HONDROS NUR 163 FINAL EXAM(Complete)2022
Introduction
This simulated final examination mirrors the structure, rigor, and cognitive level of the
Hondros College of Nursing NUR 163 course (2022 curriculum). The assessment
evaluates mastery of fundamental nursing skills, patient-safety principles, medication
administration competency, basic care interventions, vital-sign interpretation,
documentation accuracy, therapeutic communication, and foundational professional
behaviors. Use this exam to validate readiness for progression and to remediate
knowledge gaps before the proctored comprehensive final.
General Instructions
• Read each clinical scenario carefully.
• Select the ONE best action or answer from the four options provided.
• Each item is scored +1 (correct) or 0 (incorrect); there is no partial credit.
• The required passing standard is ≥ 78 % (consult your syllabus for current
policy).
Exam Items
Question 1
A post-operative client who received morphine 10 mg IV 30 min ago now has a
respiratory rate of 8/min and is difficult to arouse. Which action should the nurse take
first?
A. Administer naloxone 0.4 mg IV push
B. Apply oxygen via non-rebreather at 15 L/min
C. Stimulate the client verbally and physically
D. Increase the IV flow rate to keep vein open
Answer: A. Administer naloxone 0.4 mg IV push
Solution: Opioid-induced respiratory depression is a medical emergency; the priority is
reversal of the opioid effect. Naloxone competes at receptor sites and restores
respiratory drive. Oxygen (B) is adjunctive after reversal. Stimulation (C) is ineffective
when the client is “difficult to arouse.” Adjusting IV rate (D) does not address the cause.
pg. 1
,Question 2
When using a portable finger-stick glucometer, which action best demonstrates
adherence to infection-control principles?
A. Wipe the lancet device with alcohol after each use
B. Use the same lancet for multiple sticks on the same client
C. Change the lancet blade after every client encounter
D. Label the lancet with the client’s name for 24-h reuse
Answer: C. Change the lancet blade after every client encounter
Solution: Lancets are single-patient, single-use sharps. Reuse (B, D) risks cross-
contamination and mucocutaneous blood exposure. Alcohol wipes (A) do not sterilize
the internal blade.
Question 3
A nurse prepares to administer 40 mEq potassium chloride IV to a client with
hypokalemia. Which intervention is essential for patient safety?
A. Give the dose as an IV push over 2 min
B. Ensure the solution is diluted and infused via infusion pump
C. Administer through a 22-gauge IV in the hand
D. Verify the order with the charge nurse only if the client complains of pain
Answer: B. Ensure the solution is diluted and infused via infusion pump
Solution: Undiluted KCl causes fatal arrhythmias; maximum concentration is 10
mEq/100 mL and maximum rate is 10 mEq/h (or per agency policy). IV push (A) is
contraindicated. Hand veins (C) are too small and painful. Verification (D) is required
regardless of symptoms.
Question 4
While assessing an 8-month-old infant, the nurse notes a “plop” feeling followed by
inability to move the right arm. The parent reports the child rolled off the bed. Which
action is priority?
A. Apply ice and encourage range-of-motion exercises
B. Immobilize the arm and complete a neurovascular assessment
C. Offer a bottle to distract the infant during exam
D. Reassure the parent that clavicle fractures are never serious
Answer: B. Immobilize the arm and complete a neurovascular assessment
Solution: Suspected fracture requires immobilization to prevent further neurovascular
compromise. Ice alone (A) is insufficient. Bottle (C) may obscure pain responses. False
reassurance (D) violates truth-telling and underestimates potential injury.
pg. 2
, Question 5
The nurse delegates oral care to an assistive personnel (AP) for an unconscious client.
Which instruction is most critical to prevent aspiration?
A. Use a soft toothbrush and gentle strokes
B. Place client in a side-lying position with head lowered
A. Apply petrolatum to lips after care
D. Rinse mouth with 30 mL water after brushing
Answer: B. Place client in a side-lying position with head lowered
Solution: Gravity drains secretions out of the oral cavity, reducing aspiration risk.
Toothbrush choice (A) and petrolatum (C) are comfort measures. Rinsing with water (D)
is contraindicated in unconscious clients.
Question 6
A client is prescribed sliding-scale insulin aspart q6h. The blood glucose is 220 mg/dL.
The scale reads: give 4 units for 180–220. Which action is correct?
A. Administer 4 units subcutaneously in the upper outer arm
B. Give 6 units to correct the upper-range value
C. Hold the dose and recheck in 1 h
D. Call the provider because the dose is too low
Answer: A. Administer 4 units subcutaneously in the upper outer arm
Solution: Follow the prescribed scale exactly; 4 units is indicated. Unilateral dose
increases (B) constitute prescribing. Holding (C) or calling (D) delays needed coverage.
Question 7
The nurse auscultates a loud, continuous gurgling sound in the right lower quadrant of
an adult client 2 h post-abdominal surgery. What is the best interpretation?
A. Absent peristalsis indicating paralytic ileus
B. Active bowel sounds suggesting return of function
C. High-pitched tinkling indicating obstruction
D. Bruit suggesting abdominal aortic aneurysm
Answer: B. Active bowel sounds suggesting return of function
Solution: Gurgling, especially ≥5 sounds in 15 s, equals active peristalsis—expected
post-op progression. Absent sounds (A) would yield silence. Tinkling (C) is higher
pitched. Bruits (D) are systolic vascular murmurs.
Question 8
Which documentation entry best meets legal and professional standards?
A. “Client seems depressed today.”
pg. 3
Introduction
This simulated final examination mirrors the structure, rigor, and cognitive level of the
Hondros College of Nursing NUR 163 course (2022 curriculum). The assessment
evaluates mastery of fundamental nursing skills, patient-safety principles, medication
administration competency, basic care interventions, vital-sign interpretation,
documentation accuracy, therapeutic communication, and foundational professional
behaviors. Use this exam to validate readiness for progression and to remediate
knowledge gaps before the proctored comprehensive final.
General Instructions
• Read each clinical scenario carefully.
• Select the ONE best action or answer from the four options provided.
• Each item is scored +1 (correct) or 0 (incorrect); there is no partial credit.
• The required passing standard is ≥ 78 % (consult your syllabus for current
policy).
Exam Items
Question 1
A post-operative client who received morphine 10 mg IV 30 min ago now has a
respiratory rate of 8/min and is difficult to arouse. Which action should the nurse take
first?
A. Administer naloxone 0.4 mg IV push
B. Apply oxygen via non-rebreather at 15 L/min
C. Stimulate the client verbally and physically
D. Increase the IV flow rate to keep vein open
Answer: A. Administer naloxone 0.4 mg IV push
Solution: Opioid-induced respiratory depression is a medical emergency; the priority is
reversal of the opioid effect. Naloxone competes at receptor sites and restores
respiratory drive. Oxygen (B) is adjunctive after reversal. Stimulation (C) is ineffective
when the client is “difficult to arouse.” Adjusting IV rate (D) does not address the cause.
pg. 1
,Question 2
When using a portable finger-stick glucometer, which action best demonstrates
adherence to infection-control principles?
A. Wipe the lancet device with alcohol after each use
B. Use the same lancet for multiple sticks on the same client
C. Change the lancet blade after every client encounter
D. Label the lancet with the client’s name for 24-h reuse
Answer: C. Change the lancet blade after every client encounter
Solution: Lancets are single-patient, single-use sharps. Reuse (B, D) risks cross-
contamination and mucocutaneous blood exposure. Alcohol wipes (A) do not sterilize
the internal blade.
Question 3
A nurse prepares to administer 40 mEq potassium chloride IV to a client with
hypokalemia. Which intervention is essential for patient safety?
A. Give the dose as an IV push over 2 min
B. Ensure the solution is diluted and infused via infusion pump
C. Administer through a 22-gauge IV in the hand
D. Verify the order with the charge nurse only if the client complains of pain
Answer: B. Ensure the solution is diluted and infused via infusion pump
Solution: Undiluted KCl causes fatal arrhythmias; maximum concentration is 10
mEq/100 mL and maximum rate is 10 mEq/h (or per agency policy). IV push (A) is
contraindicated. Hand veins (C) are too small and painful. Verification (D) is required
regardless of symptoms.
Question 4
While assessing an 8-month-old infant, the nurse notes a “plop” feeling followed by
inability to move the right arm. The parent reports the child rolled off the bed. Which
action is priority?
A. Apply ice and encourage range-of-motion exercises
B. Immobilize the arm and complete a neurovascular assessment
C. Offer a bottle to distract the infant during exam
D. Reassure the parent that clavicle fractures are never serious
Answer: B. Immobilize the arm and complete a neurovascular assessment
Solution: Suspected fracture requires immobilization to prevent further neurovascular
compromise. Ice alone (A) is insufficient. Bottle (C) may obscure pain responses. False
reassurance (D) violates truth-telling and underestimates potential injury.
pg. 2
, Question 5
The nurse delegates oral care to an assistive personnel (AP) for an unconscious client.
Which instruction is most critical to prevent aspiration?
A. Use a soft toothbrush and gentle strokes
B. Place client in a side-lying position with head lowered
A. Apply petrolatum to lips after care
D. Rinse mouth with 30 mL water after brushing
Answer: B. Place client in a side-lying position with head lowered
Solution: Gravity drains secretions out of the oral cavity, reducing aspiration risk.
Toothbrush choice (A) and petrolatum (C) are comfort measures. Rinsing with water (D)
is contraindicated in unconscious clients.
Question 6
A client is prescribed sliding-scale insulin aspart q6h. The blood glucose is 220 mg/dL.
The scale reads: give 4 units for 180–220. Which action is correct?
A. Administer 4 units subcutaneously in the upper outer arm
B. Give 6 units to correct the upper-range value
C. Hold the dose and recheck in 1 h
D. Call the provider because the dose is too low
Answer: A. Administer 4 units subcutaneously in the upper outer arm
Solution: Follow the prescribed scale exactly; 4 units is indicated. Unilateral dose
increases (B) constitute prescribing. Holding (C) or calling (D) delays needed coverage.
Question 7
The nurse auscultates a loud, continuous gurgling sound in the right lower quadrant of
an adult client 2 h post-abdominal surgery. What is the best interpretation?
A. Absent peristalsis indicating paralytic ileus
B. Active bowel sounds suggesting return of function
C. High-pitched tinkling indicating obstruction
D. Bruit suggesting abdominal aortic aneurysm
Answer: B. Active bowel sounds suggesting return of function
Solution: Gurgling, especially ≥5 sounds in 15 s, equals active peristalsis—expected
post-op progression. Absent sounds (A) would yield silence. Tinkling (C) is higher
pitched. Bruits (D) are systolic vascular murmurs.
Question 8
Which documentation entry best meets legal and professional standards?
A. “Client seems depressed today.”
pg. 3
