Questions and Answers | Latest
Version | 2025/2026 | Correct & Verified
A postoperative patient is confused and attempting to get out of bed. What should the nurse do
first?
✔✔Implement fall precautions and stay with the patient while assessing mental status.
A patient develops a rash and swelling after receiving a new medication. What is the priority
nursing action?
✔✔Assess airway, stop the medication, and notify the provider for further instructions.
A child presents with a high fever and seizure activity. What should the nurse do first?
✔✔Ensure safety during the seizure, maintain airway patency, and monitor neurological status.
A patient reports dizziness and a heart rate of 42 bpm. What is the nurse’s priority action?
✔✔Assess for hypotension and symptoms, keep the patient supine, and notify the provider.
A diabetic patient reports a blood glucose of 38 mg/dL and confusion. What is the first action?
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,✔✔Administer a rapid-acting carbohydrate and recheck glucose per protocol.
A patient refuses a prescribed antibiotic due to fear of side effects. What is the best nursing
action?
✔✔Provide education on the benefits, risks, and purpose of the medication, and document the
discussion.
A postoperative patient reports severe pain unrelieved by medication. What should the nurse do
first?
✔✔Assess the surgical site and other possible complications, including infection or compartment
syndrome.
A patient develops sudden swelling of the face and lips after eating peanuts. What is the priority
action?
✔✔Assess airway, prepare emergency interventions, and notify the provider immediately.
A patient with COPD reports worsening shortness of breath and cyanosis. What is the nurse’s
first action?
✔✔Administer prescribed oxygen and assess respiratory status and effort.
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,A patient post-surgery shows hypotension and tachycardia. What should the nurse assess first?
✔✔Check for internal or external bleeding and maintain IV access for fluid replacement.
A patient reports numbness and tingling in the hands after starting a new medication. What is the
first action?
✔✔Assess for signs of adverse drug reaction and notify the provider.
A patient scheduled for surgery asks why they must be NPO. What is the nurse’s best response?
✔✔Explain that fasting reduces the risk of aspiration during anesthesia.
A patient is experiencing anxiety before surgery. What is the best nursing intervention?
✔✔Provide education, reassurance, and answer questions about the procedure to reduce anxiety.
A patient reports burning on urination after catheter placement. What should the nurse do first?
✔✔Assess for urinary tract infection, check catheter patency, and notify the provider if needed.
A patient postoperatively refuses ambulation due to pain. What is the priority nursing action?
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, ✔✔Assess pain level and provide analgesia before assisting with ambulation.
A patient develops sudden shortness of breath and low oxygen saturation. What is the nurse’s
first action?
✔✔Assess airway, administer oxygen, and notify the provider immediately.
A patient has a new antihypertensive prescription but BP is 88/56 mmHg. What is the priority
action?
✔✔Hold the medication and notify the provider for guidance.
A patient develops a rash after IV antibiotic administration. What is the first nursing action?
✔✔Stop the infusion, assess the patient, and notify the provider.
A patient on anticoagulants reports black, tarry stools. What should the nurse do first?
✔✔Hold the medication and notify the provider immediately.
A patient reports persistent nausea after chemotherapy. What is the priority nursing action?
✔✔Assess severity and administer antiemetic as prescribed.
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