NR 509 EXAM PREP 2026 STUDY SHEET WITH
FULL SOLUTIONS
▶ The nurse is a assessing a client with hypertension. Which client
outcome is indicative of effective hypertension management?
A) No complaints of sexual dysfunction occur.
B) Pedal edema is not present in the lower legs.
C) No indication of renal impairment is present.
D) The blood pressure reading is 148/94 mm Hg.. Answer: C
One expected outcome for a client with hypertension is for the client to
have no evidence of target organ damage, such as renal or heart disease,
that can occur with poorly managed hypertension. Development of pedal
edema is not directly related to the management of hypertension. Side
effects of some hypertensive agents may interfere with sexual function, but
this does not relate to the effectiveness of treatment for hypertension. The
blood pressure reading is too high to demonstrate effective management.
▶ What statement indicates that the client understands teaching about
neutropenia?
A) "I will call my doctor if I have an increase in temperature."
B) "My grandchildren may get an infection from me."
C) "I need to use a soft toothbrush."
D) "I have to wear a mask at all times.". Answer: A
Bone marrow suppression leads to neutropenia and increases the client's
risk for infection. Decreased numbers of neutrophils and other white blood
cells can minimize the clinical manifestations of infection. For this reason,
the client may not develop a high temperature, even with severe infection,
and any elevation of temperature should be reported immediately to the
health care provider. The client does not need to wear a mask or use a soft
toothbrush (although if the client has low platelets, he or she should use a
soft toothbrush to avoid causing trauma). The client is not contagious.
,▶ A client has a small-bore nasoenteric feeding tube. The nurse assesses
the following vital signs: temperature, 100.2° F (37.8° C); pulse, 112
beats/min; respiratory rate, 22 breaths/min; and blood pressure, 106/62
mm Hg. Which action by the nurse takes priority?
A) Auscultate bowel sounds and slow the feeding down.
B) Remove the tube immediately and notify the heath care provider.
C) Auscultate lung sounds and obtain oxygen saturation.
D) Add blue dye to the feeding tube formula.. Answer: C
The client may have aspirated. The nurse should further assess the client's
respiratory and oxygenation status. The client may have another reason for
the abnormal vital signs, so the nurse should not pull out the tube before
performing other assessments. Adding blue dye to the tube feeding formula
is not recommended to check for aspiration. Slowing the feeding down will
not be helpful.
▶ A client is receiving a chemotherapeutic agent intravenously through a
peripheral line. What is the nurse's first action when the client reports
burning at the site?
A) Apply a cold compress.
B) Discontinue the infusion.
C) Slow the rate of infusion.
D) Check for a blood return.. Answer: B
Both irritants and vesicants can cause tissue damage. If the nurse suspects
extravasation, he or she should immediately stop the infusion. Even if the
IV has a good blood return, some of the chemotherapeutic agent can still
be leaking into the tissues. Slowing the rate of infusion is not sufficient to
prevent further leakage and damage. Applying a cold compress may or
may not be the correct action, depending on the specific agent. However,
the compress would be applied only after the infusion has been
discontinued.
▶ which statement about a patient with a tube feeding indicates best
practice for patient safety & quality care?
A) if the tube becomes clogged, use 30 mL of water for flushing, while
applying gentle pressure with a 50 mL piston syringe
,B) when administering medications, use cold water to dissolve the drug
before administering it
C) use cranberry juice to flush the tube if it is clogged
D) administer drugs down the feeding tube without flushing first, but flush
the feeding tube after the drug is given. Answer: A
▶ A client has a wound on his left trochanter that is 4 inches in diameter,
with black tissue at the perimeter, and bone is exposed. Which is the
nurse's best action?
A) Document as a stage I pressure ulcer and apply a transparent dressing.
B) Document as a stage II pressure ulcer and start wet-to-dry gauze
treatments.
C) Document as a stage IV pressure ulcer and prepare the client for
débridement.
D) Document as a stage III pressure ulcer and start antibiotic therapy..
Answer: C
A stage IV ulcer is one in which skin loss is full thickness, with extensive
destruction, tissue necrosis, and/or damage to muscle, bone, or supporting
structures. Eschar may be present. When the bone of the trochanter area is
visible, tissue loss includes muscle loss. A potential intervention consists of
débridement of the necrotic tissue and a possible graft to promote healing.
▶ After initial placement of NG tubes is confirmed, how often must
placement be checked? SELECT ALL THAT APPLY?
A) before medication administration
B) it is not necessary to recheck placement
C) every 4-8 hours during feeding
D) before intermittent feeding
E) according to facility policy. Answer: A,C,E
▶ The nurse is preparing to administer tube feedings through a client's new
Salem sump nasogastric tube. The nurse is unable to withdraw any fluid
from the tube before starting the feeding. Which is the priority action of the
nurse?
A) Start the tube feeding as ordered and check the residual in 30 minutes.
, B) Inject air into the nasogastric tube while auscultating the client's
epigastric area.
C) Lower the head of the client's bed and attempt to aspirate fluid again.
D) Obtain orders for a chest x-ray to confirm placement before starting the
feeding.. Answer: D
The nurse must verify tube placement before beginning any tube feeding or
administering any medications through a tube. The most accurate way to
determine placement is via chest x-ray. The nurse could cause the client to
aspirate if she or he started the feeding then checked later for placement.
Insufflation does not provide accurate results and should not be used to
verify tube placement. The nurse must keep the client's head elevated at
least 30 degrees.
▶ A client has a urinary tract infection. Which assessment by the nurse is
most helpful?
A) Palpating and percussing the kidneys and bladder
B) Performing a bladder scan to assess post-void residual
C) Assessing medical history and current medical problems
D) Inquiring about recent travel to foreign countries. Answer: C
Clients who are severely immune compromised or who have diabetes
mellitus are more prone to fungal urinary tract infection. The nurse should
assess for these factors. A physical examination and a post-void residual
may be needed, but not until further information is obtained. Travel to
foreign countries probably would not be as important, because even if
exposed, the client needs some degree of immune compromise to develop
a fungal urinary tract infection.
▶ When a diabetic patient asks about maintaining adequate blood glucose
levels, which of the following statements by the nurse relates most directly
to the necessity of maintaining blood glucose levels no lower than about 74
mg/dl?
A) "Without a minimum level of glucose circulating in the blood,
erythrocytes cannot produce ATP."
B) "The presence of glucose in the blood counteracts the formation of lactic
acid and prevents acidosis."
FULL SOLUTIONS
▶ The nurse is a assessing a client with hypertension. Which client
outcome is indicative of effective hypertension management?
A) No complaints of sexual dysfunction occur.
B) Pedal edema is not present in the lower legs.
C) No indication of renal impairment is present.
D) The blood pressure reading is 148/94 mm Hg.. Answer: C
One expected outcome for a client with hypertension is for the client to
have no evidence of target organ damage, such as renal or heart disease,
that can occur with poorly managed hypertension. Development of pedal
edema is not directly related to the management of hypertension. Side
effects of some hypertensive agents may interfere with sexual function, but
this does not relate to the effectiveness of treatment for hypertension. The
blood pressure reading is too high to demonstrate effective management.
▶ What statement indicates that the client understands teaching about
neutropenia?
A) "I will call my doctor if I have an increase in temperature."
B) "My grandchildren may get an infection from me."
C) "I need to use a soft toothbrush."
D) "I have to wear a mask at all times.". Answer: A
Bone marrow suppression leads to neutropenia and increases the client's
risk for infection. Decreased numbers of neutrophils and other white blood
cells can minimize the clinical manifestations of infection. For this reason,
the client may not develop a high temperature, even with severe infection,
and any elevation of temperature should be reported immediately to the
health care provider. The client does not need to wear a mask or use a soft
toothbrush (although if the client has low platelets, he or she should use a
soft toothbrush to avoid causing trauma). The client is not contagious.
,▶ A client has a small-bore nasoenteric feeding tube. The nurse assesses
the following vital signs: temperature, 100.2° F (37.8° C); pulse, 112
beats/min; respiratory rate, 22 breaths/min; and blood pressure, 106/62
mm Hg. Which action by the nurse takes priority?
A) Auscultate bowel sounds and slow the feeding down.
B) Remove the tube immediately and notify the heath care provider.
C) Auscultate lung sounds and obtain oxygen saturation.
D) Add blue dye to the feeding tube formula.. Answer: C
The client may have aspirated. The nurse should further assess the client's
respiratory and oxygenation status. The client may have another reason for
the abnormal vital signs, so the nurse should not pull out the tube before
performing other assessments. Adding blue dye to the tube feeding formula
is not recommended to check for aspiration. Slowing the feeding down will
not be helpful.
▶ A client is receiving a chemotherapeutic agent intravenously through a
peripheral line. What is the nurse's first action when the client reports
burning at the site?
A) Apply a cold compress.
B) Discontinue the infusion.
C) Slow the rate of infusion.
D) Check for a blood return.. Answer: B
Both irritants and vesicants can cause tissue damage. If the nurse suspects
extravasation, he or she should immediately stop the infusion. Even if the
IV has a good blood return, some of the chemotherapeutic agent can still
be leaking into the tissues. Slowing the rate of infusion is not sufficient to
prevent further leakage and damage. Applying a cold compress may or
may not be the correct action, depending on the specific agent. However,
the compress would be applied only after the infusion has been
discontinued.
▶ which statement about a patient with a tube feeding indicates best
practice for patient safety & quality care?
A) if the tube becomes clogged, use 30 mL of water for flushing, while
applying gentle pressure with a 50 mL piston syringe
,B) when administering medications, use cold water to dissolve the drug
before administering it
C) use cranberry juice to flush the tube if it is clogged
D) administer drugs down the feeding tube without flushing first, but flush
the feeding tube after the drug is given. Answer: A
▶ A client has a wound on his left trochanter that is 4 inches in diameter,
with black tissue at the perimeter, and bone is exposed. Which is the
nurse's best action?
A) Document as a stage I pressure ulcer and apply a transparent dressing.
B) Document as a stage II pressure ulcer and start wet-to-dry gauze
treatments.
C) Document as a stage IV pressure ulcer and prepare the client for
débridement.
D) Document as a stage III pressure ulcer and start antibiotic therapy..
Answer: C
A stage IV ulcer is one in which skin loss is full thickness, with extensive
destruction, tissue necrosis, and/or damage to muscle, bone, or supporting
structures. Eschar may be present. When the bone of the trochanter area is
visible, tissue loss includes muscle loss. A potential intervention consists of
débridement of the necrotic tissue and a possible graft to promote healing.
▶ After initial placement of NG tubes is confirmed, how often must
placement be checked? SELECT ALL THAT APPLY?
A) before medication administration
B) it is not necessary to recheck placement
C) every 4-8 hours during feeding
D) before intermittent feeding
E) according to facility policy. Answer: A,C,E
▶ The nurse is preparing to administer tube feedings through a client's new
Salem sump nasogastric tube. The nurse is unable to withdraw any fluid
from the tube before starting the feeding. Which is the priority action of the
nurse?
A) Start the tube feeding as ordered and check the residual in 30 minutes.
, B) Inject air into the nasogastric tube while auscultating the client's
epigastric area.
C) Lower the head of the client's bed and attempt to aspirate fluid again.
D) Obtain orders for a chest x-ray to confirm placement before starting the
feeding.. Answer: D
The nurse must verify tube placement before beginning any tube feeding or
administering any medications through a tube. The most accurate way to
determine placement is via chest x-ray. The nurse could cause the client to
aspirate if she or he started the feeding then checked later for placement.
Insufflation does not provide accurate results and should not be used to
verify tube placement. The nurse must keep the client's head elevated at
least 30 degrees.
▶ A client has a urinary tract infection. Which assessment by the nurse is
most helpful?
A) Palpating and percussing the kidneys and bladder
B) Performing a bladder scan to assess post-void residual
C) Assessing medical history and current medical problems
D) Inquiring about recent travel to foreign countries. Answer: C
Clients who are severely immune compromised or who have diabetes
mellitus are more prone to fungal urinary tract infection. The nurse should
assess for these factors. A physical examination and a post-void residual
may be needed, but not until further information is obtained. Travel to
foreign countries probably would not be as important, because even if
exposed, the client needs some degree of immune compromise to develop
a fungal urinary tract infection.
▶ When a diabetic patient asks about maintaining adequate blood glucose
levels, which of the following statements by the nurse relates most directly
to the necessity of maintaining blood glucose levels no lower than about 74
mg/dl?
A) "Without a minimum level of glucose circulating in the blood,
erythrocytes cannot produce ATP."
B) "The presence of glucose in the blood counteracts the formation of lactic
acid and prevents acidosis."
