NR302 EXAM 2 CHAMBERLAIN COLLEGE OF NURSING
NR302 EXAM 2 CHAMBERLAIN COLLEGE OF NURSING 200 Q/A: |
100 % VERIFIED ANSWERS WITH DETAILED RATIONALE,
ALREADY GRADED A+ 2025/2026 LATEST
The nurse understands that tachypnea is best defined as:
a) Respiratory rate greater than 20 breaths per minute
b) Rapid, shallow breathing
c) Increased depth of respirations
d) Periodic cessation of breathing
a) Respiratory rate greater than 20 breaths per minute
Rationale:
Tachypnea is defined as an abnormally increased respiratory rate, specifically
greater than 20 breaths per minute in an adult. While rapid and shallow
breathing may occur with tachypnea, the defining characteristic is the increased
rate rather than the depth or pattern of breathing. Increased depth of
respirations describes hyperpnea, and periodic cessation of breathing refers to
apnea, making those options incorrect.
A nurse assesses four adult clients. Which client is experiencing tachypnea?
a) Respiratory rate 12 breaths/min, regular
b) Respiratory rate 16 breaths/min, shallow
c) Respiratory rate 22 breaths/min, even
d) Respiratory rate 10 breaths/min, irregular
c) Respiratory rate 22 breaths/min, even
Rationale:
An adult respiratory rate greater than 20 breaths per minute meets the
definition of tachypnea. A rate of 22 breaths per minute exceeds the normal
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, NR302 EXAM 2 CHAMBERLAIN COLLEGE OF NURSING
adult range of 12–20 breaths per minute. The other options fall within or below
the normal range and therefore do not represent tachypnea.
A client is anxious and pacing in the room. The nurse notes a respiratory rate of 26
breaths per minute. Oxygen saturation is 98% on room air. What is the nurse’s
best initial action?
a) Apply supplemental oxygen
b) Document tachypnea related to anxiety
c) Notify the healthcare provider immediately
d) Prepare for intubation
b) Document tachypnea related to anxiety
Rationale:
The client’s increased respiratory rate is consistent with anxiety, especially given
the pacing behavior and normal oxygen saturation. Since oxygenation is
adequate and there are no signs of respiratory distress, the appropriate initial
action is to document the finding and its likely cause. There is no indication for
oxygen therapy, emergency provider notification, or airway intervention at this
time.
Which client should not have their blood pressure taken in their right arm? Select
all that apply.
a) Burns to the right upper arm
b) Intravenous line inserted with fluid running in the left forearm
c) Dialysis shunt in the left forearm
d) A cast placed on the right forearm
e) Previous right mastectomy with lymph nodes removed
A, D & E
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, NR302 EXAM 2 CHAMBERLAIN COLLEGE OF NURSING
Rationale:
Blood pressure should not be taken on an arm with burns, a cast, or after a
mastectomy with lymph node removal because these conditions can cause
inaccurate readings and potential harm. Burns and casts interfere with cuff
placement and pressure distribution, while a history of mastectomy with lymph
node removal increases the risk of lymphedema. The IV line and dialysis shunt
are located in the left arm and do not affect the right arm.
Which blood pressure range represents normal adult blood pressure according to
current guidelines?
a) Systolic 120–129 mm Hg and diastolic <80 mm Hg
b) Systolic <120 mm Hg and diastolic <80 mm Hg
c) Systolic 130–139 mm Hg and diastolic 80–89 mm Hg
d) Systolic >140 mm Hg and diastolic >90 mm Hg
b) Systolic <120 mm Hg and diastolic <80 mm Hg
Rationale:
Normal adult blood pressure is defined as a systolic pressure less than 120 mm
Hg and a diastolic pressure less than 80 mm Hg. Readings above this range fall
into elevated blood pressure or hypertension categories, making the other
options incorrect.
The nurse is teaching a client about elevated blood pressure. Which range should
the nurse include in the teaching?
a) Systolic <120 mm Hg and diastolic <80 mm Hg
b) Systolic 130–139 mm Hg and diastolic 80–89 mm Hg
c) Systolic 120–129 mm Hg and diastolic <80 mm Hg
d) Systolic >180 mm Hg and diastolic >120 mm Hg
c) Systolic 120–129 mm Hg and diastolic <80 mm Hg
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, NR302 EXAM 2 CHAMBERLAIN COLLEGE OF NURSING
Rationale:
Elevated blood pressure is defined as a systolic reading between 120 and 129
mm Hg with a diastolic reading less than 80 mm Hg. This category indicates
increased risk for developing hypertension and is distinct from both normal
blood pressure and hypertension stages.
Which blood pressure range meets the criteria for hypertension stage 1?
a) Systolic 120–129 mm Hg and diastolic <80 mm Hg
b) Systolic >180 mm Hg and diastolic >120 mm Hg
c) Systolic >140 mm Hg and diastolic >90 mm Hg
d) Systolic 130–139 mm Hg and diastolic 80–89 mm Hg
d) Systolic 130–139 mm Hg and diastolic 80–89 mm Hg
Rationale:
Hypertension stage 1 is diagnosed when the systolic blood pressure is between
130 and 139 mm Hg or the diastolic pressure is between 80 and 89 mm Hg. The
other ranges represent elevated blood pressure, stage 2 hypertension, or
hypertensive crisis.
The nurse correctly identifies hypertension stage 2 when which blood pressure
range is present?
a) Systolic 130–139 mm Hg and diastolic 80–89 mm Hg
b) Systolic 120–129 mm Hg and diastolic <80 mm Hg
c) Systolic >140 mm Hg and diastolic >90 mm Hg
d) Systolic >180 mm Hg and diastolic >120 mm Hg
c) Systolic >140 mm Hg and diastolic >90 mm Hg
Rationale:
Hypertension stage 2 is defined as a systolic blood pressure of 140 mm Hg or
greater or a diastolic pressure of 90 mm Hg or greater. This level indicates a
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NR302 EXAM 2 CHAMBERLAIN COLLEGE OF NURSING 200 Q/A: |
100 % VERIFIED ANSWERS WITH DETAILED RATIONALE,
ALREADY GRADED A+ 2025/2026 LATEST
The nurse understands that tachypnea is best defined as:
a) Respiratory rate greater than 20 breaths per minute
b) Rapid, shallow breathing
c) Increased depth of respirations
d) Periodic cessation of breathing
a) Respiratory rate greater than 20 breaths per minute
Rationale:
Tachypnea is defined as an abnormally increased respiratory rate, specifically
greater than 20 breaths per minute in an adult. While rapid and shallow
breathing may occur with tachypnea, the defining characteristic is the increased
rate rather than the depth or pattern of breathing. Increased depth of
respirations describes hyperpnea, and periodic cessation of breathing refers to
apnea, making those options incorrect.
A nurse assesses four adult clients. Which client is experiencing tachypnea?
a) Respiratory rate 12 breaths/min, regular
b) Respiratory rate 16 breaths/min, shallow
c) Respiratory rate 22 breaths/min, even
d) Respiratory rate 10 breaths/min, irregular
c) Respiratory rate 22 breaths/min, even
Rationale:
An adult respiratory rate greater than 20 breaths per minute meets the
definition of tachypnea. A rate of 22 breaths per minute exceeds the normal
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, NR302 EXAM 2 CHAMBERLAIN COLLEGE OF NURSING
adult range of 12–20 breaths per minute. The other options fall within or below
the normal range and therefore do not represent tachypnea.
A client is anxious and pacing in the room. The nurse notes a respiratory rate of 26
breaths per minute. Oxygen saturation is 98% on room air. What is the nurse’s
best initial action?
a) Apply supplemental oxygen
b) Document tachypnea related to anxiety
c) Notify the healthcare provider immediately
d) Prepare for intubation
b) Document tachypnea related to anxiety
Rationale:
The client’s increased respiratory rate is consistent with anxiety, especially given
the pacing behavior and normal oxygen saturation. Since oxygenation is
adequate and there are no signs of respiratory distress, the appropriate initial
action is to document the finding and its likely cause. There is no indication for
oxygen therapy, emergency provider notification, or airway intervention at this
time.
Which client should not have their blood pressure taken in their right arm? Select
all that apply.
a) Burns to the right upper arm
b) Intravenous line inserted with fluid running in the left forearm
c) Dialysis shunt in the left forearm
d) A cast placed on the right forearm
e) Previous right mastectomy with lymph nodes removed
A, D & E
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, NR302 EXAM 2 CHAMBERLAIN COLLEGE OF NURSING
Rationale:
Blood pressure should not be taken on an arm with burns, a cast, or after a
mastectomy with lymph node removal because these conditions can cause
inaccurate readings and potential harm. Burns and casts interfere with cuff
placement and pressure distribution, while a history of mastectomy with lymph
node removal increases the risk of lymphedema. The IV line and dialysis shunt
are located in the left arm and do not affect the right arm.
Which blood pressure range represents normal adult blood pressure according to
current guidelines?
a) Systolic 120–129 mm Hg and diastolic <80 mm Hg
b) Systolic <120 mm Hg and diastolic <80 mm Hg
c) Systolic 130–139 mm Hg and diastolic 80–89 mm Hg
d) Systolic >140 mm Hg and diastolic >90 mm Hg
b) Systolic <120 mm Hg and diastolic <80 mm Hg
Rationale:
Normal adult blood pressure is defined as a systolic pressure less than 120 mm
Hg and a diastolic pressure less than 80 mm Hg. Readings above this range fall
into elevated blood pressure or hypertension categories, making the other
options incorrect.
The nurse is teaching a client about elevated blood pressure. Which range should
the nurse include in the teaching?
a) Systolic <120 mm Hg and diastolic <80 mm Hg
b) Systolic 130–139 mm Hg and diastolic 80–89 mm Hg
c) Systolic 120–129 mm Hg and diastolic <80 mm Hg
d) Systolic >180 mm Hg and diastolic >120 mm Hg
c) Systolic 120–129 mm Hg and diastolic <80 mm Hg
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, NR302 EXAM 2 CHAMBERLAIN COLLEGE OF NURSING
Rationale:
Elevated blood pressure is defined as a systolic reading between 120 and 129
mm Hg with a diastolic reading less than 80 mm Hg. This category indicates
increased risk for developing hypertension and is distinct from both normal
blood pressure and hypertension stages.
Which blood pressure range meets the criteria for hypertension stage 1?
a) Systolic 120–129 mm Hg and diastolic <80 mm Hg
b) Systolic >180 mm Hg and diastolic >120 mm Hg
c) Systolic >140 mm Hg and diastolic >90 mm Hg
d) Systolic 130–139 mm Hg and diastolic 80–89 mm Hg
d) Systolic 130–139 mm Hg and diastolic 80–89 mm Hg
Rationale:
Hypertension stage 1 is diagnosed when the systolic blood pressure is between
130 and 139 mm Hg or the diastolic pressure is between 80 and 89 mm Hg. The
other ranges represent elevated blood pressure, stage 2 hypertension, or
hypertensive crisis.
The nurse correctly identifies hypertension stage 2 when which blood pressure
range is present?
a) Systolic 130–139 mm Hg and diastolic 80–89 mm Hg
b) Systolic 120–129 mm Hg and diastolic <80 mm Hg
c) Systolic >140 mm Hg and diastolic >90 mm Hg
d) Systolic >180 mm Hg and diastolic >120 mm Hg
c) Systolic >140 mm Hg and diastolic >90 mm Hg
Rationale:
Hypertension stage 2 is defined as a systolic blood pressure of 140 mm Hg or
greater or a diastolic pressure of 90 mm Hg or greater. This level indicates a
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