2026 UPDATED QUESTIONS DOWNLOAD
NUR 325 Exam 2: Comprehensive 300-Question Study
Guide
This guide provides a massive bank of 300 practice questions covering high-yield
nursing concepts for Health and Illness II. It focuses on critical topics like advanced
respiratory care, cardiac dysrhythmias, neurological emergencies, and renal-hepatic
failure. Every question includes a bolded answer and an italicized rationale to help
you master the "why" behind the nursing interventions.
1. A patient with a chest tube has continuous bubbling in the water-seal chamber. What is
the nurse's priority?
A. Document it as a normal finding.
B. Check the system for an air leak.
C. Increase the suction wall pressure.
D. Strip the chest tube tubing.
Rationale: Continuous bubbling in the water-seal chamber indicates a leak in the
system; intermittent bubbling with breathing (tidaling) is normal.
2. Which assessment finding indicates a tension pneumothorax in a patient with chest
trauma?
A. Productive cough.
B. Tracheal deviation to the unaffected side.
C. Flat neck veins.
D. Increased breath sounds on the affected side.
Rationale: Tracheal deviation is a late, life-threatening sign where air pressure shifts the
mediastinum toward the healthy lung.
3. A nurse finds a patient’s chest tube has become disconnected from the drainage unit.
What is the immediate action?
A. Clamp the tube with a hemostat.
B. Submerge the end of the tube in sterile water.
C. Tape the end of the tube shut.
D. Instruct the patient to inhale deeply.
,2026 UPDATED QUESTIONS DOWNLOAD
Rationale: Submerging the tube in 1-2 inches of sterile water creates a temporary water
seal to prevent air from entering the pleural space.
4. A patient with ARDS is on a ventilator. Which finding suggests "refractory hypoxemia"?
A. PaO2 of 90 on 40% FiO2.
B. Low O2 saturation despite increasing FiO2 to 100%.
C. Elevated CO2 levels on arterial blood gas.
D. Increased respiratory rate.
Rationale: Refractory hypoxemia is the hallmark of ARDS, where oxygen levels stay low
regardless of how much oxygen is delivered.
5. A patient has "Flail Chest" after a car accident. What will the nurse observe?
A. Symmetrical chest expansion.
B. Paradoxical chest wall movement.
C. Bradypnea.
D. Clear lung sounds.
Rationale: In flail chest, the broken segment sinks in during inspiration and bulges out
during expiration.
6. The nurse sees Ventricular Fibrillation (VF) on the monitor. What is the first priority?
A. Administer Atropine IV.
B. Perform synchronized cardioversion.
C. Defibrillate the patient immediately.
D. Check the patient's potassium level.
Rationale: Defibrillation is the only effective treatment to stop the chaotic electrical
activity of VF and restore a rhythm.
7. A patient in Atrial Fibrillation (AFib) is prescribed Warfarin. What is the primary goal?
A. Convert the heart to a normal sinus rhythm.
B. Prevent the formation of blood clots/emboli.
C. Increase the heart rate.
D. Decrease blood pressure.
Rationale: AFib causes blood to pool in the atria, significantly increasing the risk of clots
that can lead to a stroke.
8. Which drug is the first-line treatment for a patient with symptomatic bradycardia (HR
38)?
A. Digoxin.
B. Amiodarone.
C. Atropine.
D. Adenosine.
,2026 UPDATED QUESTIONS DOWNLOAD
Rationale: Atropine blocks vagal stimulation, effectively increasing the heart rate in
symptomatic bradycardia.
9. What is the priority assessment for a patient 1 hour after a Cardiac Catheterization?
A. Presence of a gag reflex.
B. Distal pulses and insertion site for bleeding.
C. Range of motion in the affected limb.
D. Ability to walk to the bathroom.
Rationale: Hemorrhage and arterial occlusion are the most common acute complications
following catheter insertion.
10. A patient has a BNP level of 900 pg/mL. What does the nurse expect to find?
A. Dehydration.
B. Normal heart function.
C. Heart Failure exacerbation.
D. Myocardial Infarction.
Rationale: BNP is released when the ventricles are overstretched; levels above 100
indicate heart failure.
11. The nurse notes "sawtooth" P-waves on the EKG. This rhythm is identified as:
A. Atrial Fibrillation.
B. Atrial Flutter.
C. Ventricular Tachycardia.
D. First-degree AV block.
Rationale: The "sawtooth" pattern is the classic characteristic of Atrial Flutter.
12. Which lab value is most specific for diagnosing an acute Myocardial Infarction (MI)?
A. CK-MB.
B. Myoglobin.
C. Troponin I.
D. WBC count.
Rationale: Troponin is highly specific to cardiac muscle damage and stays elevated
longer than other markers.
13. A patient with a permanent pacemaker should be taught to:
A. Avoid using microwave ovens.
B. Check their pulse daily at the same time.
C. Avoid all physical activity for 6 months.
D. Never have an X-ray.
Rationale: Checking the pulse ensures the pacemaker is maintaining the set "floor" heart
rate.
, 2026 UPDATED QUESTIONS DOWNLOAD
14. What is the therapeutic INR range for a patient on Warfarin for AFib?
A. 0.5 – 1.0.
B. 2.0 – 3.0.
C. 4.0 – 5.0.
D. 10 – 15.
Rationale: An INR of 2.0–3.0 is the standard therapeutic target to prevent clots without
causing excessive bleeding.
15. A patient is receiving IV Heparin. Which lab should be monitored?
A. PT/INR.
B. Platelets.
C. aPTT.
D. Hemoglobin.
Rationale: aPTT is used to adjust heparin dosing; PT/INR is used for warfarin.
16. A patient with a T4 spinal cord injury has a BP of 190/100 and a headache. First action?
A. Administer Nifedipine.
B. Perform a bladder scan.
C. Raise the Head of Bed (HOB) to 90 degrees.
D. Document the finding.
Rationale: Elevating the HOB is the first action to use gravity to lower intracranial
pressure during autonomic dysreflexia.
17. Which sign indicates "Cushing’s Triad" in a patient with increased ICP?
A. Tachycardia, hypotension, tachypnea.
B. Bradycardia, hypertension with widening pulse pressure, irregular breathing.
C. Fever, chills, stiff neck.
D. Decreased level of consciousness and pinpoint pupils.
Rationale: Cushing's Triad is a late sign of brainstem compression and imminent
herniation.
18. A Glasgow Coma Scale (GCS) score of 7 indicates:
A. Normal neurological function.
B. Moderate brain injury.
C. Severe brain injury/Coma.
D. Brain death.
Rationale: A GCS of 8 or less is the standard definition of a coma; these patients usually
require intubation.
19. What is the priority for a patient in the "Ictal" phase of a seizure?
A. Inserting a padded tongue blade.
NUR 325 Exam 2: Comprehensive 300-Question Study
Guide
This guide provides a massive bank of 300 practice questions covering high-yield
nursing concepts for Health and Illness II. It focuses on critical topics like advanced
respiratory care, cardiac dysrhythmias, neurological emergencies, and renal-hepatic
failure. Every question includes a bolded answer and an italicized rationale to help
you master the "why" behind the nursing interventions.
1. A patient with a chest tube has continuous bubbling in the water-seal chamber. What is
the nurse's priority?
A. Document it as a normal finding.
B. Check the system for an air leak.
C. Increase the suction wall pressure.
D. Strip the chest tube tubing.
Rationale: Continuous bubbling in the water-seal chamber indicates a leak in the
system; intermittent bubbling with breathing (tidaling) is normal.
2. Which assessment finding indicates a tension pneumothorax in a patient with chest
trauma?
A. Productive cough.
B. Tracheal deviation to the unaffected side.
C. Flat neck veins.
D. Increased breath sounds on the affected side.
Rationale: Tracheal deviation is a late, life-threatening sign where air pressure shifts the
mediastinum toward the healthy lung.
3. A nurse finds a patient’s chest tube has become disconnected from the drainage unit.
What is the immediate action?
A. Clamp the tube with a hemostat.
B. Submerge the end of the tube in sterile water.
C. Tape the end of the tube shut.
D. Instruct the patient to inhale deeply.
,2026 UPDATED QUESTIONS DOWNLOAD
Rationale: Submerging the tube in 1-2 inches of sterile water creates a temporary water
seal to prevent air from entering the pleural space.
4. A patient with ARDS is on a ventilator. Which finding suggests "refractory hypoxemia"?
A. PaO2 of 90 on 40% FiO2.
B. Low O2 saturation despite increasing FiO2 to 100%.
C. Elevated CO2 levels on arterial blood gas.
D. Increased respiratory rate.
Rationale: Refractory hypoxemia is the hallmark of ARDS, where oxygen levels stay low
regardless of how much oxygen is delivered.
5. A patient has "Flail Chest" after a car accident. What will the nurse observe?
A. Symmetrical chest expansion.
B. Paradoxical chest wall movement.
C. Bradypnea.
D. Clear lung sounds.
Rationale: In flail chest, the broken segment sinks in during inspiration and bulges out
during expiration.
6. The nurse sees Ventricular Fibrillation (VF) on the monitor. What is the first priority?
A. Administer Atropine IV.
B. Perform synchronized cardioversion.
C. Defibrillate the patient immediately.
D. Check the patient's potassium level.
Rationale: Defibrillation is the only effective treatment to stop the chaotic electrical
activity of VF and restore a rhythm.
7. A patient in Atrial Fibrillation (AFib) is prescribed Warfarin. What is the primary goal?
A. Convert the heart to a normal sinus rhythm.
B. Prevent the formation of blood clots/emboli.
C. Increase the heart rate.
D. Decrease blood pressure.
Rationale: AFib causes blood to pool in the atria, significantly increasing the risk of clots
that can lead to a stroke.
8. Which drug is the first-line treatment for a patient with symptomatic bradycardia (HR
38)?
A. Digoxin.
B. Amiodarone.
C. Atropine.
D. Adenosine.
,2026 UPDATED QUESTIONS DOWNLOAD
Rationale: Atropine blocks vagal stimulation, effectively increasing the heart rate in
symptomatic bradycardia.
9. What is the priority assessment for a patient 1 hour after a Cardiac Catheterization?
A. Presence of a gag reflex.
B. Distal pulses and insertion site for bleeding.
C. Range of motion in the affected limb.
D. Ability to walk to the bathroom.
Rationale: Hemorrhage and arterial occlusion are the most common acute complications
following catheter insertion.
10. A patient has a BNP level of 900 pg/mL. What does the nurse expect to find?
A. Dehydration.
B. Normal heart function.
C. Heart Failure exacerbation.
D. Myocardial Infarction.
Rationale: BNP is released when the ventricles are overstretched; levels above 100
indicate heart failure.
11. The nurse notes "sawtooth" P-waves on the EKG. This rhythm is identified as:
A. Atrial Fibrillation.
B. Atrial Flutter.
C. Ventricular Tachycardia.
D. First-degree AV block.
Rationale: The "sawtooth" pattern is the classic characteristic of Atrial Flutter.
12. Which lab value is most specific for diagnosing an acute Myocardial Infarction (MI)?
A. CK-MB.
B. Myoglobin.
C. Troponin I.
D. WBC count.
Rationale: Troponin is highly specific to cardiac muscle damage and stays elevated
longer than other markers.
13. A patient with a permanent pacemaker should be taught to:
A. Avoid using microwave ovens.
B. Check their pulse daily at the same time.
C. Avoid all physical activity for 6 months.
D. Never have an X-ray.
Rationale: Checking the pulse ensures the pacemaker is maintaining the set "floor" heart
rate.
, 2026 UPDATED QUESTIONS DOWNLOAD
14. What is the therapeutic INR range for a patient on Warfarin for AFib?
A. 0.5 – 1.0.
B. 2.0 – 3.0.
C. 4.0 – 5.0.
D. 10 – 15.
Rationale: An INR of 2.0–3.0 is the standard therapeutic target to prevent clots without
causing excessive bleeding.
15. A patient is receiving IV Heparin. Which lab should be monitored?
A. PT/INR.
B. Platelets.
C. aPTT.
D. Hemoglobin.
Rationale: aPTT is used to adjust heparin dosing; PT/INR is used for warfarin.
16. A patient with a T4 spinal cord injury has a BP of 190/100 and a headache. First action?
A. Administer Nifedipine.
B. Perform a bladder scan.
C. Raise the Head of Bed (HOB) to 90 degrees.
D. Document the finding.
Rationale: Elevating the HOB is the first action to use gravity to lower intracranial
pressure during autonomic dysreflexia.
17. Which sign indicates "Cushing’s Triad" in a patient with increased ICP?
A. Tachycardia, hypotension, tachypnea.
B. Bradycardia, hypertension with widening pulse pressure, irregular breathing.
C. Fever, chills, stiff neck.
D. Decreased level of consciousness and pinpoint pupils.
Rationale: Cushing's Triad is a late sign of brainstem compression and imminent
herniation.
18. A Glasgow Coma Scale (GCS) score of 7 indicates:
A. Normal neurological function.
B. Moderate brain injury.
C. Severe brain injury/Coma.
D. Brain death.
Rationale: A GCS of 8 or less is the standard definition of a coma; these patients usually
require intubation.
19. What is the priority for a patient in the "Ictal" phase of a seizure?
A. Inserting a padded tongue blade.
