HealthStream Jane Assessment Test
Exam 2025/2026 – Verified Questions
with Correct Solutions (100%
Guaranteed Pass)
Question 1
What are the hallmark signs of congestive heart failure (CHF)?
A. Fever, dry cough, and weight loss
B. Shortness of breath, orthopnea, and pink frothy sputum
C. Chest pain and bradycardia
D. Hyperglycemia and polyuria
B. Shortness of breath, orthopnea, and pink frothy sputum
Rationale: CHF is characterized by fluid overload, leading to shortness of breath, orthopnea
(difficulty breathing when lying flat), and pink frothy sputum due to pulmonary edema.
Question 2
What is the priority nursing intervention for a patient with CHF experiencing dyspnea?
A. Administer a bronchodilator
B. Elevate the head of the bed to 45–90 degrees
C. Restrict all fluid intake
D. Encourage deep coughing
B. Elevate the head of the bed to 45–90 degrees
Rationale: Elevating the head of the bed facilitates lung expansion and reduces preload,
improving oxygenation in CHF patients with dyspnea.
Question 3
Which assessment finding indicates diabetic ketoacidosis (DKA)?
A. Hypoglycemia and slow breathing
B. Polydipsia, polyuria, and acetone breath
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C. Bradycardia and hypertension
D. Weight gain and edema
B. Polydipsia, polyuria, and acetone breath
Rationale: DKA presents with hyperglycemia (>300 mg/dL), causing polydipsia, polyuria,
and polyphagia, with acetone breath due to ketone production.
Question 4
What is the first nursing action for a patient with suspected DKA?
A. Administer oral glucose
B. Establish IV access and administer fluids
C. Restrict potassium intake
D. Perform a neurological assessment
B. Establish IV access and administer fluids
Rationale: Fluid resuscitation with normal saline or lactated Ringer’s is the priority in DKA
to correct dehydration and stabilize hemodynamics.
Question 5
What are the hallmark signs of increased intracranial pressure (ICP)?
A. Tachycardia and polyuria
B. Decreased level of consciousness and Cushing’s triad
C. Fever and joint pain
D. Hypoglycemia and diaphoresis
B. Decreased level of consciousness and Cushing’s triad
Rationale: Increased ICP causes neurological changes like decreased LOC, headaches, and
Cushing’s triad (irregular breathing, bradycardia, widened pulse pressure).
Question 6
What is the priority intervention for a patient with suspected increased ICP?
A. Administer a diuretic immediately
B. Perform a focused neurological assessment
C. Lower the head of the bed
D. Restrict oxygen administration
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B. Perform a focused neurological assessment
Rationale: A focused neurological assessment, including Glasgow Coma Scale (GCS) and
vital signs, is critical to evaluate the severity of increased ICP and guide interventions.
Question 7
Which finding is most indicative of a myocardial infarction (MI)?
A. Fever and productive cough
B. Crushing chest pain radiating to the left arm
C. Hypoglycemia and shakiness
D. Edema and weight gain
B. Crushing chest pain radiating to the left arm
Rationale: MI typically presents with crushing chest pain radiating to the left jaw, shoulder,
or arm, often accompanied by diaphoresis and shortness of breath.
Question 8
What is the first nursing action for a patient with suspected MI?
A. Administer ibuprofen
B. Obtain a 12-lead ECG
C. Encourage ambulation
D. Restrict all fluids
B. Obtain a 12-lead ECG
Rationale: A 12-lead ECG is the priority to confirm MI by detecting ST elevation or other
ischemic changes, guiding immediate treatment.
Question 9
What are the hallmark signs of a pneumothorax?
A. Clear lung sounds and normal respiratory rate
B. Sudden chest pain and absent breath sounds on one side
C. Productive cough and fever
D. Weight gain and edema
B. Sudden chest pain and absent breath sounds on one side
Rationale: Pneumothorax causes sudden chest pain, dyspnea, and absent or diminished
breath sounds on the affected side due to lung collapse.