NUR 320 Exam #4 Summer 2025
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Free NUR 320 Exam #4 Summer 2025 Questions
1. A client in critical condition is conscious, panicking, and questioning if they are going to survive. The MOST appropriate therapeutic response from the nurse would be:
- A. "I will call your physician NOW. There are medicines that can help you."
- B. "I understand you are anxious; I will stay right here by your side."
- C. "I promise you'll be fine. You're working with the best ER team in town."
- D. "You aren't going to die. I promise that everything is ok."
Explanation
This statement is therapeutic and supportive, acknowledging the client’s fear and providing emotional reassurance without giving false promises. By expressing understanding and a commitment to stay, the nurse conveys empathy, calm presence, and trust — essential for reducing anxiety in a panicking, critically ill client. This promotes psychological safety and emotional stability in a life-threatening situation.
2. An 87-year-old client suffered a fall while at home and sustained a right hip fracture. As the client awaits surgery, the healthcare provider (HCP) orders strict bedrest. To prevent complications of immobility, the nurse will complete the following interventions. Select all that apply. One, some, or all options may be correct.
- A. Teach the client to reposition while in bed every 2 hours.
- B. Insert an indwelling urinary catheter.
- C. Encourage the client to consume a diet rich in protein prior to being NPO for surgery.
- D. Administer an anti-diarrheal.
- E. Teach the client to use an incentive spirometer as often as they are able every hour.
Explanation
A. Teach the client to reposition while in bed every 2 hours.
Frequent repositioning prevents pressure injuries and promotes circulation in immobile clients. Turning every 2 hours reduces tissue ischemia, a major complication of immobility in bedbound elderly patients.
C. Encourage the client to consume a diet rich in protein prior to being NPO for surgery.
Protein promotes tissue repair and healing, strengthens muscles, and maintains immune function. A high-protein diet before surgery helps minimize muscle wasting and supports recovery after surgical repair.
E. Teach the client to use an incentive spirometer as often as they are able every hour.
Using an incentive spirometer helps prevent atelectasis and pneumonia by promoting lung expansion and improving oxygenation during immobility. It’s a key intervention to maintain respiratory function preoperatively.
Frequent repositioning prevents pressure injuries and promotes circulation in immobile clients. Turning every 2 hours reduces tissue ischemia, a major complication of immobility in bedbound elderly patients.
C. Encourage the client to consume a diet rich in protein prior to being NPO for surgery.
Protein promotes tissue repair and healing, strengthens muscles, and maintains immune function. A high-protein diet before surgery helps minimize muscle wasting and supports recovery after surgical repair.
E. Teach the client to use an incentive spirometer as often as they are able every hour.
Using an incentive spirometer helps prevent atelectasis and pneumonia by promoting lung expansion and improving oxygenation during immobility. It’s a key intervention to maintain respiratory function preoperatively.
3. When reviewing the client's MAR, the nurse recognizes that the client has 14 medications ordered for 0900. The nurse knows that which term is the most appropriate when referencing this client's upcoming medication pass?
- A. Multidose
- B. Multilingual
- C. Medication reconciliation
- D. Polypharmacy
Explanation
Polypharmacy refers to the use of multiple medications by a single client, often five or more at one time. This situation increases the risk of drug interactions, side effects, and medication errors, especially in older adults or those with chronic conditions. A client with 14 medications scheduled for one time clearly demonstrates polypharmacy, requiring close monitoring and possible review of necessity and compatibility.
4. Nurse Note
0700 am:
An 87-year-old client is admitted to the ER with weakness and fatigue. The client has a history of type 1 diabetes, smoking, and coronary artery disease. The client is wheelchair-bound and states that they have a nurse visit them at home 3 times per day to help them get out of bed and assist with their medication.
0800 am:
The nurse completes a complete head-to-toe assessment and notes the following during the assessment of the integument. Non-blanchable redness and partial thickness tissue loss to the left heel.
Vital Signs
HR-95
SpAO2-98% room air
Blood glucose- 150
Pain - 0/10 on a scale of 0-10
Labs
WBC-27,000
Albumin- 12 g/L
H/H- 13.0/38
Based on the nurse’s note and the table provided, which Action To Take, Potential Condition, and Parameter to Monitor are correctly matched for this client’s current findings?
0700 am:
An 87-year-old client is admitted to the ER with weakness and fatigue. The client has a history of type 1 diabetes, smoking, and coronary artery disease. The client is wheelchair-bound and states that they have a nurse visit them at home 3 times per day to help them get out of bed and assist with their medication.
0800 am:
The nurse completes a complete head-to-toe assessment and notes the following during the assessment of the integument. Non-blanchable redness and partial thickness tissue loss to the left heel.
Vital Signs
HR-95
SpAO2-98% room air
Blood glucose- 150
Pain - 0/10 on a scale of 0-10
Labs
WBC-27,000
Albumin- 12 g/L
H/H- 13.0/38
Based on the nurse’s note and the table provided, which Action To Take, Potential Condition, and Parameter to Monitor are correctly matched for this client’s current findings?
- A. Position the client to remove pressure off of bony extremity – Atelectasis – Blood Glucose
- B. Call the healthcare provider – Blood clot – Oxygen saturation
- C. Massage any reddened areas on the client’s body – Pressure injury – WBC count
- D. Position the client to remove pressure off of bony extremity – Pressure injury – WBC count
Explanation
The client’s left heel shows non-blanchable redness and partial-thickness tissue loss, consistent with a pressure injury. The appropriate nursing action is to remove pressure from bony prominences to prevent further tissue breakdown. Monitoring the WBC count is essential because an elevated value (27,000) indicates a potential infection associated with the wound. Relieving pressure and closely observing for infection are the top nursing priorities in this scenario.
5. If a nurse is using the Braden Scale for a client, the nurse is utilizing the scale to determine:
- A. Risk for impaired nutrition
- B. Risk for falls
- C. Risk for aspiration
- D. Risk for skin breakdown
Explanation
The Braden Scale is a validated assessment tool used to determine a client’s risk for developing pressure injuries (skin breakdown). It evaluates six categories: sensory perception, moisture, activity, mobility, nutrition, and friction/shear. Each category is scored from 1 to 4, with lower total scores indicating higher risk. Early identification using the Braden Scale enables the nurse to implement preventive measures such as repositioning, skin protection, and moisture control.
6. After surgery, the client with a closed abdominal wound reports a sudden "pop" after coughing. When the nurse examines the wound site, the sutures are open and the bowel can be seen protruding from the wound. Which of the following are appropriate nursing interventions? Select all that apply. One, some, or all options may be correct.
- A. Put the patient on NPO status.
- B. Apply a cold compress to the exposed bowel.
- C. Notify the surgical team immediately.
- D. Place dressing dampened with sterile water/saline over the area.
- E. Elevate the head of the bed 90 degrees.
Explanation
A. Put the patient on NPO status
The client should be kept nothing by mouth (NPO) in anticipation of emergency surgical repair. Eating or drinking could increase the risk of aspiration and delay surgery. This step prevents complications if anesthesia must be administered urgently.
C. Notify the surgical team immediately
This is a medical emergency known as evisceration, requiring immediate surgical intervention. The nurse must notify the surgeon and operating room team right away so that the client can be prepared for emergency surgery. Prompt communication helps prevent bowel necrosis and infection.
D. Place dressing dampened with sterile water/saline over the area
The nurse should cover the protruding bowel with sterile saline-moistened dressings to keep the exposed tissues moist and prevent drying, which could lead to tissue necrosis. Dry dressings or gauze must never be used because they can adhere to the organs and cause further damage when removed.
The client should be kept nothing by mouth (NPO) in anticipation of emergency surgical repair. Eating or drinking could increase the risk of aspiration and delay surgery. This step prevents complications if anesthesia must be administered urgently.
C. Notify the surgical team immediately
This is a medical emergency known as evisceration, requiring immediate surgical intervention. The nurse must notify the surgeon and operating room team right away so that the client can be prepared for emergency surgery. Prompt communication helps prevent bowel necrosis and infection.
D. Place dressing dampened with sterile water/saline over the area
The nurse should cover the protruding bowel with sterile saline-moistened dressings to keep the exposed tissues moist and prevent drying, which could lead to tissue necrosis. Dry dressings or gauze must never be used because they can adhere to the organs and cause further damage when removed.
7. The nurse is discussing home medications with the client. The nurse knows that metabolism of medications occurs mostly in the:
- A. Stomach
- B. Heart
- C. Liver
- D. Pancreas
Explanation
The liver is the primary organ responsible for drug metabolism. It contains enzymes, particularly from the cytochrome P450 system, which chemically alter medications into inactive or more easily excretable forms. This process, known as biotransformation, helps prevent drug toxicity and maintains therapeutic levels. Impaired liver function (e.g., due to cirrhosis or hepatitis) can delay metabolism, leading to drug accumulation and adverse effects—making liver assessment vital in medication management.
8. The nurse is preparing to administer 350 mg Acetaminophen PO every 6 hours PRN for mild pain. The nurse will ensure which order for the proper 6 rights of medication administration?
- A. right dose, right route, right medication, right indication, right time, right situation
- B. right day, right expiration date, right drug, right patient, right computer, right documentation
- C. right patient, right drug, right dose, right route, right time, right documentation
- D. right patient, right drug, right dose, right time, right hospital, right situation
Explanation
The six rights of medication administration ensure patient safety and prevent medication errors. They include:
1. Right patient – Verify identity using two identifiers (name and date of birth).
2. Right drug – Confirm the medication matches the provider’s order.
3. Right dose – Ensure the dosage is accurate and within safe limits.
4. Right route – Verify the correct method of administration (PO).
5. Right time – Administer at correct intervals (every 6 hours).
6. Right documentation – Record administration accurately and promptly after giving the medication.
These steps collectively safeguard against adverse drug events and uphold nursing accountability.
1. Right patient – Verify identity using two identifiers (name and date of birth).
2. Right drug – Confirm the medication matches the provider’s order.
3. Right dose – Ensure the dosage is accurate and within safe limits.
4. Right route – Verify the correct method of administration (PO).
5. Right time – Administer at correct intervals (every 6 hours).
6. Right documentation – Record administration accurately and promptly after giving the medication.
These steps collectively safeguard against adverse drug events and uphold nursing accountability.
9. A 65-year-old client is recovering from surgery and is going to ambulate for the first time in 12 hours. A priority intervention prior to ambulation includes
- A. Obtaining an OT order and arranging for an occupational therapist to visit the home within 24 hours.
- B. Sitting the client up in bed slowly and dangling their feet at the bedside prior to ambulation.
- C. Acquiring a walker for the client and setting up physical therapy sessions prior to discharge.
- D. Asking the client to describe their exercise schedule and consulting the home health department.
Explanation
After prolonged bed rest, a client is at increased risk for orthostatic hypotension due to blood pooling in the lower extremities. The nurse should first sit the client up gradually and allow them to dangle their legs at the bedside for several minutes before ambulating. This intervention helps the cardiovascular system adjust, prevents dizziness or fainting, and promotes safe mobility.
10. Which of the following are considered HIGH RISK medications?
- A. Potassium, vancomycin, insulin, and furosemide.
- B. Opioid and non-opioid pain medications.
- C. Potassium, insulins, opioids, chemotherapeutics, and heparin.
- D. Antibiotics, antifungals, antianginals, and anticoagulants.
Explanation
High-risk medications are drugs that carry a higher risk of causing significant patient harm when used incorrectly. According to the Institute for Safe Medication Practices (ISMP), medications such as potassium, insulins, opioids, chemotherapeutic agents, and heparin require special handling, double-checks, and monitoring. Errors with these medications can result in severe hypoglycemia, bleeding, respiratory depression, or cardiac arrhythmias, making them critical to administer with precision and vigilance.
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