NCM 106 M6 PART 3 EXAM BRAND NEW VERSION 2027-2028
Q&A EXAM | ALL QUESTIONS AND ANSWERS PLUS DETAILED
RATIONALES | COMPLETE STUDYGUIDE| GUARANTEED PASS |
DOWNLOAD INSTANT PDF 2027-2028
1. A nurse is assessing a client who has developed sudden shortness of breath, chest
discomfort, and an oxygen saturation of 88% on room air. Which action should the nurse
take first?
A. Obtain a detailed dietary history
B. Place the client in an appropriate position and initiate oxygen as indicated
C. Ask the client to ambulate in the hallway
D. Delay intervention until laboratory results are available
Rationale: Airway and breathing take priority. Positioning the client to optimize ventilation
and administering oxygen as indicated address the immediate oxygenation problem.
2. During a medication assessment, a nurse discovers that a client is allergic to a prescribed
medication. What is the nurse's priority action?
A. Hold the medication and notify the appropriate prescriber
B. Administer the medication with food
C. Give the medication and monitor closely
D. Document the allergy after administration
Rationale: A known medication allergy creates a significant patient-safety risk. The
medication should be withheld and the prescribing team notified before administration.
3. A client with diabetes becomes diaphoretic, shaky, confused, and irritable. Which
finding should the nurse suspect?
A. Hypernatremia
B. Hypercalcemia
C. Hypoglycemia
D. Hypermagnesemia
Rationale: Diaphoresis, tremors, confusion, and behavioral changes are common
manifestations of hypoglycemia and require prompt glucose assessment and treatment.
,4. A nurse is preparing to administer an oral medication. Which action best demonstrates
safe medication practice?
A. Prepare medications for several clients simultaneously
B. Leave the medication at the bedside without explanation
C. Ask another client to confirm the patient's identity
D. Verify the medication against the medication administration record and use two
appropriate identifiers
Rationale: Medication safety requires accurate patient identification and verification of the
medication against the prescribed order or medication administration record.
5. A client reports severe pain rated 9/10 one hour after receiving an analgesic. What
should the nurse do first?
A. Reassess the pain and evaluate the client's response to treatment
B. Tell the client that the medication needs more time regardless of the assessment
C. Document that the medication was ineffective without reassessment
D. Automatically administer another dose
Rationale: Pain management requires reassessment of severity, location, characteristics,
functional impact, and response to the previous intervention before determining the next
action.
6. A client who has been vomiting repeatedly develops weakness and muscle cramps.
Which electrolyte imbalance should the nurse consider?
A. Hyperkalemia
B. Hypokalemia
C. Hypermagnesemia
D. Hyperphosphatemia
Rationale: Repeated gastrointestinal losses can cause potassium depletion, leading to
weakness, muscle cramps, and potentially cardiac dysrhythmias.
7. A nurse is caring for a client at high risk for falls. Which intervention is most
appropriate?
,A. Keep the bed in the highest position
B. Encourage the client to walk independently
C. Keep frequently used items within reach and implement individualized fall precautions
D. Restrict all mobility
Rationale: Fall prevention should address individualized risk factors while promoting safe
mobility rather than unnecessarily restricting activity.
8. A client develops facial swelling, wheezing, and hypotension shortly after receiving an
antibiotic. Which medication should the nurse anticipate administering immediately?
A. Acetaminophen
B. Furosemide
C. Diphenhydramine only
D. Epinephrine
Rationale: Airway compromise and hypotension following medication exposure indicate
anaphylaxis. Epinephrine is the first-line emergency treatment.
9. A nurse is teaching a client how to use an incentive spirometer after surgery. Which
instruction is correct?
A. Inhale slowly and deeply through the mouthpiece, then briefly hold the breath
B. Exhale forcefully into the device
C. Use the device only when shortness of breath occurs
D. Perform one breath every four hours
Rationale: Slow, sustained inspiration with a brief breath hold promotes alveolar expansion
and helps prevent postoperative atelectasis.
10. A client has a temperature of 39.2°C, heart rate of 118/min, and respiratory rate of
26/min. What should the nurse do first?
A. Assume the findings are caused by anxiety
B. Perform a focused assessment and evaluate for possible infection or systemic deterioration
C. Encourage the client to sleep
D. Document the findings without further assessment
, Rationale: Fever with tachycardia and tachypnea may indicate infection or systemic
deterioration and requires prompt assessment.
11. A client with heart failure suddenly develops severe dyspnea and pink, frothy sputum.
Which condition should the nurse suspect?
A. Acute pulmonary edema
B. Constipation
C. Hypoglycemia
D. Urinary retention
Rationale: Acute severe dyspnea accompanied by pink, frothy sputum is strongly associated
with pulmonary edema and requires immediate intervention.
12. A nurse is evaluating a client's nutritional status. Which finding most strongly suggests
inadequate protein intake?
A. Increased muscle mass
B. Strong peripheral pulses
C. Delayed wound healing and muscle wasting
D. Increased hemoglobin concentration
Rationale: Protein deficiency can cause muscle wasting, impaired immune function, and
delayed tissue repair and wound healing.
13. A client receiving IV fluids develops crackles, increasing respiratory effort, and
peripheral edema. What is the priority nursing action?
A. Increase the IV infusion rate
B. Assess the client and notify the appropriate clinician regarding possible fluid overload
C. Encourage additional oral fluids
D. Place the client flat
Rationale: Crackles, edema, and respiratory distress suggest fluid overload. The infusion and
respiratory status should be assessed promptly and appropriate interventions initiated.
Q&A EXAM | ALL QUESTIONS AND ANSWERS PLUS DETAILED
RATIONALES | COMPLETE STUDYGUIDE| GUARANTEED PASS |
DOWNLOAD INSTANT PDF 2027-2028
1. A nurse is assessing a client who has developed sudden shortness of breath, chest
discomfort, and an oxygen saturation of 88% on room air. Which action should the nurse
take first?
A. Obtain a detailed dietary history
B. Place the client in an appropriate position and initiate oxygen as indicated
C. Ask the client to ambulate in the hallway
D. Delay intervention until laboratory results are available
Rationale: Airway and breathing take priority. Positioning the client to optimize ventilation
and administering oxygen as indicated address the immediate oxygenation problem.
2. During a medication assessment, a nurse discovers that a client is allergic to a prescribed
medication. What is the nurse's priority action?
A. Hold the medication and notify the appropriate prescriber
B. Administer the medication with food
C. Give the medication and monitor closely
D. Document the allergy after administration
Rationale: A known medication allergy creates a significant patient-safety risk. The
medication should be withheld and the prescribing team notified before administration.
3. A client with diabetes becomes diaphoretic, shaky, confused, and irritable. Which
finding should the nurse suspect?
A. Hypernatremia
B. Hypercalcemia
C. Hypoglycemia
D. Hypermagnesemia
Rationale: Diaphoresis, tremors, confusion, and behavioral changes are common
manifestations of hypoglycemia and require prompt glucose assessment and treatment.
,4. A nurse is preparing to administer an oral medication. Which action best demonstrates
safe medication practice?
A. Prepare medications for several clients simultaneously
B. Leave the medication at the bedside without explanation
C. Ask another client to confirm the patient's identity
D. Verify the medication against the medication administration record and use two
appropriate identifiers
Rationale: Medication safety requires accurate patient identification and verification of the
medication against the prescribed order or medication administration record.
5. A client reports severe pain rated 9/10 one hour after receiving an analgesic. What
should the nurse do first?
A. Reassess the pain and evaluate the client's response to treatment
B. Tell the client that the medication needs more time regardless of the assessment
C. Document that the medication was ineffective without reassessment
D. Automatically administer another dose
Rationale: Pain management requires reassessment of severity, location, characteristics,
functional impact, and response to the previous intervention before determining the next
action.
6. A client who has been vomiting repeatedly develops weakness and muscle cramps.
Which electrolyte imbalance should the nurse consider?
A. Hyperkalemia
B. Hypokalemia
C. Hypermagnesemia
D. Hyperphosphatemia
Rationale: Repeated gastrointestinal losses can cause potassium depletion, leading to
weakness, muscle cramps, and potentially cardiac dysrhythmias.
7. A nurse is caring for a client at high risk for falls. Which intervention is most
appropriate?
,A. Keep the bed in the highest position
B. Encourage the client to walk independently
C. Keep frequently used items within reach and implement individualized fall precautions
D. Restrict all mobility
Rationale: Fall prevention should address individualized risk factors while promoting safe
mobility rather than unnecessarily restricting activity.
8. A client develops facial swelling, wheezing, and hypotension shortly after receiving an
antibiotic. Which medication should the nurse anticipate administering immediately?
A. Acetaminophen
B. Furosemide
C. Diphenhydramine only
D. Epinephrine
Rationale: Airway compromise and hypotension following medication exposure indicate
anaphylaxis. Epinephrine is the first-line emergency treatment.
9. A nurse is teaching a client how to use an incentive spirometer after surgery. Which
instruction is correct?
A. Inhale slowly and deeply through the mouthpiece, then briefly hold the breath
B. Exhale forcefully into the device
C. Use the device only when shortness of breath occurs
D. Perform one breath every four hours
Rationale: Slow, sustained inspiration with a brief breath hold promotes alveolar expansion
and helps prevent postoperative atelectasis.
10. A client has a temperature of 39.2°C, heart rate of 118/min, and respiratory rate of
26/min. What should the nurse do first?
A. Assume the findings are caused by anxiety
B. Perform a focused assessment and evaluate for possible infection or systemic deterioration
C. Encourage the client to sleep
D. Document the findings without further assessment
, Rationale: Fever with tachycardia and tachypnea may indicate infection or systemic
deterioration and requires prompt assessment.
11. A client with heart failure suddenly develops severe dyspnea and pink, frothy sputum.
Which condition should the nurse suspect?
A. Acute pulmonary edema
B. Constipation
C. Hypoglycemia
D. Urinary retention
Rationale: Acute severe dyspnea accompanied by pink, frothy sputum is strongly associated
with pulmonary edema and requires immediate intervention.
12. A nurse is evaluating a client's nutritional status. Which finding most strongly suggests
inadequate protein intake?
A. Increased muscle mass
B. Strong peripheral pulses
C. Delayed wound healing and muscle wasting
D. Increased hemoglobin concentration
Rationale: Protein deficiency can cause muscle wasting, impaired immune function, and
delayed tissue repair and wound healing.
13. A client receiving IV fluids develops crackles, increasing respiratory effort, and
peripheral edema. What is the priority nursing action?
A. Increase the IV infusion rate
B. Assess the client and notify the appropriate clinician regarding possible fluid overload
C. Encourage additional oral fluids
D. Place the client flat
Rationale: Crackles, edema, and respiratory distress suggest fluid overload. The infusion and
respiratory status should be assessed promptly and appropriate interventions initiated.
