NUR 2790 / PN3 Final Exam () - Rasmussen Comprehensive 150-Question Examination
NUR 2790 / NUR2790: PROFESSIONAL NURSING III / PN3 FINAL
EXAM
(Latest ) Rasmussen University
Total Questions: 150 | Cognitive Distribution: 20% Recall / 50% Application / 30% Analysis | Format: Multiple
Choice (4 options, one correct)
Aligned With: Rasmussen University NUR 2790 Course Syllabus, NCLEX-RN Test Plan, QSEN Competencies
(Patient-Centered Care, Teamwork & Collaboration, Evidence-Based Practice, Quality Improvement, Safety, Informatics),
and Professional Nursing III Standards ( Edition).
Exam Instructions: Select the single best answer for each question. Each question is followed by the correct answer and a
2-4 sentence rationale grounded in the NUR 2790 curriculum and NCLEX-RN standards. Twenty (20) priority-setting
questions, fifteen (15) pharmacology questions, ten (10) laboratory-value interpretation questions, and five (5) integrated
case-study clusters are embedded throughout the examination.
Section 1: Complex Medical-Surgical Nursing
Q1: A 58-year-old male is admitted with a diagnosis of ST-elevation myocardial infarction (STEMI). He
reports crushing substernal chest pain rated 8/10 that radiates to the left arm. Vital signs: BP 152/94,
HR 110, RR 22, SpO2 94% on room air. The nurse anticipates immediate administration of which
medication sequence per the NUR 2790 ACS protocol?
A. Adenosine 6 mg IV push, then 12 mg if no response
B. Monoclonal antibody for STEMI reversal, IV normal saline 250 mL/hr
C. Morphine 4 mg IV, oxygen 2 L NC, nitroglycerin 0.4 mg SL, aspirin 325 mg PO
D. Aspirin 325 mg chewable PO, oxygen to keep SpO2 ≥ 94%, nitroglycerin SL, morphine IV, and activation of the
cardiac catheterization team *[CORRECT]*
Correct Answer: D
Rationale: The MONA-lite mnemonic (aspirin chewable 162-325 mg, supplemental oxygen only if hypoxic, nitroglycerin for
ischemic pain if BP allows, morphine for refractory pain) is initiated while activating the PCI team. Aspirin irreversibly inhibits
platelet aggregation; oxygen is targeted to SpO2 ≥ 94% (routine high-flow O2 is no longer recommended). Adenosine is for
supraventricular tachycardia, not STEMI; monoclonal antibodies are not part of ACS protocol.
Q2: A client with heart failure (HFrEF, EF 28%) is started on carvedilol, lisinopril, and furosemide.
Three days later the client reports new dyspnea on exertion, weight gain of 2.5 kg, and 2+ pitting
edema. Which laboratory value requires the most immediate provider notification?
A. Potassium 5.2 mEq/L with lisinopril use *[CORRECT]*
B. Sodium 134 mEq/L
C. BUN 28 mg/dL
D. Creatinine 1.4 mg/dL
Correct Answer: A
Rationale: Hyperkalemia >5.0 mEq/L in a client started on an ACE inhibitor (lisinopril) poses the greatest immediate risk of
life-threatening dysrhythmias and signals reduced renal perfusion or ACE-induced potassium retention. While sodium and BUN
changes warrant monitoring, hyperkalemia >5.5 mEq/L requires holding the ACE inhibitor and may require kayexalate,
insulin/dextrose, or calcium gluconate per NCLEX-RN prioritization frameworks.
NUR 2790 - Professional Nursing III Page 1 Confidential - Examination Use
,NUR 2790 / PN3 Final Exam () - Rasmussen Comprehensive 150-Question Examination
Q3: A client in sinus rhythm develops new-onset atrial fibrillation with a ventricular rate of 152. BP is
100/60. Which initial nursing action is most appropriate?
A. Administer ordered IV metoprolol 5 mg to slow the rate
B. Assess for unstable signs and notify the rapid response team if hypotensive *[CORRECT]*
C. Carotid massage to convert rhythm
D. Defibrillate at 200 joules biphasic
Correct Answer: B
Rationale: A fib with RVR and hypotension = unstable tachycardia. Per ACLS, unstable tachycardia warrants urgent
synchronized cardioversion (not defibrillation). The nurse should first assess and call for the team; carotid massage is
contraindicated in elderly with possible carotid disease; IV metoprolol may further drop BP. Per NUR 2790, assessment and
escalation of care is the safest first action.
Q4: A client is receiving IV heparin for acute coronary syndrome. The aPTT is 110 seconds (control
30). The client reports new epistaxis and gum bleeding. Which action should the nurse take first?
A. Apply direct pressure and notify the provider; anticipate protamine sulfate *[CORRECT]*
B. Increase heparin rate per protocol
C. Administer vitamin K IM
D. Apply ice to the nose only
Correct Answer: A
Rationale: A prolonged aPTT (≥2× control) plus bleeding signs = heparin toxicity. The first nursing action is to control
bleeding, stop the heparin infusion, and notify the provider for protamine sulfate (heparin reversal). Vitamin K reverses
warfarin, not heparin, and is contraindicated here.
Q5: A client with a mechanical mitral valve replacement asks why he must take warfarin for life. The
nurse's best explanation is:
A. The mechanical valve promotes clot formation on its surface; anticoagulation prevents valve thrombosis and
embolic stroke *[CORRECT]*
B. Warfarin prevents atrial fibrillation
C. The valve regenerates tissue over 5 years
D. Warfarin protects the coronary arteries
Correct Answer: A
Rationale: Mechanical valves are thrombogenic because blood contacts foreign material; lifelong anticoagulation (warfarin
INR 2.5-3.5) is mandatory to prevent systemic embolization. Bioprosthetic valves require only short-term anticoagulation. This
is a NUR 2790 discharge-education priority.
NUR 2790 - Professional Nursing III Page 2 Confidential - Examination Use
,NUR 2790 / PN3 Final Exam () - Rasmussen Comprehensive 150-Question Examination
Q6: A 68-year-old client is post-op day 2 from coronary artery bypass graft (CABG) surgery. Chest
tube output has decreased from 120 mL/hr to 5 mL/hr, but the client now has distended neck veins,
muffled heart sounds, and BP 86/50 with a pulsus paradoxus of 14 mmHg. What is the priority nursing
action?
A. Milk the chest tube to restore patency
B. Notify the provider immediately; suspect cardiac tamponade *[CORRECT]*
C. Increase IV fluids to 250 mL/hr
D. Reposition the client to high-Fowler's
Correct Answer: B
Rationale: Beck's triad (hypotension, distended neck veins, muffled heart sounds) + pulsus paradoxus >10 mmHg = cardiac
tamponade, a surgical emergency. Sudden cessation of chest tube output suggests clot obstruction or tamponade. Milking the
tube delays definitive treatment; the priority is immediate provider notification for emergent pericardiocentesis or surgical
exploration.
Q7: A client with heart failure has a BNP of 1,820 pg/mL. The nurse understands this value most
specifically indicates:
A. Right-sided heart failure only
B. Acute exacerbation of heart failure with ventricular strain *[CORRECT]*
C. Pericarditis
D. Pulmonary embolism
Correct Answer: B
Rationale: BNP >400 pg/mL strongly supports heart failure. A BNP >1,000 indicates significant ventricular strain and acute
decompensation. BNP is released by ventricular myocytes in response to wall stretch, correlating with NYHA class and
prognosis. This guides diuretic, vasodilator, and inotrope therapy in NUR 2790 HF management.
Q8: A client with acute respiratory distress syndrome (ARDS) is on the ventilator with FiO2 0.8, PEEP
12. ABG shows pH 7.30, PaCO2 48, PaO2 56, HCO3 24. What change is most appropriate?
A. Decrease PEEP to 5
B. Increase PEEP incrementally while monitoring for barotrauma and hypotension *[CORRECT]*
C. Increase FiO2 to 1.0 and discontinue PEEP
D. Initiate prone ventilation only after PaO2 <40
Correct Answer: B
Rationale: The client has refractory hypoxemia (PaO2 56 on FiO2 0.8). Per ARDSNet lung-protective strategy, increasing
PEEP improves oxygenation and recruits collapsed alveoli. Daily sedation interruption, low tidal volume (6 mL/kg ideal body
weight), and consideration of prone positioning for PaO2/FiO2 <150 are evidence-based. Increasing FiO2 to 1.0 risks oxygen
toxicity.
NUR 2790 - Professional Nursing III Page 3 Confidential - Examination Use
, NUR 2790 / PN3 Final Exam () - Rasmussen Comprehensive 150-Question Examination
Q9: A client on the ventilator develops sudden onset of increased peak airway pressure, absent
breath sounds on the right, tracheal deviation to the left, and SpO2 drop to 84%. What is the priority
action?
A. Suction the endotracheal tube
B. Disconnect the ventilator and immediately insert a large-bore needle into the right anterior second intercostal
space *[CORRECT]*
C. Increase the tidal volume
D. Obtain a stat chest x-ray
Correct Answer: B
Rationale: Classic tension pneumothorax presentation (peak pressure up, tracheal deviation away, hypoxia, hemodynamic
compromise). Per NUR 2790 critical care standards, this is a clinical diagnosis requiring immediate needle thoracostomy;
awaiting chest x-ray can be fatal. After decompression, a chest tube is placed.
Q10: A client has a chest tube for a hemothorax with continuous bubbling in the water-seal chamber
and tidaling that has stopped. Output is 320 mL/hr of bright red blood for the last 2 hours. What is the
most appropriate nursing action?
A. Clamp the chest tube to stop the bleeding
B. Continue to monitor; this is expected
C. Notify the provider immediately; suspect active bleeding requiring surgical intervention *[CORRECT]*
D. Strip the chest tube to remove clots
Correct Answer: C
Rationale: Continuous bubbling indicates an air leak; cessation of tidaling suggests lung re-expansion or tube occlusion.
However, >200 mL/hr of bright red blood for 2+ hours indicates active hemorrhage requiring thoracotomy. Clamping a chest
tube risks tension pneumothorax; stripping is no longer recommended. The nurse must escalate care.
Q11: A postoperative client develops sudden pleuritic chest pain, dyspnea, tachycardia, and a SpO2
drop. The D-dimer is 950 ng/mL (reference <500). What is the most appropriate initial action?
A. Administer oxygen via NC and prepare for IV anticoagulation per order *[CORRECT]*
B. Administer subcutaneous enoxaparin only
C. Apply warm moist packs to the chest
D. Reassure the client and ambulate
Correct Answer: A
Rationale: Signs of pulmonary embolism require oxygen support and prompt anticoagulation (IV unfractionated heparin is
preferred initially for large PE) while awaiting CT pulmonary angiography. D-dimer elevation supports the clinical suspicion.
Ambulation is contraindicated; warmth will not address embolic pathology. Per NUR 2790 PE pathway, oxygen + heparin is
the initial bundle.
NUR 2790 - Professional Nursing III Page 4 Confidential - Examination Use
NUR 2790 / NUR2790: PROFESSIONAL NURSING III / PN3 FINAL
EXAM
(Latest ) Rasmussen University
Total Questions: 150 | Cognitive Distribution: 20% Recall / 50% Application / 30% Analysis | Format: Multiple
Choice (4 options, one correct)
Aligned With: Rasmussen University NUR 2790 Course Syllabus, NCLEX-RN Test Plan, QSEN Competencies
(Patient-Centered Care, Teamwork & Collaboration, Evidence-Based Practice, Quality Improvement, Safety, Informatics),
and Professional Nursing III Standards ( Edition).
Exam Instructions: Select the single best answer for each question. Each question is followed by the correct answer and a
2-4 sentence rationale grounded in the NUR 2790 curriculum and NCLEX-RN standards. Twenty (20) priority-setting
questions, fifteen (15) pharmacology questions, ten (10) laboratory-value interpretation questions, and five (5) integrated
case-study clusters are embedded throughout the examination.
Section 1: Complex Medical-Surgical Nursing
Q1: A 58-year-old male is admitted with a diagnosis of ST-elevation myocardial infarction (STEMI). He
reports crushing substernal chest pain rated 8/10 that radiates to the left arm. Vital signs: BP 152/94,
HR 110, RR 22, SpO2 94% on room air. The nurse anticipates immediate administration of which
medication sequence per the NUR 2790 ACS protocol?
A. Adenosine 6 mg IV push, then 12 mg if no response
B. Monoclonal antibody for STEMI reversal, IV normal saline 250 mL/hr
C. Morphine 4 mg IV, oxygen 2 L NC, nitroglycerin 0.4 mg SL, aspirin 325 mg PO
D. Aspirin 325 mg chewable PO, oxygen to keep SpO2 ≥ 94%, nitroglycerin SL, morphine IV, and activation of the
cardiac catheterization team *[CORRECT]*
Correct Answer: D
Rationale: The MONA-lite mnemonic (aspirin chewable 162-325 mg, supplemental oxygen only if hypoxic, nitroglycerin for
ischemic pain if BP allows, morphine for refractory pain) is initiated while activating the PCI team. Aspirin irreversibly inhibits
platelet aggregation; oxygen is targeted to SpO2 ≥ 94% (routine high-flow O2 is no longer recommended). Adenosine is for
supraventricular tachycardia, not STEMI; monoclonal antibodies are not part of ACS protocol.
Q2: A client with heart failure (HFrEF, EF 28%) is started on carvedilol, lisinopril, and furosemide.
Three days later the client reports new dyspnea on exertion, weight gain of 2.5 kg, and 2+ pitting
edema. Which laboratory value requires the most immediate provider notification?
A. Potassium 5.2 mEq/L with lisinopril use *[CORRECT]*
B. Sodium 134 mEq/L
C. BUN 28 mg/dL
D. Creatinine 1.4 mg/dL
Correct Answer: A
Rationale: Hyperkalemia >5.0 mEq/L in a client started on an ACE inhibitor (lisinopril) poses the greatest immediate risk of
life-threatening dysrhythmias and signals reduced renal perfusion or ACE-induced potassium retention. While sodium and BUN
changes warrant monitoring, hyperkalemia >5.5 mEq/L requires holding the ACE inhibitor and may require kayexalate,
insulin/dextrose, or calcium gluconate per NCLEX-RN prioritization frameworks.
NUR 2790 - Professional Nursing III Page 1 Confidential - Examination Use
,NUR 2790 / PN3 Final Exam () - Rasmussen Comprehensive 150-Question Examination
Q3: A client in sinus rhythm develops new-onset atrial fibrillation with a ventricular rate of 152. BP is
100/60. Which initial nursing action is most appropriate?
A. Administer ordered IV metoprolol 5 mg to slow the rate
B. Assess for unstable signs and notify the rapid response team if hypotensive *[CORRECT]*
C. Carotid massage to convert rhythm
D. Defibrillate at 200 joules biphasic
Correct Answer: B
Rationale: A fib with RVR and hypotension = unstable tachycardia. Per ACLS, unstable tachycardia warrants urgent
synchronized cardioversion (not defibrillation). The nurse should first assess and call for the team; carotid massage is
contraindicated in elderly with possible carotid disease; IV metoprolol may further drop BP. Per NUR 2790, assessment and
escalation of care is the safest first action.
Q4: A client is receiving IV heparin for acute coronary syndrome. The aPTT is 110 seconds (control
30). The client reports new epistaxis and gum bleeding. Which action should the nurse take first?
A. Apply direct pressure and notify the provider; anticipate protamine sulfate *[CORRECT]*
B. Increase heparin rate per protocol
C. Administer vitamin K IM
D. Apply ice to the nose only
Correct Answer: A
Rationale: A prolonged aPTT (≥2× control) plus bleeding signs = heparin toxicity. The first nursing action is to control
bleeding, stop the heparin infusion, and notify the provider for protamine sulfate (heparin reversal). Vitamin K reverses
warfarin, not heparin, and is contraindicated here.
Q5: A client with a mechanical mitral valve replacement asks why he must take warfarin for life. The
nurse's best explanation is:
A. The mechanical valve promotes clot formation on its surface; anticoagulation prevents valve thrombosis and
embolic stroke *[CORRECT]*
B. Warfarin prevents atrial fibrillation
C. The valve regenerates tissue over 5 years
D. Warfarin protects the coronary arteries
Correct Answer: A
Rationale: Mechanical valves are thrombogenic because blood contacts foreign material; lifelong anticoagulation (warfarin
INR 2.5-3.5) is mandatory to prevent systemic embolization. Bioprosthetic valves require only short-term anticoagulation. This
is a NUR 2790 discharge-education priority.
NUR 2790 - Professional Nursing III Page 2 Confidential - Examination Use
,NUR 2790 / PN3 Final Exam () - Rasmussen Comprehensive 150-Question Examination
Q6: A 68-year-old client is post-op day 2 from coronary artery bypass graft (CABG) surgery. Chest
tube output has decreased from 120 mL/hr to 5 mL/hr, but the client now has distended neck veins,
muffled heart sounds, and BP 86/50 with a pulsus paradoxus of 14 mmHg. What is the priority nursing
action?
A. Milk the chest tube to restore patency
B. Notify the provider immediately; suspect cardiac tamponade *[CORRECT]*
C. Increase IV fluids to 250 mL/hr
D. Reposition the client to high-Fowler's
Correct Answer: B
Rationale: Beck's triad (hypotension, distended neck veins, muffled heart sounds) + pulsus paradoxus >10 mmHg = cardiac
tamponade, a surgical emergency. Sudden cessation of chest tube output suggests clot obstruction or tamponade. Milking the
tube delays definitive treatment; the priority is immediate provider notification for emergent pericardiocentesis or surgical
exploration.
Q7: A client with heart failure has a BNP of 1,820 pg/mL. The nurse understands this value most
specifically indicates:
A. Right-sided heart failure only
B. Acute exacerbation of heart failure with ventricular strain *[CORRECT]*
C. Pericarditis
D. Pulmonary embolism
Correct Answer: B
Rationale: BNP >400 pg/mL strongly supports heart failure. A BNP >1,000 indicates significant ventricular strain and acute
decompensation. BNP is released by ventricular myocytes in response to wall stretch, correlating with NYHA class and
prognosis. This guides diuretic, vasodilator, and inotrope therapy in NUR 2790 HF management.
Q8: A client with acute respiratory distress syndrome (ARDS) is on the ventilator with FiO2 0.8, PEEP
12. ABG shows pH 7.30, PaCO2 48, PaO2 56, HCO3 24. What change is most appropriate?
A. Decrease PEEP to 5
B. Increase PEEP incrementally while monitoring for barotrauma and hypotension *[CORRECT]*
C. Increase FiO2 to 1.0 and discontinue PEEP
D. Initiate prone ventilation only after PaO2 <40
Correct Answer: B
Rationale: The client has refractory hypoxemia (PaO2 56 on FiO2 0.8). Per ARDSNet lung-protective strategy, increasing
PEEP improves oxygenation and recruits collapsed alveoli. Daily sedation interruption, low tidal volume (6 mL/kg ideal body
weight), and consideration of prone positioning for PaO2/FiO2 <150 are evidence-based. Increasing FiO2 to 1.0 risks oxygen
toxicity.
NUR 2790 - Professional Nursing III Page 3 Confidential - Examination Use
, NUR 2790 / PN3 Final Exam () - Rasmussen Comprehensive 150-Question Examination
Q9: A client on the ventilator develops sudden onset of increased peak airway pressure, absent
breath sounds on the right, tracheal deviation to the left, and SpO2 drop to 84%. What is the priority
action?
A. Suction the endotracheal tube
B. Disconnect the ventilator and immediately insert a large-bore needle into the right anterior second intercostal
space *[CORRECT]*
C. Increase the tidal volume
D. Obtain a stat chest x-ray
Correct Answer: B
Rationale: Classic tension pneumothorax presentation (peak pressure up, tracheal deviation away, hypoxia, hemodynamic
compromise). Per NUR 2790 critical care standards, this is a clinical diagnosis requiring immediate needle thoracostomy;
awaiting chest x-ray can be fatal. After decompression, a chest tube is placed.
Q10: A client has a chest tube for a hemothorax with continuous bubbling in the water-seal chamber
and tidaling that has stopped. Output is 320 mL/hr of bright red blood for the last 2 hours. What is the
most appropriate nursing action?
A. Clamp the chest tube to stop the bleeding
B. Continue to monitor; this is expected
C. Notify the provider immediately; suspect active bleeding requiring surgical intervention *[CORRECT]*
D. Strip the chest tube to remove clots
Correct Answer: C
Rationale: Continuous bubbling indicates an air leak; cessation of tidaling suggests lung re-expansion or tube occlusion.
However, >200 mL/hr of bright red blood for 2+ hours indicates active hemorrhage requiring thoracotomy. Clamping a chest
tube risks tension pneumothorax; stripping is no longer recommended. The nurse must escalate care.
Q11: A postoperative client develops sudden pleuritic chest pain, dyspnea, tachycardia, and a SpO2
drop. The D-dimer is 950 ng/mL (reference <500). What is the most appropriate initial action?
A. Administer oxygen via NC and prepare for IV anticoagulation per order *[CORRECT]*
B. Administer subcutaneous enoxaparin only
C. Apply warm moist packs to the chest
D. Reassure the client and ambulate
Correct Answer: A
Rationale: Signs of pulmonary embolism require oxygen support and prompt anticoagulation (IV unfractionated heparin is
preferred initially for large PE) while awaiting CT pulmonary angiography. D-dimer elevation supports the clinical suspicion.
Ambulation is contraindicated; warmth will not address embolic pathology. Per NUR 2790 PE pathway, oxygen + heparin is
the initial bundle.
NUR 2790 - Professional Nursing III Page 4 Confidential - Examination Use
