TEST STUDY GUIDE 2025/2026 QUESTIONS BANK
AND CORRECT DETAILED ANSWERS WITH
RATIONALES || 100% GUARANTEED PASS
<RECENT VERSION>
1. A mother runs into the emergency department with a toddler in her arms and
tells the nurse that her child got into some cleaning products. the child
smells of chemicals on the hands, face, and on the front of the child's
clothes. after ensuring the airway is patent, what action should the nurse
implement first?
a. Assess the child for altered sensorium
b. Determine type of chemical exposure
c. Obtain equipment for gastric lavage
d. Call poison control emergency number - ANSWER ✓ b. Determine
type of chemical exposure
2. Which conditions are most likely to respond to treatment with
antihistamines? Select all that apply.
a. Bronchitis
b. Allergic rhinitis
c. Otitis media
d. Contact dermatitis
e. Myocarditis - ANSWER ✓ b. Allergic rhinitis
d. Contact dermatitis
3. An older client's daughter calls the home health nurse and reports that her
mother has become forgetful and is very confused at night. The daughter
states that her mother's behavior changed suddenly a few days ago and is
now getting worse. Which action should the nurse take? Select all that apply.
a. Ask if the mother is experiencing any pain with urination
b. Encourage increased intake of high protein foods
c. Instruct the daughter to check her mother's temperature
, d. Review the client's current food and medication allergies
e. Determine if the mother has recently experienced a fall - ANSWER ✓
a. Ask if the mother is experiencing any pain with urination
c. Instruct the daughter to check her mother's temperature
e. Determine if the mother has recently experienced a fall
4. When assessing a multigravida on the first postpartum day, the nurse finds a
moderate amount of lochia rubra, with the uterus firm, and three
fingerbreadths above the umbilicus. What action should the nurse implement
first?
a. Check for a distended bladder
b. Review the hemoglobin to determine hemorrhage
c. Massage the uterus to decrease atony
d. Increase intravenous infusion - ANSWER ✓ a. Check for a distended
bladder
5. A client with delusions tells the nurse, "You aren't doing your job. Go get
those people over there and shoot them before they get me." Which
statement is the nurse's best response?
a. "What would you like to see me do to protect you?"
b. "You are in a safe place. No one can get you here."
c. "You seem quite frightened right now."
d. "There is no one who will hurt you." - ANSWER ✓ c. "You seem
quite frightened right now."
6. The nurse is preparing to administer a suspension ampicillin labeled, 250
mg/5 mL, to a child with impetigo. The prescription is for 500 mg four times
a day. How many mL should the child receive per day? - ANSWER ✓ 40
7. A client is admitted to the emergency department with a respiratory rate of
34 breaths per minute and high-pitched wheezing on inspiration and
expiration. The medical diagnosis is severe exacerbation of asthma. Which
assessment finding, obtained 10 minutes after the admission assessment,
should the nurse report immediately to the emergency department health
care provider?
a. Client reports being anxious
b. Extreme agitation with staff and family
c. An apical pulse of 120 beats per minute
, d. No wheezing upon auscultation of the client - ANSWER ✓ d. No
wheezing upon auscultation of the client
8. A client with renal lithiasis is receiving morphine sulfate every four hours
for pain and renal colic. Which assessment finding should prompt the nurse
to administer a PRN dose of naloxone?
a. Complaints of increasing flank pain
b. Unresponsive to verbal or tactile stimuli
c. Statements about visual hallucinations
d. Respiratory rate of 12 breaths/minute - ANSWER ✓ d. Respiratory
rate of 12 breaths/minute
9. A client with a history of upper respiratory symptoms is admitted with chest
tightness, a productive cough, and difficulty breathing. The client's arterial
blood gases (ABGs) indicate respiratory acidosis. An increase in which
laboratory test results supports this finding?
a. Arterial ph
b. PaCO2
c. HCO3
d. PaO2 - ANSWER ✓ b. PaCO2
10.Which clients' vital signs indicating increased intracranial pressure (ICP)
should the nurse report to the health care provider?
a. P 70, BP 120/60 mmhg; P 100, BP 90/60 mmhg; rapid respirations
b. P 110, BP 130/ \70 mmhg; P 100, BP 110/70 mmhg; shallow
respirations
c. P 130, BP 190/90 mmhg; P 136, BP 200/100 mmhg; Kussmaul
respirations
d. P 55, BP 160/70 mmhg; P 50, BP 194/70 mmhg; irregular respirations
- ANSWER ✓ d. P 55, BP 160/70 mmhg; P 50, BP 194/70 mmhg;
irregular respirations
11.The nurse is assisting a new mother with infant feeding. Which information
should the nurse provide that is most likely to result in a decrease milk
supply for the mother who is breastfeeding - ANSWER ✓ Supplemental
feedings with formula
, 12.Which assessment is more important for the nurse to include in the daily
plan of care for a client with a burned extremity - ANSWER ✓ Distal pulse
intensity
13.An elderly client with degenerative joint disease asks if she should use the
rubber jar openers that are available. The nurse's response should be based
on which information about assistive devices - ANSWER ✓ They decrease
the risk for joint trauma
14.When assessing a 6-month old infant, the nurse determines that the anterior
fontanel is bulging. In which situation would this finding be most significant
- ANSWER ✓ Sitting upright
Rationale: The anterior fontanel closes at 9 months of age and may bulge
when venous return is reduced from the head, but a bulging anterior fontanel
is most significant if the infant is sitting up and may indicated an increase in
cerebrospinal fluid. Activities that reduce venous return from the head, such
as crying, a Valsalva maneuver, vomiting or a dependent position of the
head, cause a normal transient increase in intracranial pressure
15.A client with angina pectoris is being discharge from the hospital. What
instruction should the nurse plan to include in this discharge teaching -
ANSWER ✓ Avoid all isometric exercises, but walk regularly
Rationale: Isometric exercise can raise blood pressure for the duration of the
exercise, which may be dangerous for a client with cardiovascular disease,
while walking provides aerobic conditioning that improves ling, blood
vessel, and muscle function. Client with angina should refrain from physical
exercise for 2 hours after meals, but exercising does not decrease cholesterol
levels. Cold water cause vasoconstriction that may cause chest pain.
Nitroglycerin should be readily available and stored in a dark-colored glass
bottle not C, to ensure freshness of the medication
16.What is the priority nursing action when initiating morphine therapy via an
intravenous patient-controlled analgesia (PCA) pump - ANSWER ✓ Initiate
the dosage lockout mechanism on the PCA pump
17.While undergoing hemodialysis, a male client suddenly complains of
dizziness. He is alert and oriented, but his skin is cool and clammy. His vital