1. When caring for a patient on anticoagulant therapy, which of the
following signs should the nurse monitor for that could indicate a
bleeding complication?
A. Decreased blood pressure and dizziness
B. Increased heart rate and fever
C. Shortness of breath and cough
D. Severe headache and visual disturbances
Answer: A
Rationale: Decreased blood pressure and dizziness could indicate
internal bleeding or hemorrhage, which is a potential complication of
anticoagulant therapy.
2. What is the first step when a patient is suspected of having a stroke?
A. Administer oxygen
B. Call for immediate medical assistance
C. Start an IV line
D. Perform a neurological assessment
Answer: B
Rationale: Immediate medical intervention is essential in stroke
management, so the first step is to call for medical assistance to ensure
timely treatment.
,3. When caring for a patient with a chest tube, which action is most
important to prevent complications?
A. Clamping the chest tube periodically to check for leaks
B. Keeping the chest tube securely taped and positioned
C. Regularly irrigating the chest tube to clear it
D. Removing the chest tube as soon as possible
Answer: B
Rationale: Keeping the chest tube securely taped and positioned ensures
proper drainage and reduces the risk of accidental dislodgement or
obstruction.
4. Which of the following interventions is most appropriate for a
patient with a nasogastric (NG) tube who is receiving enteral
nutrition?
A. Checking the tube placement every 8 hours
B. Aspirating the tube to check for residual before each feeding
C. Restricting fluid intake to prevent diarrhea
D. Flushing the tube with a small amount of water before and after
each use
Answer: D
Rationale: Flushing the NG tube with water before and after each use
ensures it remains patent and prevents clogging, which is a common
complication in enteral nutrition.
, 5. What is the primary goal when caring for a patient with chronic
obstructive pulmonary disease (COPD)?
A. To cure the disease through medical intervention
B. To manage symptoms and improve quality of life
C. To increase physical activity levels as much as possible
D. To administer large doses of oxygen
Answer: B
Rationale: The primary goal in COPD care is to manage symptoms,
prevent exacerbations, and improve the patient's quality of life, as
COPD is a progressive disease with no cure.
6. Which medication administration route is the fastest in terms of
absorption?
A. Oral
B. Intravenous
C. Subcutaneous
D. Intramuscular
Answer: B
Rationale: Intravenous administration provides direct access to the
bloodstream, leading to the quickest absorption of medication
compared to other routes.
following signs should the nurse monitor for that could indicate a
bleeding complication?
A. Decreased blood pressure and dizziness
B. Increased heart rate and fever
C. Shortness of breath and cough
D. Severe headache and visual disturbances
Answer: A
Rationale: Decreased blood pressure and dizziness could indicate
internal bleeding or hemorrhage, which is a potential complication of
anticoagulant therapy.
2. What is the first step when a patient is suspected of having a stroke?
A. Administer oxygen
B. Call for immediate medical assistance
C. Start an IV line
D. Perform a neurological assessment
Answer: B
Rationale: Immediate medical intervention is essential in stroke
management, so the first step is to call for medical assistance to ensure
timely treatment.
,3. When caring for a patient with a chest tube, which action is most
important to prevent complications?
A. Clamping the chest tube periodically to check for leaks
B. Keeping the chest tube securely taped and positioned
C. Regularly irrigating the chest tube to clear it
D. Removing the chest tube as soon as possible
Answer: B
Rationale: Keeping the chest tube securely taped and positioned ensures
proper drainage and reduces the risk of accidental dislodgement or
obstruction.
4. Which of the following interventions is most appropriate for a
patient with a nasogastric (NG) tube who is receiving enteral
nutrition?
A. Checking the tube placement every 8 hours
B. Aspirating the tube to check for residual before each feeding
C. Restricting fluid intake to prevent diarrhea
D. Flushing the tube with a small amount of water before and after
each use
Answer: D
Rationale: Flushing the NG tube with water before and after each use
ensures it remains patent and prevents clogging, which is a common
complication in enteral nutrition.
, 5. What is the primary goal when caring for a patient with chronic
obstructive pulmonary disease (COPD)?
A. To cure the disease through medical intervention
B. To manage symptoms and improve quality of life
C. To increase physical activity levels as much as possible
D. To administer large doses of oxygen
Answer: B
Rationale: The primary goal in COPD care is to manage symptoms,
prevent exacerbations, and improve the patient's quality of life, as
COPD is a progressive disease with no cure.
6. Which medication administration route is the fastest in terms of
absorption?
A. Oral
B. Intravenous
C. Subcutaneous
D. Intramuscular
Answer: B
Rationale: Intravenous administration provides direct access to the
bloodstream, leading to the quickest absorption of medication
compared to other routes.
