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RN FUNDAMENTALS ONLINE PRACTICE 2025 B QUESTIONS
AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) |
ASSURED SUCCESS | WITH RATIONALES
1. A nurse in a medical-surgical unit is caring for six clients. Which two should she see first?
1. Rheumatoid arthritis, C-reactive protein 3.2 mg/dL
2. History of hyperlipidemia, Cholesterol 250 mg/dL
3. 1 day postoperative. Reports pain as 8 on a scale of 0 to 10, Oxygen saturation 88%
4. New diagnosis of heart failure, Potassium 3.2 mEq/L
5. Stage 2 pressure injury, Prealbumin 14 mg/dL
6. New diagnosis of diabetes mellitus, Glycosylated hemoglobin 8%
a. Clients 3 & 4
b. Clients 1 & 6
c. Clients 2 & 5
d. Clients 4 & 5
Answer: a. Clients 3 & 4
Rationale: The priority clients to assess first are those with immediate life-threatening conditions. Client
3 has hypoxia (O2 saturation 88%) which requires prompt intervention. Client 4 has hypokalemia
(Potassium 3.2 mEq/L), which can cause dysrhythmias.
2. A nurse is caring for a client with a peripheral IV inserted for fluid replacement. Day 2 assessment
reveals the IV site is edematous with skin surrounding the catheter site taut, blanched, and cool to
touch. What should the nurse do next?
a. Start a new IV in the client's left hand.
b. Place a pressure dressing over the IV site.
c. Apply heat to the client's left hand.
d. Elevate the client's left arm.
e. Stop the IV infusion.
Answer: c, d, e
Rationale: The client is showing signs of infiltration (edema, blanching, coolness). The nurse should stop
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the infusion, elevate the arm to reduce swelling, and apply heat to promote absorption of the infiltrated
fluid. A new IV should be placed in another extremity.
3. A nurse is giving a change-of-shift report about a client admitted with pneumonia. Which of the
following pieces of information is the priority for the nurse to provide?
a. Admitting diagnosis
b. Breath sounds
c. Body temperature
d. Diagnostic test results
Answer: b. Breath sounds
Rationale: Breath sounds are directly related to the airway and breathing, which are the priority aspects
of client care in pneumonia. The nurse must assess for signs of respiratory distress or abnormal lung
sounds.
4. A nurse is preparing to transfer a client who can bear weight on one leg from the bed to a chair.
After securing a safe environment, which action should the nurse take next?
a. Rock the client up to a standing position.
b. Pivot on the foot that is the farthest from the chair.
c. Assess the client for orthostatic hypotension.
d. Apply a gait belt to the client.
Answer: c. Assess the client for orthostatic hypotension.
Rationale: Before assisting the client to stand, it is important to assess for orthostatic hypotension by
having the client dangle their feet and monitor for dizziness or a significant drop in blood pressure.
5. A nurse is teaching an older adult client at risk for osteoporosis about starting a physical activity
program. Which type of activity should the nurse recommend?
a. Walking briskly
b. Riding a bicycle
c. Performing isometric exercises
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d. Engaging in high-impact aerobics
Answer: a. Walking briskly
Rationale: Weight-bearing exercises like brisk walking are essential for bone health and are
recommended for clients at risk for osteoporosis to help prevent further bone loss.
6. A nurse is caring for a client with terminal liver cancer. Which of the following statements indicates
the client is experiencing spiritual distress?
a. "What could I have done to deserve this illness?"
b. "I blame medical science for not curing me."
c. "Where is my daughter at a time like this?"
d. "Will I ever begin to feel in charge of my life again?"
Answer: a. "What could I have done to deserve this illness?"
Rationale: Spiritual distress often involves questioning the meaning or purpose of life and illness. The
client is expressing feelings of guilt or questioning the reasons behind their illness.
7. A nurse is reviewing protocol before suctioning secretions from a client with a new tracheostomy.
Which of the following actions should the nurse take?
a. Use a resuscitation bag with 80% oxygen prior to the procedure.
b. Select a suction catheter that is half the size of the lumen.
c. Place the end of the suction catheter in water-soluble lubricant.
d. Adjust the wall suction apparatus to a pressure of 170 mm Hg.
Answer: b. Select a suction catheter that is half the size of the lumen.
Rationale: A suction catheter that is half the size of the tracheostomy tube lumen prevents damage to
the mucosa and minimizes the risk of hypoxemia.
8. A nurse is inserting a nasogastric (NG) tube for stomach decompression. Which action should the
nurse take during the insertion?
a. Position the client with the head of the bed elevated to 30° prior to insertion of the NG tube.
b. Remove the NG tube if the client begins to gag or choke.
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c. Apply suction to the NG tube prior to insertion.
d. Have the client take sips of water to promote insertion of the NG tube into the esophagus.
Answer: d. Have the client take sips of water to promote insertion of the NG tube into the esophagus.
Rationale: Sipping water while inserting the NG tube helps to close the epiglottis and directs the tube
into the esophagus instead of the trachea.
9. A nurse is reviewing a client's medication prescription for digoxin, "digoxin 0.25 by mouth every
day." Which component should the nurse verify with the provider?
a. Medication name
b. Route of administration
c. Medication dose
d. Frequency of administration
Answer: c. Medication dose
Rationale: The dose of digoxin is incomplete because it lacks a unit of measurement (e.g., mg). The
nurse should clarify this before administration.
10. A nurse is evaluating a client's use of a cane. Which of the following actions indicates correct use?
a. The top of the cane is parallel to the client's waist.
b. When walking, the client moves the cane 46 cm (18 in) forward.
c. The client holds the cane on the stronger side of their body.
d. The client moves their stronger limb forward with the cane.
Answer: c. The client holds the cane on the stronger side of their body.
Rationale: The cane should be held on the stronger side to provide additional support and maintain
balance.
11. A nurse is caring for a client in a hospital setting. Which action should the nurse take to prevent
the spread of infection?
a. Carry a client's soiled linens out of the room in a mesh linen bag.
b. Place a client who has tuberculosis in a room with negative-pressure airflow.
RN FUNDAMENTALS ONLINE PRACTICE 2025 B QUESTIONS
AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) |
ASSURED SUCCESS | WITH RATIONALES
1. A nurse in a medical-surgical unit is caring for six clients. Which two should she see first?
1. Rheumatoid arthritis, C-reactive protein 3.2 mg/dL
2. History of hyperlipidemia, Cholesterol 250 mg/dL
3. 1 day postoperative. Reports pain as 8 on a scale of 0 to 10, Oxygen saturation 88%
4. New diagnosis of heart failure, Potassium 3.2 mEq/L
5. Stage 2 pressure injury, Prealbumin 14 mg/dL
6. New diagnosis of diabetes mellitus, Glycosylated hemoglobin 8%
a. Clients 3 & 4
b. Clients 1 & 6
c. Clients 2 & 5
d. Clients 4 & 5
Answer: a. Clients 3 & 4
Rationale: The priority clients to assess first are those with immediate life-threatening conditions. Client
3 has hypoxia (O2 saturation 88%) which requires prompt intervention. Client 4 has hypokalemia
(Potassium 3.2 mEq/L), which can cause dysrhythmias.
2. A nurse is caring for a client with a peripheral IV inserted for fluid replacement. Day 2 assessment
reveals the IV site is edematous with skin surrounding the catheter site taut, blanched, and cool to
touch. What should the nurse do next?
a. Start a new IV in the client's left hand.
b. Place a pressure dressing over the IV site.
c. Apply heat to the client's left hand.
d. Elevate the client's left arm.
e. Stop the IV infusion.
Answer: c, d, e
Rationale: The client is showing signs of infiltration (edema, blanching, coolness). The nurse should stop
,ESTUDYR
the infusion, elevate the arm to reduce swelling, and apply heat to promote absorption of the infiltrated
fluid. A new IV should be placed in another extremity.
3. A nurse is giving a change-of-shift report about a client admitted with pneumonia. Which of the
following pieces of information is the priority for the nurse to provide?
a. Admitting diagnosis
b. Breath sounds
c. Body temperature
d. Diagnostic test results
Answer: b. Breath sounds
Rationale: Breath sounds are directly related to the airway and breathing, which are the priority aspects
of client care in pneumonia. The nurse must assess for signs of respiratory distress or abnormal lung
sounds.
4. A nurse is preparing to transfer a client who can bear weight on one leg from the bed to a chair.
After securing a safe environment, which action should the nurse take next?
a. Rock the client up to a standing position.
b. Pivot on the foot that is the farthest from the chair.
c. Assess the client for orthostatic hypotension.
d. Apply a gait belt to the client.
Answer: c. Assess the client for orthostatic hypotension.
Rationale: Before assisting the client to stand, it is important to assess for orthostatic hypotension by
having the client dangle their feet and monitor for dizziness or a significant drop in blood pressure.
5. A nurse is teaching an older adult client at risk for osteoporosis about starting a physical activity
program. Which type of activity should the nurse recommend?
a. Walking briskly
b. Riding a bicycle
c. Performing isometric exercises
,ESTUDYR
d. Engaging in high-impact aerobics
Answer: a. Walking briskly
Rationale: Weight-bearing exercises like brisk walking are essential for bone health and are
recommended for clients at risk for osteoporosis to help prevent further bone loss.
6. A nurse is caring for a client with terminal liver cancer. Which of the following statements indicates
the client is experiencing spiritual distress?
a. "What could I have done to deserve this illness?"
b. "I blame medical science for not curing me."
c. "Where is my daughter at a time like this?"
d. "Will I ever begin to feel in charge of my life again?"
Answer: a. "What could I have done to deserve this illness?"
Rationale: Spiritual distress often involves questioning the meaning or purpose of life and illness. The
client is expressing feelings of guilt or questioning the reasons behind their illness.
7. A nurse is reviewing protocol before suctioning secretions from a client with a new tracheostomy.
Which of the following actions should the nurse take?
a. Use a resuscitation bag with 80% oxygen prior to the procedure.
b. Select a suction catheter that is half the size of the lumen.
c. Place the end of the suction catheter in water-soluble lubricant.
d. Adjust the wall suction apparatus to a pressure of 170 mm Hg.
Answer: b. Select a suction catheter that is half the size of the lumen.
Rationale: A suction catheter that is half the size of the tracheostomy tube lumen prevents damage to
the mucosa and minimizes the risk of hypoxemia.
8. A nurse is inserting a nasogastric (NG) tube for stomach decompression. Which action should the
nurse take during the insertion?
a. Position the client with the head of the bed elevated to 30° prior to insertion of the NG tube.
b. Remove the NG tube if the client begins to gag or choke.
, ESTUDYR
c. Apply suction to the NG tube prior to insertion.
d. Have the client take sips of water to promote insertion of the NG tube into the esophagus.
Answer: d. Have the client take sips of water to promote insertion of the NG tube into the esophagus.
Rationale: Sipping water while inserting the NG tube helps to close the epiglottis and directs the tube
into the esophagus instead of the trachea.
9. A nurse is reviewing a client's medication prescription for digoxin, "digoxin 0.25 by mouth every
day." Which component should the nurse verify with the provider?
a. Medication name
b. Route of administration
c. Medication dose
d. Frequency of administration
Answer: c. Medication dose
Rationale: The dose of digoxin is incomplete because it lacks a unit of measurement (e.g., mg). The
nurse should clarify this before administration.
10. A nurse is evaluating a client's use of a cane. Which of the following actions indicates correct use?
a. The top of the cane is parallel to the client's waist.
b. When walking, the client moves the cane 46 cm (18 in) forward.
c. The client holds the cane on the stronger side of their body.
d. The client moves their stronger limb forward with the cane.
Answer: c. The client holds the cane on the stronger side of their body.
Rationale: The cane should be held on the stronger side to provide additional support and maintain
balance.
11. A nurse is caring for a client in a hospital setting. Which action should the nurse take to prevent
the spread of infection?
a. Carry a client's soiled linens out of the room in a mesh linen bag.
b. Place a client who has tuberculosis in a room with negative-pressure airflow.
