Comprehensive Exam 3 Questions and
Answers | Latest Version | 2025/2026 |
Correct & Verified
What is the nurse's first action if a client’s oxygen saturation drops to 85% during ambulation?
✔✔ Stop the activity and place the client in a high Fowler’s position
What is the correct method to verify nasogastric tube placement before feeding?
✔✔ Check the pH of the gastric aspirate
What is the priority nursing action when a client reports new onset of confusion and restlessness?
✔✔ Assess oxygenation and vital signs
How should the nurse respond when a client expresses fear about an upcoming surgery?
✔✔ Encourage the client to share feelings and offer emotional support
What is the nurse’s best intervention to prevent aspiration in a client receiving enteral feedings?
✔✔ Keep the head of the bed elevated at least 30 degrees
1
,What is the purpose of applying heat therapy to a localized area?
✔✔ To promote blood flow and reduce muscle tension
What is the expected outcome of range-of-motion exercises in a bedbound client?
✔✔ To maintain joint mobility and prevent contractures
How does the nurse evaluate the effectiveness of a pain medication given 30 minutes ago?
✔✔ Ask the client to rate current pain level
What action should the nurse take first when finding a client lying on the floor?
✔✔ Assess for injury and check responsiveness
What lab value should the nurse monitor closely in a client taking furosemide?
✔✔ Potassium level
What is the most effective way to prevent the spread of infection in a clinical setting?
✔✔ Perform hand hygiene before and after client contact
2
,What is the nurse’s role in client advocacy?
✔✔ Protect the client’s rights and support informed decision-making
What is the primary goal of hospice care?
✔✔ To provide comfort and support at the end of life
How should the nurse handle a medication that a client refuses to take?
✔✔ Document the refusal and notify the provider
What dietary instruction should the nurse give to a client on a low-sodium diet?
✔✔ Avoid processed and canned foods
What is a sign of fluid volume overload the nurse should report immediately?
✔✔ Crackles in the lungs and increased weight
What assessment finding is a priority to report in a postoperative client?
✔✔ Absence of bowel sounds and firm, distended abdomen
3
, How does the nurse maintain sterile technique during a dressing change?
✔✔ Do not touch sterile supplies with bare hands or non-sterile gloves
What is the proper method to remove PPE after caring for a client on contact precautions?
✔✔ Remove gloves, then gown, then perform hand hygiene
How should the nurse assess for orthostatic hypotension?
✔✔ Measure blood pressure and pulse lying, sitting, and standing
What is the most appropriate action when a client expresses dissatisfaction with care?
✔✔ Listen actively and report concerns to the appropriate team member
How should a nurse document a client’s pain accurately?
✔✔ Use a pain scale and describe location, intensity, and duration
What should the nurse include in teaching a client using crutches?
✔✔ Support body weight on hands, not axillae
4
Answers | Latest Version | 2025/2026 |
Correct & Verified
What is the nurse's first action if a client’s oxygen saturation drops to 85% during ambulation?
✔✔ Stop the activity and place the client in a high Fowler’s position
What is the correct method to verify nasogastric tube placement before feeding?
✔✔ Check the pH of the gastric aspirate
What is the priority nursing action when a client reports new onset of confusion and restlessness?
✔✔ Assess oxygenation and vital signs
How should the nurse respond when a client expresses fear about an upcoming surgery?
✔✔ Encourage the client to share feelings and offer emotional support
What is the nurse’s best intervention to prevent aspiration in a client receiving enteral feedings?
✔✔ Keep the head of the bed elevated at least 30 degrees
1
,What is the purpose of applying heat therapy to a localized area?
✔✔ To promote blood flow and reduce muscle tension
What is the expected outcome of range-of-motion exercises in a bedbound client?
✔✔ To maintain joint mobility and prevent contractures
How does the nurse evaluate the effectiveness of a pain medication given 30 minutes ago?
✔✔ Ask the client to rate current pain level
What action should the nurse take first when finding a client lying on the floor?
✔✔ Assess for injury and check responsiveness
What lab value should the nurse monitor closely in a client taking furosemide?
✔✔ Potassium level
What is the most effective way to prevent the spread of infection in a clinical setting?
✔✔ Perform hand hygiene before and after client contact
2
,What is the nurse’s role in client advocacy?
✔✔ Protect the client’s rights and support informed decision-making
What is the primary goal of hospice care?
✔✔ To provide comfort and support at the end of life
How should the nurse handle a medication that a client refuses to take?
✔✔ Document the refusal and notify the provider
What dietary instruction should the nurse give to a client on a low-sodium diet?
✔✔ Avoid processed and canned foods
What is a sign of fluid volume overload the nurse should report immediately?
✔✔ Crackles in the lungs and increased weight
What assessment finding is a priority to report in a postoperative client?
✔✔ Absence of bowel sounds and firm, distended abdomen
3
, How does the nurse maintain sterile technique during a dressing change?
✔✔ Do not touch sterile supplies with bare hands or non-sterile gloves
What is the proper method to remove PPE after caring for a client on contact precautions?
✔✔ Remove gloves, then gown, then perform hand hygiene
How should the nurse assess for orthostatic hypotension?
✔✔ Measure blood pressure and pulse lying, sitting, and standing
What is the most appropriate action when a client expresses dissatisfaction with care?
✔✔ Listen actively and report concerns to the appropriate team member
How should a nurse document a client’s pain accurately?
✔✔ Use a pain scale and describe location, intensity, and duration
What should the nurse include in teaching a client using crutches?
✔✔ Support body weight on hands, not axillae
4
