RN COMPREHENSIVE ONLINE PRACTICE 2023
B WITH QUESTIONS AND VERIFIED
RATIONALIZED ANSWERS, 100% GUARANTEE
PASS..
1. A nurse is reviewing the laboratory results of a client who has chronic kidney disease (CKD) and
is receiving epoetin alfa. Which finding indicates that the therapy is effective?
A. Increased serum ferritin level
B. Increased reticulocyte count
C. Decreased serum creatinine level
D. Decreased platelet count
Answer: B
Rationale: Epoetin alfa stimulates erythropoiesis, leading to an increased reticulocyte count as new red
blood cells are released. Increased ferritin indicates adequate iron stores but not direct effectiveness;
decreased creatinine reflects improved kidney function, not epoetin action; decreased platelets are
unrelated.
2. A nurse is assessing a client who has just returned from the post-anesthesia care unit after a
laparoscopic cholecystectomy. Which finding requires immediate intervention?
A. Heart rate 102/min
B. Blood pressure 100/60 mm Hg
C. Oxygen saturation 91% on room air
D. Pain level 4 on a 0-10 scale
Answer: C
Rationale: An oxygen saturation of 91% indicates hypoxemia, which may result from atelectasis or
respiratory depression and requires immediate intervention. Mild tachycardia and slightly low BP can
be post-anesthesia; pain level 4 is expected and manageable.
3. A nurse is providing discharge teaching to a client who has a new prescription for warfarin.
Which statement by the client indicates a need for further teaching?
A. I will use a soft toothbrush to brush my teeth.
B. I will eat a consistent amount of green leafy vegetables each day.
C. I will take aspirin if I have a headache.
D. I will report any nosebleeds to my provider.
Answer: C
Rationale: Aspirin increases the risk of bleeding when taken with warfarin; the client should avoid
aspirin and use acetaminophen instead. Using a soft toothbrush, maintaining consistent vitamin K
intake, and reporting bleeding are correct.
Page 1
,4. A nurse is evaluating the effectiveness of interventions for a client who has acute pancreatitis.
Which assessment finding indicates that the interventions are effective?
A. Amylase level 200 units/L
B. Lipase level 150 units/L
C. Absence of abdominal pain
D. Increased bowel sounds
Answer: C
Rationale: The primary goal in acute pancreatitis is pain relief; absence of pain indicates effective
intervention. Amylase and lipase levels may remain elevated initially; increased bowel sounds suggest
resolution of ileus but are secondary to pain control.
5. A nurse is caring for a client who has a chest tube connected to a dry suction water seal drainage
system. The nurse notes that the water seal chamber is fluctuating. Which action should the nurse
take?
A. Clamp the chest tube immediately
B. Notify the provider of a possible air leak
C. Document the finding as normal
D. Increase the suction pressure
Answer: C
Rationale: Fluctuation (tidaling) in the water seal chamber is normal and indicates that the chest tube is
patent and the system is functioning. Clamping is not indicated; an air leak would cause continuous
bubbling, not fluctuation; suction adjustment is not needed.
6. A nurse is assessing a client who has heart failure and is receiving furosemide. Which finding
suggests that the client is experiencing an adverse effect of the medication?
A. Serum potassium 3.8 mEq/L
B. Serum sodium 138 mEq/L
C. Serum magnesium 1.2 mEq/L
D. Serum calcium 9.5 mg/dL
Answer: C
Rationale: Furosemide is a loop diuretic that can cause hypomagnesemia (serum magnesium < 1.5
mEq/L). Potassium 3.8 is normal; sodium 138 is normal; calcium 9.5 is normal. Hypomagnesemia can
lead to arrhythmias and requires correction.
7. A nurse is teaching a client with type 2 diabetes mellitus about the prescribed insulin glargine.
Which statement by the client indicates an understanding of the teaching?
A. I will inject this insulin before each meal.
B. I will mix this insulin with regular insulin in the same syringe.
C. I will give this insulin at the same time every day.
D. I will shake the vial vigorously before drawing up the dose.
Answer: C
Rationale: Insulin glargine is a long-acting insulin with a peakless profile and should be given at the
same time daily to maintain consistent basal levels. It is not given with meals, should not be mixed with
Page 2
, other insulins, and should not be shaken.
8. A nurse is caring for a client who has a nasogastric tube set to low intermittent suction. The
nurse observes that the client's respiratory rate has decreased from 16 to 8 breaths per minute.
Which acid-base imbalance should the nurse suspect?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Answer: D
Rationale: Nasogastric suctioning removes gastric acid, leading to loss of hydrogen ions and chloride,
causing metabolic alkalosis. Respiratory rate of 8 indicates compensatory hypoventilation. Respiratory
acidosis would occur with hypoventilation and CO2 retention, but the primary problem is metabolic.
9. A nurse is preparing to administer a blood transfusion to a client. Which action is most
important to prevent a transfusion reaction?
A. Obtain the client's vital signs before the transfusion
B. Verify the client's identity with two identifiers
C. Prime the blood tubing with 0.9% sodium chloride
D. Check the blood product for discoloration
Answer: B
Rationale: The most critical step to prevent a transfusion reaction is verifying the correct patient and
blood product using two identifiers, as most reactions are due to misidentification. Vital signs, priming,
and checking for discoloration are important but secondary to identity verification.
10. A nurse is assessing a client who has a traumatic brain injury and has an intracranial pressure
(ICP) monitor in place. The nurse notes that the ICP is 18 mm Hg. Which action should the nurse
take?
A. Administer a bolus of IV fluids
B. Elevate the head of the bed to 45 degrees
C. Suction the client's airway
D. Administer mannitol as prescribed
Answer: D
Rationale: An ICP of 18 mm Hg is elevated (normal 5-15 mm Hg). Mannitol, an osmotic diuretic, reduces
cerebral edema and ICP. IV fluids may increase ICP; head elevation to 30 degrees is appropriate, but 45
degrees may reduce venous outflow; suctioning can increase ICP transiently.
11. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
acute respiratory failure. Arterial blood gas (ABG) results on room air: pH 7.28, PaCO2 58 mm
Hg, PaO2 50 mm Hg, HCO3- 24 mEq/L. The provider prescribes noninvasive positive pressure
ventilation (NIPPV). Which assessment finding indicates the need for immediate intubation and
mechanical ventilation?
Page 3
B WITH QUESTIONS AND VERIFIED
RATIONALIZED ANSWERS, 100% GUARANTEE
PASS..
1. A nurse is reviewing the laboratory results of a client who has chronic kidney disease (CKD) and
is receiving epoetin alfa. Which finding indicates that the therapy is effective?
A. Increased serum ferritin level
B. Increased reticulocyte count
C. Decreased serum creatinine level
D. Decreased platelet count
Answer: B
Rationale: Epoetin alfa stimulates erythropoiesis, leading to an increased reticulocyte count as new red
blood cells are released. Increased ferritin indicates adequate iron stores but not direct effectiveness;
decreased creatinine reflects improved kidney function, not epoetin action; decreased platelets are
unrelated.
2. A nurse is assessing a client who has just returned from the post-anesthesia care unit after a
laparoscopic cholecystectomy. Which finding requires immediate intervention?
A. Heart rate 102/min
B. Blood pressure 100/60 mm Hg
C. Oxygen saturation 91% on room air
D. Pain level 4 on a 0-10 scale
Answer: C
Rationale: An oxygen saturation of 91% indicates hypoxemia, which may result from atelectasis or
respiratory depression and requires immediate intervention. Mild tachycardia and slightly low BP can
be post-anesthesia; pain level 4 is expected and manageable.
3. A nurse is providing discharge teaching to a client who has a new prescription for warfarin.
Which statement by the client indicates a need for further teaching?
A. I will use a soft toothbrush to brush my teeth.
B. I will eat a consistent amount of green leafy vegetables each day.
C. I will take aspirin if I have a headache.
D. I will report any nosebleeds to my provider.
Answer: C
Rationale: Aspirin increases the risk of bleeding when taken with warfarin; the client should avoid
aspirin and use acetaminophen instead. Using a soft toothbrush, maintaining consistent vitamin K
intake, and reporting bleeding are correct.
Page 1
,4. A nurse is evaluating the effectiveness of interventions for a client who has acute pancreatitis.
Which assessment finding indicates that the interventions are effective?
A. Amylase level 200 units/L
B. Lipase level 150 units/L
C. Absence of abdominal pain
D. Increased bowel sounds
Answer: C
Rationale: The primary goal in acute pancreatitis is pain relief; absence of pain indicates effective
intervention. Amylase and lipase levels may remain elevated initially; increased bowel sounds suggest
resolution of ileus but are secondary to pain control.
5. A nurse is caring for a client who has a chest tube connected to a dry suction water seal drainage
system. The nurse notes that the water seal chamber is fluctuating. Which action should the nurse
take?
A. Clamp the chest tube immediately
B. Notify the provider of a possible air leak
C. Document the finding as normal
D. Increase the suction pressure
Answer: C
Rationale: Fluctuation (tidaling) in the water seal chamber is normal and indicates that the chest tube is
patent and the system is functioning. Clamping is not indicated; an air leak would cause continuous
bubbling, not fluctuation; suction adjustment is not needed.
6. A nurse is assessing a client who has heart failure and is receiving furosemide. Which finding
suggests that the client is experiencing an adverse effect of the medication?
A. Serum potassium 3.8 mEq/L
B. Serum sodium 138 mEq/L
C. Serum magnesium 1.2 mEq/L
D. Serum calcium 9.5 mg/dL
Answer: C
Rationale: Furosemide is a loop diuretic that can cause hypomagnesemia (serum magnesium < 1.5
mEq/L). Potassium 3.8 is normal; sodium 138 is normal; calcium 9.5 is normal. Hypomagnesemia can
lead to arrhythmias and requires correction.
7. A nurse is teaching a client with type 2 diabetes mellitus about the prescribed insulin glargine.
Which statement by the client indicates an understanding of the teaching?
A. I will inject this insulin before each meal.
B. I will mix this insulin with regular insulin in the same syringe.
C. I will give this insulin at the same time every day.
D. I will shake the vial vigorously before drawing up the dose.
Answer: C
Rationale: Insulin glargine is a long-acting insulin with a peakless profile and should be given at the
same time daily to maintain consistent basal levels. It is not given with meals, should not be mixed with
Page 2
, other insulins, and should not be shaken.
8. A nurse is caring for a client who has a nasogastric tube set to low intermittent suction. The
nurse observes that the client's respiratory rate has decreased from 16 to 8 breaths per minute.
Which acid-base imbalance should the nurse suspect?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Answer: D
Rationale: Nasogastric suctioning removes gastric acid, leading to loss of hydrogen ions and chloride,
causing metabolic alkalosis. Respiratory rate of 8 indicates compensatory hypoventilation. Respiratory
acidosis would occur with hypoventilation and CO2 retention, but the primary problem is metabolic.
9. A nurse is preparing to administer a blood transfusion to a client. Which action is most
important to prevent a transfusion reaction?
A. Obtain the client's vital signs before the transfusion
B. Verify the client's identity with two identifiers
C. Prime the blood tubing with 0.9% sodium chloride
D. Check the blood product for discoloration
Answer: B
Rationale: The most critical step to prevent a transfusion reaction is verifying the correct patient and
blood product using two identifiers, as most reactions are due to misidentification. Vital signs, priming,
and checking for discoloration are important but secondary to identity verification.
10. A nurse is assessing a client who has a traumatic brain injury and has an intracranial pressure
(ICP) monitor in place. The nurse notes that the ICP is 18 mm Hg. Which action should the nurse
take?
A. Administer a bolus of IV fluids
B. Elevate the head of the bed to 45 degrees
C. Suction the client's airway
D. Administer mannitol as prescribed
Answer: D
Rationale: An ICP of 18 mm Hg is elevated (normal 5-15 mm Hg). Mannitol, an osmotic diuretic, reduces
cerebral edema and ICP. IV fluids may increase ICP; head elevation to 30 degrees is appropriate, but 45
degrees may reduce venous outflow; suctioning can increase ICP transiently.
11. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
acute respiratory failure. Arterial blood gas (ABG) results on room air: pH 7.28, PaCO2 58 mm
Hg, PaO2 50 mm Hg, HCO3- 24 mEq/L. The provider prescribes noninvasive positive pressure
ventilation (NIPPV). Which assessment finding indicates the need for immediate intubation and
mechanical ventilation?
Page 3
