PRACTICE QUESTIONS & ANSWERS
100% CORRECT (FULLY SOLVED)
1. A nurse assesses a client who had a myocardial infarction and
is hypotensive. Which additional assessment finding should the
nurse expect?
a. Heart rate of 120 beats/min
b. Cool, clammy skin
c. Oxygen saturation of 90%
d. Respiratory rate of 8 breaths/min - correct answer- A.
Heart rate of 120 beats/min
2. A nurse assesses a client after administering a prescribed beta
blocker. Which assessment should the nurse expect to find?
a. Blood pressure increased from 98/42 mm Hg to 132/60 mm
Hg
b. Respiratory rate decreased from 25 breaths/min to 14
breaths/min
c. Oxygen saturation increased from 88% to 96%
,d. Pulse decreased from 100 beats/min to 80 beats/min -
correct answer- D. Pulse decreased from 100 beats/min to
80 beats/min
3. A nurse assesses clients on a medical-surgical unit. Which
client should the nurse identify as having the greatest risk for
cardiovascular disease?
a. An 86-year-old man with a history of asthma
b. A 32-year-old Asian-American man with colorectal cancer
c. A 45-year-old American Indian woman with diabetes mellitus
d. A 53-year-old postmenopausal woman who is on hormone
therapy - correct answer- C. A 45-year-old American
Indian woman with diabetes mellitus
A client arrives in the emergency department after being in a car
crash with fatalities. The client has a nearly amputated leg that is
bleeding profusely. What action by the nurse takes priority?
a. Apply direct pressure to the bleeding.
b. Ensure the client has a patent airway.
c. Obtain consent for emergency surgery.
d. Start two large-bore IV catheters. - correct answer- B.
Ensure the client has a patent airway
,A client had a percutaneous transluminal coronary angioplasty
for peripheral arterial disease. What assessment finding by the
nurse indicates a priority outcome for this client has been met?
a. Pain rated as 2/10 after medication
b. Distal pulse on affected extremity 2+/4+
c. Remains on bedrest as directed
d. Verbalizes understanding of procedure - correct answer-
B. Distal pulse on affected extremity 2+/4+
A client had an acute myocardial infarction. What assessment
finding indicates to the nurse that a significant complication has
occurred?
a. Blood pressure that is 20 mm Hg below baseline
b. Oxygen saturation of 94% on room air
c. Poor peripheral pulses and cool skin
d. Urine output of 1.2 mL/kg/hr for 4 hours - correct
answer- C. Poor peripheral pulses and cool skin
A client has a deep vein thrombosis (DVT). What comfort
measure does the nurse delegate to the unlicensed assistive
personnel (UAP)?
a. Ambulate the client.
, b. Apply a warm moist pack.
c. Massage the clients leg.
d. Provide an ice pack. - correct answer- B. Apply a warm
moist pack
A client has been bedridden for several days after major
abdominal surgery. What action does the nurse delegate to the
unlicensed assistive personnel (UAP) for deep vein thrombosis
(DVT) prevention? (Select all that apply.)
a. Apply compression stockings.
b. Assist with ambulation.
c. Encourage coughing and deep breathing.
d. Offer fluids frequently.
e. Teach leg exercises. - correct answer- A. Apply
compression stockings
B. Assist with ambulation
D. Offer fluids frequently
A client has been diagnosed with a deep vein thrombosis and is
to be discharged on warfarin (Coumadin). The client is adamant
about refusing the drug because its dangerous. What action by
the nurse is best?