and Answers | Latest Version |
2025/2026 | Correct & Verified
A client with pneumonia has oxygen saturation of 84% on room air. What is the nurse’s priority
action?
A. Encourage coughing and deep breathing
✔✔B. Apply oxygen via nasal cannula
C. Obtain a sputum culture
D. Notify the healthcare provider
A client receiving IV potassium reports burning at the IV site. What should the nurse do first?
✔✔A. Slow the infusion rate
B. Discontinue the infusion immediately
C. Apply cold compress
D. Flush with heparin
A client on lithium therapy reports excessive thirst and frequent urination. Which lab result
requires immediate action?
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,A. Sodium 138 mEq/L
✔✔B. Lithium 2.0 mEq/L
C. Potassium 4.0 mEq/L
D. Calcium 9.0 mg/dL
A nurse is teaching a client with heart failure about daily care. Which statement indicates correct
understanding?
A. “I should limit weighing myself to once a week.”
✔✔B. “I will call my provider if I gain more than 2 pounds in 24 hours.”
C. “I should increase my salt intake for hydration.”
D. “I don’t need to track my fluid intake.”
A client receiving chemotherapy reports tingling in the fingers and toes. Which complication
should the nurse suspect?
A. Mucositis
B. Alopecia
✔✔C. Peripheral neuropathy
D. Neutropenia
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,A client with type 1 diabetes is sweating, shaky, and pale. What is the nurse’s first action?
A. Call the healthcare provider
B. Administer insulin
✔✔C. Provide a fast-acting carbohydrate
D. Recheck glucose in 1 hour
A client with a chest tube has continuous bubbling in the water seal chamber. What should the
nurse do?
A. Document the finding as normal
✔✔B. Assess for an air leak
C. Increase suction
D. Clamp the chest tube
A nurse is caring for a client post-thyroidectomy. Which finding requires immediate
intervention?
A. Hoarse voice
✔✔B. Stridor
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, C. Sore throat
D. Fatigue
A client prescribed warfarin asks about diet. Which food should the nurse advise limiting?
A. Bananas
✔✔B. Kale
C. Apples
D. Potatoes
A nurse is teaching a client about digoxin. Which statement indicates a need for further teaching?
A. “I should check my pulse before taking this medication.”
✔✔B. “If I feel nauseated, I should take another dose.”
C. “I should report any vision changes.”
D. “I should not stop the medication suddenly.”
A client with dehydration is receiving IV fluids. Which assessment best indicates therapy is
effective?
A. Decreased appetite
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