1. A patient in the progressive care unit is receiving continuous intravenous (IV)
nitroglycerin for chest pain. Which of the following should the nurse monitor
most closely?
A) Electrolyte levels
B) Blood pressure
C) Liver function tests
D) Hemoglobin levels
Answer: B) Blood pressure
Rationale: Nitroglycerin is a vasodilator, and it can significantly lower blood pressure. Close
monitoring is required to prevent hypotension.
2. A patient with chronic obstructive pulmonary disease (COPD) is admitted to
the progressive care unit for respiratory distress. Which of the following
interventions is most appropriate for this patient?
A) Administering high-flow oxygen
B) Encouraging deep breathing exercises
C) Administering supplemental oxygen as ordered
D) Withholding oxygen to prevent respiratory depression
Answer: C) Administering supplemental oxygen as ordered
Rationale: Patients with COPD require oxygen therapy to maintain adequate oxygen saturation.
High-flow oxygen can worsen CO2 retention, so oxygen should be administered cautiously as
per orders.
3. A patient with heart failure develops acute pulmonary edema. What is the
most important initial intervention?
A) Administering diuretics
B) Placing the patient in a low Fowler's position
C) Administering IV nitroglycerin
D) Providing high-flow oxygen therapy
Answer: D) Providing high-flow oxygen therapy
Rationale: The patient with acute pulmonary edema requires immediate oxygen to maintain
adequate oxygenation, as the fluid accumulation in the lungs hampers gas exchange.
,4. A 65-year-old patient is being transferred from the ICU to the progressive care
unit after a coronary artery bypass graft (CABG). Which of the following
interventions should the nurse prioritize?
A) Monitoring for signs of infection at the surgical site
B) Encouraging ambulation within 24 hours
C) Monitoring ECG for arrhythmias
D) Administering pain medication as needed
Answer: C) Monitoring ECG for arrhythmias
Rationale: Patients post-CABG are at high risk for arrhythmias, particularly within the first 48
hours after surgery, and continuous monitoring of the ECG is crucial.
5. The nurse is caring for a patient with a central venous catheter (CVC) in
place. Which of the following actions should the nurse take to reduce the risk of
infection?
A) Change the dressing over the CVC insertion site every 7 days
B) Clean the site with alcohol before administering medications
C) Use sterile technique when accessing the catheter
D) Flush the CVC with saline every 24 hours
Answer: C) Use sterile technique when accessing the catheter
Rationale: To reduce the risk of infection, sterile technique should always be used when
accessing or manipulating a central venous catheter.
6. A 70-year-old patient with a history of hypertension is admitted with a stroke.
The nurse should closely monitor for which of the following complications in the
immediate post-stroke period?
A) Increased intracranial pressure (ICP)
B) Hemorrhoids
C) Hypertension
D) Hypoglycemia
Answer: A) Increased intracranial pressure (ICP)
Rationale: Stroke patients are at high risk for increased intracranial pressure, particularly during
the acute phase, and require frequent monitoring.
, 7. A patient is recovering from a major abdominal surgery and is receiving
epidural analgesia for pain management. The nurse should monitor the patient
for which of the following potential complications?
A) Hypovolemia
B) Infection at the insertion site
C) Respiratory depression
D) Hyperglycemia
Answer: C) Respiratory depression
Rationale: Epidural analgesia can cause respiratory depression due to its effects on the central
nervous system, requiring close monitoring of respiratory status.
8. Which of the following is a priority nursing intervention for a patient receiving
continuous hemodialysis in the progressive care unit?
A) Monitor vital signs every 15 minutes
B) Assess the access site for bleeding or clotting
C) Restrict fluid intake
D) Encourage ambulation every 2 hours
Answer: B) Assess the access site for bleeding or clotting
Rationale: The access site for hemodialysis is at risk for bleeding or clotting. Monitoring for
complications is a priority during dialysis.
9. A patient with acute renal failure develops hyperkalemia. Which of the
following interventions should the nurse anticipate?
A) Administer sodium bicarbonate
B) Administer calcium gluconate
C) Withhold diuretics
D) Increase potassium intake
Answer: B) Administer calcium gluconate
Rationale: Calcium gluconate helps stabilize the heart's electrical activity during hyperkalemia
and reduces the risk of life-threatening arrhythmias.
nitroglycerin for chest pain. Which of the following should the nurse monitor
most closely?
A) Electrolyte levels
B) Blood pressure
C) Liver function tests
D) Hemoglobin levels
Answer: B) Blood pressure
Rationale: Nitroglycerin is a vasodilator, and it can significantly lower blood pressure. Close
monitoring is required to prevent hypotension.
2. A patient with chronic obstructive pulmonary disease (COPD) is admitted to
the progressive care unit for respiratory distress. Which of the following
interventions is most appropriate for this patient?
A) Administering high-flow oxygen
B) Encouraging deep breathing exercises
C) Administering supplemental oxygen as ordered
D) Withholding oxygen to prevent respiratory depression
Answer: C) Administering supplemental oxygen as ordered
Rationale: Patients with COPD require oxygen therapy to maintain adequate oxygen saturation.
High-flow oxygen can worsen CO2 retention, so oxygen should be administered cautiously as
per orders.
3. A patient with heart failure develops acute pulmonary edema. What is the
most important initial intervention?
A) Administering diuretics
B) Placing the patient in a low Fowler's position
C) Administering IV nitroglycerin
D) Providing high-flow oxygen therapy
Answer: D) Providing high-flow oxygen therapy
Rationale: The patient with acute pulmonary edema requires immediate oxygen to maintain
adequate oxygenation, as the fluid accumulation in the lungs hampers gas exchange.
,4. A 65-year-old patient is being transferred from the ICU to the progressive care
unit after a coronary artery bypass graft (CABG). Which of the following
interventions should the nurse prioritize?
A) Monitoring for signs of infection at the surgical site
B) Encouraging ambulation within 24 hours
C) Monitoring ECG for arrhythmias
D) Administering pain medication as needed
Answer: C) Monitoring ECG for arrhythmias
Rationale: Patients post-CABG are at high risk for arrhythmias, particularly within the first 48
hours after surgery, and continuous monitoring of the ECG is crucial.
5. The nurse is caring for a patient with a central venous catheter (CVC) in
place. Which of the following actions should the nurse take to reduce the risk of
infection?
A) Change the dressing over the CVC insertion site every 7 days
B) Clean the site with alcohol before administering medications
C) Use sterile technique when accessing the catheter
D) Flush the CVC with saline every 24 hours
Answer: C) Use sterile technique when accessing the catheter
Rationale: To reduce the risk of infection, sterile technique should always be used when
accessing or manipulating a central venous catheter.
6. A 70-year-old patient with a history of hypertension is admitted with a stroke.
The nurse should closely monitor for which of the following complications in the
immediate post-stroke period?
A) Increased intracranial pressure (ICP)
B) Hemorrhoids
C) Hypertension
D) Hypoglycemia
Answer: A) Increased intracranial pressure (ICP)
Rationale: Stroke patients are at high risk for increased intracranial pressure, particularly during
the acute phase, and require frequent monitoring.
, 7. A patient is recovering from a major abdominal surgery and is receiving
epidural analgesia for pain management. The nurse should monitor the patient
for which of the following potential complications?
A) Hypovolemia
B) Infection at the insertion site
C) Respiratory depression
D) Hyperglycemia
Answer: C) Respiratory depression
Rationale: Epidural analgesia can cause respiratory depression due to its effects on the central
nervous system, requiring close monitoring of respiratory status.
8. Which of the following is a priority nursing intervention for a patient receiving
continuous hemodialysis in the progressive care unit?
A) Monitor vital signs every 15 minutes
B) Assess the access site for bleeding or clotting
C) Restrict fluid intake
D) Encourage ambulation every 2 hours
Answer: B) Assess the access site for bleeding or clotting
Rationale: The access site for hemodialysis is at risk for bleeding or clotting. Monitoring for
complications is a priority during dialysis.
9. A patient with acute renal failure develops hyperkalemia. Which of the
following interventions should the nurse anticipate?
A) Administer sodium bicarbonate
B) Administer calcium gluconate
C) Withhold diuretics
D) Increase potassium intake
Answer: B) Administer calcium gluconate
Rationale: Calcium gluconate helps stabilize the heart's electrical activity during hyperkalemia
and reduces the risk of life-threatening arrhythmias.
