BSN266 – Concepts of Nursing II | Practice Examination Page 1
BSN266
Concepts of Nursing II
Comprehensive Practice Examination
100 Questions | Multiple Choice with Rationales
Covering: Pharmacology • Fluids & Electrolytes • Acid-Base • Cardiovascular • Respiratory
Neurological • Endocrine • Renal • GI • Musculoskeletal • Critical Care • Maternity • Pediatrics
Oncology • Ethics & Legal • Delegation • Infection Control & More
Instructions:
• Select the single BEST answer for each question.
• Each question has four answer choices labeled A–D.
• The correct answer and detailed rationale appear at the end of each question.
• Focus on the NCLEX-style critical thinking required to arrive at the correct answer.
PHARMACOLOGY & MEDICATION ADMINISTRATION
1. A nurse is preparing to administer digoxin (Lanoxin) to a patient. Before administration, the nurse
should assess which of the following?
A. Blood pressure
B. Apical pulse for a full minute
C. Respiratory rate
D. Temperature
✔ Correct Answer: B | Rationale: Digoxin can cause bradycardia. The nurse must count the apical
pulse for a full 60 seconds before administration. If the pulse is less than 60 bpm (or per facility policy), the
nurse holds the dose and notifies the provider.
2. A patient is receiving heparin infusion for DVT. Which lab value is the primary parameter used to
monitor heparin therapy?
A. PT/INR
B. Platelet count
C. aPTT (activated partial thromboplastin time)
D. Fibrinogen level
✔ Correct Answer: C | Rationale: aPTT is used to monitor unfractionated heparin therapy. The
therapeutic range is typically 1.5–2.5 times the control value. PT/INR monitors warfarin therapy.
For educational use only | Nursing faculty review recommended before clinical application
,BSN266 – Concepts of Nursing II | Practice Examination Page 2
3. A nurse administers 40 mg of furosemide (Lasix) IV to a patient with heart failure. Which
assessment finding is the PRIORITY concern?
A. Urine output of 300 mL in 1 hour
B. Serum potassium of 3.0 mEq/L
C. Blood pressure of 118/76 mmHg
D. Weight loss of 1 lb
✔ Correct Answer: B | Rationale: Hypokalemia (K+ < 3.5 mEq/L) is the priority concern with
furosemide therapy. Potassium is lost with diuresis, and hypokalemia can lead to life-threatening
dysrhythmias.
4. Which of the following is a priority nursing action before administering an opioid analgesic?
A. Check the patient's blood pressure
B. Assess the patient's pain using a 0–10 scale
C. Assess the patient's respiratory rate
D. Review the patient's last bowel movement
✔ Correct Answer: C | Rationale: Opioids depress the respiratory center. If respirations are below
12/min, the nurse must hold the medication and notify the provider. Respiratory depression is the most life-
threatening adverse effect.
5. A patient is prescribed metformin for type 2 diabetes and is scheduled for a CT scan with contrast
dye. What is the nurse's most important action?
A. Administer metformin as scheduled
B. Hold metformin before and 48 hours after the procedure
C. Double the metformin dose post-procedure
D. Administer insulin instead of metformin
✔ Correct Answer: B | Rationale: Contrast dye can cause acute kidney injury, and metformin can
accumulate when kidneys are impaired, causing lactic acidosis. Metformin is held before and for 48 hours
after contrast administration until renal function is confirmed normal.
6. A nurse is teaching a patient about warfarin (Coumadin) therapy. Which statement by the patient
indicates the need for further teaching?
A. 'I will report any unusual bruising or bleeding to my doctor.'
B. 'I can take aspirin whenever I have a headache.'
C. 'I need to keep all my lab appointments to check my INR.'
D. 'I should eat a consistent amount of vitamin K-rich foods.'
✔ Correct Answer: B | Rationale: Aspirin is an antiplatelet agent that, when combined with warfarin,
significantly increases the risk of bleeding. The patient should avoid OTC NSAIDs and aspirin unless
specifically prescribed.
7. Which of the following medications requires the nurse to wear gloves during administration due to
risk of absorption through the skin?
A. Oral metoprolol
B. Nitroglycerin transdermal patch
C. Subcutaneous insulin
D. Oral lisinopril
For educational use only | Nursing faculty review recommended before clinical application
, BSN266 – Concepts of Nursing II | Practice Examination Page 3
✔ Correct Answer: B | Rationale: Nitroglycerin is a vasodilator that can be absorbed transdermally by
the nurse during application. Gloves must be worn to prevent inadvertent absorption, which can cause
headache and hypotension in the nurse.
8. A patient is receiving vancomycin IV and develops flushing, erythema, and hypotension during
infusion. What should the nurse do FIRST?
A. Administer diphenhydramine (Benadryl)
B. Stop the infusion immediately
C. Slow the infusion rate
D. Notify the physician immediately
✔ Correct Answer: B | Rationale: These are signs of Red Man Syndrome, a non-immune reaction to
rapid vancomycin infusion. The nurse stops the infusion first, then may slow the rate after symptoms
resolve. Vancomycin must be infused over at least 60 minutes.
FLUID & ELECTROLYTE IMBALANCES
9. A patient has a serum sodium of 128 mEq/L. The nurse should assess for which of the following
manifestations?
A. Extreme thirst and dry mucous membranes
B. Confusion, headache, and muscle cramps
C. Tall peaked T-waves on ECG
D. Chvostek's sign and Trousseau's sign
✔ Correct Answer: B | Rationale: Hyponatremia (Na+ < 135 mEq/L) causes neurological symptoms
because water shifts into brain cells, causing cerebral edema. Option A reflects hypernatremia; C reflects
hyperkalemia; D reflects hypocalcemia.
10. Which IV solution is considered isotonic and is most appropriate for a patient who is dehydrated
and has normal electrolyte levels?
A. D5W (5% dextrose in water)
B. 0.45% NaCl (half-normal saline)
C. 0.9% NaCl (normal saline)
D. 3% NaCl (hypertonic saline)
✔ Correct Answer: C | Rationale: 0.9% NaCl is isotonic and expands the extracellular fluid volume
without causing fluid shifts. D5W becomes hypotonic after dextrose is metabolized; 0.45% NaCl is
hypotonic; 3% NaCl is hypertonic and used only for severe hyponatremia.
11. A patient with chronic kidney disease has a potassium level of 6.2 mEq/L. The nurse anticipates
which intervention?
A. Administer potassium chloride IV
B. Prepare for cardiac monitoring and calcium gluconate administration
C. Encourage potassium-rich foods
D. Administer a loop diuretic
✔ Correct Answer: B | Rationale: Hyperkalemia (K+ > 5.0 mEq/L) causes cardiac dysrhythmias.
Calcium gluconate is given to stabilize the myocardial membrane. Continuous cardiac monitoring is
essential. Kayexalate or dialysis may follow to remove excess potassium.
For educational use only | Nursing faculty review recommended before clinical application
BSN266
Concepts of Nursing II
Comprehensive Practice Examination
100 Questions | Multiple Choice with Rationales
Covering: Pharmacology • Fluids & Electrolytes • Acid-Base • Cardiovascular • Respiratory
Neurological • Endocrine • Renal • GI • Musculoskeletal • Critical Care • Maternity • Pediatrics
Oncology • Ethics & Legal • Delegation • Infection Control & More
Instructions:
• Select the single BEST answer for each question.
• Each question has four answer choices labeled A–D.
• The correct answer and detailed rationale appear at the end of each question.
• Focus on the NCLEX-style critical thinking required to arrive at the correct answer.
PHARMACOLOGY & MEDICATION ADMINISTRATION
1. A nurse is preparing to administer digoxin (Lanoxin) to a patient. Before administration, the nurse
should assess which of the following?
A. Blood pressure
B. Apical pulse for a full minute
C. Respiratory rate
D. Temperature
✔ Correct Answer: B | Rationale: Digoxin can cause bradycardia. The nurse must count the apical
pulse for a full 60 seconds before administration. If the pulse is less than 60 bpm (or per facility policy), the
nurse holds the dose and notifies the provider.
2. A patient is receiving heparin infusion for DVT. Which lab value is the primary parameter used to
monitor heparin therapy?
A. PT/INR
B. Platelet count
C. aPTT (activated partial thromboplastin time)
D. Fibrinogen level
✔ Correct Answer: C | Rationale: aPTT is used to monitor unfractionated heparin therapy. The
therapeutic range is typically 1.5–2.5 times the control value. PT/INR monitors warfarin therapy.
For educational use only | Nursing faculty review recommended before clinical application
,BSN266 – Concepts of Nursing II | Practice Examination Page 2
3. A nurse administers 40 mg of furosemide (Lasix) IV to a patient with heart failure. Which
assessment finding is the PRIORITY concern?
A. Urine output of 300 mL in 1 hour
B. Serum potassium of 3.0 mEq/L
C. Blood pressure of 118/76 mmHg
D. Weight loss of 1 lb
✔ Correct Answer: B | Rationale: Hypokalemia (K+ < 3.5 mEq/L) is the priority concern with
furosemide therapy. Potassium is lost with diuresis, and hypokalemia can lead to life-threatening
dysrhythmias.
4. Which of the following is a priority nursing action before administering an opioid analgesic?
A. Check the patient's blood pressure
B. Assess the patient's pain using a 0–10 scale
C. Assess the patient's respiratory rate
D. Review the patient's last bowel movement
✔ Correct Answer: C | Rationale: Opioids depress the respiratory center. If respirations are below
12/min, the nurse must hold the medication and notify the provider. Respiratory depression is the most life-
threatening adverse effect.
5. A patient is prescribed metformin for type 2 diabetes and is scheduled for a CT scan with contrast
dye. What is the nurse's most important action?
A. Administer metformin as scheduled
B. Hold metformin before and 48 hours after the procedure
C. Double the metformin dose post-procedure
D. Administer insulin instead of metformin
✔ Correct Answer: B | Rationale: Contrast dye can cause acute kidney injury, and metformin can
accumulate when kidneys are impaired, causing lactic acidosis. Metformin is held before and for 48 hours
after contrast administration until renal function is confirmed normal.
6. A nurse is teaching a patient about warfarin (Coumadin) therapy. Which statement by the patient
indicates the need for further teaching?
A. 'I will report any unusual bruising or bleeding to my doctor.'
B. 'I can take aspirin whenever I have a headache.'
C. 'I need to keep all my lab appointments to check my INR.'
D. 'I should eat a consistent amount of vitamin K-rich foods.'
✔ Correct Answer: B | Rationale: Aspirin is an antiplatelet agent that, when combined with warfarin,
significantly increases the risk of bleeding. The patient should avoid OTC NSAIDs and aspirin unless
specifically prescribed.
7. Which of the following medications requires the nurse to wear gloves during administration due to
risk of absorption through the skin?
A. Oral metoprolol
B. Nitroglycerin transdermal patch
C. Subcutaneous insulin
D. Oral lisinopril
For educational use only | Nursing faculty review recommended before clinical application
, BSN266 – Concepts of Nursing II | Practice Examination Page 3
✔ Correct Answer: B | Rationale: Nitroglycerin is a vasodilator that can be absorbed transdermally by
the nurse during application. Gloves must be worn to prevent inadvertent absorption, which can cause
headache and hypotension in the nurse.
8. A patient is receiving vancomycin IV and develops flushing, erythema, and hypotension during
infusion. What should the nurse do FIRST?
A. Administer diphenhydramine (Benadryl)
B. Stop the infusion immediately
C. Slow the infusion rate
D. Notify the physician immediately
✔ Correct Answer: B | Rationale: These are signs of Red Man Syndrome, a non-immune reaction to
rapid vancomycin infusion. The nurse stops the infusion first, then may slow the rate after symptoms
resolve. Vancomycin must be infused over at least 60 minutes.
FLUID & ELECTROLYTE IMBALANCES
9. A patient has a serum sodium of 128 mEq/L. The nurse should assess for which of the following
manifestations?
A. Extreme thirst and dry mucous membranes
B. Confusion, headache, and muscle cramps
C. Tall peaked T-waves on ECG
D. Chvostek's sign and Trousseau's sign
✔ Correct Answer: B | Rationale: Hyponatremia (Na+ < 135 mEq/L) causes neurological symptoms
because water shifts into brain cells, causing cerebral edema. Option A reflects hypernatremia; C reflects
hyperkalemia; D reflects hypocalcemia.
10. Which IV solution is considered isotonic and is most appropriate for a patient who is dehydrated
and has normal electrolyte levels?
A. D5W (5% dextrose in water)
B. 0.45% NaCl (half-normal saline)
C. 0.9% NaCl (normal saline)
D. 3% NaCl (hypertonic saline)
✔ Correct Answer: C | Rationale: 0.9% NaCl is isotonic and expands the extracellular fluid volume
without causing fluid shifts. D5W becomes hypotonic after dextrose is metabolized; 0.45% NaCl is
hypotonic; 3% NaCl is hypertonic and used only for severe hyponatremia.
11. A patient with chronic kidney disease has a potassium level of 6.2 mEq/L. The nurse anticipates
which intervention?
A. Administer potassium chloride IV
B. Prepare for cardiac monitoring and calcium gluconate administration
C. Encourage potassium-rich foods
D. Administer a loop diuretic
✔ Correct Answer: B | Rationale: Hyperkalemia (K+ > 5.0 mEq/L) causes cardiac dysrhythmias.
Calcium gluconate is given to stabilize the myocardial membrane. Continuous cardiac monitoring is
essential. Kayexalate or dialysis may follow to remove excess potassium.
For educational use only | Nursing faculty review recommended before clinical application
