3276 Adult Nursing II - Final Exam Review (Qns & Ans) - OSU 2025, Exams of Nursing

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3276 Adult Nursing II

Final Exam Review

(Questions & Solutions)

1. Multiple Choice Question: A 82‑year‑old male with a history of congestive heart failure, chronic kidney disease, and diabetes presents to the ED with acute dyspnea and confusion. Which initial assessment parameter is most critical to determine his imminent risk?

• A. Temperature
• B. Oxygen saturation
• C. Blood glucose
• D. Jugular venous distension Correct ANS : B. Oxygen saturation Rationale: Oxygen saturation provides a rapid measure of tissue oxygenation. In patients with multiple chronic comorbidities, hypoxemia may signal imminent decompensation and necessitates urgent intervention.

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2. Fill-in-the-Blank Question: The systematic framework consisting of assessment, diagnosis, planning, implementation, and evaluation is known as the __________. Correct ANS : nursing process Rationale: The nursing process is the foundational structure for delivering individualized, evidence‑based care. It is essential in both acute and

Rationale: A complete assessment integrates objective physiologic data, mental status, nutritional history, and the patient's social context. An astrological sign (E) is not relevant to clinical decision-making.

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

• A. High tidal volume ventilation
• B. Lung‑protective ventilation with low tidal volumes and optimal PEEP
• C. Pressure‑controlled ventilation with minimal PEEP
• D. Immediate conversion to non‑invasive ventilation Correct ANS : B. Lung‑protective ventilation with low tidal volumes and optimal PEEP Rationale: Lung‑protective ventilation (using low tidal volumes around 6 mL/kg of predicted body weight along with appropriate PEEP) minimizes alveolar overdistension and injury. This strategy is key for patients with compromised pulmonary reserves.

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6. Fill-in-the-Blank Question: When adjusting medication dosages in patients with renal impairment, nurses estimate drug clearance using calculations of __________ clearance.

Correct ANS : creatinine Rationale: Creatinine clearance is used (via formulas such as Cockcroft–Gault) to estimate renal function. This estimation enables safe medication dosing and prevents drug accumulation in patients with decreased renal excretion.

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7. True/False Question: True or False: Early goal‑directed therapy (EGDT) in septic patients— especially administering antibiotics within the first hour—is critical to preventing progression to multi‑organ failure. Correct ANS : True Rationale: EGDT strives to quickly optimize hemodynamic parameters and initiate antimicrobial therapy, thereby reducing mortality and preventing further organ dysfunction in septic patients.

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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
• B. Reviewing each medication’s indication, dose, and interaction profile
• C. Relying solely on established long‑term prescriptions without periodic review

Question: Care that incorporates shared decision‑making with patients and their families, respecting their values and preferences, is termed __________ care. Correct ANS : patient‑ and family‑centered Rationale: Patient‑ and family‑centered care involves engaging both the patient and family in care planning. This collaborative approach improves outcomes by ensuring that treatments align with individual goals and cultural values.

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11. True/False Question: True or False: Due to complex medication regimens, older adults are at increased risk for adverse drug events, which mandates frequent medication reviews. Correct ANS : True Rationale: Polypharmacy in older adults increases the likelihood of drug–drug interactions and adverse effects; therefore, regular medication reconciliation is essential for maintaining patient safety.

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12. Multiple Response Question: Which components are critical to an effective discharge plan for an adult

with chronic health alterations following an acute hospitalization? (Select all that apply)

• A. Detailed medication management instructions
• B. Scheduled follow‑up appointments and laboratory tests
• C. Coordination with home health services and rehabilitation programs
• D. Clear patient and family education about warning signs
• E. A generic discharge packet with non‑specific instructions Correct ANS s: A, B, C, D Rationale: Discharge planning must be individualized, including clear instructions, follow‑up plans, and coordination with support services. A generic packet (E) is insufficient to address complex patient 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 to complement medical management?

• A. Strict bed rest
• B. Early mobilization as tolerated
• C. Complete fluid restriction without individualized assessment
• D. Isolation from family and caregivers Correct ANS : B. Early mobilization as tolerated Rationale: Early mobilization helps reduce complications such as deconditioning and thromboembolism while also promoting recovery, provided it is implemented safely in an individualized manner.

16. Multiple Response Question: Which aspects of interdisciplinary collaboration are essential in the care of acutely ill adults with multiple comorbidities? (Select all that apply)

• A. Regular communication among nursing, physician, and pharmacy teams
• B. Inclusion of case managers and social workers in transitional planning
• C. Use of standardized, evidence‑based protocols
• D. Decision-making made solely by the primary physician without consultation
• E. Active family involvement in care discussions Correct ANS s: A, B, C, E Rationale: Effective interdisciplinary collaboration involves input from multiple healthcare professionals and the family. Relying exclusively on one provider (D) may neglect important aspects of comprehensive care.

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17. Multiple Choice Question: A 75‑year‑old patient with chronic renal failure develops hyperkalemia and shows signs of cardiac arrhythmia. Which immediate pharmacologic intervention should be prioritized?

• A. High‑volume IV fluids
• B. Intravenous calcium gluconate
• C. Oral potassium‑binding resins
• D. Beta‑agonist administration Correct ANS :

B. Intravenous calcium gluconate Rationale: IV calcium gluconate stabilizes the myocardial cell membrane in hyperkalemia and is the immediate treatment to reduce the risk of fatal arrhythmias, while additional measures to reduce serum potassium are being initiated.

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18. Fill-in-the-Blank Question: Before initiating advanced interventions in acutely ill patients with complex conditions, it is essential to perform a __________ assessment to establish a baseline for ongoing evaluation. Correct ANS : comprehensive Rationale: A comprehensive assessment that includes physical, cognitive, psychosocial, and functional domains is critical to tailoring interventions and tracking patient progress over time.

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

• B. Delaying pharmacologic therapy until full lab data are available
• C. Starting high‑dose diuretics for volume control
• D. Initiating beta‑blocker treatment immediately in all cases Correct ANS : A. Immediate initiation of antiplatelet and reperfusion therapy Rationale: Rapid reperfusion therapy, combined with antiplatelet agents, minimizes the extent of myocardial injury and improves survival rates. Delaying treatment can result in irreversible damage.

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22. Fill-in-the-Blank Question: 

Clinical practice guidelines are integral to evidence‑based care because they provide standardized, __________ recommendations that help clinicians deliver consistent treatment. Correct ANS : evidence‑based Rationale: Evidence‑based recommendations synthesize current research and expert consensus, ensuring that treatment protocols are reliable and current, and help reduce practice variability.

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23. True/False Question: 

True or False: Continuous monitoring of vital signs and physiologic parameters is essential for early detection of deterioration in acutely ill patients.

Correct ANS : True Rationale: Continuous monitoring allows clinicians to promptly identify and respond to adverse clinical changes, which is particularly important in the management of critically ill adults.

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

• A. Noise levels and sleep quality
• B. Appropriate lighting and orientation cues
• C. Family presence and support
• D. Institutional policies regarding staff communication
• E. The patient’s preferred background music on loop throughout the day Correct ANS s: A, B, C, D Rationale: The physical environment (noise and light), family involvement, and system-level practices all contribute to patient recovery. While preferred music (E) can have a beneficial effect, it is secondary and may vary by individual.

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25. Multiple Choice Question:

is associated with earlier detection of deterioration and improved outcomes in acutely ill patients. Correct ANS : True Rationale: Rapid response teams provide immediate assessment and intervention for patients showing signs of deterioration, thereby reducing the incidence of cardiac arrest and other critical events through prompt actions.

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28. Multiple Response Question: Which nursing actions are vital in minimizing adverse drug events in the care of older adults with complex medication regimens? (Select all that apply)

• A. Performing regular medication reconciliation
• B. Utilizing electronic documentation with interaction alerts
• C. Educating patients about their medications and potential side effects
• D. Relying solely on previous prescriptions without ongoing review
• E. Collaborating closely with pharmacy services Correct ANS s: A, B, C, E Rationale: Regular reconciliation, use of technology to flag interactions, patient education, and interdisciplinary collaboration help decrease the risk of adverse events. Reliance on unchanged prescriptions (D) can lead to errors and is not acceptable.

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29. Multiple Choice Question: An older adult with acute respiratory distress is being managed in the ICU. Which evidence-based ventilatory strategy is recommended to minimize lung injury?

• A. High tidal volume ventilation
• B. Use of an alveolar recruitment strategy with low tidal volumes
• C. Exclusive reliance on non-invasive ventilation
• D. Rapid weaning regardless of oxygenation parameters Correct ANS : B. Use of an alveolar recruitment strategy with low tidal volumes Rationale: A strategy utilizing low tidal volumes, combined with appropriate recruitment maneuvers (such as PEEP adjustments), minimizes ventilator-induced lung injury. This is particularly essential in the care of older adults with fragile pulmonary systems. A 78-year-old patient with a history of heart failure presents to the emergency department with shortness of breath, crackles in the lungs, and a heart rate of 110 bpm. Which of the following medications should the nurse anticipate administering first? a) Furosemide b) Lisinopril c) Digoxin d) Metoprolol ANS : a) Furosemide Rationale: Furosemide is a loop diuretic that rapidly reduces fluid overload, a common manifestation of heart failure exacerbation. It

afterward. d) Offer small bites of food. e) Encourage the patient to eat as quickly as possible to maintain nutritional intake. ANS : a, b, c, d Rationale: These interventions reduce the risk of aspiration. Rapid eating should be avoided to prevent aspiration. Multiple Choice: A patient with a history of COPD is admitted with an acute exacerbation. Which of the following assessment findings would indicate the greatest need for immediate intervention? a) A productive cough with yellow sputum. b) A respiratory rate of 28 breaths/min and use of accessory muscles. c) A SpO2 of 92% on room air. d) A PaCO2 of 48 mmHg. ANS : b) A respiratory rate of 28 breaths/min and use of accessory muscles. Rationale: This indicates increased work of breathing and potential respiratory distress. Fill-in-the-Blank: The Glasgow Coma Scale (GCS) is used to assess a patient's level of consciousness. A GCS score of _ indicates a patient is in a coma. ANS : 8 or less Rationale: A GCS score of 8 or less is generally considered indicative of

a coma. True/False: In a patient with a suspected pulmonary embolism, the nurse should immediately administer oxygen and prepare for a chest X-ray. ANS : True Rationale: Oxygenation is a priority, and a chest X-ray can help rule out other causes of respiratory distress. Multiple Response: A patient with diabetes is experiencing hypoglycemia. Which of the following interventions should the nurse implement? (Select all that apply.) a) Administer 15 grams of a fast-acting carbohydrate. b) Recheck the blood glucose in 15 minutes. c) Administer intravenous dextrose if the patient is unable to take oral carbohydrates. d) Administer insulin. e) Encourage the patient to eat a meal high in protein. ANS : a, b, c Rationale: These interventions are appropriate to treat hypoglycemia. Insulin would worsen the condition, and a meal high in protein would not be the first action. Multiple Choice: A patient is admitted with a head injury. The nurse notes clear fluid leaking from the patient's nose. What is the priority nursing action?