QUESTIONS AND CORRECT ANSWERS
WITH RATIONALES 2025\2026
A nurse is preparing to bottle feed an infant who has a cleft lip. Which of the
following actions should the nurse take to reduce the risk of aspiration?
a) burp the infant once at the end of the feeding
b) use a bottle that has a two way valve
c) place a low-flow rate nipple on the bottle
d) squeeze the infants cheeks together while feeding - CORRECT ANSWER D)
squeeze the infants cheeks together while feeding
Rationale: nurse should identify that an infant who has a cleft lip will have
difficulty in obtaining an adequate seal during feeding. nurse should gently
squeeze the infants cheeks together to decrease the width of the cleft allowing
the infant to achieve a better seal, which reduces risk of aspiration
A nurse is preparing a health promotion seminar for a group of clients about
cancer prevention. Which of the following information should the nurse include?
a) consume high-calorie foods and beverages at meal time
b) eat at least 2.5 cups of fruits and vegetables each day
c) plant to perform moderate-intensity exercise for 90 minutes/week
d) limit alcohol consumption to no more than 3 drinks per day - CORRECT
ANSWER B) Eat at least 2.5 cups of fruits and vegetables each day
Rationale: The nurse should include in the teaching that clients should eat at
least 2.5 cups of fruits and vegetables daily to help maintain body weight and
reduce risk for cancer of the lungs and gastrointestinal system
,A nurse is teaching a client about stress management. Which of the following
statements by the client indicates an understanding of the teaching?
a) I will take a long walk every evening
b) I will keep a daily diet and activity log
c) I will avoid eating 1 hr before each bedtime
d) I will drink a full glass of water with each meal - CORRECT ANSWER a) I will take
a long walk every evening
Rationale: Exercise has many benefits including reduction of tension, promotion
of relaxation and improved sense of well being. All of these will assist the client in
stress management
A nurse is providing dietary instructions for a client who has a prescription for
warfarin. Which of the following foods should the nurse recommend the client
eat in moderation while taking this medication?
a) leafy green vegetables
b) whole grains
c) fruits with skin
d) nuts and seeds - CORRECT ANSWER a) leafy green vegetables
Rationale: the nurse should recommend the client eat in moderation and
maintain consistent intake of leafy green veggies which contain a natural form of
vit k that can negate the anticoagulation effects of warfarin
, A nurse in a long term care facility is monitoring a client during mealtime who has
Parkinson's disease. Which of the following findings should the nurse identify as
the priority?
a) the client eats all their cake and a few bites of bread
b) the client drools while eating
c) the clients hand trembles when they hold their spoon
d) the client chooses to sit alone during the meal - CORRECT ANSWER b) the client
drools while eating
Rationale: drooling while eating can indicate that this client is at greatest risk for
aspiration of food from dysphagia, which can lead to pulmonary complications:
therefore nurse should identify this as a priority problem
A nurse is reviewing the laboratory values of a group of clients. Which of the
following clients should the nurse identify as experiencing dehydration?
a) a client who has a potassium level of 4.4 mEq/L
b) a client who has a hematocrit of 45%
c) a client who has a sodium level of 150 mEq/L
d) a client who has a BUN of 18 mg/dL - CORRECT ANSWER c) a client who has a
sodium level of 150 mEq/L
Rationale: the nurse should identify that a sodium level of 150 mEq/L is above
expected reference range of 136-145 mEq/L and indicates hypernatremia.
Hypernatremia often called water diuretic is a decrease of sodium concentration
in blood caused by excess of water. Manifestations of hypernatremia include:
confusion, headache, nausea, and fatigue