NUR 101 : Exam 1 Questions & Answers
a a a a a a a
2022
Aapatientatellsatheanurse,aImahavingaaalotaofapainainamyahip.aWhicharesponseabyatheanurseaisa
open-endedaandawouldastimulateatheapatientatoaprovideatheamostacompleteadata?
Chooseaallathataareacorrect.
1) Isayourapainasevere?
2) Tellameaaboutayourapain.
3) Whenadidayouafirstanoticeathisapain?
4) Howawouldayouadescribeayourapain?a-aCORRECTaANS:
2)aTellameaaboutayourapain.
4)aHowawouldayouadescribeayourapain?
ThearesponsesaTellameaaboutayourapainaandaHowawouldayouadescribeayourapain?aareaope
n-
endedaresponsesathatastimulateaconversation.aAlthoughaitaisaimportantainformation,atheaqu
estionaIsayourapainasevere?apromptsaaayesaoranoaresponse.aWhenadidayouafirstanoticeathisa
pain?alsoaimportantainformationisalikelyatoastimulateaaabrief,afactualaanswer.
Suchaquestionsaallowatheanurseatoacontrolatheapatientsaresponse.aLimitingathearesponseami
ghtaleadatoaanaincompleteaassessment.
Aaclientsavitalasignsaatatheabeginningaofatheashiftaareaasafollows:aoralatemperaturea99.3Fa(37
C),aheartaratea82abeats/min,arespiratoryaratea14abreaths/min,aandabloodapressurea118/76a
mmaHg.aFourahoursalateratheaclientsaoralatemperatureaisa102.2Fa(39C).aBasedaonatheatemp
eratureachange,atheanurseashouldaanticipateatheaclientsaheartarateawouldabeahowamanyabea
ts/min?
1)a62
2)a82
3)a102
4)a122a-aCORRECTaANS:a3)a102
Heartarateaincreasesaabouta10abeatsaperaminuteaforaeachadegreeaofatemperatureatoameetain
creasedametabolicaneedsaandacompensateaforaperipheraladilation.
Theanurseaisaassessingavitalasignsaforaaaclientaafterasurgicalaprocedureaonathealeftaleg.aIVaflui
dsaareainfusing.aItawouldabeamostaimportantaforatheanurseato
1) Compareathealeftapedalapulseawithathearightapedalapulse
2) Countatheaclientsarespiratoryarateafora1afullaminute
3) TakeatheabloodapressureainatheaarmawithoutaanaIV
4) Takeaanaoralatemperatureawithaanaelectronicathermometera-
aCORRECTaANS:a1)aCompareathealeftapedalapulseawithathearightapedalapulse
,Foraaaclientahavingasurgeryaonathealeg,atheamostaimportantadataawouldabeawhetheratheacircu
lationahasabeenacompromisedabecauseaofatheasurgery.aThisacanabeadoneaonlyabyacomparin
gaonealegawithatheaother.aTheanurseawould,aofacourse,acountathearespiratoryarateafora1afullami
nuteaandatakeatheaBPainatheaarmawithoutatheaIV.aOralatemperaturesaareacommonlyaobtained
ausingaelectronicathermometers.
Theanurseahearsarhonchiawhenaauscultatingaaaclientsalungs.aWhichanursingainterventionaw
ouldabeaappropriateaforatheanurseatoaimplementabeforeareassessingalungasounds?
1) Haveatheaclientatakeaseveraladeepabreaths.
2) Requestatheaclientatakeaaadeepabreathaandacough.
3) Takeatheaclientsabloodapressureaandaapicalapulse.
4) Countatheaclientsarespiratoryarateafora1aminute.a-
aCORRECTaANS:a2)aRequestatheaclientatakeaaadeepabreathaandacough.
Rhonchiaareacausedabyasecretionsainathealargeaairwaysaandamayaclearawithacoughing.aThi
saisahowayouadifferentiateabetweenarhonchiaandaotheraadventitiousasounds.aDeepabreathin
gawillanotahelpatoacleararhonchi.aTakingatheabloodapressureaandaapicalapulseaandacountingat
hearespiratoryarateaareanotaeffectiveaforaclearingarhonchiaandawouldanotabeasufficientaforath
eanurseatoaidentifyawhetheratheasoundsawere,aindeed,arhonchi.
Whichaofatheafollowingasetsaofavitalasignsaareaallawithinanormalalimitsaforapatientsaatarest?
1) Infant:aTa98.8Fa(rectal),aHRa160,aRRa16,aBPa120/54
2) Adolescent:aTa98.2Fa(oral),aHRa80,aRRa18,aBPa108/68
3) Adult:aTa99.6Fa(oral),aHRa48,aRRa22,aBPa130/84
4) Olderaadult:aTa98.6Fa(oral),aHRa110,aRRa28,aBPa170/95a-aCORRECTaANS:a2)
Adolescent:aTa98.2Fa(oral),aHRa80,aRRa18,aBPa108/68
Allaofatheaadolescentsavitalasignsaareawithinanormalaparametersaforatheaage.aTheainfantsate
mperatureaisabelowanormalaforaaarectalareadingabecauseatheacoreatemperatureaisaapproxim
atelya1adegreeahigherathanareadingsafromaotherasites.aTheaheartaratea(HR)aforaanainfantaisah
igh,athearespiratoryaratea(RR)aisalow,aandatheabloodapressurea(BP)aisahighaforatheaage.aForat
heatypicalaadult,atheatemperatureaisahigh,atheaHRaisalow,atheaRRaisahigh,aandatheaBPaisaeleva
tedaforatheaage.aForatheaolderaadult,atheatemperatureaisahigh-
endanormal,atheaHRaisahigh,atheaRRaisahigh,aandatheaBPaisahighaforatheaage.
Theanurseaassessesatheafollowingachangesainaaaclientsavitalasigns.aWhichaclientasituationas
houldabeareportedatoatheaprimaryacareaprovider?
1) Decreasedabloodapressurea(BP)aafterastandingaupa2)
Decreasedatemperatureaafteraaaperiodaofadiaphoresisa3)
Increasedaheartarateaafterawalkingadownatheahall
4)Increasedarespiratoryarateawhenatheaheartarateaincreasesa-
aCORRECTaANS:a1)Decreasedabloodapressurea(BP)aafterastandingaup
,Aadropainatheaclientsabloodapressureawhenastandingaindicatesaorthostaticahypotension,aand
atheacauseashouldabeainvestigated.aTheachangesainavitalasignsaindicatedainatheaotheraoption
saareanormalachangesaforatheasituations.
PTS:1DIF:ModerateREF:p.a439aforahypotensionainformationabutashouldareadacontentaabou
taallaofatheavitalasigns
Theaclientsatemperatureaisa101.1F.aWhichaisatheacorrectaconversionatoacentigrade?
1) 38.0C
2) 38.4C
3) 38.8C
4) 39.2Ca-aCORRECTaANS:a2)a38.4C
ToaconvertaFahrenheitatoacentigrade,asubtracta32afromatheatemperature,aandamultiplyabya5/
9.
Theaclientahasahadaaafever,arangingafroma99.8Faorallyatoa103Faorally,aoverathealasta24ahour
s.aTheaclientsafeverawouldabeaclassifiedaas
1) Constanta2
)Intermittenta
3)Relapsing
4)Remittenta-aCORRECTaANS:a4)aRemittent
Remittentafeversafluctuateawidelyaoveraaa24-
houraperiod.aConstantafeversastayaaboveanormalawithaonlyaslightafluctuations.aIntermittentaf
eversaalternateabetweenanormalaorasubnormalatemperaturesawithaperiodsaofafever.aRelapsi
ngafeversaalternateabetweenaperiodsaofafeveraandaperiodsaofanormalatemperature,aeachaph
asealastinga1atoa2adays.
Aaclientsavitalasignsa4ahoursaagoawereatemperaturea(oral)a101.4Fa(38.6C),aheartaratea110ab
eats/min,arespiratoryaratea26abreaths/min,aandabloodapressurea124/78ammaHg.aTheatemp
eratureaisanowa99.4Fa(37.4C).aBasedaonlyaonatheaexpectedarelationshipabetweenatempera
tureaandarespiratoryarate,atheanurseamightabestaanticipateatheaclientsarespiratoryarateatoabe
1)16
2) 18
3) 20
4) 22a-aCORRECTaANS:a2)a18
ForaeveryadegreeaFahrenheita(0.6C)atheatemperatureafalls,athearespiratoryarateamayadecre
aseaupatoa4abreathsaperaminute.aTheaclientsatemperatureahasafallena2adegrees;amultiplieda
bya4,athisaisa8.aItawasa26abreaths/min:a26a8a=a18abreaths/min.aKeepainamind,athisaisaanaesti
mateaandawouldavaryadependingaonatheapatientsabaselineahealth,acurrentacondition,aage,aa
ndaotherafactors.
, Whichaoneaofatheafollowingaclientsawouldaprobablyahaveaaahigherathananormalarespiratoryara
te?aAaclientawhoahas
1) Hadasurgeryaandaisareceivingaaanarcoticaanalgesic
2) Hadasurgeryaandalostaaaunitaofabloodaintraoperatively
3) Livedaataaahighaaltitudeaandathenamovedatoaseaalevel
4) Beenaexposedatoatheacoldaandaisanowahypothermica-
aCORRECTaANS:a2)aHadasurgeryaandalostaaaunitaof abloodaintraoperatively
Aareductionainahemoglobinafromabloodalossawouldaincreaseathearespiratoryarate.aNarcoticsaa
ndahypothermiaaslowathearespiratoryarate.aGoingafromaloweraaltitudesatoahigheraaltitudesain
hibitsaoxygenabinding,asoagoingatoaaaloweraaltitudeawouldadecreaseathearespiratoryarateaora
haveanoaeffect.aHypothermiaadecreasesatheametabolicarate,asoathearespiratoryarateawouldali
kelyadecrease.
Forawhichaofatheafollowingaadultaclientsashouldatheanurseamakeafollow-
upaobservationsaandamonitoratheavitalasignsaclosely?aAaclientawhose
1) Restingamorningabloodapressureaisa136/86awhileatheaafternoonaBPaisa128/84ammaHg
2) Oralatemperatureaisa97.9Fainatheamorningaanda99.8Fainatheaevening
3) Heartarateawasa76abeats/minabeforeaeatingaanda88abeats/minaafteraeating
4) Respiratoryarateaisa16abreaths/minawhenastandingaanda18awhenalyingadowna-
aCORRECTaANS:a1)aRestingamorningabloodapressureaisa136/86awhileatheaafternoonaBPaisa
128/84ammaHg
BothatheabloodapressuresawouldabeaclassifiedaasaprehypertensionaaccordingatoatheaJNCa7
aExpressaguidelines.aBodyatemperatureanormallyaincreasesaduringatheacourseaofaaaday.aH
eartarateaincreasesaforaseveralahoursaafteraeating.aRespiratoryadepthadecreasesawhenalyin
gadown,asoaitawouldabeanormalaforathearateawouldaincrease;abotharatesaareawithinanormalali
mits.
Aaclientawhoahasabeenahospitalizedaforaanainfectionastates,aTheanursingaassistantatoldameam
yavitalasignsaareaallawithinanormalalimits;athatameansaImacured.aTheanursesabestaresponseaw
ouldabeawhichaofatheafollowing?
1) Youravitalasignsaconfirmathatayourainfectionaisaresolved;ahowadoayouafeel?
2) Illaletayourahealthcareaprovideraknowasoayouacanabeadischarged.
3) Youravitalasignsaareastable,abutathereaareaotherathingsatoaassess.
4) Weastillaneedatoakeepamonitoringayouratemperatureaforaaawhile.a-
aCORRECTaANS:a3)aYouravitalasignsaareastable,abutathereaareaotherathingsatoaassess.
Vitalasignsaareaoneaindicatoraofaaaclientsaphysiologicalastatus,abutatheyaareanotaanaabsolutea
indicatoraofawell-
beingafromaeveryaaspect.aItamayabeainaccurateatoastateathatatheavitalasignsaindicateatheainfe
ctionaisaresolved;avitalasignsacouldastabilizeaevenaifatheainfectionaremainsaactive.aTheahealt
hcareaprovidersadecisionaregardingatheaclientsareadinessaforadischargeaisanotabasedaexclu
sivelyaonatheavitalasignsabutaratheraisabasedaon
a a a a a a a
2022
Aapatientatellsatheanurse,aImahavingaaalotaofapainainamyahip.aWhicharesponseabyatheanurseaisa
open-endedaandawouldastimulateatheapatientatoaprovideatheamostacompleteadata?
Chooseaallathataareacorrect.
1) Isayourapainasevere?
2) Tellameaaboutayourapain.
3) Whenadidayouafirstanoticeathisapain?
4) Howawouldayouadescribeayourapain?a-aCORRECTaANS:
2)aTellameaaboutayourapain.
4)aHowawouldayouadescribeayourapain?
ThearesponsesaTellameaaboutayourapainaandaHowawouldayouadescribeayourapain?aareaope
n-
endedaresponsesathatastimulateaconversation.aAlthoughaitaisaimportantainformation,atheaqu
estionaIsayourapainasevere?apromptsaaayesaoranoaresponse.aWhenadidayouafirstanoticeathisa
pain?alsoaimportantainformationisalikelyatoastimulateaaabrief,afactualaanswer.
Suchaquestionsaallowatheanurseatoacontrolatheapatientsaresponse.aLimitingathearesponseami
ghtaleadatoaanaincompleteaassessment.
Aaclientsavitalasignsaatatheabeginningaofatheashiftaareaasafollows:aoralatemperaturea99.3Fa(37
C),aheartaratea82abeats/min,arespiratoryaratea14abreaths/min,aandabloodapressurea118/76a
mmaHg.aFourahoursalateratheaclientsaoralatemperatureaisa102.2Fa(39C).aBasedaonatheatemp
eratureachange,atheanurseashouldaanticipateatheaclientsaheartarateawouldabeahowamanyabea
ts/min?
1)a62
2)a82
3)a102
4)a122a-aCORRECTaANS:a3)a102
Heartarateaincreasesaabouta10abeatsaperaminuteaforaeachadegreeaofatemperatureatoameetain
creasedametabolicaneedsaandacompensateaforaperipheraladilation.
Theanurseaisaassessingavitalasignsaforaaaclientaafterasurgicalaprocedureaonathealeftaleg.aIVaflui
dsaareainfusing.aItawouldabeamostaimportantaforatheanurseato
1) Compareathealeftapedalapulseawithathearightapedalapulse
2) Countatheaclientsarespiratoryarateafora1afullaminute
3) TakeatheabloodapressureainatheaarmawithoutaanaIV
4) Takeaanaoralatemperatureawithaanaelectronicathermometera-
aCORRECTaANS:a1)aCompareathealeftapedalapulseawithathearightapedalapulse
,Foraaaclientahavingasurgeryaonathealeg,atheamostaimportantadataawouldabeawhetheratheacircu
lationahasabeenacompromisedabecauseaofatheasurgery.aThisacanabeadoneaonlyabyacomparin
gaonealegawithatheaother.aTheanurseawould,aofacourse,acountathearespiratoryarateafora1afullami
nuteaandatakeatheaBPainatheaarmawithoutatheaIV.aOralatemperaturesaareacommonlyaobtained
ausingaelectronicathermometers.
Theanurseahearsarhonchiawhenaauscultatingaaaclientsalungs.aWhichanursingainterventionaw
ouldabeaappropriateaforatheanurseatoaimplementabeforeareassessingalungasounds?
1) Haveatheaclientatakeaseveraladeepabreaths.
2) Requestatheaclientatakeaaadeepabreathaandacough.
3) Takeatheaclientsabloodapressureaandaapicalapulse.
4) Countatheaclientsarespiratoryarateafora1aminute.a-
aCORRECTaANS:a2)aRequestatheaclientatakeaaadeepabreathaandacough.
Rhonchiaareacausedabyasecretionsainathealargeaairwaysaandamayaclearawithacoughing.aThi
saisahowayouadifferentiateabetweenarhonchiaandaotheraadventitiousasounds.aDeepabreathin
gawillanotahelpatoacleararhonchi.aTakingatheabloodapressureaandaapicalapulseaandacountingat
hearespiratoryarateaareanotaeffectiveaforaclearingarhonchiaandawouldanotabeasufficientaforath
eanurseatoaidentifyawhetheratheasoundsawere,aindeed,arhonchi.
Whichaofatheafollowingasetsaofavitalasignsaareaallawithinanormalalimitsaforapatientsaatarest?
1) Infant:aTa98.8Fa(rectal),aHRa160,aRRa16,aBPa120/54
2) Adolescent:aTa98.2Fa(oral),aHRa80,aRRa18,aBPa108/68
3) Adult:aTa99.6Fa(oral),aHRa48,aRRa22,aBPa130/84
4) Olderaadult:aTa98.6Fa(oral),aHRa110,aRRa28,aBPa170/95a-aCORRECTaANS:a2)
Adolescent:aTa98.2Fa(oral),aHRa80,aRRa18,aBPa108/68
Allaofatheaadolescentsavitalasignsaareawithinanormalaparametersaforatheaage.aTheainfantsate
mperatureaisabelowanormalaforaaarectalareadingabecauseatheacoreatemperatureaisaapproxim
atelya1adegreeahigherathanareadingsafromaotherasites.aTheaheartaratea(HR)aforaanainfantaisah
igh,athearespiratoryaratea(RR)aisalow,aandatheabloodapressurea(BP)aisahighaforatheaage.aForat
heatypicalaadult,atheatemperatureaisahigh,atheaHRaisalow,atheaRRaisahigh,aandatheaBPaisaeleva
tedaforatheaage.aForatheaolderaadult,atheatemperatureaisahigh-
endanormal,atheaHRaisahigh,atheaRRaisahigh,aandatheaBPaisahighaforatheaage.
Theanurseaassessesatheafollowingachangesainaaaclientsavitalasigns.aWhichaclientasituationas
houldabeareportedatoatheaprimaryacareaprovider?
1) Decreasedabloodapressurea(BP)aafterastandingaupa2)
Decreasedatemperatureaafteraaaperiodaofadiaphoresisa3)
Increasedaheartarateaafterawalkingadownatheahall
4)Increasedarespiratoryarateawhenatheaheartarateaincreasesa-
aCORRECTaANS:a1)Decreasedabloodapressurea(BP)aafterastandingaup
,Aadropainatheaclientsabloodapressureawhenastandingaindicatesaorthostaticahypotension,aand
atheacauseashouldabeainvestigated.aTheachangesainavitalasignsaindicatedainatheaotheraoption
saareanormalachangesaforatheasituations.
PTS:1DIF:ModerateREF:p.a439aforahypotensionainformationabutashouldareadacontentaabou
taallaofatheavitalasigns
Theaclientsatemperatureaisa101.1F.aWhichaisatheacorrectaconversionatoacentigrade?
1) 38.0C
2) 38.4C
3) 38.8C
4) 39.2Ca-aCORRECTaANS:a2)a38.4C
ToaconvertaFahrenheitatoacentigrade,asubtracta32afromatheatemperature,aandamultiplyabya5/
9.
Theaclientahasahadaaafever,arangingafroma99.8Faorallyatoa103Faorally,aoverathealasta24ahour
s.aTheaclientsafeverawouldabeaclassifiedaas
1) Constanta2
)Intermittenta
3)Relapsing
4)Remittenta-aCORRECTaANS:a4)aRemittent
Remittentafeversafluctuateawidelyaoveraaa24-
houraperiod.aConstantafeversastayaaboveanormalawithaonlyaslightafluctuations.aIntermittentaf
eversaalternateabetweenanormalaorasubnormalatemperaturesawithaperiodsaofafever.aRelapsi
ngafeversaalternateabetweenaperiodsaofafeveraandaperiodsaofanormalatemperature,aeachaph
asealastinga1atoa2adays.
Aaclientsavitalasignsa4ahoursaagoawereatemperaturea(oral)a101.4Fa(38.6C),aheartaratea110ab
eats/min,arespiratoryaratea26abreaths/min,aandabloodapressurea124/78ammaHg.aTheatemp
eratureaisanowa99.4Fa(37.4C).aBasedaonlyaonatheaexpectedarelationshipabetweenatempera
tureaandarespiratoryarate,atheanurseamightabestaanticipateatheaclientsarespiratoryarateatoabe
1)16
2) 18
3) 20
4) 22a-aCORRECTaANS:a2)a18
ForaeveryadegreeaFahrenheita(0.6C)atheatemperatureafalls,athearespiratoryarateamayadecre
aseaupatoa4abreathsaperaminute.aTheaclientsatemperatureahasafallena2adegrees;amultiplieda
bya4,athisaisa8.aItawasa26abreaths/min:a26a8a=a18abreaths/min.aKeepainamind,athisaisaanaesti
mateaandawouldavaryadependingaonatheapatientsabaselineahealth,acurrentacondition,aage,aa
ndaotherafactors.
, Whichaoneaofatheafollowingaclientsawouldaprobablyahaveaaahigherathananormalarespiratoryara
te?aAaclientawhoahas
1) Hadasurgeryaandaisareceivingaaanarcoticaanalgesic
2) Hadasurgeryaandalostaaaunitaofabloodaintraoperatively
3) Livedaataaahighaaltitudeaandathenamovedatoaseaalevel
4) Beenaexposedatoatheacoldaandaisanowahypothermica-
aCORRECTaANS:a2)aHadasurgeryaandalostaaaunitaof abloodaintraoperatively
Aareductionainahemoglobinafromabloodalossawouldaincreaseathearespiratoryarate.aNarcoticsaa
ndahypothermiaaslowathearespiratoryarate.aGoingafromaloweraaltitudesatoahigheraaltitudesain
hibitsaoxygenabinding,asoagoingatoaaaloweraaltitudeawouldadecreaseathearespiratoryarateaora
haveanoaeffect.aHypothermiaadecreasesatheametabolicarate,asoathearespiratoryarateawouldali
kelyadecrease.
Forawhichaofatheafollowingaadultaclientsashouldatheanurseamakeafollow-
upaobservationsaandamonitoratheavitalasignsaclosely?aAaclientawhose
1) Restingamorningabloodapressureaisa136/86awhileatheaafternoonaBPaisa128/84ammaHg
2) Oralatemperatureaisa97.9Fainatheamorningaanda99.8Fainatheaevening
3) Heartarateawasa76abeats/minabeforeaeatingaanda88abeats/minaafteraeating
4) Respiratoryarateaisa16abreaths/minawhenastandingaanda18awhenalyingadowna-
aCORRECTaANS:a1)aRestingamorningabloodapressureaisa136/86awhileatheaafternoonaBPaisa
128/84ammaHg
BothatheabloodapressuresawouldabeaclassifiedaasaprehypertensionaaccordingatoatheaJNCa7
aExpressaguidelines.aBodyatemperatureanormallyaincreasesaduringatheacourseaofaaaday.aH
eartarateaincreasesaforaseveralahoursaafteraeating.aRespiratoryadepthadecreasesawhenalyin
gadown,asoaitawouldabeanormalaforathearateawouldaincrease;abotharatesaareawithinanormalali
mits.
Aaclientawhoahasabeenahospitalizedaforaanainfectionastates,aTheanursingaassistantatoldameam
yavitalasignsaareaallawithinanormalalimits;athatameansaImacured.aTheanursesabestaresponseaw
ouldabeawhichaofatheafollowing?
1) Youravitalasignsaconfirmathatayourainfectionaisaresolved;ahowadoayouafeel?
2) Illaletayourahealthcareaprovideraknowasoayouacanabeadischarged.
3) Youravitalasignsaareastable,abutathereaareaotherathingsatoaassess.
4) Weastillaneedatoakeepamonitoringayouratemperatureaforaaawhile.a-
aCORRECTaANS:a3)aYouravitalasignsaareastable,abutathereaareaotherathingsatoaassess.
Vitalasignsaareaoneaindicatoraofaaaclientsaphysiologicalastatus,abutatheyaareanotaanaabsolutea
indicatoraofawell-
beingafromaeveryaaspect.aItamayabeainaccurateatoastateathatatheavitalasignsaindicateatheainfe
ctionaisaresolved;avitalasignsacouldastabilizeaevenaifatheainfectionaremainsaactive.aTheahealt
hcareaprovidersadecisionaregardingatheaclientsareadinessaforadischargeaisanotabasedaexclu
sivelyaonatheavitalasignsabutaratheraisabasedaon
