BSN 346 | BSN346 Final Exam: Concepts of Nursing
III - Nightingale College Updated and Latest
Questions and Correct Answers with Rationale
1. A nurse is caring for a patient who was admitted with a suspected pulmonary embolism.
Which of the following diagnostic tests is considered the ‘gold standard’ for confirming this
diagnosis?
A. Chest X-ray
B. Arterial Blood Gas (ABG)
C. Electrocardiogram (ECG)
D. Pulmonary Angiography
Correct Answer: D
Expert Explanation: Pulmonary angiography provides the most definitive visualization of
the pulmonary vasculature to confirm an embolism. While chest X-rays can rule out other
conditions, they rarely show the embolism itself. ABGs might show hypoxemia but are not
specific to pulmonary embolism. ECGs are used to assess for right heart strain rather than
confirming a clot. Therefore, angiography remains the definitive diagnostic tool in complex
cases.
2. When assessing a patient with a traumatic brain injury, the nurse notes a Glasglow Coma
Scale (GCS) score of 7. How should the nurse interpret and act upon this finding?
A. Monitor the patient every 4 hours as this indicates a mild injury.
B. Administer a sedative to keep the patient calm and reduce ICP.
C. Prepare for immediate intubation as the patient cannot protect their airway.
D. Encourage the family to provide sensory stimulation to improve the score.
Correct Answer: C
Expert Explanation: A GCS score of 8 or less is generally indicative of a severe brain injury
and the inability to maintain a patent airway. The clinical adage ‘less than eight, intubate’ is
a standard emergency protocol. Monitoring every 4 hours is insufficient for a patient in this
critical condition. Sedatives might mask further neurological decline and should be used
cautiously. Airway management is the highest priority for survival and prevention of
secondary injury.
3. A patient is presenting with signs of septic shock. Which of the following interventions
should the nurse prioritize within the first hour of treatment?
A. Starting a continuous infusion of norepinephrine.
,B. Administering a dose of broad-spectrum antibiotics.
C. Inserting an indwelling urinary catheter for intake/output.
D. Obtaining a blood culture after starting the first antibiotic.
Correct Answer: B
Expert Explanation: Early administration of broad-spectrum antibiotics is a critical
component of the Surviving Sepsis Bundle. Blood cultures must be obtained before starting
antibiotics to ensure diagnostic accuracy. While vasopressors like norepinephrine are used
for hypotension, fluid resuscitation is usually the initial hemodynamic intervention.
Urinary catheters are helpful for monitoring but are not the primary life-saving priority.
Rapid antibiotic delivery significantly reduces mortality in septic patients.
4. The nurse is reviewing the laboratory results for a patient with Chronic Kidney Disease
(CKD). Which finding requires immediate notification of the healthcare provider?
A. Creatinine level of 2.8 mg/dL
B. Hemoglobin level of 9.5 g/dL
C. Calcium level of 8.2 mg/dL
D. Potassium level of 6.8 mEq/L
Correct Answer: D
Expert Explanation: A potassium level of 6.8 mEq/L indicates severe hyperkalemia, which
carries a high risk of lethal cardiac arrhythmias. Elevated creatinine and low hemoglobin
are expected chronic findings in CKD patients. While the calcium is slightly low, it does not
pose the immediate life-threatening risk that hyperkalemia does. The nurse must act
quickly to facilitate potassium-lowering treatments like insulin/dextrose or dialysis. Safety
in renal care requires constant vigilance over electrolyte stability.
5. A post-operative patient suddenly becomes restless and reports sharp chest pain on
inspiration. Which action should the nurse take first?
A. Administer the prescribed PRN dose of morphine.
B. Encourage the patient to use their incentive spirometer.
C. Perform a comprehensive 12-lead EKG.
D. Apply 2L of oxygen via nasal cannula and check pulse oximetry.
Correct Answer: D
Expert Explanation: Pleuritic chest pain and restlessness are hallmark signs of a potential
pulmonary embolism or atelectasis. Supplemental oxygen and oxygen saturation
monitoring are the initial steps to address potential hypoxia. Pain medication might mask
symptoms and does not address the underlying respiratory distress. An EKG is useful for
, ruling out MI but follows basic airway/breathing interventions. Rapid assessment and
oxygenation are essential in acute post-operative complications.
6. A nurse is caring for a patient with Acute Respiratory Distress Syndrome (ARDS) who is on a
mechanical ventilator. Which strategy is most effective for improving oxygenation in this
patient?
A. High-volume tidal ventilation
B. Supine positioning only
C. Prone positioning
D. Increasing the FiO2 to 100% indefinitely
Correct Answer: C
Expert Explanation: Prone positioning helps recruit collapsed alveoli in the dorsal regions
of the lungs and improves ventilation-perfusion matching. High tidal volumes can cause
ventilator-associated lung injury and are avoided in ARDS. Prolonged exposure to 100%
FiO2 can lead to oxygen toxicity and should be titrated down as possible. Supine
positioning often leads to further atelectasis in ARDS patients. Evidence-based practice
supports prone positioning as a standard maneuver for severe ARDS.
7. In a patient with SIADH (Syndrome of Inappropriate Antidiuretic Hormone), which
laboratory value is the nurse most likely to observe?
A. Serum sodium of 120 mEq/L
B. Serum osmolality of 320 mOsm/kg
C. Urine specific gravity of 1.002
D. Hematocrit of 55%
Correct Answer: A
Expert Explanation: SIADH involves excessive water retention, leading to dilutional
hyponatremia. A serum sodium of 120 mEq/L is a classic finding of this fluid overload state.
Serum osmolality in SIADH is typically low, not high, due to the excess water. Urine specific
gravity would be high because the urine is very concentrated, whereas 1.002 is dilute. High
hematocrit indicates dehydration, which is the opposite of the fluid volume excess seen in
SIADH.
8. A nurse is preparing to administer a blood transfusion. What is the most critical step to
prevent a hemolytic transfusion reaction?
A. Warming the blood to room temperature before administration.
B. Using a 22-gauge catheter for the IV access.
C. Administering diphenhydramine before starting the transfusion.
III - Nightingale College Updated and Latest
Questions and Correct Answers with Rationale
1. A nurse is caring for a patient who was admitted with a suspected pulmonary embolism.
Which of the following diagnostic tests is considered the ‘gold standard’ for confirming this
diagnosis?
A. Chest X-ray
B. Arterial Blood Gas (ABG)
C. Electrocardiogram (ECG)
D. Pulmonary Angiography
Correct Answer: D
Expert Explanation: Pulmonary angiography provides the most definitive visualization of
the pulmonary vasculature to confirm an embolism. While chest X-rays can rule out other
conditions, they rarely show the embolism itself. ABGs might show hypoxemia but are not
specific to pulmonary embolism. ECGs are used to assess for right heart strain rather than
confirming a clot. Therefore, angiography remains the definitive diagnostic tool in complex
cases.
2. When assessing a patient with a traumatic brain injury, the nurse notes a Glasglow Coma
Scale (GCS) score of 7. How should the nurse interpret and act upon this finding?
A. Monitor the patient every 4 hours as this indicates a mild injury.
B. Administer a sedative to keep the patient calm and reduce ICP.
C. Prepare for immediate intubation as the patient cannot protect their airway.
D. Encourage the family to provide sensory stimulation to improve the score.
Correct Answer: C
Expert Explanation: A GCS score of 8 or less is generally indicative of a severe brain injury
and the inability to maintain a patent airway. The clinical adage ‘less than eight, intubate’ is
a standard emergency protocol. Monitoring every 4 hours is insufficient for a patient in this
critical condition. Sedatives might mask further neurological decline and should be used
cautiously. Airway management is the highest priority for survival and prevention of
secondary injury.
3. A patient is presenting with signs of septic shock. Which of the following interventions
should the nurse prioritize within the first hour of treatment?
A. Starting a continuous infusion of norepinephrine.
,B. Administering a dose of broad-spectrum antibiotics.
C. Inserting an indwelling urinary catheter for intake/output.
D. Obtaining a blood culture after starting the first antibiotic.
Correct Answer: B
Expert Explanation: Early administration of broad-spectrum antibiotics is a critical
component of the Surviving Sepsis Bundle. Blood cultures must be obtained before starting
antibiotics to ensure diagnostic accuracy. While vasopressors like norepinephrine are used
for hypotension, fluid resuscitation is usually the initial hemodynamic intervention.
Urinary catheters are helpful for monitoring but are not the primary life-saving priority.
Rapid antibiotic delivery significantly reduces mortality in septic patients.
4. The nurse is reviewing the laboratory results for a patient with Chronic Kidney Disease
(CKD). Which finding requires immediate notification of the healthcare provider?
A. Creatinine level of 2.8 mg/dL
B. Hemoglobin level of 9.5 g/dL
C. Calcium level of 8.2 mg/dL
D. Potassium level of 6.8 mEq/L
Correct Answer: D
Expert Explanation: A potassium level of 6.8 mEq/L indicates severe hyperkalemia, which
carries a high risk of lethal cardiac arrhythmias. Elevated creatinine and low hemoglobin
are expected chronic findings in CKD patients. While the calcium is slightly low, it does not
pose the immediate life-threatening risk that hyperkalemia does. The nurse must act
quickly to facilitate potassium-lowering treatments like insulin/dextrose or dialysis. Safety
in renal care requires constant vigilance over electrolyte stability.
5. A post-operative patient suddenly becomes restless and reports sharp chest pain on
inspiration. Which action should the nurse take first?
A. Administer the prescribed PRN dose of morphine.
B. Encourage the patient to use their incentive spirometer.
C. Perform a comprehensive 12-lead EKG.
D. Apply 2L of oxygen via nasal cannula and check pulse oximetry.
Correct Answer: D
Expert Explanation: Pleuritic chest pain and restlessness are hallmark signs of a potential
pulmonary embolism or atelectasis. Supplemental oxygen and oxygen saturation
monitoring are the initial steps to address potential hypoxia. Pain medication might mask
symptoms and does not address the underlying respiratory distress. An EKG is useful for
, ruling out MI but follows basic airway/breathing interventions. Rapid assessment and
oxygenation are essential in acute post-operative complications.
6. A nurse is caring for a patient with Acute Respiratory Distress Syndrome (ARDS) who is on a
mechanical ventilator. Which strategy is most effective for improving oxygenation in this
patient?
A. High-volume tidal ventilation
B. Supine positioning only
C. Prone positioning
D. Increasing the FiO2 to 100% indefinitely
Correct Answer: C
Expert Explanation: Prone positioning helps recruit collapsed alveoli in the dorsal regions
of the lungs and improves ventilation-perfusion matching. High tidal volumes can cause
ventilator-associated lung injury and are avoided in ARDS. Prolonged exposure to 100%
FiO2 can lead to oxygen toxicity and should be titrated down as possible. Supine
positioning often leads to further atelectasis in ARDS patients. Evidence-based practice
supports prone positioning as a standard maneuver for severe ARDS.
7. In a patient with SIADH (Syndrome of Inappropriate Antidiuretic Hormone), which
laboratory value is the nurse most likely to observe?
A. Serum sodium of 120 mEq/L
B. Serum osmolality of 320 mOsm/kg
C. Urine specific gravity of 1.002
D. Hematocrit of 55%
Correct Answer: A
Expert Explanation: SIADH involves excessive water retention, leading to dilutional
hyponatremia. A serum sodium of 120 mEq/L is a classic finding of this fluid overload state.
Serum osmolality in SIADH is typically low, not high, due to the excess water. Urine specific
gravity would be high because the urine is very concentrated, whereas 1.002 is dilute. High
hematocrit indicates dehydration, which is the opposite of the fluid volume excess seen in
SIADH.
8. A nurse is preparing to administer a blood transfusion. What is the most critical step to
prevent a hemolytic transfusion reaction?
A. Warming the blood to room temperature before administration.
B. Using a 22-gauge catheter for the IV access.
C. Administering diphenhydramine before starting the transfusion.
