and answers correctly solved 2025
1. A nurse is assessing a client who has an acute respiratory infection,
increasing the risk for hypoxemia. Which of the following findings are early
indications that should alert the nurse that the client is developing hypoxia?
(Select all that apply.)
A. Restlessness
B. Tachypnea
C. Bradycardia
D. Confusion
E. Hypertension - correct answer ✔A. Restlessness
B. Tachypnea
D. Confusion
E. Hypertension
2. A provider is discharging a client who has a prescription for home oxygen
therapy via nasal cannula. Client and family teaching by the nurse should
include which of the following instructions? (Select all that apply.)
A. Apply petroleum jelly around and inside the nares.
B. Remove the nasal cannula during mealtimes.
C. Check the position of the cannula frequently.
D. Report any nausea or difficulty breathing.
E. Post "No Smoking" signs in prominent locations - correct answer ✔C.
Check the position of the cannula frequently.
D. Report any nausea or difficulty breathing.
,E. Post "No Smoking" signs in prominent locations
3. A nurse is caring for a client who is having difficulty breathing. The client is
lying in bed and is already receiving oxygen therapy via nasal cannula. Which
of the following interventions is the nurse's priority?
A. Increase the oxygen flow.
B. Assist the client to Fowler's position.
C. Promote removal of pulmonary secretions.
D. Obtain a specimen for arterial blood gases - correct answer ✔B. Assist
the client to Fowler's position.
4. A nurse is preparing to perform endotracheal suctioning for a client. The
nurse should follow which of the following guidelines? (Select all that apply.)
A. Apply suction while withdrawing the catheter.
B. Perform suctioning on a routine basis every 2 to 3 hr.
C. Maintain medical asepsis during suctioning.
D. Use a new catheter for each suctioning attempt.
E. Apply suction for 10 to 15 seconds. - correct answer ✔A. Apply suction
while withdrawing the catheter.
D. Use a new catheter for each suctioning attempt.
E. Apply suction for 10 to 15 seconds.
5. A nurse is caring for a client who has a tracheostomy. Which of the
following actions should the nurse take when providing tracheostomy care?
(Select all that apply.)
, A. Apply the oxygen source loosely if the SpO2 decreases during the
procedure.
B. Use surgical asepsis to remove and clean the inner cannula.
C. Clean the outer cannula surfaces in a circular motion from the stoma site
outward.
D. Replace the tracheostomy ties with new ties.
E. Cut a slit in gauze squares to place beneath the tube holder. - correct
answer ✔A. Apply the oxygen source loosely if the SpO2 decreases during
the procedure.
B. Use surgical asepsis to remove and clean the inner cannula.
C. Clean the outer cannula surfaces in a circular motion from the stoma site
outward.
1. A nurse is teaching a client who reports stress urinary incontinence. Which
of the following instructions should the nurse include? (Select all that apply.)
A. Limit total daily fluid intake.
B. Decrease or avoid caffeine.
C. Take calcium supplements.
D. Avoid drinking alcohol.
E. Use the Credé maneuver - correct answer ✔B. Decrease or avoid
caffeine.
D. Avoid drinking alcohol.
2. A client who has an indwelling catheter reports a need to urinate. Which of
the following actions should the nurse take?
A. Check to see whether the catheter is patent.