Answers | Latest Version | 2025/2026 |
Correct & Verified
A client is experiencing sudden onset of shortness of breath and chest tightness. What is the
nurse’s first action?
A. Administer a bronchodilator
✔✔B. Assess airway, breathing, and circulation
C. Call the healthcare provider
D. Place the client in Trendelenburg position
A client is prescribed enoxaparin after knee surgery. Which teaching is correct?
A. Take the injection orally
✔✔B. Inject into the abdomen subcutaneously
C. Massage the injection site after administration
D. Avoid monitoring for bleeding
A client with type 2 diabetes reports blood glucose of 58 mg/dL. What is the priority action?
A. Administer insulin
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,✔✔B. Give 15 g of fast-acting carbohydrate
C. Check hemoglobin A1C
D. Encourage exercise
A client with a nasogastric tube is receiving enteral feeding. Which action prevents aspiration?
A. Keep the client supine
B. Flush tube once per day
✔✔C. Elevate head of bed 30–45 degrees during feeding
D. Clamp the tube after feeding
A client is prescribed prednisone for asthma. Which side effect requires teaching?
A. Dry mouth
B. Increased appetite
✔✔C. Hyperglycemia
D. Mild fatigue
A nurse is assessing a client with left-sided heart failure. Which finding is expected?
A. Peripheral edema
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,✔✔B. Dyspnea and pulmonary crackles
C. Jugular vein distention
D. Hepatomegaly
A client is receiving vancomycin IV. Which finding requires immediate intervention?
A. Mild nausea
✔✔B. Red rash on neck and chest
C. Slight headache
D. Fatigue
A client with a urinary tract infection is prescribed ciprofloxacin. Which statement indicates
understanding?
A. “I should take the medication on an empty stomach only.”
✔✔B. “I should avoid dairy products while taking this medication.”
C. “I can stop the medication once I feel better.”
D. “I should increase salt intake while on this medication.”
A client with hypokalemia is prescribed potassium chloride. Which instruction is important?
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, A. Take medication on an empty stomach
✔✔B. Never crush or chew extended-release tablets
C. Reduce fluid intake
D. Avoid monitoring potassium levels
A nurse is caring for a client postoperatively who is drowsy and has a respiratory rate of 7/min.
What is the priority intervention?
A. Reposition the client
✔✔B. Administer naloxone
C. Give oxygen
D. Document the findings
A client is experiencing an acute asthma attack. Which assessment finding is most concerning?
A. Mild wheezing
B. Productive cough
✔✔C. Use of accessory muscles and inability to speak full sentences
D. Slight tachycardia
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