ANSWERS (VERIFIED ANSWERS) Q&A 2027
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1. Which action is the priority when a nurse identifies a
patient with severe difficulty breathing?
A. Obtain a complete medical history B. Assess airway and
breathing C. Document the patient's symptoms D. Provide
discharge instructions
Correct answer: B. Assess airway and breathing.
Rationale: Airway and breathing are immediate priorities under
the ABC approach to emergency assessment.
2. Which finding is most suggestive of hypoxia?
A. Warm, dry skin B. Increased appetite C. Restlessness and
confusion D. Increased urine output
Correct answer: C. Restlessness and confusion.
Rationale: Early hypoxia may cause restlessness, anxiety, and
altered mental status.
3. Which action is most effective in preventing healthcare-
associated infections?
,A. Wearing gloves for every patient interaction B. Performing
hand hygiene appropriately C. Keeping patient doors closed D.
Administering prophylactic antibiotics to everyone
Correct answer: B. Performing hand hygiene appropriately.
Rationale: Proper hand hygiene is a primary measure for
reducing the transmission of infectious organisms.
4. A nurse is preparing to administer medication. Which action
is essential before administration?
A. Ask another patient to confirm the identity B. Identify the
patient using two approved identifiers C. Identify the patient by
room number D. Administer the medication before checking
the order
Correct answer: B. Identify the patient using two approved
identifiers.
Rationale: Two approved identifiers help prevent medication
administration errors.
5. Which assessment finding is most consistent with fluid
volume deficit?
A. Peripheral edema B. Bounding pulse C. Dry mucous
membranes and tachycardia D. Increased blood pressure with
weight gain
Correct answer: C. Dry mucous membranes and tachycardia.
,Rationale: Dehydration can reduce circulating volume, causing
dry mucous membranes and a compensatory increase in heart
rate.
6. Which electrolyte imbalance is particularly associated with
potentially life-threatening cardiac dysrhythmias?
A. Potassium imbalance B. Mild chloride elevation C. Slight
phosphate reduction D. Mild magnesium-independent sodium
variation
Correct answer: A. Potassium imbalance.
Rationale: Abnormal potassium levels can disrupt cardiac
electrical conduction and cause serious dysrhythmias.
7. Which position generally helps a patient experiencing
dyspnea breathe more comfortably?
A. Flat supine B. Trendelenburg C. High Fowler's D. Prone with
the head turned downward
Correct answer: C. High Fowler's.
Rationale: An upright position improves chest expansion and
may reduce the work of breathing.
8. What is the nurse's priority when a patient becomes
unresponsive and is not breathing normally?
A. Offer oral fluids B. Activate the emergency response and
begin CPR as indicated C. Obtain a complete medication history
D. Leave to find the patient's family
, Correct answer: B. Activate the emergency response and begin
CPR as indicated.
Rationale: Immediate emergency activation and resuscitation
are essential when cardiac arrest is suspected.
9. Which finding is most characteristic of hypoglycemia?
A. Sweating, tremors, and confusion B. Slow wound healing
alone C. Increased thirst over several weeks D. Persistent dry
skin without other symptoms
Correct answer: A. Sweating, tremors, and confusion.
Rationale: Low blood glucose can trigger adrenergic symptoms
and impair brain function.
10. A conscious patient with diabetes has a blood glucose
level of 58 mg/dL and can swallow safely. What is the
appropriate initial action?
A. Administer the scheduled insulin B. Give approximately 15 g
of fast-acting carbohydrate C. Restrict all oral intake D.
Encourage vigorous exercise
Correct answer: B. Give approximately 15 g of fast-acting
carbohydrate.
Rationale: The standard initial treatment for an alert patient
with hypoglycemia who can swallow is fast-acting
carbohydrate, followed by reassessment in about 15 minutes.
11. Which finding may indicate an acute stroke?