions (e.g., thrombolytics).
10. A patient on warfarin has INR of 6.2 and is asymptomatic. Best nursing action:
A. Hold warfarin and notify provider for vitamin K orders.
B. Give fresh frozen plasma immediately.
C. Administer protamine.
D. Increase warfarin dose.
Answer: A
Rationale: Elevated INR requires holding warfarin and consulting provider;
vitamin K may be given depending on bleeding risk. FFP is for major bleeding or
urgent reversal.
11. A patient with pneumonia and sepsis shows low BP 82/48 and cool extremities.
According to sepsis bundle, nurse should first:
A. Start rapid IV crystalloid bolus (30 mL/kg).
B. Obtain wound cultures.
C. Administer PRN antipyretic.
D. Begin enteral nutrition.
Answer: A
Rationale: Early aggressive fluid resuscitation is key to restore perfusion in
sepsis/septic shock before or while antibiotics are started.
12. A patient with chest tube has continuous bubbling in the water seal chamber.
Nurse action:
A. Check for an air leak in tubing and connections.
, NUR 445 EXAM 1
WITH ANSWERS AND RATIONALES
GUARENTEED PASS
B. Decrease suction.
C. Strip the chest tube.
D. Clamp the tube.
Answer: A
Rationale: Continuous bubbling in water-seal suggests an air leak—assess
tubing, connections, and dressing for leak source. Clamping/trimming can be
dangerous without orders.
13. A patient scheduled for surgery receives preoperative beta-blocker. On arrival,
pulse is 48 bpm and systolic BP 90. Nurse should:
A. Hold beta-blocker and notify provider.
B. Give atropine.
C. Proceed to OR.
D. Administer IV fluids only.
Answer: A
Rationale: Bradycardia and hypotension require holding the med and notifying
provider; proceeding could risk intraoperative instability.
14. A patient in hypovolemic shock has narrow pulse pressure, tachycardia, and
cool, clammy skin. Priority interventions include:
A. Rapid IV fluid resuscitation and blood products as needed.
B. High-dose vasopressors only.
C. Immediate diuretics.
D. NPO and oxygen only.
Answer: A
Rationale: Restore circulating volume quickly with crystalloids and blood as
indicated; vasopressors may be used after volume resuscitation if needed.
15. A client with acute pancreatitis is NPO and reports severe pain unrelieved by
opioids. What is the rationale for NPO status?
A. To prevent stimulation of pancreatic enzyme secretion.
B. To increase bile production.
C. To avoid aspiration only.
D. To decrease GI bleeding risk.
Answer: A
Rationale: NPO reduces pancreatic stimulation and enzyme secretion, allowing
pancreatic rest and reducing inflammation and pain.
WITH ANSWERS AND RATIONALES
GUARENTEED PASS
1. A patient with chronic COPD becomes increasingly confused and has an SpO₂ of
85% on 2 L/min via nasal cannula. Nurse’s first action:
A. Increase oxygen to 6 L/min.
B. Encourage pursed-lip breathing and position upright.
C. Administer a sedative for anxiety.
D. Obtain a sputum culture.
Answer: B
Rationale: Positioning upright and pursed-lip breathing improve ventilation and
oxygenation immediately. High-flow O₂ can blunt hypoxic drive in some COPD
patients — titrate carefully after assessment.
2. A postoperative patient’s dressing is saturated and BP falls from 120/78 to 86/52.
Priority nursing action:
A. Call the surgeon.
B. Reinforce dressing and apply direct pressure.
C. Increase IV maintenance fluids.
D. Elevate legs and monitor.
Answer: B
Rationale: Control external hemorrhage immediately by applying
pressure/reinforcing dressing; then notify surgeon and initiate fluid resuscitation
as needed.
3. A patient on heparin develops sudden platelet drop from 250k to 80k. Nurse
suspects:
A. Heparin-induced thrombocytopenia (HIT).
B. Lab error only.
C. Heparin overdose.
D. Immune thrombocytopenic purpura.
Answer: A
Rationale: A significant platelet drop after heparin suggests HIT; stop heparin,
notify provider, and prepare for alternative anticoagulation per protocol.
4. Which ECG change is most characteristic of hyperkalemia?
A. Peaked T waves.
B. U waves.
C. Short PR interval.
D. ST elevation.
,NUR 445 EXAM 1
WITH ANSWERS AND RATIONALES
GUARENTEED PASS
Answer: A
Rationale: Tall, peaked T waves are an early ECG sign of elevated potassium and
may progress to widened QRS and ventricular arrhythmias.
5. A patient with congestive heart failure has new crackles, orthopnea, and 3+
peripheral edema. Best immediate medication class:
A. Beta-blocker.
B. Loop diuretic.
C. ACE inhibitor.
D. Statin.
Answer: B
Rationale: Loop diuretics reduce pulmonary and peripheral fluid overload
quickly, relieving congestion and dyspnea.
6. A diabetic on insulin has diaphoresis, tremors, and confusion. Best immediate
action:
A. Administer 10–20 g fast-acting carbohydrate orally.
B. Give insulin per sliding scale.
C. Check A1c.
D. Give long-acting carbohydrate only.
Answer: A
Rationale: These reflect hypoglycemia—administer a fast-acting carb (juice,
glucose gel). If patient cannot swallow, give IV dextrose or IM glucagon.
7. After thyroidectomy the patient reports perioral tingling and positive Chvostek
sign. Nurse priority:
A. Call provider and assess calcium level.
B. Encourage deep breathing.
C. Give acetaminophen.
D. Start levothyroxine.
Answer: A
Rationale: Signs suggest hypocalcemia (parathyroid compromise). Assess,
notify provider, and prepare calcium replacement if ordered.
8. A patient with DKA: ABC priorities show tachypnea, dehydration, and blood
glucose 480 mg/dL. First intervention:
A. IV isotonic fluid bolus.
B. Immediate IV insulin infusion.
C. Give oral glucose.
,NUR 445 EXAM 1
WITH ANSWERS AND RATIONALES
GUARENTEED PASS
D. Administer sodium bicarbonate.
Answer: A
Rationale: Correct dehydration first with isotonic fluids to restore perfusion;
insulin started after initial fluids and after potassium assessment due to risk of
hypokalemia.
9. In a patient with suspected stroke, what is the first diagnostic test to differentiate
ischemic from hemorrhagic stroke?
A. CT head without contrast.
B. MRI brain.
C. Carotid doppler.
D. Lumbar puncture.
Answer: A
Rationale: Noncontrast CT quickly identifies hemorrhage and guides acute
management decisions (e.g., thrombolytics).
10. A patient on warfarin has INR of 6.2 and is asymptomatic. Best nursing action:
A. Hold warfarin and notify provider for vitamin K orders.
B. Give fresh frozen plasma immediately.
C. Administer protamine.
D. Increase warfarin dose.
Answer: A
Rationale: Elevated INR requires holding warfarin and consulting provider;
vitamin K may be given depending on bleeding risk. FFP is for major bleeding or
urgent reversal.
11. A patient with pneumonia and sepsis shows low BP 82/48 and cool extremities.
According to sepsis bundle, nurse should first:
A. Start rapid IV crystalloid bolus (30 mL/kg).
B. Obtain wound cultures.
C. Administer PRN antipyretic.
D. Begin enteral nutrition.
Answer: A
Rationale: Early aggressive fluid resuscitation is key to restore perfusion in
sepsis/septic shock before or while antibiotics are started.
12. A patient with chest tube has continuous bubbling in the water seal chamber.
Nurse action:
A. Check for an air leak in tubing and connections.
, NUR 445 EXAM 1
WITH ANSWERS AND RATIONALES
GUARENTEED PASS
B. Decrease suction.
C. Strip the chest tube.
D. Clamp the tube.
Answer: A
Rationale: Continuous bubbling in water-seal suggests an air leak—assess
tubing, connections, and dressing for leak source. Clamping/trimming can be
dangerous without orders.
13. A patient scheduled for surgery receives preoperative beta-blocker. On arrival,
pulse is 48 bpm and systolic BP 90. Nurse should:
A. Hold beta-blocker and notify provider.
B. Give atropine.
C. Proceed to OR.
D. Administer IV fluids only.
Answer: A
Rationale: Bradycardia and hypotension require holding the med and notifying
provider; proceeding could risk intraoperative instability.
14. A patient in hypovolemic shock has narrow pulse pressure, tachycardia, and
cool, clammy skin. Priority interventions include:
A. Rapid IV fluid resuscitation and blood products as needed.
B. High-dose vasopressors only.
C. Immediate diuretics.
D. NPO and oxygen only.
Answer: A
Rationale: Restore circulating volume quickly with crystalloids and blood as
indicated; vasopressors may be used after volume resuscitation if needed.
15. A client with acute pancreatitis is NPO and reports severe pain unrelieved by
opioids. What is the rationale for NPO status?
A. To prevent stimulation of pancreatic enzyme secretion.
B. To increase bile production.
C. To avoid aspiration only.
D. To decrease GI bleeding risk.
Answer: A
Rationale: NPO reduces pancreatic stimulation and enzyme secretion, allowing
pancreatic rest and reducing inflammation and pain.
