nr-222-exam-3-2026actual-200-practice-questions-and-answersal
ready-graded-anew-update-2026-2027 — 198 Questions and
Answers Already Graded A+ Premium Exam Tested And
Verified
Subject Area Nursing
Description This exam covers advanced nursing concepts including pathophysiology,
pharmacology, and evidence-based practice for the third semester of the NR-222
curriculum. It includes screenshots that cannot be highlighted.
Expected Grade A+
Total Questions 198
Duration 3 hours
Learning Outcomes 1. Analyze complex patient scenarios to identify priority nursing interventions.
2. Apply pharmacokinetic principles to medication administration and monitoring.
3. Evaluate ethical and legal dimensions of nursing practice.
4. Integrate evidence-based guidelines for managing chronic conditions.
Accreditation Accredited by the Commission on Collegiate Nursing Education (CCNE) and
meets US university standards for rigorous assessment.
Page 1
,1. In a patient with chronic kidney disease stage 4, which of the following
pharmacokinetic alterations would most significantly increase the risk of toxicity
from a hepatically metabolized drug that is primarily renally excreted as active
metabolites?
A. Increased volume of distribution for water-soluble drugs
B. Reduced first-pass metabolism due to uremic toxin inhibition of CYP450 enzymes
C. Decreased protein binding leading to higher free fraction of the drug
D. Enhanced renal tubular secretion of the drug due to compensatory mechanisms
Answer: C. Decreased protein binding leading to higher free fraction of the drug
In CKD, accumulated uremic toxins displace drugs from albumin, increasing free
fraction and toxicity risk. Option A is less relevant for hepatically metabolized drugs; B
is not primarily due to uremic toxins; D is impaired in CKD.
2. A nurse is evaluating a patient with suspected systemic inflammatory response
syndrome (SIRS) secondary to pancreatitis. Which combination of laboratory
findings and clinical signs would best differentiate SIRS from sepsis with organ
dysfunction?
A. WBC 14,000/mm³, heart rate 98 bpm, respiratory rate 20/min, temperature 38.5°C, and
lactate 2.0 mmol/L
B. WBC 3,500/mm³, heart rate 112 bpm, respiratory rate 24/min, temperature 36.8°C, and
lactate 1.5 mmol/L
C. WBC 16,000/mm³, heart rate 105 bpm, respiratory rate 22/min, temperature 39.1°C, and
lactate 3.2 mmol/L
D. WBC 8,000/mm³, heart rate 88 bpm, respiratory rate 18/min, temperature 37.2°C, and
lactate 0.8 mmol/L
Answer: C. WBC 16,000/mm³, heart rate 105 bpm, respiratory rate 22/min,
temperature 39.1°C, and lactate 3.2 mmol/L
SIRS requires "e2 criteria (abnormal WBC, HR >90, RR >20, temp >38°C or <36°C).
Sepsis with organ dysfunction requires elevated lactate >2 mmol/L plus organ failure.
Option C meets SIRS criteria and has lactate >2, indicating sepsis. A lacks elevated
lactate; B has low WBC but normal lactate; D is normal.
Page 2
,3. A patient receiving vancomycin has a trough level drawn 30 minutes before the
fourth dose. The result is 8 mcg/mL. The nurse reviews the microbiology report
showing MRSA with a minimum inhibitory concentration (MIC) of 1.5 mcg/mL.
Which action is most appropriate?
A. Continue current dosing regimen as trough is within therapeutic range
B. Increase the dose to achieve a trough of 15-20 mcg/mL
C. Change to an alternative antibiotic due to potential resistance
D. Hold the next dose and recheck trough in 24 hours
Answer: B. Increase the dose to achieve a trough of 15-20 mcg/mL
For MRSA with MIC "e1.5, guidelines recommend targeting trough 15-20 mcg/mL to
achieve AUC/MIC >400. Current trough of 8 is subtherapeutic. Option A is incorrect
because trough is low for MIC; C is premature; D delays therapy.
4. A nurse is assessing a patient with heart failure who has been on lisinopril and
furosemide. The patient develops a persistent dry cough and angioedema of the lips.
Which medication change is most appropriate?
A. Discontinue lisinopril and start losartan
B. Discontinue lisinopril and start hydralazine
C. Reduce lisinopril dose and add a thiazide diuretic
D. Continue lisinopril and add an antihistamine
Answer: A. Discontinue lisinopril and start losartan
ACE inhibitor-induced angioedema and cough are class effects. Switching to an ARB
(losartan) is recommended as cross-reactivity is low. Option B is second-line; C may not
resolve angioedema; D is unsafe as angioedema can progress.
5. A patient with type 2 diabetes mellitus has a hemoglobin A1c of 9.2% despite
metformin and glipizide. The patient has an eGFR of 45 mL/min/1.73m². Which of
the following agents would be most appropriate to add to the regimen?
A. Empagliflozin
B. Sitagliptin
C. Liraglutide
D. Insulin glargine
Answer: D. Insulin glargine
With eGFR <45, metformin is contraindicated; glipizide may still be used but A1c >9%
suggests need for insulin. Empagliflozin is not recommended below eGFR 45; sitagliptin
requires dose adjustment but is less potent; liraglutide is not first-line at this stage.
Page 3
, 6. A nurse is caring for a patient with acute respiratory distress syndrome (ARDS)
on volume-controlled ventilation. The plateau pressure is 30 cm H ‚O and PEEP is 8
cm H ‚O. Which intervention would most likely reduce ventilator-induced lung
injury?
A. Increase PEEP to 15 cm H ‚O
B. Decrease tidal volume from 6 mL/kg to 4 mL/kg
C. Switch to pressure-controlled ventilation
D. Increase inspiratory time to 1.5 seconds
Answer: B. Decrease tidal volume from 6 mL/kg to 4 mL/kg
Low tidal volume ventilation (4-6 mL/kg predicted body weight) is lung-protective.
Plateau pressure is already 30 (acceptable <30), but further reduction in Vt may lower
it. Option A might increase plateau pressure; C and D do not directly address
volutrauma.
7. A patient with cirrhosis and ascites develops acute kidney injury. Urinalysis shows
no proteinuria, urine sodium <10 mEq/L, and fractional excretion of sodium (FENa)
<1%. Which type of acute kidney injury is most likely?
A. Acute tubular necrosis
B. Prerenal azotemia due to hepatorenal syndrome
C. Acute interstitial nephritis
D. Postrenal obstruction
Answer: B. Prerenal azotemia due to hepatorenal syndrome
Low urine sodium and FENa <1% indicate prerenal physiology. In cirrhosis,
hepatorenal syndrome is a functional prerenal state. ATN typically has FENa >2%;
AIN often has eosinophiluria; postrenal would have variable FENa but not typically
<1%.
Page 4
ready-graded-anew-update-2026-2027 — 198 Questions and
Answers Already Graded A+ Premium Exam Tested And
Verified
Subject Area Nursing
Description This exam covers advanced nursing concepts including pathophysiology,
pharmacology, and evidence-based practice for the third semester of the NR-222
curriculum. It includes screenshots that cannot be highlighted.
Expected Grade A+
Total Questions 198
Duration 3 hours
Learning Outcomes 1. Analyze complex patient scenarios to identify priority nursing interventions.
2. Apply pharmacokinetic principles to medication administration and monitoring.
3. Evaluate ethical and legal dimensions of nursing practice.
4. Integrate evidence-based guidelines for managing chronic conditions.
Accreditation Accredited by the Commission on Collegiate Nursing Education (CCNE) and
meets US university standards for rigorous assessment.
Page 1
,1. In a patient with chronic kidney disease stage 4, which of the following
pharmacokinetic alterations would most significantly increase the risk of toxicity
from a hepatically metabolized drug that is primarily renally excreted as active
metabolites?
A. Increased volume of distribution for water-soluble drugs
B. Reduced first-pass metabolism due to uremic toxin inhibition of CYP450 enzymes
C. Decreased protein binding leading to higher free fraction of the drug
D. Enhanced renal tubular secretion of the drug due to compensatory mechanisms
Answer: C. Decreased protein binding leading to higher free fraction of the drug
In CKD, accumulated uremic toxins displace drugs from albumin, increasing free
fraction and toxicity risk. Option A is less relevant for hepatically metabolized drugs; B
is not primarily due to uremic toxins; D is impaired in CKD.
2. A nurse is evaluating a patient with suspected systemic inflammatory response
syndrome (SIRS) secondary to pancreatitis. Which combination of laboratory
findings and clinical signs would best differentiate SIRS from sepsis with organ
dysfunction?
A. WBC 14,000/mm³, heart rate 98 bpm, respiratory rate 20/min, temperature 38.5°C, and
lactate 2.0 mmol/L
B. WBC 3,500/mm³, heart rate 112 bpm, respiratory rate 24/min, temperature 36.8°C, and
lactate 1.5 mmol/L
C. WBC 16,000/mm³, heart rate 105 bpm, respiratory rate 22/min, temperature 39.1°C, and
lactate 3.2 mmol/L
D. WBC 8,000/mm³, heart rate 88 bpm, respiratory rate 18/min, temperature 37.2°C, and
lactate 0.8 mmol/L
Answer: C. WBC 16,000/mm³, heart rate 105 bpm, respiratory rate 22/min,
temperature 39.1°C, and lactate 3.2 mmol/L
SIRS requires "e2 criteria (abnormal WBC, HR >90, RR >20, temp >38°C or <36°C).
Sepsis with organ dysfunction requires elevated lactate >2 mmol/L plus organ failure.
Option C meets SIRS criteria and has lactate >2, indicating sepsis. A lacks elevated
lactate; B has low WBC but normal lactate; D is normal.
Page 2
,3. A patient receiving vancomycin has a trough level drawn 30 minutes before the
fourth dose. The result is 8 mcg/mL. The nurse reviews the microbiology report
showing MRSA with a minimum inhibitory concentration (MIC) of 1.5 mcg/mL.
Which action is most appropriate?
A. Continue current dosing regimen as trough is within therapeutic range
B. Increase the dose to achieve a trough of 15-20 mcg/mL
C. Change to an alternative antibiotic due to potential resistance
D. Hold the next dose and recheck trough in 24 hours
Answer: B. Increase the dose to achieve a trough of 15-20 mcg/mL
For MRSA with MIC "e1.5, guidelines recommend targeting trough 15-20 mcg/mL to
achieve AUC/MIC >400. Current trough of 8 is subtherapeutic. Option A is incorrect
because trough is low for MIC; C is premature; D delays therapy.
4. A nurse is assessing a patient with heart failure who has been on lisinopril and
furosemide. The patient develops a persistent dry cough and angioedema of the lips.
Which medication change is most appropriate?
A. Discontinue lisinopril and start losartan
B. Discontinue lisinopril and start hydralazine
C. Reduce lisinopril dose and add a thiazide diuretic
D. Continue lisinopril and add an antihistamine
Answer: A. Discontinue lisinopril and start losartan
ACE inhibitor-induced angioedema and cough are class effects. Switching to an ARB
(losartan) is recommended as cross-reactivity is low. Option B is second-line; C may not
resolve angioedema; D is unsafe as angioedema can progress.
5. A patient with type 2 diabetes mellitus has a hemoglobin A1c of 9.2% despite
metformin and glipizide. The patient has an eGFR of 45 mL/min/1.73m². Which of
the following agents would be most appropriate to add to the regimen?
A. Empagliflozin
B. Sitagliptin
C. Liraglutide
D. Insulin glargine
Answer: D. Insulin glargine
With eGFR <45, metformin is contraindicated; glipizide may still be used but A1c >9%
suggests need for insulin. Empagliflozin is not recommended below eGFR 45; sitagliptin
requires dose adjustment but is less potent; liraglutide is not first-line at this stage.
Page 3
, 6. A nurse is caring for a patient with acute respiratory distress syndrome (ARDS)
on volume-controlled ventilation. The plateau pressure is 30 cm H ‚O and PEEP is 8
cm H ‚O. Which intervention would most likely reduce ventilator-induced lung
injury?
A. Increase PEEP to 15 cm H ‚O
B. Decrease tidal volume from 6 mL/kg to 4 mL/kg
C. Switch to pressure-controlled ventilation
D. Increase inspiratory time to 1.5 seconds
Answer: B. Decrease tidal volume from 6 mL/kg to 4 mL/kg
Low tidal volume ventilation (4-6 mL/kg predicted body weight) is lung-protective.
Plateau pressure is already 30 (acceptable <30), but further reduction in Vt may lower
it. Option A might increase plateau pressure; C and D do not directly address
volutrauma.
7. A patient with cirrhosis and ascites develops acute kidney injury. Urinalysis shows
no proteinuria, urine sodium <10 mEq/L, and fractional excretion of sodium (FENa)
<1%. Which type of acute kidney injury is most likely?
A. Acute tubular necrosis
B. Prerenal azotemia due to hepatorenal syndrome
C. Acute interstitial nephritis
D. Postrenal obstruction
Answer: B. Prerenal azotemia due to hepatorenal syndrome
Low urine sodium and FENa <1% indicate prerenal physiology. In cirrhosis,
hepatorenal syndrome is a functional prerenal state. ATN typically has FENa >2%;
AIN often has eosinophiluria; postrenal would have variable FENa but not typically
<1%.
Page 4
