NUR 283 Comp 2 and 3 | Full Questions and
Answers with Rationales | 2026/2027
Updated | 100% Correct - Galen College of
Nursing.
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
144 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This comprehensive examination assesses application-level clinical judgment across the NUR 283
curriculum, covering cardiovascular, respiratory, renal, endocrine, neurologic, gastrointestinal, hematologic,
oncologic, and emergency/critical care nursing. Items emphasize prioritization, delegation, medication safety,
lab interpretation, and evidence-based interventions aligned with current NCLEX-RN test plan and AACN
Essentials.
STUDY GUIDE
Recommended duration: 3 hours. Passing target: 75% (minimum 38/50 correct).
HIGHP - Page 1 of 46
,1. A patient with acute decompensated heart failure is receiving furosemide IV. Which
laboratory finding is the priority concern?
[ ] A. Serum potassium 2.9 mEq/L
[ ] B. Serum sodium 134 mEq/L
[ ] C. Serum magnesium 1.8 mg/dL
[ ] D. Serum creatinine 1.1 mg/dL
CORRECT: A. Serum potassium 2.9 mEq/L
Loop diuretics like furosemide cause significant potassium wasting, and hypokalemia (<3.5 mEq/L)
predisposes to lethal dysrhythmias, especially in heart failure patients. Sodium 134 and magnesium 1.8 are
within normal limits, and creatinine 1.1 is normal. Potassium 2.9 requires immediate replacement and cardiac
monitoring.
2. Which assessment finding best indicates effective use of an incentive spirometer in a
postoperative patient?
[ ] A. Sustained inspiratory effort raising the flow indicator to the target volume
[ ] B. Ability to perform 10 rapid exhalations into the device
[ ] C. Completion of the maneuver within 2 seconds
[ ] D. Use of the device only when experiencing dyspnea
CORRECT: A. Sustained inspiratory effort raising the flow indicator to the target volume
Incentive spirometry promotes deep lung expansion; the goal is sustained maximal inspiration (incentive) that
raises the flow indicator to the preset target. Rapid exhalations, speed, or use only for dyspnea do not
achieve alveolar recruitment. Correct technique prevents atelectasis and pneumonia.
3. A patient with diabetic ketoacidosis has a blood glucose of 480 mg/dL and pH 7.22.
Which provider prescription should the nurse question?
[ ] A. Regular insulin IV infusion at 0.1 units/kg/hr
[ ] B. 0.9% sodium chloride IV bolus
[ ] C. Potassium chloride 20 mEq IV push
[ ] D. Hourly blood glucose monitoring
CORRECT: C. Potassium chloride 20 mEq IV push
Potassium chloride must never be administered IV push; it can cause fatal cardiac arrest. It should be infused
at a controlled rate (usually 10 mEq/hr) via pump. Insulin infusion, isotonic fluid resuscitation, and hourly
glucose checks are standard DKA management.
4. Which finding in a patient with a new tracheostomy requires immediate nursing
intervention?
[ ] A. Copious thin secretions requiring frequent suctioning
HIGHP - Page 2 of 46
, [ ] B. Faint whistling sound heard over the tracheostomy site
[ ] C. Presence of a small amount of serosanguineous drainage on the dressing
[ ] D. Patient mouthing words without audible voice
CORRECT: B. Faint whistling sound heard over the tracheostomy site
A whistling sound indicates partial airway obstruction or cuff leak, which can rapidly progress to complete
obstruction. Copious secretions, minimal serosanguineous drainage, and inability to vocalize with a cuff
inflated are expected findings. Immediate assessment and possible cuff inflation or suctioning are required.
5. Which intervention is most appropriate for preventing catheter-associated urinary tract
infection (CAUTI)?
[ ] A. Irrigating the catheter daily with sterile saline
[ ] B. Maintaining the drainage bag below the level of the bladder
[ ] C. Changing the catheter every 72 hours
[ ] D. Administering prophylactic antibiotics while the catheter is in place
CORRECT: B. Maintaining the drainage bag below the level of the bladder
Keeping the drainage bag below bladder level prevents backflow of urine and bacterial ascent, a key CAUTI
prevention strategy. Routine irrigation, scheduled catheter changes, and prophylactic antibiotics are not
recommended and may increase infection risk. Early removal remains the best prevention.
6. A patient is prescribed warfarin and has an INR of 6.2 without active bleeding. Which
action should the nurse anticipate?
[ ] A. Administer vitamin K (phytonadione) as prescribed
[ ] B. Give the next scheduled warfarin dose
[ ] C. Administer protamine sulfate IV
[ ] D. Encourage a diet high in vitamin K
CORRECT: A. Administer vitamin K (phytonadione) as prescribed
An INR of 6.2 is supratherapeutic and increases bleeding risk; vitamin K is the antidote for warfarin.
Protamine sulfate reverses heparin, not warfarin. Holding warfarin (not giving the next dose) and avoiding
sudden vitamin K dietary changes are appropriate, but the priority is reversal.
7. Which assessment finding in a patient receiving a blood transfusion requires stopping
the transfusion immediately?
[ ] A. Temperature elevation of 1.0°F above baseline
[ ] B. Urticaria and complaints of itching
[ ] C. Low back pain and dark urine
[ ] D. Mild fatigue and pale skin
HIGHP - Page 3 of 46
, CORRECT: C. Low back pain and dark urine
Low back pain and dark urine (hemoglobinuria) indicate an acute hemolytic transfusion reaction, which is
life-threatening and requires immediate cessation. Urticaria suggests a mild allergic reaction; a 1°F
temperature rise may be a febrile nonhemolytic reaction. Hemolytic reactions demand stopping the
transfusion, maintaining IV access, and notifying the provider.
8. A patient with chronic kidney disease has a serum potassium of 6.8 mEq/L. Which
prescribed medication should the nurse administer first?
[ ] A. Sodium polystyrene sulfonate orally
[ ] B. Regular insulin IV with dextrose
[ ] C. Calcium carbonate orally
[ ] D. Furosemide orally
CORRECT: B. Regular insulin IV with dextrose
IV insulin with dextrose rapidly shifts potassium intracellularly, making it the immediate treatment for severe
hyperkalemia. Sodium polystyrene sulfonate and furosemide remove potassium but act too slowly for a
critical level. Calcium carbonate does not lower potassium; IV calcium gluconate would be used for cardiac
protection.
9. Which nursing action best demonstrates proper delegation to unlicensed assistive
personnel (UAP)?
[ ] A. Asking the UAP to assess a patient's new-onset confusion
[ ] B. Requesting the UAP to reinforce teaching about a new medication
[ ] C. Directing the UAP to obtain and record a patient's vital signs
[ ] D. Instructing the UAP to administer a PRN oral analgesic
CORRECT: C. Directing the UAP to obtain and record a patient's vital signs
Vital sign measurement and recording are within UAP scope when the patient is stable. Assessment,
teaching, and medication administration require the licensed nurse's clinical judgment and cannot be
delegated to UAP. Delegation must follow the five rights and state nurse practice acts.
10. A client receiving vancomycin IV develops flushing of the face, neck, and upper torso
with pruritus during the infusion. Which action should the nurse take first?
[ ] A. Stop the infusion and prepare to administer epinephrine IM
[ ] B. Slow the infusion rate and administer diphenhydramine as prescribed
[ ] C. Continue the infusion and document the reaction as expected
[ ] D. Obtain an immediate serum vancomycin trough level
CORRECT: B. Slow the infusion rate and administer diphenhydramine as prescribed
HIGHP - Page 4 of 46
Answers with Rationales | 2026/2027
Updated | 100% Correct - Galen College of
Nursing.
Practice Question Bank & Answer Rationale
THIS PACK CONTAINS
144 exam-style multiple-choice questions. Each question includes the correct answer and a complete
rationale for focused revision.
COVERAGE
This comprehensive examination assesses application-level clinical judgment across the NUR 283
curriculum, covering cardiovascular, respiratory, renal, endocrine, neurologic, gastrointestinal, hematologic,
oncologic, and emergency/critical care nursing. Items emphasize prioritization, delegation, medication safety,
lab interpretation, and evidence-based interventions aligned with current NCLEX-RN test plan and AACN
Essentials.
STUDY GUIDE
Recommended duration: 3 hours. Passing target: 75% (minimum 38/50 correct).
HIGHP - Page 1 of 46
,1. A patient with acute decompensated heart failure is receiving furosemide IV. Which
laboratory finding is the priority concern?
[ ] A. Serum potassium 2.9 mEq/L
[ ] B. Serum sodium 134 mEq/L
[ ] C. Serum magnesium 1.8 mg/dL
[ ] D. Serum creatinine 1.1 mg/dL
CORRECT: A. Serum potassium 2.9 mEq/L
Loop diuretics like furosemide cause significant potassium wasting, and hypokalemia (<3.5 mEq/L)
predisposes to lethal dysrhythmias, especially in heart failure patients. Sodium 134 and magnesium 1.8 are
within normal limits, and creatinine 1.1 is normal. Potassium 2.9 requires immediate replacement and cardiac
monitoring.
2. Which assessment finding best indicates effective use of an incentive spirometer in a
postoperative patient?
[ ] A. Sustained inspiratory effort raising the flow indicator to the target volume
[ ] B. Ability to perform 10 rapid exhalations into the device
[ ] C. Completion of the maneuver within 2 seconds
[ ] D. Use of the device only when experiencing dyspnea
CORRECT: A. Sustained inspiratory effort raising the flow indicator to the target volume
Incentive spirometry promotes deep lung expansion; the goal is sustained maximal inspiration (incentive) that
raises the flow indicator to the preset target. Rapid exhalations, speed, or use only for dyspnea do not
achieve alveolar recruitment. Correct technique prevents atelectasis and pneumonia.
3. A patient with diabetic ketoacidosis has a blood glucose of 480 mg/dL and pH 7.22.
Which provider prescription should the nurse question?
[ ] A. Regular insulin IV infusion at 0.1 units/kg/hr
[ ] B. 0.9% sodium chloride IV bolus
[ ] C. Potassium chloride 20 mEq IV push
[ ] D. Hourly blood glucose monitoring
CORRECT: C. Potassium chloride 20 mEq IV push
Potassium chloride must never be administered IV push; it can cause fatal cardiac arrest. It should be infused
at a controlled rate (usually 10 mEq/hr) via pump. Insulin infusion, isotonic fluid resuscitation, and hourly
glucose checks are standard DKA management.
4. Which finding in a patient with a new tracheostomy requires immediate nursing
intervention?
[ ] A. Copious thin secretions requiring frequent suctioning
HIGHP - Page 2 of 46
, [ ] B. Faint whistling sound heard over the tracheostomy site
[ ] C. Presence of a small amount of serosanguineous drainage on the dressing
[ ] D. Patient mouthing words without audible voice
CORRECT: B. Faint whistling sound heard over the tracheostomy site
A whistling sound indicates partial airway obstruction or cuff leak, which can rapidly progress to complete
obstruction. Copious secretions, minimal serosanguineous drainage, and inability to vocalize with a cuff
inflated are expected findings. Immediate assessment and possible cuff inflation or suctioning are required.
5. Which intervention is most appropriate for preventing catheter-associated urinary tract
infection (CAUTI)?
[ ] A. Irrigating the catheter daily with sterile saline
[ ] B. Maintaining the drainage bag below the level of the bladder
[ ] C. Changing the catheter every 72 hours
[ ] D. Administering prophylactic antibiotics while the catheter is in place
CORRECT: B. Maintaining the drainage bag below the level of the bladder
Keeping the drainage bag below bladder level prevents backflow of urine and bacterial ascent, a key CAUTI
prevention strategy. Routine irrigation, scheduled catheter changes, and prophylactic antibiotics are not
recommended and may increase infection risk. Early removal remains the best prevention.
6. A patient is prescribed warfarin and has an INR of 6.2 without active bleeding. Which
action should the nurse anticipate?
[ ] A. Administer vitamin K (phytonadione) as prescribed
[ ] B. Give the next scheduled warfarin dose
[ ] C. Administer protamine sulfate IV
[ ] D. Encourage a diet high in vitamin K
CORRECT: A. Administer vitamin K (phytonadione) as prescribed
An INR of 6.2 is supratherapeutic and increases bleeding risk; vitamin K is the antidote for warfarin.
Protamine sulfate reverses heparin, not warfarin. Holding warfarin (not giving the next dose) and avoiding
sudden vitamin K dietary changes are appropriate, but the priority is reversal.
7. Which assessment finding in a patient receiving a blood transfusion requires stopping
the transfusion immediately?
[ ] A. Temperature elevation of 1.0°F above baseline
[ ] B. Urticaria and complaints of itching
[ ] C. Low back pain and dark urine
[ ] D. Mild fatigue and pale skin
HIGHP - Page 3 of 46
, CORRECT: C. Low back pain and dark urine
Low back pain and dark urine (hemoglobinuria) indicate an acute hemolytic transfusion reaction, which is
life-threatening and requires immediate cessation. Urticaria suggests a mild allergic reaction; a 1°F
temperature rise may be a febrile nonhemolytic reaction. Hemolytic reactions demand stopping the
transfusion, maintaining IV access, and notifying the provider.
8. A patient with chronic kidney disease has a serum potassium of 6.8 mEq/L. Which
prescribed medication should the nurse administer first?
[ ] A. Sodium polystyrene sulfonate orally
[ ] B. Regular insulin IV with dextrose
[ ] C. Calcium carbonate orally
[ ] D. Furosemide orally
CORRECT: B. Regular insulin IV with dextrose
IV insulin with dextrose rapidly shifts potassium intracellularly, making it the immediate treatment for severe
hyperkalemia. Sodium polystyrene sulfonate and furosemide remove potassium but act too slowly for a
critical level. Calcium carbonate does not lower potassium; IV calcium gluconate would be used for cardiac
protection.
9. Which nursing action best demonstrates proper delegation to unlicensed assistive
personnel (UAP)?
[ ] A. Asking the UAP to assess a patient's new-onset confusion
[ ] B. Requesting the UAP to reinforce teaching about a new medication
[ ] C. Directing the UAP to obtain and record a patient's vital signs
[ ] D. Instructing the UAP to administer a PRN oral analgesic
CORRECT: C. Directing the UAP to obtain and record a patient's vital signs
Vital sign measurement and recording are within UAP scope when the patient is stable. Assessment,
teaching, and medication administration require the licensed nurse's clinical judgment and cannot be
delegated to UAP. Delegation must follow the five rights and state nurse practice acts.
10. A client receiving vancomycin IV develops flushing of the face, neck, and upper torso
with pruritus during the infusion. Which action should the nurse take first?
[ ] A. Stop the infusion and prepare to administer epinephrine IM
[ ] B. Slow the infusion rate and administer diphenhydramine as prescribed
[ ] C. Continue the infusion and document the reaction as expected
[ ] D. Obtain an immediate serum vancomycin trough level
CORRECT: B. Slow the infusion rate and administer diphenhydramine as prescribed
HIGHP - Page 4 of 46
