1. A nurse is caring for a client with heart failure who has an ejection fraction of 35%.
Which medication is most likely to reduce mortality?
A. Digoxin
B. Furosemide
C. Metoprolol succinate
D. Dobutamine
Answer: C. Metoprolol succinate
Rationale: Metoprolol succinate is a beta-blocker that has been proven to reduce mortality
and hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF). It
works by blocking the harmful effects of chronic sympathetic nervous system stimulation,
which leads to cardiac remodeling and worsening heart failure. Digoxin (A) improves
cardiac contractility and controls symptoms but does not reduce mortality. Furosemide (B)
is a loop diuretic that manages fluid overload but has no mortality benefit. Dobutamine (D)
is a short-term inotropic agent used in acute decompensated heart failure and is not
indicated for chronic mortality reduction.
2. A client with COPD has an SpO2 of 88% on room air. Which oxygen delivery device
should the nurse use first?
A. Non-rebreather mask at 15 L/min
B. Nasal cannula at 2 L/min
C. Simple face mask at 6 L/min
D. Venturi mask at 28%
Answer: B. Nasal cannula at 2 L/min
Rationale: In patients with COPD, the hypoxic drive (peripheral chemoreceptors) may
become the primary stimulus for breathing. High-flow oxygen can suppress this drive,
leading to hypoventilation, respiratory acidosis, and apnea. The goal is to maintain SpO2
between 88-92% using low-flow oxygen. A nasal cannula at 1-2 L/min is the safest initial
device. A non-rebreather (A) at 15 L/min delivers nearly 100% oxygen and is
contraindicated in COPD without careful monitoring. A simple face mask (C) at 6 L/min
1
,delivers higher concentrations (40-60%) and is not the first choice. A Venturi mask (D)
delivers precise oxygen concentrations but is typically used when precise control is
needed, not as the initial device for mild hypoxemia.
3. A nurse is assessing a client with diabetic ketoacidosis (DKA). Which finding requires
immediate intervention?
A. Blood glucose 350 mg/dL
B. Serum potassium 2.8 mEq/L
C. Kussmaul respirations
D. Fruity breath odor
Answer: B. Serum potassium 2.8 mEq/L
Rationale: Hypokalemia (potassium < 3.5 mEq/L) in DKA is a life-threatening emergency.
Total body potassium is depleted in DKA due to osmotic diuresis, and insulin therapy will
drive potassium intracellularly, further decreasing serum levels. This places the patient at
high risk for fatal cardiac arrhythmias, including ventricular tachycardia and fibrillation.
Blood glucose of 350 mg/dL (A) is expected in DKA and requires insulin but is not
immediately life-threatening. Kussmaul respirations (C) are a compensatory mechanism
for metabolic acidosis and indicate the body is trying to blow off CO2; while serious, it is
not the priority over a critically low potassium. Fruity breath odor (D) is a classic sign of
ketoacidosis from acetone production and does not require immediate intervention.
4. A client with cirrhosis has ascites and an abdominal paracentesis is performed. After the
procedure, the nurse should monitor for which complication?
A. Hyperglycemia
B. Hypotension and hypovolemia
C. Hyponatremia
D. Respiratory alkalosis
Answer: B. Hypotension and hypovolemia
Rationale: Abdominal paracentesis involves the removal of large volumes of ascitic fluid
(sometimes 4-6 liters or more). This rapid removal of fluid from the peritoneal cavity can
cause a sudden shift of fluid from the intravascular space into the peritoneal cavity, leading
to hypovolemia and hypotension. This is known as post-paracentesis circulatory
dysfunction. The nurse must monitor vital signs closely for signs of shock. Hyperglycemia
(A) is not directly related to paracentesis; it is more common in liver disease due to
impaired glucose metabolism but not a direct complication. Hyponatremia (C) is common
in cirrhosis due to dilutional effects but is not an immediate post-procedure concern.
2
,Respiratory alkalosis (D) is not a typical complication; the patient may experience
respiratory distress from pressure changes, but alkalosis is not expected.
5. A client with a new colostomy asks how to prevent odor. Which instruction should the
nurse provide?
A. "Place an aspirin tablet in the pouch."
B. "Eat yogurt and buttermilk regularly."
C. "Change the pouch every 4 hours."
D. "Rinse the pouch with vinegar daily."
Answer: B. "Eat yogurt and buttermilk regularly."
Rationale: Yogurt and buttermilk contain probiotics (active cultures such as Lactobacillus)
that help normalize intestinal flora and reduce the production of malodorous gases. This is
a safe, non-invasive dietary measure. Placing an aspirin (A) in the pouch is dangerous;
aspirin can irritate and cause chemical burns to the stoma mucosa. Changing the pouch
every 4 hours (C) is excessive and will cause severe skin breakdown due to frequent
adhesive removal; pouches are typically changed every 3-7 days. Rinsing the pouch with
vinegar (D) is an outdated practice that can irritate the peristomal skin and is not
recommended.
6. A nurse is caring for a client with an indwelling urinary catheter. Which finding suggests
a catheter-associated urinary tract infection (CAUTI)?
A. Clear yellow urine
B. Foul-smelling, cloudy urine with fever
C. Low back pain only
D. Urine output of 30 mL/hour
Answer: B. Foul-smelling, cloudy urine with fever
Rationale: Classic signs of a CAUTI include cloudy urine, a foul or strong odor, fever, chills,
and suprapubic or flank tenderness. The presence of bacteria, white blood cells, and pus in
the urine causes the cloudiness and odor. Clear yellow urine (A) is normal and does not
indicate infection. Low back pain only (C) is a nonspecific symptom; while it could indicate
pyelonephritis, it must be accompanied by other urinary signs to suggest CAUTI. Urine
output of 30 mL/hour (D) is within the normal range (at least 30 mL/hour) and does not
indicate infection; it suggests adequate renal perfusion.
3
, 7. A client with angina pectoris reports chest pain that is relieved by rest and nitroglycerin.
The nurse recognizes this as:
A. Unstable angina
B. Variant angina
C. Stable angina
D. Myocardial infarction
Answer: C. Stable angina
Rationale: Stable angina is predictable chest pain that occurs with physical exertion,
emotional stress, or increased myocardial oxygen demand and is consistently relieved by
rest or sublingual nitroglycerin within a few minutes. It is caused by fixed coronary artery
atherosclerosis. Unstable angina (A) occurs at rest or with minimal exertion, is
unpredictable, and is not easily relieved by nitroglycerin; it is a medical emergency. Variant
angina (Prinzmetal's) (B) is caused by coronary artery spasm and often occurs at rest,
typically at night. Myocardial infarction (D) involves actual myocardial cell death; pain is
not relieved by rest or nitroglycerin and is accompanied by elevated cardiac biomarkers.
8. A nurse is preparing to administer furosemide 40 mg IV push. Which lab value should the
nurse check before administering?
A. Hemoglobin
B. Potassium
C. Platelets
D. Sodium
Answer: B. Potassium
Rationale: Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption in
the ascending loop of Henle, leading to significant potassium wasting in the distal tubule.
Hypokalemia is a common and dangerous adverse effect. The nurse must check the serum
potassium level before administration; if the potassium is already low (e.g., < 3.5 mEq/L),
the nurse should hold the medication and notify the provider to prevent severe
hypokalemia, which can cause cardiac arrhythmias. Hemoglobin (A) and platelets (C) are
not directly affected by a single dose of furosemide. Sodium (D) can be affected, but
potassium is the primary and most critical value to assess prior to administration due to
the risk of life-threatening arrhythmias.
9. A client with chronic kidney disease (CKD) has a potassium level of 6.2 mEq/L. Which
intervention should the nurse implement first?
A. Administer sodium polystyrene sulfonate
4
Which medication is most likely to reduce mortality?
A. Digoxin
B. Furosemide
C. Metoprolol succinate
D. Dobutamine
Answer: C. Metoprolol succinate
Rationale: Metoprolol succinate is a beta-blocker that has been proven to reduce mortality
and hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF). It
works by blocking the harmful effects of chronic sympathetic nervous system stimulation,
which leads to cardiac remodeling and worsening heart failure. Digoxin (A) improves
cardiac contractility and controls symptoms but does not reduce mortality. Furosemide (B)
is a loop diuretic that manages fluid overload but has no mortality benefit. Dobutamine (D)
is a short-term inotropic agent used in acute decompensated heart failure and is not
indicated for chronic mortality reduction.
2. A client with COPD has an SpO2 of 88% on room air. Which oxygen delivery device
should the nurse use first?
A. Non-rebreather mask at 15 L/min
B. Nasal cannula at 2 L/min
C. Simple face mask at 6 L/min
D. Venturi mask at 28%
Answer: B. Nasal cannula at 2 L/min
Rationale: In patients with COPD, the hypoxic drive (peripheral chemoreceptors) may
become the primary stimulus for breathing. High-flow oxygen can suppress this drive,
leading to hypoventilation, respiratory acidosis, and apnea. The goal is to maintain SpO2
between 88-92% using low-flow oxygen. A nasal cannula at 1-2 L/min is the safest initial
device. A non-rebreather (A) at 15 L/min delivers nearly 100% oxygen and is
contraindicated in COPD without careful monitoring. A simple face mask (C) at 6 L/min
1
,delivers higher concentrations (40-60%) and is not the first choice. A Venturi mask (D)
delivers precise oxygen concentrations but is typically used when precise control is
needed, not as the initial device for mild hypoxemia.
3. A nurse is assessing a client with diabetic ketoacidosis (DKA). Which finding requires
immediate intervention?
A. Blood glucose 350 mg/dL
B. Serum potassium 2.8 mEq/L
C. Kussmaul respirations
D. Fruity breath odor
Answer: B. Serum potassium 2.8 mEq/L
Rationale: Hypokalemia (potassium < 3.5 mEq/L) in DKA is a life-threatening emergency.
Total body potassium is depleted in DKA due to osmotic diuresis, and insulin therapy will
drive potassium intracellularly, further decreasing serum levels. This places the patient at
high risk for fatal cardiac arrhythmias, including ventricular tachycardia and fibrillation.
Blood glucose of 350 mg/dL (A) is expected in DKA and requires insulin but is not
immediately life-threatening. Kussmaul respirations (C) are a compensatory mechanism
for metabolic acidosis and indicate the body is trying to blow off CO2; while serious, it is
not the priority over a critically low potassium. Fruity breath odor (D) is a classic sign of
ketoacidosis from acetone production and does not require immediate intervention.
4. A client with cirrhosis has ascites and an abdominal paracentesis is performed. After the
procedure, the nurse should monitor for which complication?
A. Hyperglycemia
B. Hypotension and hypovolemia
C. Hyponatremia
D. Respiratory alkalosis
Answer: B. Hypotension and hypovolemia
Rationale: Abdominal paracentesis involves the removal of large volumes of ascitic fluid
(sometimes 4-6 liters or more). This rapid removal of fluid from the peritoneal cavity can
cause a sudden shift of fluid from the intravascular space into the peritoneal cavity, leading
to hypovolemia and hypotension. This is known as post-paracentesis circulatory
dysfunction. The nurse must monitor vital signs closely for signs of shock. Hyperglycemia
(A) is not directly related to paracentesis; it is more common in liver disease due to
impaired glucose metabolism but not a direct complication. Hyponatremia (C) is common
in cirrhosis due to dilutional effects but is not an immediate post-procedure concern.
2
,Respiratory alkalosis (D) is not a typical complication; the patient may experience
respiratory distress from pressure changes, but alkalosis is not expected.
5. A client with a new colostomy asks how to prevent odor. Which instruction should the
nurse provide?
A. "Place an aspirin tablet in the pouch."
B. "Eat yogurt and buttermilk regularly."
C. "Change the pouch every 4 hours."
D. "Rinse the pouch with vinegar daily."
Answer: B. "Eat yogurt and buttermilk regularly."
Rationale: Yogurt and buttermilk contain probiotics (active cultures such as Lactobacillus)
that help normalize intestinal flora and reduce the production of malodorous gases. This is
a safe, non-invasive dietary measure. Placing an aspirin (A) in the pouch is dangerous;
aspirin can irritate and cause chemical burns to the stoma mucosa. Changing the pouch
every 4 hours (C) is excessive and will cause severe skin breakdown due to frequent
adhesive removal; pouches are typically changed every 3-7 days. Rinsing the pouch with
vinegar (D) is an outdated practice that can irritate the peristomal skin and is not
recommended.
6. A nurse is caring for a client with an indwelling urinary catheter. Which finding suggests
a catheter-associated urinary tract infection (CAUTI)?
A. Clear yellow urine
B. Foul-smelling, cloudy urine with fever
C. Low back pain only
D. Urine output of 30 mL/hour
Answer: B. Foul-smelling, cloudy urine with fever
Rationale: Classic signs of a CAUTI include cloudy urine, a foul or strong odor, fever, chills,
and suprapubic or flank tenderness. The presence of bacteria, white blood cells, and pus in
the urine causes the cloudiness and odor. Clear yellow urine (A) is normal and does not
indicate infection. Low back pain only (C) is a nonspecific symptom; while it could indicate
pyelonephritis, it must be accompanied by other urinary signs to suggest CAUTI. Urine
output of 30 mL/hour (D) is within the normal range (at least 30 mL/hour) and does not
indicate infection; it suggests adequate renal perfusion.
3
, 7. A client with angina pectoris reports chest pain that is relieved by rest and nitroglycerin.
The nurse recognizes this as:
A. Unstable angina
B. Variant angina
C. Stable angina
D. Myocardial infarction
Answer: C. Stable angina
Rationale: Stable angina is predictable chest pain that occurs with physical exertion,
emotional stress, or increased myocardial oxygen demand and is consistently relieved by
rest or sublingual nitroglycerin within a few minutes. It is caused by fixed coronary artery
atherosclerosis. Unstable angina (A) occurs at rest or with minimal exertion, is
unpredictable, and is not easily relieved by nitroglycerin; it is a medical emergency. Variant
angina (Prinzmetal's) (B) is caused by coronary artery spasm and often occurs at rest,
typically at night. Myocardial infarction (D) involves actual myocardial cell death; pain is
not relieved by rest or nitroglycerin and is accompanied by elevated cardiac biomarkers.
8. A nurse is preparing to administer furosemide 40 mg IV push. Which lab value should the
nurse check before administering?
A. Hemoglobin
B. Potassium
C. Platelets
D. Sodium
Answer: B. Potassium
Rationale: Furosemide is a loop diuretic that inhibits sodium and chloride reabsorption in
the ascending loop of Henle, leading to significant potassium wasting in the distal tubule.
Hypokalemia is a common and dangerous adverse effect. The nurse must check the serum
potassium level before administration; if the potassium is already low (e.g., < 3.5 mEq/L),
the nurse should hold the medication and notify the provider to prevent severe
hypokalemia, which can cause cardiac arrhythmias. Hemoglobin (A) and platelets (C) are
not directly affected by a single dose of furosemide. Sodium (D) can be affected, but
potassium is the primary and most critical value to assess prior to administration due to
the risk of life-threatening arrhythmias.
9. A client with chronic kidney disease (CKD) has a potassium level of 6.2 mEq/L. Which
intervention should the nurse implement first?
A. Administer sodium polystyrene sulfonate
4
