EXAM #2 QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
100% GUARANTEED PASS!!
<LATEST VERSION>
Question 1
A patient with pneumonia has an oxygen saturation of 88% on room air, a
respiratory rate of 28/min, and use of accessory muscles. Which nursing action is
the priority?
A. Encourage incentive spirometry
B. Apply supplemental oxygen
C. Obtain sputum cultures
D. Administer prescribed antibiotics
Correct Answer: B
Rationale:
An SpO₂ of 88% with respiratory distress indicates hypoxia. Supplemental oxygen
is the immediate priority to improve oxygenation before diagnostic or long-term
treatments.
,Question 2
A nurse suspects hypoxia in a hospitalized patient. Which assessment finding most
strongly supports this suspicion?
A. Bradycardia
B. Cyanosis of lips
C. Hypotension
D. Decreased bowel sounds
Correct Answer: B
Rationale:
Cyanosis is a late but definitive sign of hypoxia, indicating inadequate oxygen
delivery to tissues.
Question 3
A patient receiving rifampin for tuberculosis asks what side effect to expect.
Which response by the nurse is accurate?
A. “Your urine may turn orange-red.”
B. “This medication causes hearing loss.”
C. “Expect severe hypoglycemia.”
D. “Hair loss is common.”
Correct Answer: A
Rationale:
Rifampin commonly causes orange-red discoloration of urine, sweat, and tears.
This is expected and harmless but must be explained to prevent alarm.
Question 4
A nurse enters the room of a patient with suspected active pulmonary tuberculosis.
Which precaution is required?
A. Contact precautions
B. Droplet precautions
,C. Airborne precautions
D. Protective isolation
Correct Answer: C
Rationale:
Tuberculosis is transmitted via airborne particles and requires a negative-pressure
room and N95 respirator.
Question 5
A patient presents with clear fluid draining from the nose after head trauma. Which
additional finding is most concerning?
A. Unequal pupils
B. Periorbital ecchymosis
C. Facial swelling
D. Epistaxis
Correct Answer: B
Rationale:
Periorbital ecchymosis (“raccoon eyes”) and clear fluid leakage suggest a basilar
skull fracture.
Question 6
Which arterial blood gas (ABG) result indicates respiratory alkalosis?
A. pH 7.30, PaCO₂ 55 mmHg
B. pH 7.48, PaCO₂ 30 mmHg
C. pH 7.35, HCO₃⁻ 18 mEq/L
D. pH 7.25, PaCO₂ 60 mmHg
Correct Answer: B
Rationale:
Respiratory alkalosis is characterized by elevated pH and decreased PaCO₂, often
caused by hyperventilation.
, Question 7
A patient has absent pedal pulses bilaterally. What is the nurse’s best initial action?
A. Document the finding
B. Apply warm compresses
C. Notify the provider immediately
D. Encourage ambulation
Correct Answer: C
Rationale:
Absent pedal pulses indicate compromised peripheral circulation and possible
arterial occlusion, requiring urgent provider notification.
Question 8
A patient with a diagnosed DVT suddenly becomes short of breath and anxious.
What complication does the nurse suspect?
A. Pneumonia
B. Pulmonary embolism
C. Myocardial infarction
D. Heart failure
Correct Answer: B
Rationale:
Sudden dyspnea and anxiety in a patient with DVT are classic signs of pulmonary
embolism.
Question 9
Which dietary selection is appropriate for a patient following a Halal diet?
A. Ham sandwich
B. Cheeseburger