3275 Adult Nursing 1 - Final Exam Review (Qns & Ans) - OSU 2025, Exams of Nursing

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3275 Adult Nursing 1

Final Exam Review

(Questions & Solutions)

1. Multiple Choice Question: An 82-year-old male with a history of congestive heart failure, chronic kidney disease, and diabetes presents to the emergency department with acute shortness of breath and confusion. Which initial assessment parameter is most critical to determine the immediacy of his decompensation?

• A. Temperature
• B. Oxygen saturation
• C. Blood glucose
• D. Jugular venous distension Correct ANS : B. Oxygen saturation Rationale: Oxygen saturation provides immediate information about tissue oxygenation and respiratory function. In an acutely decompensating older adult, hypoxemia is a life-threatening sign that necessitates prompt intervention.

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2. Fill-in-the-Blank Question: The systematic framework comprising assessment, diagnosis, planning, implementation, and evaluation that guides individualized care is known as the __________. Correct ANS : nursing process

A, B, C, D

Rationale: A thorough assessment must include objective physiologic measurements, evaluation of mental status, nutritional history, and social/cultural context. An astrological sign (E) has no relevance in clinical assessment.

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5. Multiple Choice Question: A 70-year-old female with COPD and heart failure is admitted with severe pneumonia. To optimize her oxygenation while minimizing the risk of ventilator-induced lung injury, which strategy is most appropriate?

• A. High tidal volume ventilation
• B. Lung-protective ventilation with low tidal volumes and appropriate PEEP
• C. Pressure-controlled ventilation with minimal PEEP
• D. Immediate transition to non-invasive ventilation Correct ANS : B. Lung-protective ventilation with low tidal volumes and appropriate PEEP Rationale: Lung-protective ventilation (approximately 6 mL/kg of predicted body weight with appropriate PEEP) minimizes the risk of barotrauma and volutrauma, which is especially important in patients with compromised pulmonary reserve.

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6. Fill-in-the-Blank Question:

When adjusting medication dosages in patients with renal impairment, nurses calculate estimated __________ clearance—often via the Cockcroft–Gault equation. Correct ANS : creatinine Rationale: Estimating creatinine clearance helps assess renal function and guides dosage adjustments for renally excreted drugs, reducing the risk of toxicity.

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7. True/False Question: True or False: Early goal-directed therapy in septic patients—including the administration of antibiotics within the first hour—is essential to reducing mortality. Correct ANS : True Rationale: Timely interventions in sepsis, such as early antibiotic administration and hemodynamic optimization, are proven to reduce mortality and prevent progression to multi-organ dysfunction.

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8. Multiple Response Question: Which strategies are essential to safely managing polypharmacy in older adults with multiple chronic conditions? (Select all that apply)

• A. Regular medication reconciliation

10. Fill-in-the-Blank Question: Approaches that actively include patients and their families in care decisions—respecting their values and preferences—are described as __________ care. Correct ANS : patient- and family-centered Rationale: Patient- and family-centered care ensures that treatment plans are mutually agreed upon and tailored to the unique needs of the patient, improving satisfaction and adherence.

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11. True/False Question: True or False: Polypharmacy in older adults is associated with an increased risk of adverse drug events, making regular medication reviews essential. Correct ANS : True Rationale: Older adults are at a higher risk for drug interactions and side effects due to polypharmacy. Regular review and reconciliation of medications are necessary to maintain safety.

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12. Multiple Response

Question: Which components should be included in discharge planning for an adult with chronic health alterations and recent acute decompensation? (Select all that apply)

• A. Detailed medication management instructions
• B. Scheduled follow-up appointments and lab tests
• C. Coordination with home health and rehabilitation services
• D. Clear education regarding warning signs and when to seek help
• E. A generic discharge summary without personalization Correct ANS s: A, B, C, D Rationale: Effective discharge planning requires detailed, individualized instructions, follow-up care, and education, ensuring a safe transition from hospital to home. A generic summary (E) does not meet these personalized needs.

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13. Multiple Choice Question: 

For an adult with chronic heart failure experiencing an acute exacerbation, which non-pharmacologic intervention is most beneficial alongside medical management?

• A. Complete bed rest
• B. Early mobilization as tolerated
• C. Strict fluid restriction without monitoring
• D. Isolation from family visits Correct ANS : B. Early mobilization as tolerated Rationale: Early mobilization helps prevent complications related to immobility

16. Multiple Response Question: Which elements of interdisciplinary care are vital when managing acutely ill adults with complex chronic conditions? (Select all that apply)

• A. Collaborative communication among nurses, physicians, and pharmacists
• B. Involvement of case managers and social workers in discharge planning
• C. Implementation of standardized treatment protocols
• D. Decision-making dictated solely by the attending physician
• E. Active family involvement in care discussions Correct ANS s: A, B, C, E Rationale: Interdisciplinary collaboration—including input from multiple healthcare professionals and family involvement—enhances the quality and safety of care. Sole decision-making by one discipline (D) does not capture the holistic needs of the patient.

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17. Multiple Choice Question: A 75-year-old patient with chronic renal failure develops hyperkalemia and is at risk for arrhythmias. Which immediate nursing intervention is indicated to protect the myocardium?

• A. Infusion of high-volume isotonic saline
• B. Administration of intravenous calcium gluconate
• C. Oral administration of potassium-binding agents
• D. Immediate diuretic therapy

Correct ANS : B. Administration of intravenous calcium gluconate Rationale: Calcium gluconate stabilizes the cardiac cell membrane in the setting of hyperkalemia, reducing the risk of arrhythmias while additional measures to lower potassium are initiated.

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18. Fill-in-the-Blank Question: Prior to initiating advanced interventions in acutely ill adults, a thorough __________ assessment is essential to establish a baseline for ongoing evaluation and intervention adjustments. Correct ANS : comprehensive Rationale: A comprehensive assessment includes physical, cognitive, psychosocial, and functional domains. Establishing a robust baseline allows for continuous monitoring and tailored adjustments in care.

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19. True/False Question: True or False: Beta-blockers are contraindicated in patients with acute myocardial infarction if they are in cardiogenic shock due to their negative inotropic effects. Correct ANS : True

• B. Withhold all medications until re-assessment
• C. Provide an oral carbohydrate-rich drink
• D. Schedule a family meeting to discuss long-term care goals Correct ANS : A. Initiate rapid IV fluid resuscitation after obtaining necessary cultures Rationale: In an acutely decompensated, dehydrated patient, stabilizing hemodynamics with fluid resuscitation is critical. Cultures are obtained if infection is suspected, but addressing volume deficits is the immediate priority.

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22. Fill-in-the-Blank Question: 

The practice of designing care plans that are tailored to each patient’s unique clinical, psychosocial, and cultural needs is known as __________ care. Correct ANS : individualized Rationale: Individualized care ensures that interventions address the patient’s specific conditions, preferences, and circumstances, leading to more effective and respectful care.

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23. True/False Question: 

True or False: “Silent hypoxia,” where patients have dangerously low oxygen levels without prominent dyspnea, is an increasingly recognized

phenomenon in acute respiratory conditions in adults. Correct ANS : True Rationale: Silent hypoxia has been observed in various acute conditions (for example, in some COVID-19 patients) and underscores the need for diligent monitoring of oxygen saturation rather than reliance solely on subjective dyspnea.

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24. Multiple Response Question: Which non-pharmacologic interventions are crucial for promoting recovery in acutely ill adults with chronic conditions? (Select all that apply)

• A. Nutritional support and tailored dietary recommendations
• B. Physical therapy and early mobilization
• C. Psychological support and stress management strategies
• D. Strict bed rest without repositioning
• E. Family education and involvement in care planning Correct ANS s: A, B, C, E Rationale: Non-pharmacologic interventions play a critical role in recovery. Nutritional support, mobilization, psychological care, and family engagement are beneficial, while strict prolonged immobilization (D) typically increases the risk of complications.

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27. True/False Question: True or False: Continuous monitoring of vital signs and other physiologic parameters is essential for early detection of deterioration in acutely ill adults. Correct ANS : True Rationale: Continuous monitoring allows for immediate detection of subtle changes in patient status, enabling rapid intervention. This is especially important in critically ill patients who may deteriorate quickly.

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28. Multiple Response Question: Which environmental factors within the hospital setting can significantly influence outcomes in acutely ill adults? (Select all that apply)

• A. Noise levels and sleep quality
• B. Adequate lighting and orientation cues
• C. Family presence and support
• D. Institutional policies on resource allocation
• E. The patient’s favorite music Correct ANS s: A, B, C, D Rationale: The patient’s physical environment—including noise, lighting, family involvement, and institutional culture—affects recovery and well-being. Although preferred music (E) may be beneficial when offered, it is not as

critical as the other factors listed.

29. Multiple Choice Question: During a routine medication review for an older adult with chronic obstructive pulmonary disease (COPD) and heart failure, which strategy is most effective for identifying potential adverse interactions?

• A. Relying solely on the prescriber’s initial order
• B. Utilizing an electronic medication reconciliation system with built-in interaction alerts
• C. Limiting the review to medications prescribed during the current admission
• D. Deferring the review until the patient is discharged Correct ANS : B. Utilizing an electronic medication reconciliation system with built-in interaction alerts Rationale: An electronic medication reconciliation system can systematically identify potential drug–drug interactions, especially in patients with complex regimens. This promotes safety and reduces the likelihood of adverse events.

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30. Fill-in-the-Blank Question: Prior to initiating advanced interventions in acutely ill patients with both acute and chronic health alterations, it is imperative to perform a __________ assessment to establish a baseline for continuous evaluation.

depleted due to osmotic diuresis.

3. True/False: A patient with a severe traumatic brain injury (TBI) requires frequent neurological assessments. The nurse should prioritize monitoring the patient's level of consciousness, pupillary response, and motor function. ANS : True Rationale: These assessments are critical for detecting changes in neurological status and preventing further complications.
4. Multiple Response: A patient is admitted with a diagnosis of sepsis. The nurse recognizes which of the following as early signs and symptoms of sepsis? (Select all that apply.) a) Elevated blood pressure. b) Fever or hypothermia. c) Tachycardia. d) Decreased urine output. e) Confusion. ANS : b) Fever or hypothermia, c) Tachycardia, e) Confusion. Rationale: These are common early indicators of the systemic inflammatory response syndrome (SIRS) associated with sepsis.
5. Multiple Choice: A patient undergoing chemotherapy develops neutropenia. The nurse's primary concern is: a) Risk of bleeding. b) Risk of infection.

c) Risk of anemia. d) Risk of fluid overload. ANS : b) Risk of infection. Rationale: Neutropenia (low neutrophil count) significantly increases the patient's susceptibility to infection.

6. Fill-in-the-Blank: A patient with chronic obstructive pulmonary disease (COPD) experiences an acute exacerbation. The nurse anticipates that the patient may require _ and _ to manage the exacerbation. ANS : Bronchodilators, Corticosteroids Rationale: These medications help to open airways and reduce inflammation.
7. True/False: A patient with a spinal cord injury at the level of T6 is at risk for autonomic dysreflexia. The nurse should be prepared to assess for and treat this potentially life-threatening condition. ANS : True Rationale: Autonomic dysreflexia is a common complication of spinal cord injuries above T6, triggered by noxious stimuli.
8. Multiple Response: A patient with a history of atrial fibrillation is prescribed warfarin. The nurse should educate the patient on which of the following? (Select all that apply.) a) The importance of regular blood tests (INR monitoring). b) The need to avoid foods high in vitamin K.