1
NSG 3280 EXAM 4 REVIEW 2026/2027 | Official Practice Exam | 50
Questions 90 Minutes | 80% Pass | Graded A | Pass Guaranteed -
A+ Graded
TABLE OF CONTENTS
Section 1 | Clinical Judgment & Priority Setting | Q1 – Q10
Section 2 | Pharmacology & Medication Administration | Q11 – Q20
Section 3 | Pathophysiology & Disease Management | Q21 – Q30
Section 4 | Nursing Interventions & Patient Safety | Q31 – Q40
Section 5 | Professional Standards & Ethics | Q41 – Q50
Instructions: Choose the single best answer. Pass: 40 in 90 minutes.
══════════════════════════════════════
SECTION 1: CLINICAL JUDGMENT & PRIORITY SETTING Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 72-year-old patient with COPD is admitted for pneumonia. The nurse
assesses respiratory rate 28, SpO2 86% on 2L NC, use of accessory muscles,
and inability to speak in full sentences. Which priority action should the nurse
take first?
A. Encourage the patient to use pursed-lip breathing
B. Increase oxygen to 4L and notify the provider immediately
C. Administer the scheduled bronchodilator
D. Place the patient in high-Fowler's position
,2
Correct Answer: B
Rationale: This patient shows signs of respiratory failure with hypoxemia and
increased work of breathing. Increasing oxygen and immediate provider
notification addresses the life-threatening priority first. Pursed-lip breathing
and positioning are helpful adjuncts but do not address the acute hypoxemia.
Bronchodilators may help but require a provider order and take time to work.
Question 2 of 50
A 58-year-old patient post-MI day 2 calls the nurse complaining of sudden
severe chest pain rated 10/10, diaphoresis, and nausea. Vital signs show HR
110, BP 88/50, SpO2 89%. The nurse suspects cardiac tamponade. Which
assessment finding would most confirm this suspicion?
A. Crackles in bilateral lung bases
B. Distended neck veins with muffled heart sounds
C. 2+ pitting edema in lower extremities
D. S3 gallop on cardiac auscultation
Correct Answer: B
Rationale: Beck's triad—distended neck veins, muffled heart sounds, and
hypotension—is the classic presentation of cardiac tamponade from
pericardial effusion post-MI. Crackles and edema suggest fluid overload, not
tamponade. An S3 gallop indicates heart failure but does not specifically point
to pericardial compression.
Question 3 of 50
,3
A 45-year-old patient with diabetic ketoacidosis has the following arterial
blood gas: pH 7.25, PaCO2 28, HCO3 14. The nurse is reviewing the morning
labs. Which value would the nurse expect to see as a compensatory response?
A. Decreased potassium level
B. Increased anion gap
C. Decreased PaCO2
D. Increased chloride level
Correct Answer: C
Rationale: In metabolic acidosis, the respiratory system compensates by
hyperventilating to blow off CO2, resulting in decreased PaCO2. The given ABG
already shows this compensation with PaCO2 28. An increased anion gap is the
cause of DKA acidosis, not a compensatory response. Potassium levels are
typically elevated in DKA despite total body depletion.
Question 4 of 50
The nurse is caring for four patients on a medical-surgical unit. Which patient
requires the most immediate assessment?
A. A 35-year-old post-appendectomy day 1 with pain rated 3/10
B. A 62-year-old with heart failure who gained 2 pounds overnight
C. A 48-year-old with new-onset confusion and a sodium of 118 mEq/L
D. A 55-year-old with stable Crohn's disease awaiting discharge
Correct Answer: C
Rationale: New-onset confusion with severe hyponatremia (118 mEq/L)
indicates potential cerebral edema and seizure risk, requiring immediate
, 4
neurologic assessment and intervention. A 2-pound weight gain in heart failure
needs attention but is not emergent. Stable post-op pain and discharge-ready
patients are lower priorities.
Question 5 of 50
A 67-year-old patient with a history of atrial fibrillation is on warfarin and
presents with a nosebleed that has been oozing for 30 minutes. INR is 6.8.
Which intervention is the priority?
A. Apply bilateral pressure to the nasal alae and hold for 10 minutes
B. Administer vitamin K 10 mg subcutaneously immediately
C. Hold the next warfarin dose and apply ice to the posterior neck
D. Prepare for immediate transfusion of fresh frozen plasma
Correct Answer: A
Rationale: Direct pressure to the nasal alae is the first-line intervention for
anterior epistaxis, and most bleeds can be controlled with sustained pressure.
Vitamin K takes hours to work and is not first-line for active bleeding. Ice to the
neck does not address the bleeding site. FFP is reserved for life-threatening
bleeding not controlled by local measures.
Question 6 of 50
A 38-year-old patient with acute pancreatitis is receiving lactated Ringer's at
125 mL/hr. The nurse notes the patient has become increasingly restless, with
HR 118, BP 94/62, and urine output 15 mL/hr for the past 2 hours. Which
complication is most likely developing?
A. Acute kidney injury from contrast dye
NSG 3280 EXAM 4 REVIEW 2026/2027 | Official Practice Exam | 50
Questions 90 Minutes | 80% Pass | Graded A | Pass Guaranteed -
A+ Graded
TABLE OF CONTENTS
Section 1 | Clinical Judgment & Priority Setting | Q1 – Q10
Section 2 | Pharmacology & Medication Administration | Q11 – Q20
Section 3 | Pathophysiology & Disease Management | Q21 – Q30
Section 4 | Nursing Interventions & Patient Safety | Q31 – Q40
Section 5 | Professional Standards & Ethics | Q41 – Q50
Instructions: Choose the single best answer. Pass: 40 in 90 minutes.
══════════════════════════════════════
SECTION 1: CLINICAL JUDGMENT & PRIORITY SETTING Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 72-year-old patient with COPD is admitted for pneumonia. The nurse
assesses respiratory rate 28, SpO2 86% on 2L NC, use of accessory muscles,
and inability to speak in full sentences. Which priority action should the nurse
take first?
A. Encourage the patient to use pursed-lip breathing
B. Increase oxygen to 4L and notify the provider immediately
C. Administer the scheduled bronchodilator
D. Place the patient in high-Fowler's position
,2
Correct Answer: B
Rationale: This patient shows signs of respiratory failure with hypoxemia and
increased work of breathing. Increasing oxygen and immediate provider
notification addresses the life-threatening priority first. Pursed-lip breathing
and positioning are helpful adjuncts but do not address the acute hypoxemia.
Bronchodilators may help but require a provider order and take time to work.
Question 2 of 50
A 58-year-old patient post-MI day 2 calls the nurse complaining of sudden
severe chest pain rated 10/10, diaphoresis, and nausea. Vital signs show HR
110, BP 88/50, SpO2 89%. The nurse suspects cardiac tamponade. Which
assessment finding would most confirm this suspicion?
A. Crackles in bilateral lung bases
B. Distended neck veins with muffled heart sounds
C. 2+ pitting edema in lower extremities
D. S3 gallop on cardiac auscultation
Correct Answer: B
Rationale: Beck's triad—distended neck veins, muffled heart sounds, and
hypotension—is the classic presentation of cardiac tamponade from
pericardial effusion post-MI. Crackles and edema suggest fluid overload, not
tamponade. An S3 gallop indicates heart failure but does not specifically point
to pericardial compression.
Question 3 of 50
,3
A 45-year-old patient with diabetic ketoacidosis has the following arterial
blood gas: pH 7.25, PaCO2 28, HCO3 14. The nurse is reviewing the morning
labs. Which value would the nurse expect to see as a compensatory response?
A. Decreased potassium level
B. Increased anion gap
C. Decreased PaCO2
D. Increased chloride level
Correct Answer: C
Rationale: In metabolic acidosis, the respiratory system compensates by
hyperventilating to blow off CO2, resulting in decreased PaCO2. The given ABG
already shows this compensation with PaCO2 28. An increased anion gap is the
cause of DKA acidosis, not a compensatory response. Potassium levels are
typically elevated in DKA despite total body depletion.
Question 4 of 50
The nurse is caring for four patients on a medical-surgical unit. Which patient
requires the most immediate assessment?
A. A 35-year-old post-appendectomy day 1 with pain rated 3/10
B. A 62-year-old with heart failure who gained 2 pounds overnight
C. A 48-year-old with new-onset confusion and a sodium of 118 mEq/L
D. A 55-year-old with stable Crohn's disease awaiting discharge
Correct Answer: C
Rationale: New-onset confusion with severe hyponatremia (118 mEq/L)
indicates potential cerebral edema and seizure risk, requiring immediate
, 4
neurologic assessment and intervention. A 2-pound weight gain in heart failure
needs attention but is not emergent. Stable post-op pain and discharge-ready
patients are lower priorities.
Question 5 of 50
A 67-year-old patient with a history of atrial fibrillation is on warfarin and
presents with a nosebleed that has been oozing for 30 minutes. INR is 6.8.
Which intervention is the priority?
A. Apply bilateral pressure to the nasal alae and hold for 10 minutes
B. Administer vitamin K 10 mg subcutaneously immediately
C. Hold the next warfarin dose and apply ice to the posterior neck
D. Prepare for immediate transfusion of fresh frozen plasma
Correct Answer: A
Rationale: Direct pressure to the nasal alae is the first-line intervention for
anterior epistaxis, and most bleeds can be controlled with sustained pressure.
Vitamin K takes hours to work and is not first-line for active bleeding. Ice to the
neck does not address the bleeding site. FFP is reserved for life-threatening
bleeding not controlled by local measures.
Question 6 of 50
A 38-year-old patient with acute pancreatitis is receiving lactated Ringer's at
125 mL/hr. The nurse notes the patient has become increasingly restless, with
HR 118, BP 94/62, and urine output 15 mL/hr for the past 2 hours. Which
complication is most likely developing?
A. Acute kidney injury from contrast dye
