RN ADULT MEDICAL SURGICAL 2025 VERSION
Question 20 of 90:
A nurse is providing teaching to a client who has cancer and a new prescription for an opioid analgesic for
pain management. Which of the following information should the nurse include in the teaching?
Options:
• A) "It is an expected effect to sleep through the day when taking this medication."
• B) "Your constipation will be lessened as you develop a tolerance to the medication."
• C) "You should void every 4 hours to decrease the risk of urinary retention."
• D) "If you experience ringing in your ears, your dose will need to be reduced."
Correct Answer:
• C) "You should void every 4 hours to decrease the risk of urinary retention."
Explanation:
Opioids can cause urinary retention, so the nurse should instruct the client to void regularly (every 4
hours) to reduce this risk. Constipation is a common side effect of opioid analgesics, and it does not
,typically improve with continued use (Option B is incorrect). Sedation or excessive sleepiness (Option A)
may occur, but it's important to caution the client about this effect rather than accept it as expected.
Ringing in the ears (Option D) is not a typical adverse effect of opioids, so this is not a correct teaching
point.
Question 32 of 90:
A nurse is reviewing the ABG results of a client who has advanced COPD. Which of the following results
should the nurse expect?
Options:
• A) PaCO2 56 mm Hg (35 to 45 mm Hg)
• B) pH 7.50 (7.35 to 7.45)
• C) HCO3 18 mEq/L (21 to 28 mEq/L)
• D) PaO2 130 mm Hg (80 to 100 mm Hg)
Correct Answer:
• A) PaCO2 56 mm Hg (35 to 45 mm Hg)
Explanation:
In advanced COPD, the client is likely to have respiratory acidosis due to hypoventilation, leading to an
elevated PaCO2 level. A PaCO2 of 56 mm Hg is above the normal range of 35 to 45 mm Hg, which is
expected in COPD patients who are retaining carbon dioxide. The pH in COPD patients can be normal or
slightly elevated, but a pH of 7.50 is high (Option B), and bicarbonate levels (HCO3) are typically normal or
slightly increased in compensation for respiratory acidosis, so Option C is unlikely. A PaO2 of 130 mm Hg
(Option D) is also higher than normal, as COPD typically results in lower oxygen levels.
,Question 35 of 90:
The nurse is assisting with the care of the client.
Graphic Record:
Day 1 2330:
• Vital signs from the emergency department:
o Heart rate 125/min
o Respiratory rate 28/min
o Temperature 36°C (96.8°F)
o Blood pressure 145/90 mm Hg
o Oxygen saturation 90% on oxygen 2 L/min via nasal cannula
Day 1 2345:
• Heart rate 135/min
• Respiratory rate 34/min
, • Temperature 35.9°C (96.6°F)
• Blood pressure 96/45 mm Hg
• Oxygen saturation 92% on oxygen 40% via face mask
The nurse should first address the client's __________, followed by the client's __________.
Options:
• A) Pedal pulses
• B) Oxygenation
• C) Blood pressure
• D) Temperature
• E) Pain
Correct Answer:
• B) Oxygenation
• C) Blood pressure
Explanation:
The nurse should prioritize addressing oxygenation first, as the client is exhibiting low oxygen saturation
(90% on nasal cannula and 92% on a face mask), indicating that oxygen levels need to be optimized. Next,
the nurse should address the client's blood pressure, as the drop in blood pressure from 145/90 mm Hg to
96/45 mm Hg is concerning. Both of these factors take priority over temperature, pedal pulses, or pain in
this situation.
Question 20 of 90:
A nurse is providing teaching to a client who has cancer and a new prescription for an opioid analgesic for
pain management. Which of the following information should the nurse include in the teaching?
Options:
• A) "It is an expected effect to sleep through the day when taking this medication."
• B) "Your constipation will be lessened as you develop a tolerance to the medication."
• C) "You should void every 4 hours to decrease the risk of urinary retention."
• D) "If you experience ringing in your ears, your dose will need to be reduced."
Correct Answer:
• C) "You should void every 4 hours to decrease the risk of urinary retention."
Explanation:
Opioids can cause urinary retention, so the nurse should instruct the client to void regularly (every 4
hours) to reduce this risk. Constipation is a common side effect of opioid analgesics, and it does not
,typically improve with continued use (Option B is incorrect). Sedation or excessive sleepiness (Option A)
may occur, but it's important to caution the client about this effect rather than accept it as expected.
Ringing in the ears (Option D) is not a typical adverse effect of opioids, so this is not a correct teaching
point.
Question 32 of 90:
A nurse is reviewing the ABG results of a client who has advanced COPD. Which of the following results
should the nurse expect?
Options:
• A) PaCO2 56 mm Hg (35 to 45 mm Hg)
• B) pH 7.50 (7.35 to 7.45)
• C) HCO3 18 mEq/L (21 to 28 mEq/L)
• D) PaO2 130 mm Hg (80 to 100 mm Hg)
Correct Answer:
• A) PaCO2 56 mm Hg (35 to 45 mm Hg)
Explanation:
In advanced COPD, the client is likely to have respiratory acidosis due to hypoventilation, leading to an
elevated PaCO2 level. A PaCO2 of 56 mm Hg is above the normal range of 35 to 45 mm Hg, which is
expected in COPD patients who are retaining carbon dioxide. The pH in COPD patients can be normal or
slightly elevated, but a pH of 7.50 is high (Option B), and bicarbonate levels (HCO3) are typically normal or
slightly increased in compensation for respiratory acidosis, so Option C is unlikely. A PaO2 of 130 mm Hg
(Option D) is also higher than normal, as COPD typically results in lower oxygen levels.
,Question 35 of 90:
The nurse is assisting with the care of the client.
Graphic Record:
Day 1 2330:
• Vital signs from the emergency department:
o Heart rate 125/min
o Respiratory rate 28/min
o Temperature 36°C (96.8°F)
o Blood pressure 145/90 mm Hg
o Oxygen saturation 90% on oxygen 2 L/min via nasal cannula
Day 1 2345:
• Heart rate 135/min
• Respiratory rate 34/min
, • Temperature 35.9°C (96.6°F)
• Blood pressure 96/45 mm Hg
• Oxygen saturation 92% on oxygen 40% via face mask
The nurse should first address the client's __________, followed by the client's __________.
Options:
• A) Pedal pulses
• B) Oxygenation
• C) Blood pressure
• D) Temperature
• E) Pain
Correct Answer:
• B) Oxygenation
• C) Blood pressure
Explanation:
The nurse should prioritize addressing oxygenation first, as the client is exhibiting low oxygen saturation
(90% on nasal cannula and 92% on a face mask), indicating that oxygen levels need to be optimized. Next,
the nurse should address the client's blood pressure, as the drop in blood pressure from 145/90 mm Hg to
96/45 mm Hg is concerning. Both of these factors take priority over temperature, pedal pulses, or pain in
this situation.
