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NUR 257 FINAL ACTUAL EXAM NEWEST ACTUAL EXAM COMPLETE
QUESTIONS AND CORRECT DETAILED ANSWERS 2025-2026,
ALREADY GRADED A+
1. (Multiple choice)
A client with chronic heart failure (CHF) is being discharged on furosemide 40 mg
PO daily and lisinopril 10 mg PO daily. Which instruction is most important for
the nurse to include in discharge teaching?
A. "Take the furosemide at bedtime."
B. "Check your weight every morning and call if it increases by 2 kg (4.4 lb) in 2
days."
C. "Avoid foods containing potassium."
D. "Stop taking lisinopril if your blood pressure feels low."
Answer: B
Rationale: Daily weights detect fluid retention early. A gain of ~2 kg (4.4 lb) in 48
hours is clinically significant and should prompt contact with the provider.
Furosemide is usually taken in the morning to avoid nocturia (not bedtime). ACE
inhibitors (lisinopril) are continued; the client should report lightheadedness but
not stop without provider advice. Avoiding potassium is incorrect — furosemide
causes potassium loss, so potassium intake may need monitoring.
2. (Multiple choice)
A patient with chronic obstructive pulmonary disease (COPD) uses a short-acting
beta2 agonist inhaler (albuterol) 4–6 times per day at home. The nurse recognizes
this pattern indicates:
A. Good control of COPD.
B. Need for increased use of long-acting bronchodilator and evaluation.
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C. Increased tolerance to albuterol only.
D. Immediate hospitalization.
Answer: B
Rationale: Frequent use (>2x/day) of a short-acting rescue inhaler indicates poor
control and a need to reassess the regimen and likely add or adjust controller
therapy (long-acting bronchodilators, inhaled corticosteroids). Not necessarily
immediate hospitalization unless severe exacerbation.
3. (Select all that apply)
Which findings are consistent with hypovolemic shock?
A. Tachycardia
B. Elevated central venous pressure (CVP)
C. Decreased urine output
D. Cool, clammy skin
E. Bounding peripheral pulses
Answer: A, C, D
Rationale: Hypovolemic shock causes tachycardia (A), decreased urine output (C)
due to poor renal perfusion, and cool, clammy skin (D) from peripheral
vasoconstriction. CVP is decreased (not elevated), and peripheral pulses are
weak/thready (not bounding).
4. (Short answer / calculation)
A physician orders ceftriaxone 1 g IV every 24 hours. The available vial contains
500 mg powder; reconstitute to make 250 mg/mL. How many mL will you
administer per dose?
Answer: 4 mL
Calculation & Rationale: 1 g = 1000 mg. Concentration = 250 mg/mL. Volume =
1000 mg ÷ 250 mg/mL = 4 mL.
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5. (Multiple choice)
A patient on warfarin (Coumadin) has an INR of 5.8 and is asymptomatic. Which
action should the nurse expect?
A. Continue same dose—no change unless bleeding happens.
B. Hold warfarin and administer vitamin K per provider order.
C. Give fresh frozen plasma immediately.
D. Double the dose today to bring INR down.
Answer: B
Rationale: An INR >5 and <9 without bleeding often warrants holding warfarin
and giving oral vitamin K per protocol. FFP is reserved for major bleeding or very
high risk/urgent reversal. Doubling the dose is incorrect.
6. (Multiple choice)
Which electrolyte disturbance is most likely if a patient receiving high-dose loop
diuretics reports muscle cramps and weakness?
A. Hyperkalemia
B. Hypokalemia
C. Hypermagnesemia
D. Hypernatremia
Answer: B
Rationale: Loop diuretics (e.g., furosemide) cause loss of potassium and
magnesium — hypokalemia manifests with muscle cramps and weakness.
7. (Priority / delegation)
Which task is appropriate to delegate to a licensed practical nurse (LPN/LVN) for
a stable postoperative patient (24 hours post-op) who had a total knee replacement?
A. Initial postoperative teaching about discharge medications.
B. Administer scheduled opioid analgesic and document response.
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C. Perform the initial comprehensive admission assessment.
D. Teach the patient how to use crutches for discharge.
Answer: B
Rationale: LPNs commonly administer medications and monitor/document
routine responses. Initial teaching and comprehensive assessments are RN
responsibilities. Teaching crutch use is more complex and typically RN or PT-led.
8. (Multiple choice)
Which finding best indicates effective treatment of pneumonia in an elderly patient
after 48 hours of IV antibiotics?
A. WBC decreased from 18,000 to 13,000/mm³ and afebrile for 24 hours.
B. Productive cough persists with green sputum.
C. SOB has worsened when ambulating.
D. Chest x-ray shows no change.
Answer: A
Rationale: Decrease in WBC and becoming afebrile indicate clinical
improvement. Persistent green sputum alone doesn't indicate failure if overall
clinical signs improve. Worsening SOB is concerning.
9. (Multiple choice)
A patient with type 1 diabetes receives regular insulin at 0830. At 1000 the patient
is sweaty, pale, and confused. Which action should the nurse take first?
A. Give orange juice by mouth.
B. Check the patient's blood glucose.
C. Call the physician for a dextrose order.
D. Give glucagon IM.
Answer: B
Rationale: Always assess (check blood glucose) before treatment if possible. If
hypoglycemia is confirmed and the patient is conscious and able to swallow, give
NUR 257 FINAL ACTUAL EXAM NEWEST ACTUAL EXAM COMPLETE
QUESTIONS AND CORRECT DETAILED ANSWERS 2025-2026,
ALREADY GRADED A+
1. (Multiple choice)
A client with chronic heart failure (CHF) is being discharged on furosemide 40 mg
PO daily and lisinopril 10 mg PO daily. Which instruction is most important for
the nurse to include in discharge teaching?
A. "Take the furosemide at bedtime."
B. "Check your weight every morning and call if it increases by 2 kg (4.4 lb) in 2
days."
C. "Avoid foods containing potassium."
D. "Stop taking lisinopril if your blood pressure feels low."
Answer: B
Rationale: Daily weights detect fluid retention early. A gain of ~2 kg (4.4 lb) in 48
hours is clinically significant and should prompt contact with the provider.
Furosemide is usually taken in the morning to avoid nocturia (not bedtime). ACE
inhibitors (lisinopril) are continued; the client should report lightheadedness but
not stop without provider advice. Avoiding potassium is incorrect — furosemide
causes potassium loss, so potassium intake may need monitoring.
2. (Multiple choice)
A patient with chronic obstructive pulmonary disease (COPD) uses a short-acting
beta2 agonist inhaler (albuterol) 4–6 times per day at home. The nurse recognizes
this pattern indicates:
A. Good control of COPD.
B. Need for increased use of long-acting bronchodilator and evaluation.
,2|Page
C. Increased tolerance to albuterol only.
D. Immediate hospitalization.
Answer: B
Rationale: Frequent use (>2x/day) of a short-acting rescue inhaler indicates poor
control and a need to reassess the regimen and likely add or adjust controller
therapy (long-acting bronchodilators, inhaled corticosteroids). Not necessarily
immediate hospitalization unless severe exacerbation.
3. (Select all that apply)
Which findings are consistent with hypovolemic shock?
A. Tachycardia
B. Elevated central venous pressure (CVP)
C. Decreased urine output
D. Cool, clammy skin
E. Bounding peripheral pulses
Answer: A, C, D
Rationale: Hypovolemic shock causes tachycardia (A), decreased urine output (C)
due to poor renal perfusion, and cool, clammy skin (D) from peripheral
vasoconstriction. CVP is decreased (not elevated), and peripheral pulses are
weak/thready (not bounding).
4. (Short answer / calculation)
A physician orders ceftriaxone 1 g IV every 24 hours. The available vial contains
500 mg powder; reconstitute to make 250 mg/mL. How many mL will you
administer per dose?
Answer: 4 mL
Calculation & Rationale: 1 g = 1000 mg. Concentration = 250 mg/mL. Volume =
1000 mg ÷ 250 mg/mL = 4 mL.
,3|Page
5. (Multiple choice)
A patient on warfarin (Coumadin) has an INR of 5.8 and is asymptomatic. Which
action should the nurse expect?
A. Continue same dose—no change unless bleeding happens.
B. Hold warfarin and administer vitamin K per provider order.
C. Give fresh frozen plasma immediately.
D. Double the dose today to bring INR down.
Answer: B
Rationale: An INR >5 and <9 without bleeding often warrants holding warfarin
and giving oral vitamin K per protocol. FFP is reserved for major bleeding or very
high risk/urgent reversal. Doubling the dose is incorrect.
6. (Multiple choice)
Which electrolyte disturbance is most likely if a patient receiving high-dose loop
diuretics reports muscle cramps and weakness?
A. Hyperkalemia
B. Hypokalemia
C. Hypermagnesemia
D. Hypernatremia
Answer: B
Rationale: Loop diuretics (e.g., furosemide) cause loss of potassium and
magnesium — hypokalemia manifests with muscle cramps and weakness.
7. (Priority / delegation)
Which task is appropriate to delegate to a licensed practical nurse (LPN/LVN) for
a stable postoperative patient (24 hours post-op) who had a total knee replacement?
A. Initial postoperative teaching about discharge medications.
B. Administer scheduled opioid analgesic and document response.
, 4|Page
C. Perform the initial comprehensive admission assessment.
D. Teach the patient how to use crutches for discharge.
Answer: B
Rationale: LPNs commonly administer medications and monitor/document
routine responses. Initial teaching and comprehensive assessments are RN
responsibilities. Teaching crutch use is more complex and typically RN or PT-led.
8. (Multiple choice)
Which finding best indicates effective treatment of pneumonia in an elderly patient
after 48 hours of IV antibiotics?
A. WBC decreased from 18,000 to 13,000/mm³ and afebrile for 24 hours.
B. Productive cough persists with green sputum.
C. SOB has worsened when ambulating.
D. Chest x-ray shows no change.
Answer: A
Rationale: Decrease in WBC and becoming afebrile indicate clinical
improvement. Persistent green sputum alone doesn't indicate failure if overall
clinical signs improve. Worsening SOB is concerning.
9. (Multiple choice)
A patient with type 1 diabetes receives regular insulin at 0830. At 1000 the patient
is sweaty, pale, and confused. Which action should the nurse take first?
A. Give orange juice by mouth.
B. Check the patient's blood glucose.
C. Call the physician for a dextrose order.
D. Give glucagon IM.
Answer: B
Rationale: Always assess (check blood glucose) before treatment if possible. If
hypoglycemia is confirmed and the patient is conscious and able to swallow, give
