exam 2026 Exam UPDATED EXAM ACTUAL
LATEST VERSIONS 265 QUESTIONS AND
CORRECT VERIFIED ANSWERS WITH
RATIONALES (100% CORRECT) A+ GRADED
ASSURED
. If a client develops cor pulmonale (right-sided heart failure), the nurse
would expect to observe
1. increasing respiratory difficulty seen with exertion.
2. cough productive of a large amount of thick, yellow mucus.
3. peripheral edema and anorexia.
4. twitching of extremities. CORRECT ANSWER: 3
. The nursing team includes two RNs, one LPN/LVN, and one nursing
assistant. The nurse should consider the assignments appropriate if the
nursing assistant is assigned to care for
1. a client with Alzheimer's requiring assistance with feeding.
2. a client with osteoporosis complaining of burning on urination.
3. a client with scleroderma receiving a tube feeding.
4. a client with cancer who has Cheyne-Stokes respirations. CORRECT ANSWER: 1
A 23-year-old man is admitted with a subdural hematoma and cerebral
edema after a motorcycle accident. Which of the following symptoms should
the nurse expect to see INITIALLY?
1. Unequal and dilated pupils.
2. Decerebrate posturing.
,3. Grand mal seizures.
4. Decreased level of consciousness. CORRECT ANSWER: 4
A 23-year-old woman at 32-weeks gestation is seen in the outpatient
clinic. Which of the following findings, if assessed by the nurse, would
indicate a possible complication?
1. The client's urine test is positive for glucose and acetone.
2. The client has 1+ pedal edema in both feet at the end of the day.
3. The client complains of an increase in vaginal discharge.
4. The client says she feels pressure against her diaphragm when the baby moves. CORRECT
ANSWER: 1
A 38-year-old woman is returned to her room after a subtotal
thyroidectomy for treatment of hyperthyroidism. Which of the following, if
found by the nurse at the patient's bedside, is nonessential?
1. Potassium chloride for IV administration.
2. Calcium gluconate for IV administration.
3. Tracheostomy set-up.
4. Suction equipment. CORRECT ANSWER: 1
A 59-year-old woman with bipolar disorder is receiving haloperidol
(Haldol) 2 mg PO tid. She tells the nurse, "Milk is coming out of my
breasts." Which of the following responses by the nurse is BEST?
1. "You are seeing things that aren't real."
2. "Why don't we go make some fudge."
3. "You are experiencing a side effect of Haldol."
4. "I'll contact your physician to change your medication." CORRECT ANSWER: 3
,A 69-year-old client is undergoing his second exchange of intermittent
peritoneal dialysis (IPD). Which of the following would require an
intervention by the nurse?
1. The client complains of pain during the inflow of the dialysate.
2. The client complains of constipation.
3. The dialysate outflow is cloudy.
4. There is blood-tinged fluid around the intra-abdominal catheter. CORRECT ANSWER: 3
A charge nurse in a long-term care facility is reinforcing teaching with a group of nurses about
fall precautions. Which of the following statements made by the nurse indicates an understanding
of the teaching? CORRECT ANSWER: "I will instruct the client to sit when putting on a pair of
pants"
A charge nurse is discussing the responsibility of nurses carig for clients who have C. difficile.
Which of the following information should the nurse include in the teaching?
a) Assign the client to a room with a negative air-flow system
b) Use alcohol-based hand sanitizer when leaving the clients room
c) clean contaminated surfaces in the clients room with a phenol solution
d) have family members wear a gown and gloves when visiting CORRECT ANSWER: D
A charge nurse is reinforcing teaching with a newly licensed nurse about floating to a different
unit. Which of the following statements by the newly licensed nurse indicates an understanding
of the teaching? CORRECT ANSWER: "I will document in the medical record the support nurse
who assists with planning care for my clients"
A charge nurse on a mental health unit is supervising a newly licensed nurse. For which
of the following actions by the newly licensed nurse should the supervising nurse
, intervene? CORRECT ANSWER: Tells a client he will lose his phone privileges if he does not
take his
medication
A client diagnosed with dementia wanders the halls of the locked nursing unit during the day. To
ensure the client's safety while walking in the halls, the nurse should do which of the following?
1. Administer PRN haloperidol (Haldol) to decrease the need to walk.
2. Assess the client's gait for steadiness.
3. Restrain the client in a geriatric chair.
4. Administer PRN lorazepam (Ativan) to provide sedation. CORRECT ANSWER: 2
A client has a history of oliguria, hypertension, and peripheral edema.
Current lab values are: BUN -25, K+ -4.0 mEq/L. Which nutrient should be
restricted in the client's diet?
1. Protein.
2. Fats.
3. Carbohydrates.
4. Magnesium. CORRECT ANSWER: 1
a client has a new prescription for spironilactone ( aldactone ) which of the following laboratory
value should the nurse recognized as a reason to withhold the morning dose of the medication
and notify the provider CORRECT ANSWER: serum potassium 5.2
a client has prescription for valproic ( Depakote) which of the following laboratory value should
the nurse anticipate monitor for the client taking this medication CORRECT ANSWER:
thrombocytes, amylase count and liver function test
A client is admitted with a diagnosis of acute appendicitis. When assessing the abdomen, the
nurse would expect to find rebound tenderness at which location?