1. The nurse is caring for a patient with a cast on the leg. Which of the
following actions should the nurse take to prevent complications such
as compartment syndrome?
A. Elevate the leg above the level of the heart
B. Apply warm compresses to the affected area
C. Encourage the patient to ambulate frequently
D. Monitor for increased pain, swelling, or numbness
Answer: d) Monitor for increased pain, swelling, or numbness
Rationale: Compartment syndrome can occur due to increased pressure
within the limb. Monitoring for symptoms like pain, swelling, and
numbness is essential to detect this potentially dangerous condition
early.
2. A nurse is caring for a patient receiving chemotherapy. Which of the
following is an appropriate intervention for managing nausea related to
chemotherapy?
A. Administer antiemetics as prescribed
B. Increase the patient's fluid intake
C. Encourage the patient to eat large meals
D. Avoid all oral fluids
Answer: a) Administer antiemetics as prescribed
,Rationale: Antiemetics help control nausea and vomiting, which are
common side effects of chemotherapy.
3. A patient is receiving morphine for pain relief. The nurse notices that
the patient is becoming increasingly drowsy. What should the nurse do
next?
A. Withhold the next dose of morphine
B. Increase the morphine dosage
C. Monitor the patient’s respiratory rate
D. Administer naloxone immediately
Answer: c) Monitor the patient’s respiratory rate
Rationale: Morphine can cause respiratory depression, and the nurse
should monitor for this potentially life-threatening side effect before
taking further action.
4. Which of the following actions would be most appropriate when
providing culturally sensitive care?
A. Assume all patients from the same culture have the same values
B. Ask open-ended questions to understand the patient’s cultural beliefs
C. Provide care based solely on the nurse’s understanding of the
patient's culture
D. Avoid discussing cultural preferences to prevent discomfort
Answer: b) Ask open-ended questions to understand the patient’s
cultural beliefs
, Rationale: Understanding the patient’s cultural background is essential
for providing individualized care that respects their values and beliefs.
5. The nurse is administering a blood transfusion. Which of the
following is the most important action to take during the first 15
minutes of transfusion?
A. Monitor the patient’s vital signs
B. Ensure the blood is compatible with the patient’s type
C. Check the patient’s identification band
D. Confirm the transfusion rate is correct
Answer: a) Monitor the patient’s vital signs
Rationale: Close monitoring of vital signs during the initial transfusion
period helps detect early signs of a transfusion reaction.
6. Which of the following is a priority nursing intervention for a
patient who is experiencing an asthma attack?
A. Administer oxygen as needed
B. Encourage the patient to cough to clear the airway
C. Offer a warm drink to relax the patient
D. Monitor the patient’s temperature
Answer: a) Administer oxygen as needed
Rationale: Administering oxygen helps to increase oxygen levels
during an asthma attack, which is crucial for patient stability.
following actions should the nurse take to prevent complications such
as compartment syndrome?
A. Elevate the leg above the level of the heart
B. Apply warm compresses to the affected area
C. Encourage the patient to ambulate frequently
D. Monitor for increased pain, swelling, or numbness
Answer: d) Monitor for increased pain, swelling, or numbness
Rationale: Compartment syndrome can occur due to increased pressure
within the limb. Monitoring for symptoms like pain, swelling, and
numbness is essential to detect this potentially dangerous condition
early.
2. A nurse is caring for a patient receiving chemotherapy. Which of the
following is an appropriate intervention for managing nausea related to
chemotherapy?
A. Administer antiemetics as prescribed
B. Increase the patient's fluid intake
C. Encourage the patient to eat large meals
D. Avoid all oral fluids
Answer: a) Administer antiemetics as prescribed
,Rationale: Antiemetics help control nausea and vomiting, which are
common side effects of chemotherapy.
3. A patient is receiving morphine for pain relief. The nurse notices that
the patient is becoming increasingly drowsy. What should the nurse do
next?
A. Withhold the next dose of morphine
B. Increase the morphine dosage
C. Monitor the patient’s respiratory rate
D. Administer naloxone immediately
Answer: c) Monitor the patient’s respiratory rate
Rationale: Morphine can cause respiratory depression, and the nurse
should monitor for this potentially life-threatening side effect before
taking further action.
4. Which of the following actions would be most appropriate when
providing culturally sensitive care?
A. Assume all patients from the same culture have the same values
B. Ask open-ended questions to understand the patient’s cultural beliefs
C. Provide care based solely on the nurse’s understanding of the
patient's culture
D. Avoid discussing cultural preferences to prevent discomfort
Answer: b) Ask open-ended questions to understand the patient’s
cultural beliefs
, Rationale: Understanding the patient’s cultural background is essential
for providing individualized care that respects their values and beliefs.
5. The nurse is administering a blood transfusion. Which of the
following is the most important action to take during the first 15
minutes of transfusion?
A. Monitor the patient’s vital signs
B. Ensure the blood is compatible with the patient’s type
C. Check the patient’s identification band
D. Confirm the transfusion rate is correct
Answer: a) Monitor the patient’s vital signs
Rationale: Close monitoring of vital signs during the initial transfusion
period helps detect early signs of a transfusion reaction.
6. Which of the following is a priority nursing intervention for a
patient who is experiencing an asthma attack?
A. Administer oxygen as needed
B. Encourage the patient to cough to clear the airway
C. Offer a warm drink to relax the patient
D. Monitor the patient’s temperature
Answer: a) Administer oxygen as needed
Rationale: Administering oxygen helps to increase oxygen levels
during an asthma attack, which is crucial for patient stability.
