CARE II QUESTIONS & ANSWERS 100% CORRECT, ALREADY
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1
Which assessment finding indicates early hypoxia in a postoperative client?
A) Cyanosis of lips and fingers
B) Restlessness and anxiety
C) Bradycardia and hypotension
D) Cool clammy skin
Correct Answer: B) Restlessness and anxiety
Explanation: Early hypoxia often presents with subtle signs such as restlessness,
agitation, and anxiety. Cyanosis is a late sign, and bradycardia usually occurs in
severe hypoxia.
2
Which intervention is priority for a client with a new tracheostomy?
A) Suctioning using sterile technique as needed
B) Instilling saline before suctioning routinely
C) Changing ties daily without assistance
D) Keeping the head of bed flat during care
Correct Answer: A) Suctioning using sterile technique as needed
Explanation: Maintaining airway patency is critical. Sterile technique prevents
infection. Routine saline instillation is not recommended, and the head should be
elevated to reduce aspiration risk.
,3
Which dietary recommendation is most appropriate for a client with iron-
deficiency anemia?
A) Skim milk and bread
B) Chicken liver and spinach
C) Apples and rice
D) Yogurt and bananas
Correct Answer: B) Chicken liver and spinach
Explanation: Iron-rich foods, including organ meats and leafy green vegetables,
help replenish iron stores. Vitamin C-rich foods improve absorption, whereas dairy
may inhibit it.
4
Which lab finding indicates fluid volume deficit?
A) Hematocrit 55%
B) Hematocrit 40%
C) Sodium 138 mEq/L
D) BUN 12 mg/dL
Correct Answer: A) Hematocrit 55%
Explanation: Hemoconcentration from fluid loss increases hematocrit. Normal
adult hematocrit is 36–50%.
5
Which assessment finding suggests right-sided heart failure?
A) Crackles in lungs
B) Peripheral edema and jugular vein distention
C) Dyspnea and orthopnea
D) Frothy pink sputum
Correct Answer: B) Peripheral edema and jugular vein distention
Explanation: Right-sided heart failure causes systemic venous congestion, while
left-sided failure leads to pulmonary symptoms.
,6
Which intervention is priority for a client experiencing a seizure?
A) Insert a tongue blade
B) Restrain the client
C) Turn the client onto their side and protect airway
D) Provide oral fluids immediately after seizure
Correct Answer: C) Turn the client onto their side and protect airway
Explanation: Protecting the airway and preventing injury are critical. Do not
place objects in the mouth or restrain.
7
Which lab finding indicates risk for digoxin toxicity?
A) Potassium 2.8 mEq/L
B) Sodium 140 mEq/L
C) Calcium 9 mg/dL
D) Magnesium 2 mg/dL
Correct Answer: A) Potassium 2.8 mEq/L
Explanation: Hypokalemia increases digoxin binding to cardiac tissue, raising
toxicity risk.
8
Which client is at highest risk for developing a pulmonary embolism?
A) Postoperative hip replacement patient
B) Client with controlled hypertension
C) Client recovering from a cold
D) Client with mild osteoarthritis
Correct Answer: A) Postoperative hip replacement patient
Explanation: Surgery and immobility increase venous stasis, predisposing to DVT
and pulmonary embolism.
, 9
Which assessment finding suggests hypervolemia?
A) Flat neck veins
B) Hypotension
C) Bounding pulses and elevated blood pressure
D) Dry mucous membranes
Correct Answer: C) Bounding pulses and elevated blood pressure
Explanation: Fluid overload causes hypertension, elevated jugular venous
pressure, and edema.
10
Which assessment is priority after a thyroidectomy?
A) Monitor bowel sounds
B) Monitor for tetany and laryngeal stridor
C) Monitor blood pressure hourly
D) Monitor for skin breakdown
Correct Answer: B) Monitor for tetany and laryngeal stridor
Explanation: Hypocalcemia from parathyroid injury can cause tetany. Stridor may
indicate airway obstruction and requires immediate intervention.
11
Which lab result is expected in diabetic ketoacidosis?
A) pH 7.48, HCO₃⁻ 28
B) pH 7.25, HCO₃⁻ 16, glucose 420 mg/dL
C) pH 7.40, PaCO₂ 40, glucose 95 mg/dL
D) pH 7.32, HCO₃⁻ 18, glucose 100 mg/dL
Correct Answer: B) pH 7.25, HCO₃⁻ 16, glucose 420 mg/dL
Explanation: DKA presents with metabolic acidosis and hyperglycemia. Ketones
are usually present in urine/blood.