NUR 216 Exam 3 Actual 2026/2027 with Detailed Rationales |
Complete Exam-Style Questions | 100% Verified | Pass
Guaranteed - A+ Graded
Total Questions: 50 | Time: 90 min | Pass: 100%
TABLE OF CONTENTS
Section 1 | Health Assessment & Physical Examination | Q1 – Q10
Section 2 | Nursing Process & Clinical Reasoning | Q11 – Q20
Section 3 | Pharmacological Interventions | Q21 – Q30
Section 4 | Patient Safety & Infection Control | Q31 – Q40
Section 5 | Therapeutic Communication & Patient Education | Q41 – Q50
Instructions: Choose the single best answer. Pass: 100% in 90 minutes.
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SECTION 1: HEALTH ASSESSMENT & PHYSICAL EXAMINATION Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old patient admitted to the medical-surgical unit reports shortness of breath
and chest tightness. The nurse auscultates the apical pulse and counts 18 beats in 15
seconds. The nurse calculates the heart rate and notes the rhythm is irregular. When
assessing a patient with an irregular heart rhythm, the nurse should:
A. Count the apical pulse for a full 60 seconds to ensure accuracy ✓ CORRECT
B. Count the radial pulse for 30 seconds and multiply by two
C. Palpate the carotid artery bilaterally for 15 seconds
D. Subtract the radial pulse rate from the apical rate to obtain the blood pressure
Correct Answer: A
Rationale: Counting the apical pulse for 60 seconds ensures accuracy when the rhythm
is irregular because shorter counts can miss beat-to-beat variation. Counting the radial
pulse for 30 seconds and multiplying by two is a common mistake that underestimates
,or overestimates the true rate in irregular rhythms. Accurate heart rate assessment
guides clinical decisions about cardiac status and medication administration.
Question 2 of 50
A 45-year-old patient with a history of type 2 diabetes arrives in the emergency
department with slurred speech and weakness on the left side. The nurse performs a
neurological assessment using the Glasgow Coma Scale. The patient opens eyes to
pain, makes incomprehensible sounds, and withdraws from painful stimuli. The nurse
documents the total score and recognizes that:
A. A score of 8 indicates the patient is fully oriented and appropriate
B. A score of 8 indicates severe neurological impairment requiring immediate
intervention ✓ CORRECT
C. A score of 12 is consistent with normal neurological function
D. A score of 15 requires immediate intubation and sedation
Correct Answer: B
Rationale: A GCS score of 8 or below indicates severe neurological impairment and
requires immediate intervention and possible airway protection. A score of 15
represents fully alert and oriented status, not a need for intubation. Early recognition of
declining GCS scores allows for timely intervention and improved outcomes in
neurological emergencies.
Question 3 of 50
A nurse is assessing the skin of a 78-year-old patient who has been bedridden for three
days. The nurse observes a localized area of non-blanchable erythema over the patient's
sacrum. The skin is intact with no open areas. The nurse correctly identifies this finding
as:
A. A stage 3 pressure injury with full-thickness skin loss
B. A stage 2 pressure injury with partial-thickness skin loss
, C. A stage 1 pressure injury with intact skin and non-blanchable redness ✓ CORRECT
D. An unstageable pressure injury covered by slough and eschar
Correct Answer: C
Rationale: Stage 1 pressure injuries present with intact skin and non-blanchable
erythema over a bony prominence, which matches the described findings. Stage 2 and 3
injuries involve partial or full-thickness skin loss, which is not present here. Early
identification allows for prompt intervention to prevent progression to deeper tissue
damage.
Question 4 of 50
A 22-year-old college athlete is seen at the student health clinic after collapsing during
practice. His oral temperature is 39.8°C, heart rate is 110 beats per minute, respiratory
rate is 24 breaths per minute, and blood pressure is 98/62 mmHg. The nurse recognizes
that these vital signs are most consistent with:
A. Hypothermia and bradycardia requiring warming measures
B. Normal vital signs for a well-conditioned athlete at rest
C. Hypertension and tachypnea indicating anxiety
D. Hyperthermia and tachycardia indicating possible heat-related illness ✓ CORRECT
Correct Answer: D
Rationale: A temperature of 39.8°C with tachycardia and hypotension in an athlete who
collapsed during practice is consistent with heat-related illness such as heat exhaustion
or heat stroke. Normal vital signs for a resting athlete would not include fever and
hypotension. Prompt cooling and fluid resuscitation are critical to prevent organ
damage.
Question 5 of 50
During an abdominal assessment of a 55-year-old patient reporting cramping and
bloating, the nurse inspects, auscultates, percusses, and palpates in the correct
Complete Exam-Style Questions | 100% Verified | Pass
Guaranteed - A+ Graded
Total Questions: 50 | Time: 90 min | Pass: 100%
TABLE OF CONTENTS
Section 1 | Health Assessment & Physical Examination | Q1 – Q10
Section 2 | Nursing Process & Clinical Reasoning | Q11 – Q20
Section 3 | Pharmacological Interventions | Q21 – Q30
Section 4 | Patient Safety & Infection Control | Q31 – Q40
Section 5 | Therapeutic Communication & Patient Education | Q41 – Q50
Instructions: Choose the single best answer. Pass: 100% in 90 minutes.
══════════════════════════════════════
SECTION 1: HEALTH ASSESSMENT & PHYSICAL EXAMINATION Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 68-year-old patient admitted to the medical-surgical unit reports shortness of breath
and chest tightness. The nurse auscultates the apical pulse and counts 18 beats in 15
seconds. The nurse calculates the heart rate and notes the rhythm is irregular. When
assessing a patient with an irregular heart rhythm, the nurse should:
A. Count the apical pulse for a full 60 seconds to ensure accuracy ✓ CORRECT
B. Count the radial pulse for 30 seconds and multiply by two
C. Palpate the carotid artery bilaterally for 15 seconds
D. Subtract the radial pulse rate from the apical rate to obtain the blood pressure
Correct Answer: A
Rationale: Counting the apical pulse for 60 seconds ensures accuracy when the rhythm
is irregular because shorter counts can miss beat-to-beat variation. Counting the radial
pulse for 30 seconds and multiplying by two is a common mistake that underestimates
,or overestimates the true rate in irregular rhythms. Accurate heart rate assessment
guides clinical decisions about cardiac status and medication administration.
Question 2 of 50
A 45-year-old patient with a history of type 2 diabetes arrives in the emergency
department with slurred speech and weakness on the left side. The nurse performs a
neurological assessment using the Glasgow Coma Scale. The patient opens eyes to
pain, makes incomprehensible sounds, and withdraws from painful stimuli. The nurse
documents the total score and recognizes that:
A. A score of 8 indicates the patient is fully oriented and appropriate
B. A score of 8 indicates severe neurological impairment requiring immediate
intervention ✓ CORRECT
C. A score of 12 is consistent with normal neurological function
D. A score of 15 requires immediate intubation and sedation
Correct Answer: B
Rationale: A GCS score of 8 or below indicates severe neurological impairment and
requires immediate intervention and possible airway protection. A score of 15
represents fully alert and oriented status, not a need for intubation. Early recognition of
declining GCS scores allows for timely intervention and improved outcomes in
neurological emergencies.
Question 3 of 50
A nurse is assessing the skin of a 78-year-old patient who has been bedridden for three
days. The nurse observes a localized area of non-blanchable erythema over the patient's
sacrum. The skin is intact with no open areas. The nurse correctly identifies this finding
as:
A. A stage 3 pressure injury with full-thickness skin loss
B. A stage 2 pressure injury with partial-thickness skin loss
, C. A stage 1 pressure injury with intact skin and non-blanchable redness ✓ CORRECT
D. An unstageable pressure injury covered by slough and eschar
Correct Answer: C
Rationale: Stage 1 pressure injuries present with intact skin and non-blanchable
erythema over a bony prominence, which matches the described findings. Stage 2 and 3
injuries involve partial or full-thickness skin loss, which is not present here. Early
identification allows for prompt intervention to prevent progression to deeper tissue
damage.
Question 4 of 50
A 22-year-old college athlete is seen at the student health clinic after collapsing during
practice. His oral temperature is 39.8°C, heart rate is 110 beats per minute, respiratory
rate is 24 breaths per minute, and blood pressure is 98/62 mmHg. The nurse recognizes
that these vital signs are most consistent with:
A. Hypothermia and bradycardia requiring warming measures
B. Normal vital signs for a well-conditioned athlete at rest
C. Hypertension and tachypnea indicating anxiety
D. Hyperthermia and tachycardia indicating possible heat-related illness ✓ CORRECT
Correct Answer: D
Rationale: A temperature of 39.8°C with tachycardia and hypotension in an athlete who
collapsed during practice is consistent with heat-related illness such as heat exhaustion
or heat stroke. Normal vital signs for a resting athlete would not include fever and
hypotension. Prompt cooling and fluid resuscitation are critical to prevent organ
damage.
Question 5 of 50
During an abdominal assessment of a 55-year-old patient reporting cramping and
bloating, the nurse inspects, auscultates, percusses, and palpates in the correct
