adult health theory II exam 1 Questions With Complete
Solutions
A nurse is assessing a newly admitted patient with chronic heart
failure who forgot to take prescribed medications. the patient
seems confused and short of breath with peripheral edema.
Which assessment would the nurse complete first?
a. Skin turgor
b. Heart sounds
c. Mental status
d. Capillary refill Correct Answer c. Mental status
A patient admitted to the coronary care unit (CCU) with an ST-
segment-elevation myocardial infarction (STEMI) is restless and
anxious. The blood pressure is 86/40 mm Hg, and heart rate is
132 beats/min. Based on this information, which patient problem
is the priority?
a. Acute pain
b. Deficient knowledge
c. Impaired cardiac function
d. Health maintenance alteration Correct Answer c. Impaired
cardiac function
A patient asks the nurse why a peripherally inserted central
catheter is needed to begin receiving parenteral nutrition with
25% dextrose. Which response by the nurse is accurate?
a. "The prescribed infusion can be given more rapidly when
there is a central line."
b. "The hypertonic solution is more rapidly diluted when given
through a central line."
,c. "There is a decreased risk for infection when 25% dextrose is
infused through a
central line."
d. "The required blood glucose monitoring is based on samples
obtained from a central line" Correct Answer b. "The
hypertonic solution is more rapidly diluted when given through
a central line."
A patient had a non-ST-segment-elevation myocardial infarction
(NSTEMI) 3 days ago. Which nursing intervention is
appropriate for the registered nurse (RN) to delegate to an
experienced licensed practical/vocational nurse (LPN/VN)?
a. Reinforcement of teaching about the prescribed medications
b. Evaluation of the patient's response to walking in the hallway
c. Completion of the referral form for a home health nurse
follow-up
d. Education of the patient about the pathophysiology of heart
disease Correct Answer a. Reinforcement of teaching about the
prescribed medications
A patient has a magnesium level of 1.3 mg/dL. Which
information from the patient's health history would help the
nurse identify a likely cause of this value?
a. Daily alcohol intake
b. Dietary protein intake
c. Daily multivitamin use
d. Occasional laxative use Correct Answer a. Daily alcohol
intake
,A patient has a serum calcium level of 7.0 mEq/L. Which
assessment finding is most important for the nurse to report to
the health care provider?
a. Stridor
b. Fatigue
c. Constipation for 4 days
d. Numbness around the lips Correct Answer a. Stridor
A patient is admitted to the emergency department and
diagnosed as having an ST-segment-elevation myocardial
infarction (STEMI). Which question would the nurse ask to
determine whether the patient is a candidate for thrombolytic
therapy?
a. "Do you have any allergies?"
b. "Did you take aspirin today?"
c. "What time did your pain begin?"
d. "Can you rate the pain on a 0 to 10 scale?" Correct Answer
c. "What time did your pain begin?"
A patient is admitted to the emergency department with severe
fatigue and confusion. Which laboratory value requires the most
immediate action by the nurse?
a. Arterial blood pH is 7.32.
b. Serum calcium is 18 mg/dL.
c. Serum potassium is 5.1 mEq/L.
d. Arterial oxygen saturation is 91%. Correct Answer b. Serum
calcium is 18 mg/dL.
A patient is being treated for heart failure. Which laboratory test
result will the nurse review to determine the effects of the
treatment?
, a. Troponin
b. Homocysteine (Hcy)
c. Low-density lipoprotein (LDL)
d. B-type natriuretic peptide (BNP) Correct Answer d. B-type
natriuretic peptide (BNP)
A patient is receiving a 3% saline continuous IV infusion for
hyponatremia. Which assessment data require the most rapid
response by the nurse?
a. The patient's radial pulse is 105 beats/min.
b. There are crackles throughout both lung fields.
c. There is sediment and blood in the patient's urine.
d. The patient's blood pressure increases to 142/94 mm Hg.
Correct Answer b. There are crackles throughout both lung
fields.
A patient is scheduled for a cardiac catheterization with
coronary angiography. What information would the nurse
provide before the procedure?
a. It will be important not to move at all during the procedure.
b. A flushed feeling is common when the contrast dye is
injected.
c. Monitored anesthesia care will be provided during the
procedure.
d. Arterial pressure monitoring will be needed for 24 hours after
the test. Correct Answer b. A flushed feeling is common when
the contrast dye is injected.
A patient receives 3% NaCl solution for correction of
hyponatremia. Which assessment is most important for the nurse
to monitor while the patient is receiving this infusion?
Solutions
A nurse is assessing a newly admitted patient with chronic heart
failure who forgot to take prescribed medications. the patient
seems confused and short of breath with peripheral edema.
Which assessment would the nurse complete first?
a. Skin turgor
b. Heart sounds
c. Mental status
d. Capillary refill Correct Answer c. Mental status
A patient admitted to the coronary care unit (CCU) with an ST-
segment-elevation myocardial infarction (STEMI) is restless and
anxious. The blood pressure is 86/40 mm Hg, and heart rate is
132 beats/min. Based on this information, which patient problem
is the priority?
a. Acute pain
b. Deficient knowledge
c. Impaired cardiac function
d. Health maintenance alteration Correct Answer c. Impaired
cardiac function
A patient asks the nurse why a peripherally inserted central
catheter is needed to begin receiving parenteral nutrition with
25% dextrose. Which response by the nurse is accurate?
a. "The prescribed infusion can be given more rapidly when
there is a central line."
b. "The hypertonic solution is more rapidly diluted when given
through a central line."
,c. "There is a decreased risk for infection when 25% dextrose is
infused through a
central line."
d. "The required blood glucose monitoring is based on samples
obtained from a central line" Correct Answer b. "The
hypertonic solution is more rapidly diluted when given through
a central line."
A patient had a non-ST-segment-elevation myocardial infarction
(NSTEMI) 3 days ago. Which nursing intervention is
appropriate for the registered nurse (RN) to delegate to an
experienced licensed practical/vocational nurse (LPN/VN)?
a. Reinforcement of teaching about the prescribed medications
b. Evaluation of the patient's response to walking in the hallway
c. Completion of the referral form for a home health nurse
follow-up
d. Education of the patient about the pathophysiology of heart
disease Correct Answer a. Reinforcement of teaching about the
prescribed medications
A patient has a magnesium level of 1.3 mg/dL. Which
information from the patient's health history would help the
nurse identify a likely cause of this value?
a. Daily alcohol intake
b. Dietary protein intake
c. Daily multivitamin use
d. Occasional laxative use Correct Answer a. Daily alcohol
intake
,A patient has a serum calcium level of 7.0 mEq/L. Which
assessment finding is most important for the nurse to report to
the health care provider?
a. Stridor
b. Fatigue
c. Constipation for 4 days
d. Numbness around the lips Correct Answer a. Stridor
A patient is admitted to the emergency department and
diagnosed as having an ST-segment-elevation myocardial
infarction (STEMI). Which question would the nurse ask to
determine whether the patient is a candidate for thrombolytic
therapy?
a. "Do you have any allergies?"
b. "Did you take aspirin today?"
c. "What time did your pain begin?"
d. "Can you rate the pain on a 0 to 10 scale?" Correct Answer
c. "What time did your pain begin?"
A patient is admitted to the emergency department with severe
fatigue and confusion. Which laboratory value requires the most
immediate action by the nurse?
a. Arterial blood pH is 7.32.
b. Serum calcium is 18 mg/dL.
c. Serum potassium is 5.1 mEq/L.
d. Arterial oxygen saturation is 91%. Correct Answer b. Serum
calcium is 18 mg/dL.
A patient is being treated for heart failure. Which laboratory test
result will the nurse review to determine the effects of the
treatment?
, a. Troponin
b. Homocysteine (Hcy)
c. Low-density lipoprotein (LDL)
d. B-type natriuretic peptide (BNP) Correct Answer d. B-type
natriuretic peptide (BNP)
A patient is receiving a 3% saline continuous IV infusion for
hyponatremia. Which assessment data require the most rapid
response by the nurse?
a. The patient's radial pulse is 105 beats/min.
b. There are crackles throughout both lung fields.
c. There is sediment and blood in the patient's urine.
d. The patient's blood pressure increases to 142/94 mm Hg.
Correct Answer b. There are crackles throughout both lung
fields.
A patient is scheduled for a cardiac catheterization with
coronary angiography. What information would the nurse
provide before the procedure?
a. It will be important not to move at all during the procedure.
b. A flushed feeling is common when the contrast dye is
injected.
c. Monitored anesthesia care will be provided during the
procedure.
d. Arterial pressure monitoring will be needed for 24 hours after
the test. Correct Answer b. A flushed feeling is common when
the contrast dye is injected.
A patient receives 3% NaCl solution for correction of
hyponatremia. Which assessment is most important for the nurse
to monitor while the patient is receiving this infusion?
