Adult Health Nursing Exam Questions
And Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A |
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1. A client with chronic obstructive pulmonary disease (COPD) is receiving
oxygen therapy. Which oxygen-delivery method is most appropriate when a
precise concentration of oxygen is required?
A. Nonrebreather mask
B. Simple face mask
C. Venturi mask
D. Nasal cannula
Answer: C. Venturi mask
Rationale: A Venturi mask delivers a controlled and precise oxygen concentration,
making it particularly useful for clients with COPD who may be sensitive to excessive
oxygen administration. Nonrebreather masks provide high oxygen concentrations,
simple masks provide variable concentrations, and nasal cannulas provide low-flow
oxygen.
2. A nurse assesses a client experiencing an acute exacerbation of asthma.
Which finding requires the most immediate intervention?
A. Expiratory wheezing
B. Productive cough
C. Mild anxiety
D. Silent chest with severe respiratory distress
Answer: D. Silent chest with severe respiratory distress
Answer: D. Silent chest with severe respiratory distress
,Rationale: A silent chest in a client with severe asthma indicates critically reduced
airflow and may signal impending respiratory failure. Wheezing can occur with
airway narrowing, but disappearance of wheezing in a severely distressed client
may indicate that airflow is becoming dangerously limited.
3. A client with pneumonia has a temperature of 39°C (102.2°F), productive
cough, and dyspnea. Which nursing intervention is most appropriate?
A. Encourage adequate fluid intake if not contraindicated
B. Restrict fluids
C. Maintain strict bed rest without repositioning
D. Administer cough suppressants routinely
Answer: A. Encourage adequate fluid intake if not contraindicated
Rationale: Adequate hydration helps thin respiratory secretions and facilitates
expectoration. Repositioning, coughing, and deep-breathing exercises can also
improve ventilation and secretion clearance. Fluid restriction is inappropriate unless
specifically prescribed for another condition.
4. A client with a pneumothorax suddenly develops severe dyspnea,
hypotension, and tracheal deviation. Which complication should the nurse
suspect?
A. Atelectasis
B. Tension pneumothorax
C. Pulmonary fibrosis
D. Pleural effusion
Answer: B. Tension pneumothorax
Rationale: A tension pneumothorax occurs when trapped air progressively increases
intrathoracic pressure, compressing the affected lung and major vessels. Severe
respiratory distress, hypotension, and tracheal deviation are emergency findings
requiring immediate intervention.
5. A client with a chest tube has continuous bubbling in the water-seal
chamber. What should the nurse suspect?
,A. Normal lung re-expansion
B. An air leak
C. Complete tube obstruction
D. Excessive fluid administration
Answer: B. An air leak
Rationale: Continuous bubbling in the water-seal chamber generally indicates an air
leak somewhere in the system. The nurse should assess the tubing, connections,
insertion site, and drainage system to locate the source.
6. Which assessment finding is most characteristic of left-sided heart failure?
A. Peripheral edema only
B. Jugular venous distention only
C. Pulmonary crackles and dyspnea
D. Enlarged liver
Answer: C. Pulmonary crackles and dyspnea
Rationale: Left-sided heart failure causes blood to back up into the pulmonary
circulation, producing pulmonary congestion. Crackles, dyspnea, orthopnea, and
pulmonary edema are common manifestations. Right-sided failure more commonly
produces systemic venous congestion, peripheral edema, and hepatic enlargement.
7. A client with heart failure is prescribed furosemide. Which laboratory value
should the nurse monitor closely?
A. Potassium
B. Hemoglobin
C. Platelet count
D. Bilirubin
Answer: A. Potassium
Rationale: Furosemide is a loop diuretic that can increase urinary potassium
excretion and cause hypokalemia. Potassium monitoring is essential because
, significant hypokalemia can contribute to muscle weakness and potentially
dangerous cardiac dysrhythmias.
8. A client reports crushing substernal chest pain radiating to the left arm.
Which action should the nurse take first?
A. Obtain a detailed dietary history
B. Assess vital signs and initiate rapid cardiac assessment
C. Encourage the client to walk
D. Give a large meal
Answer: B. Assess vital signs and initiate rapid cardiac assessment
Rationale: Crushing chest pain with radiation is highly suspicious for acute coronary
syndrome. Rapid assessment, cardiac monitoring, oxygen assessment,
electrocardiographic evaluation, and prescribed emergency treatment are
priorities. The nurse should not delay evaluation for less urgent assessments.
9. Which electrocardiographic finding is most associated with acute myocardial
infarction?
A. ST-segment elevation or depression associated with ischemia
B. Normal sinus rhythm
C. Shortened PR interval only
D. Isolated sinus bradycardia
Answer: A. ST-segment elevation or depression associated with ischemia
Rationale: Acute myocardial ischemia can produce ST-segment changes and other
electrocardiographic abnormalities. The specific pattern depends on the location
and severity of ischemia and whether infarction involves an ST-elevation or non-ST-
elevation presentation.
10.A client with angina asks why nitroglycerin is prescribed. Which response is
most accurate?
A. It increases blood volume
B. It decreases myocardial oxygen demand and improves coronary blood flow
And Correct Answers (Verified
Answers) Plus Rationales 2026 Q&A |
Instant Download Pdf
1. A client with chronic obstructive pulmonary disease (COPD) is receiving
oxygen therapy. Which oxygen-delivery method is most appropriate when a
precise concentration of oxygen is required?
A. Nonrebreather mask
B. Simple face mask
C. Venturi mask
D. Nasal cannula
Answer: C. Venturi mask
Rationale: A Venturi mask delivers a controlled and precise oxygen concentration,
making it particularly useful for clients with COPD who may be sensitive to excessive
oxygen administration. Nonrebreather masks provide high oxygen concentrations,
simple masks provide variable concentrations, and nasal cannulas provide low-flow
oxygen.
2. A nurse assesses a client experiencing an acute exacerbation of asthma.
Which finding requires the most immediate intervention?
A. Expiratory wheezing
B. Productive cough
C. Mild anxiety
D. Silent chest with severe respiratory distress
Answer: D. Silent chest with severe respiratory distress
Answer: D. Silent chest with severe respiratory distress
,Rationale: A silent chest in a client with severe asthma indicates critically reduced
airflow and may signal impending respiratory failure. Wheezing can occur with
airway narrowing, but disappearance of wheezing in a severely distressed client
may indicate that airflow is becoming dangerously limited.
3. A client with pneumonia has a temperature of 39°C (102.2°F), productive
cough, and dyspnea. Which nursing intervention is most appropriate?
A. Encourage adequate fluid intake if not contraindicated
B. Restrict fluids
C. Maintain strict bed rest without repositioning
D. Administer cough suppressants routinely
Answer: A. Encourage adequate fluid intake if not contraindicated
Rationale: Adequate hydration helps thin respiratory secretions and facilitates
expectoration. Repositioning, coughing, and deep-breathing exercises can also
improve ventilation and secretion clearance. Fluid restriction is inappropriate unless
specifically prescribed for another condition.
4. A client with a pneumothorax suddenly develops severe dyspnea,
hypotension, and tracheal deviation. Which complication should the nurse
suspect?
A. Atelectasis
B. Tension pneumothorax
C. Pulmonary fibrosis
D. Pleural effusion
Answer: B. Tension pneumothorax
Rationale: A tension pneumothorax occurs when trapped air progressively increases
intrathoracic pressure, compressing the affected lung and major vessels. Severe
respiratory distress, hypotension, and tracheal deviation are emergency findings
requiring immediate intervention.
5. A client with a chest tube has continuous bubbling in the water-seal
chamber. What should the nurse suspect?
,A. Normal lung re-expansion
B. An air leak
C. Complete tube obstruction
D. Excessive fluid administration
Answer: B. An air leak
Rationale: Continuous bubbling in the water-seal chamber generally indicates an air
leak somewhere in the system. The nurse should assess the tubing, connections,
insertion site, and drainage system to locate the source.
6. Which assessment finding is most characteristic of left-sided heart failure?
A. Peripheral edema only
B. Jugular venous distention only
C. Pulmonary crackles and dyspnea
D. Enlarged liver
Answer: C. Pulmonary crackles and dyspnea
Rationale: Left-sided heart failure causes blood to back up into the pulmonary
circulation, producing pulmonary congestion. Crackles, dyspnea, orthopnea, and
pulmonary edema are common manifestations. Right-sided failure more commonly
produces systemic venous congestion, peripheral edema, and hepatic enlargement.
7. A client with heart failure is prescribed furosemide. Which laboratory value
should the nurse monitor closely?
A. Potassium
B. Hemoglobin
C. Platelet count
D. Bilirubin
Answer: A. Potassium
Rationale: Furosemide is a loop diuretic that can increase urinary potassium
excretion and cause hypokalemia. Potassium monitoring is essential because
, significant hypokalemia can contribute to muscle weakness and potentially
dangerous cardiac dysrhythmias.
8. A client reports crushing substernal chest pain radiating to the left arm.
Which action should the nurse take first?
A. Obtain a detailed dietary history
B. Assess vital signs and initiate rapid cardiac assessment
C. Encourage the client to walk
D. Give a large meal
Answer: B. Assess vital signs and initiate rapid cardiac assessment
Rationale: Crushing chest pain with radiation is highly suspicious for acute coronary
syndrome. Rapid assessment, cardiac monitoring, oxygen assessment,
electrocardiographic evaluation, and prescribed emergency treatment are
priorities. The nurse should not delay evaluation for less urgent assessments.
9. Which electrocardiographic finding is most associated with acute myocardial
infarction?
A. ST-segment elevation or depression associated with ischemia
B. Normal sinus rhythm
C. Shortened PR interval only
D. Isolated sinus bradycardia
Answer: A. ST-segment elevation or depression associated with ischemia
Rationale: Acute myocardial ischemia can produce ST-segment changes and other
electrocardiographic abnormalities. The specific pattern depends on the location
and severity of ischemia and whether infarction involves an ST-elevation or non-ST-
elevation presentation.
10.A client with angina asks why nitroglycerin is prescribed. Which response is
most accurate?
A. It increases blood volume
B. It decreases myocardial oxygen demand and improves coronary blood flow
