Frequently Tested Questions With ELABORATED 100% Correct COMPLETE SOLUTIONS
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A nurse is assessing a client with a PICC line. Which finding
requires immediate intervention?
Correct Answer: C
A. Mild bruising at the insertion site Rationale: Upper extremity swelling suggests thrombosis
B. Transparent dressing dated 24 hours ago or infiltration—a known complication of PICC lines.
C. Upper extremity swelling
D. Client requesting to shower
A client on nitroglycerin SL develops dizziness after admin-
istration. What is the nurse's priority?
Correct Answer: B
A. Encourage deep breathing Rationale: Nitroglycerin can cause hypotension, which in-
B. Have the client sit or lie down creases fall risk. Sitting prevents injury
C. Administer a second dose immediately
D. Provide oral fluids
A client with bradycardia performs a Valsalva maneuver
during a bowel movement. What is the nurse's best ac-
tion?
Correct Answer: C
Rationale: Valsalva slows conduction and can worsen
A. Document the finding
bradycardia
B. Encourage completion of the maneuver
C. Teach that Valsalva can slow the heart further
D. Administer the prescribed stool softener
A nurse is assessing a rhythm strip showing ventricular
tachycardia. The patient is awake with a pulse. What is the
priority treatment?
Correct Answer: C
Rationale: VT with a pulse = synchronized cardioversion.
A. CPR
Defibrillation is for pulseless VT.
B. Defibrillation
C. Synchronized cardioversion
D. Adenosine
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Frequently Tested Questions With ELABORATED 100% Correct COMPLETE SOLUTIONS
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A patient with chronic lung disease is prescribed a
beta-blocker. Which medication is safest?
Correct Answer: C
A. Propranolol Rationale: Cardio-selective (β1-specific) metoprolol has
B. Nadolol the lowest bronchospasm risk
C. Metoprolol
D. Timolol
A client with a MEWS score of 6 should be prioritized for
which intervention?
Correct Answer: C
A. Give routine meds Rationale: MEWS >5 = high risk for deterioration ’rapid
B. Monitor in one hour intervention required
C. Activate rapid response
D. Provide discharge teaching
Which client is at highest risk for MODS?
Correct Answer: B
A. A client following minor surgery
Rationale: MODS commonly occurs with severe infection
B. A client with sepsis requiring antibiotics
or sepsis requiring immediate intervention
C. A client with a viral cold
D. A client on oral steroids for asthma
A nurse caring for a client on nitroprusside should take
which priority action?
Correct Answer: A
A. Protect IV bag from light Rationale: Nitroprusside degrades in light and must be
B. Administer IM protected
C. Stop if systolic BP >160
D. Hang with dextrose only
A pregnant client shows rapid weight gain and increased
BP. What is the priority?
A. Provide fluids
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Frequently Tested Questions With ELABORATED 100% Correct COMPLETE SOLUTIONS
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B. Assess for proteinuria Correct Answer: B
C. Encourage activity Rationale: Rapid weight gain + ‘BP = preeclampsia ’assess
D. Otter warm blankets for proteinuria.
A nurse caring for a preeclamptic patient sees brisk (4+)
DTRs. What complication is imminent?
Correct Answer: C
A. HELLP Rationale: Hyperreflexia is a sign of severe irritability ’im-
B. Stroke pending seizure
C. Seizures
D. Infection
A newborn has poor feeding and tachypnea. These are
early signs of:
Correct Answer: B
A. Infection Rationale: Infant cardiomyopathy presents as poor feed-
B. Heart failure ing + tachypnea
C. Hypoglycemia
D. Hyperbilirubinemia
A postpartum nurse inspects the placenta immediately
after delivery to prevent:
Correct Answer: B
A. Jaundice Rationale: Missing fragments can cause late postpartum
B. Late hemorrhage hemorrhage
C. Newborn hypoxia
D. Uterine infection
A client with suspected concealed hemorrhage will exhib-
it:
Correct Answer: B
A. Soft abdomen Rationale: Concealed bleeding ’increasing fundal height +
B. Rising fundal height shock signs.
C. Slow pulse
D. Normal BP