2026 ACTUAL EXAM FULL SOLUTION
◍ the nurse is admitting a stable patient for a minor outpatient
procedure. what site would the nurse most commonly use to assess
pulse rate?
a- radial site
b- apical site
c- brachial site
d- carotid site. Answer: a
◍ the UAP reports vital signs for a patient to the nurse: temp of 99.2
oral, pulse of 88bpm and regular respirations of 18bpm, BP
178/112mmHg, O2 sat of 96%. which vital sign should the nurse be
most concerned about?
a- temp
b- pulse
c- respiration
d- BP. Answer: d
◍ From the nurse's understanding, which statements regarding
temperature and heat production in the body are accurate? (Select all
that apply.)
a. Heat generates energy for cellular functions.
,b. Hormones, such as the thyroid, decrease metabolism and heat
production.
c. Exercise decreases heat production through muscular activity.
d. Body temperature is 1º to 2º higher in the morning than in late
afternoon.
e. Expected temperature readings vary by the route selected for
measurement.
f. Women tend to have more fluctuations in temperature than do men..
Answer: a, d, e
◍ the nurse is performing an initial assessment of a patient with a
severe infection at hospital admission. vital signs for the patient
indicate hypotension and tachycardia. which data would support this
evaluation?
a- pulse 78, BP 140/88
b- pulse 86, BP 120/76
c- pulse 100, BP 118/68
d- pulse 114, BP 88/56. Answer: d
◍ The nurse places a patient with a high fever on a cooling blanket.
How is heat loss achieved with this treatment?
a. Radiation
b. Convection
c. Conduction
d. Evaporation. Answer: c
, ◍ which clinical patient scenario is associated with the most critical
need for the nurse to obtain vital signs?
a- ambulating for the first time after surgery
b- complaining of pressure in the chest
c- completing ambulating 100ft after a stroke
d- complaining of hunger while NPO (nothing by mouth). Answer: b
◍ the nurse understands that which statement is correct regarding
respiratory rates?
a- infants have a lower respiratory rate
b- healthy adults breathe between 12-20 times a minute
c- a compensatory response to a fever is to breathe at a slower rate
d- an increase in intracranial pressure results in an increase rate.
Answer: b
◍ the nurse is caring for a patient who has a blood pressure of
184/110. an hour after administering an antihypertensive med, the
nurse returns to recheck the BP, only to find the patient in the chair
pale, sweaty, feeling faint. which is the expected explanation for the
nurse's observation?
a- the BP is 184/110; medication has no effect
b- the BP is 118/76; the sudden drop has caused the signs
c- the BP is 174/96; the medication has made the patient sick
d- the BP is 13-/82; the symptoms are from another cause. Answer: b