AND VERIFIED ANSWERS VERSION 2025 100% CORRECT
ANSWERS GRADED A+ WITH RATIONALES
1. A nurse is reinforcing teaching about crutches with a client. Which of the
following instructions should the nurse include?
A. Keep elbows straight while using crutches
B. Place crutches 12 inches in front of the feet when walking
C. Support weight with hands, not axillae
D. Keep crutches close together when walking
Using the hands to bear weight prevents pressure on the axillae, which
could cause nerve damage.
2. A client reports pain of 8 on a 0-10 scale. Which of the following actions
should the nurse take first?
A. Reposition the client
B. Notify the provider
C. Administer prescribed analgesic
D. Document the pain level
Treating the pain promptly is a priority; administer analgesics first if
prescribed.
,3. A nurse is caring for a client who is on a low-residue diet. Which food should
the nurse recommend?
A. Fresh strawberries
B. White rice
C. Whole wheat bread
D. Broccoli
White rice is low in fiber and appropriate for a low-residue diet.
4. A client receiving oxygen via nasal cannula at 5 L/min complains of nasal
dryness. What action should the nurse take?
A. Switch to a nonrebreather mask
B. Humidify the oxygen
C. Reduce oxygen flow rate
D. Apply petroleum jelly inside nostrils
Humidifying the oxygen helps relieve dryness without reducing
therapeutic benefits.
5. Which of the following is an expected finding in a client with hypokalemia?
A. Bradycardia
B. Muscle weakness
C. Hyperactive reflexes
,D. Increased peristalsis
Low potassium levels impair muscle contraction, leading to weakness.
6. A nurse prepares to administer digoxin to a client. Which finding is a
contraindication?
A. Apical pulse 54/min
B. BP 138/86 mm Hg
C. Respirations 16/min
D. Temperature 37.0°C (98.6°F)
Digoxin is withheld if the apical pulse is less than 60/min due to risk of
bradycardia.
7. A nurse is reinforcing teaching with a client prescribed furosemide. Which
statement indicates understanding?
A. "I will take this at bedtime."
B. "I’ll avoid potassium-rich foods."
C. "I’ll change positions slowly."
D. "I can stop taking it when I feel better."
Furosemide can cause orthostatic hypotension, so position changes
should be slow.
8. Which food should a nurse recommend to increase iron intake?
A. Cottage cheese
, B. Apples
C. Red meat
D. White bread
Red meat is an excellent source of heme iron.
9. A client with a new ileostomy asks how to prevent peristomal skin irritation.
What should the nurse suggest?
A. Use a soap-based cleanser
B. Ensure skin is dry before applying the barrier
C. Remove pouch daily
D. Apply lotion to the skin
Dry skin helps adhesive barriers stick and protects against leakage.
10. What is a manifestation of fluid volume excess?
A. Weak pulses
B. Distended neck veins
C. Hypotension
D. Weight loss
Distended neck veins are a sign of circulatory overload.
11. A nurse is assisting a client post-op. Which finding indicates hypoxia?
A. Hypotension
B. Restlessness