SWIFT RIVER 2.0: JULIA
MONROE EXAM
QUESTIONS AND
ANSWERS
1. Julia Monroe, age 52, presents with shortness of breath and bilateral lower
extremity edema. Which initial assessment finding indicates fluid overload?
A. Dry mucous membranes
B. Crackles in lung bases
C. Flat neck veins
D. Weak peripheral pulses
✅ Answer: B. Crackles in lung bases
Rationale: Crackles indicate fluid accumulation in alveoli due to pulmonary
congestion from heart failure.
2. Julia has a serum potassium of 2.9 mEq/L. Which order should the nurse question?
A. Administer furosemide 40 mg IV push
B. Place the patient on cardiac monitoring
C. Give potassium chloride 40 mEq PO
D. Reassess potassium level after replacement
✅ Answer: A. Administer furosemide 40 mg IV push
Rationale: Furosemide promotes further potassium loss and can worsen
hypokalemia, risking arrhythmias.
3. Julia reports fatigue and palpitations. Her telemetry shows irregular rhythm. What
should the nurse do first?
,A. Notify the provider
B. Check vital signs and assess for dizziness
C. Prepare for cardioversion
D. Document the rhythm strip
✅ Answer: B. Check vital signs and assess for dizziness
Rationale: Assess patient stability before taking other actions; interventions depend
on hemodynamic status.
4. Julia’s blood glucose is 338 mg/dL. What is the priority nursing intervention?
A. Offer orange juice
B. Administer prescribed insulin
C. Restrict fluids
D. Provide a high-protein snack
✅ Answer: B. Administer prescribed insulin
Rationale: Hyperglycemia should be treated promptly to prevent complications like
DKA or HHS.
5. Julia complains of shortness of breath when lying flat. This symptom is called:
A. Orthopnea
B. Dyspnea on exertion
C. Paroxysmal nocturnal dyspnea
D. Apnea
✅ Answer: A. Orthopnea
Rationale: Orthopnea refers to difficulty breathing when lying flat, common in CHF.
6. Julia’s oxygen saturation drops to 88% on room air. What action is appropriate?
, A. Recheck in 30 minutes
B. Increase activity to improve ventilation
C. Apply oxygen via nasal cannula at 2 L/min
D. Call respiratory therapy immediately
✅ Answer: C. Apply oxygen via nasal cannula at 2 L/min
Rationale: Provide supplemental oxygen for SpO₂ < 90%; reassess after intervention.
7. Julia is prescribed metoprolol. Which finding requires immediate notification of
the provider?
A. Heart rate 58 bpm
B. Blood pressure 102/60 mm Hg
C. Heart rate 44 bpm
D. Reports of fatigue
✅ Answer: C. Heart rate 44 bpm
Rationale: Metoprolol can cause bradycardia; HR < 50 bpm requires provider
notification before administration.
8. Julia’s weight increased by 2 kg in 24 hours. What does this indicate?
A. Poor nutrition
B. Dehydration
C. Fluid retention
D. Electrolyte imbalance
✅ Answer: C. Fluid retention
Rationale: A 2 kg increase = ~2 L of retained fluid, common in CHF exacerbations.
9. Julia reports anxiety and chest tightness. What is the nurse’s first action?
MONROE EXAM
QUESTIONS AND
ANSWERS
1. Julia Monroe, age 52, presents with shortness of breath and bilateral lower
extremity edema. Which initial assessment finding indicates fluid overload?
A. Dry mucous membranes
B. Crackles in lung bases
C. Flat neck veins
D. Weak peripheral pulses
✅ Answer: B. Crackles in lung bases
Rationale: Crackles indicate fluid accumulation in alveoli due to pulmonary
congestion from heart failure.
2. Julia has a serum potassium of 2.9 mEq/L. Which order should the nurse question?
A. Administer furosemide 40 mg IV push
B. Place the patient on cardiac monitoring
C. Give potassium chloride 40 mEq PO
D. Reassess potassium level after replacement
✅ Answer: A. Administer furosemide 40 mg IV push
Rationale: Furosemide promotes further potassium loss and can worsen
hypokalemia, risking arrhythmias.
3. Julia reports fatigue and palpitations. Her telemetry shows irregular rhythm. What
should the nurse do first?
,A. Notify the provider
B. Check vital signs and assess for dizziness
C. Prepare for cardioversion
D. Document the rhythm strip
✅ Answer: B. Check vital signs and assess for dizziness
Rationale: Assess patient stability before taking other actions; interventions depend
on hemodynamic status.
4. Julia’s blood glucose is 338 mg/dL. What is the priority nursing intervention?
A. Offer orange juice
B. Administer prescribed insulin
C. Restrict fluids
D. Provide a high-protein snack
✅ Answer: B. Administer prescribed insulin
Rationale: Hyperglycemia should be treated promptly to prevent complications like
DKA or HHS.
5. Julia complains of shortness of breath when lying flat. This symptom is called:
A. Orthopnea
B. Dyspnea on exertion
C. Paroxysmal nocturnal dyspnea
D. Apnea
✅ Answer: A. Orthopnea
Rationale: Orthopnea refers to difficulty breathing when lying flat, common in CHF.
6. Julia’s oxygen saturation drops to 88% on room air. What action is appropriate?
, A. Recheck in 30 minutes
B. Increase activity to improve ventilation
C. Apply oxygen via nasal cannula at 2 L/min
D. Call respiratory therapy immediately
✅ Answer: C. Apply oxygen via nasal cannula at 2 L/min
Rationale: Provide supplemental oxygen for SpO₂ < 90%; reassess after intervention.
7. Julia is prescribed metoprolol. Which finding requires immediate notification of
the provider?
A. Heart rate 58 bpm
B. Blood pressure 102/60 mm Hg
C. Heart rate 44 bpm
D. Reports of fatigue
✅ Answer: C. Heart rate 44 bpm
Rationale: Metoprolol can cause bradycardia; HR < 50 bpm requires provider
notification before administration.
8. Julia’s weight increased by 2 kg in 24 hours. What does this indicate?
A. Poor nutrition
B. Dehydration
C. Fluid retention
D. Electrolyte imbalance
✅ Answer: C. Fluid retention
Rationale: A 2 kg increase = ~2 L of retained fluid, common in CHF exacerbations.
9. Julia reports anxiety and chest tightness. What is the nurse’s first action?
