Questions with Correct Detailed Answers
and Rationales | Graded A+ | Newest Version
110 Questions – Newest Version (Graded A+)
1. A client with heart failure is prescribed furosemide. The nurse should monitor for which
electrolyte imbalance? HypokalemiaRationale: Loop diuretics cause significant
potassium loss in urine.
2. A client receiving heparin IV develops hematuria. Priority action: Stop the infusion and
notify the providerRationale: Indicates bleeding complication; antidote is protamine
sulfate.
3. The nurse is assessing a client with cirrhosis. Which finding indicates worsening liver
function? Asterixis (flapping tremor)Rationale: Sign of hepatic encephalopathy from
ammonia buildup.
4. A client with diabetes mellitus has a blood glucose of 52 mg/dL. First action: Administer
15 g of fast-acting carbohydrateRationale: Follows the 15-15 rule for hypoglycemia.
5. A postpartum client has a boggy uterus. First nursing intervention: Massage the
fundusRationale: Promotes contraction to control bleeding; check bladder next if
persists.
6. The nurse is teaching a client with COPD about pursed-lip breathing. Purpose: Prolong
exhalation and prevent airway collapseRationale: Increases positive end-expiratory
pressure.
, 7. A client with acute kidney injury has potassium 6.2 mEq/L. Priority intervention: Prepare
for kayexalate or emergency treatmentRationale: Hyperkalemia can cause fatal
arrhythmias.
8. The nurse is caring for a client with neutropenia. Highest infection risk activity: Eating
fresh fruits and vegetablesRationale: Raw produce may harbor bacteria.
9. A client post-thyroidectomy reports tingling around mouth. First action: Check for
Chvostek’s sign and prepare calciumRationale: Indicates hypocalcemia from parathyroid
damage.
10. The nurse is administering digoxin. Which finding requires holding the dose? Apical
pulse <60 bpmRationale: Bradycardia is a common toxicity sign.
11. A client with peptic ulcer disease is prescribed sucralfate. Teaching: Take on empty
stomach 1 hour before mealsRationale: Coats ulcer without food interference.
12. The nurse is assessing a client with pneumonia. Expected finding: Crackles in affected
lung areasRationale: Fluid in alveoli causes discontinuous sounds.
13. A client with rheumatoid arthritis reports morning stiffness >1 hour. This distinguishes
from: OsteoarthritisRationale: OA stiffness brief (<30 min).
14. The nurse is caring for a client with Parkinson’s disease. Expected gait: Shuffling with
festinating stepsRationale: Bradykinesia and postural instability.
15. A client with multiple sclerosis reports fatigue. Best intervention: Plan activities with rest
periodsRationale: Energy conservation technique.