NUR 122 -Final study guide with
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questions and answers with rationales.
### 1. A nurse is assessing a client’s radial pulse. Which action is
correct?
**A.** Use the thumb to palpate
**B.** Count for 15 seconds and multiply by 4
**C.** Count for 30 seconds and multiply by 2
**D.** Count for 1 full minute if irregular
**Answer:** D
**Rationale:** For an irregular pulse, count for a full minute to ensure
accuracy. Counting for 15 or 30 seconds can miss irregularities.
---
### 2. Which finding indicates that a client’s Foley catheter is draining
properly?
**A.** Balloon port filled with 10 mL saline
**B.** Urine output 500 mL in 8 hours
**C.** Drainage bag on the bed
,**D.** Tubing coiled below bladder level
**Answer:** D
**Rationale:** Tubing must be kept below bladder level to allow
gravity drainage; urine output depends on hydration, not catheter
function alone.
---
### 3. A nurse is preparing to insert a nasogastric (NG) tube. What
position is most appropriate?
**A.** Supine with head flat
**B.** High Fowler’s
**C.** Left side-lying
**D.** Trendelenburg
**Answer:** B
**Rationale:** High Fowler’s facilitates swallowing and reduces risk of
aspiration during NG insertion.
---
### 4. Which lab value indicates hypokalemia?
,**A.** Potassium 5.2 mEq/L
**B.** Potassium 3.2 mEq/L
**C.** Sodium 150 mEq/L
**D.** Calcium 8.5 mg/dL
**Answer:** B
**Rationale:** Normal potassium: 3.5–5.0 mEq/L. 3.2 is low
(hypokalemia).
---
### 5. A client with a tracheostomy has thick, dried secretions around
the stoma. Which action is best?
**A.** Clean with hydrogen peroxide
**B.** Use sterile cotton swabs dry
**C.** Clean with normal saline and gauze
**D.** Apply alcohol wipe
**Answer:** C
**Rationale:** Normal saline is gentle and loosens dried secretions;
hydrogen peroxide and alcohol can irritate skin/tracheal tissue.
---
, ### 6. Which client is at highest risk for falls?
**A.** 25-year-old post-op day 2
**B.** 75-year-old with history of stroke and confusion
**C.** 40-year-old with ankle sprain
**D.** 60-year-old with controlled hypertension
**Answer:** B
**Rationale:** Older age + stroke + confusion are major fall risk factors
(use a fall risk scale like Morse).
---
### 7. What is the priority action when a client’s pulse oximetry drops
to 88%?
**A.** Call rapid response
**B.** Apply oxygen
**C.** Reposition and reassess
**D.** Suction airway
**Answer:** B
**Rationale:** Apply O2 first per protocol; SpO2 <90% is hypoxemia.
After O2, reassess, then suction if needed.
---
questions and answers with rationales.
### 1. A nurse is assessing a client’s radial pulse. Which action is
correct?
**A.** Use the thumb to palpate
**B.** Count for 15 seconds and multiply by 4
**C.** Count for 30 seconds and multiply by 2
**D.** Count for 1 full minute if irregular
**Answer:** D
**Rationale:** For an irregular pulse, count for a full minute to ensure
accuracy. Counting for 15 or 30 seconds can miss irregularities.
---
### 2. Which finding indicates that a client’s Foley catheter is draining
properly?
**A.** Balloon port filled with 10 mL saline
**B.** Urine output 500 mL in 8 hours
**C.** Drainage bag on the bed
,**D.** Tubing coiled below bladder level
**Answer:** D
**Rationale:** Tubing must be kept below bladder level to allow
gravity drainage; urine output depends on hydration, not catheter
function alone.
---
### 3. A nurse is preparing to insert a nasogastric (NG) tube. What
position is most appropriate?
**A.** Supine with head flat
**B.** High Fowler’s
**C.** Left side-lying
**D.** Trendelenburg
**Answer:** B
**Rationale:** High Fowler’s facilitates swallowing and reduces risk of
aspiration during NG insertion.
---
### 4. Which lab value indicates hypokalemia?
,**A.** Potassium 5.2 mEq/L
**B.** Potassium 3.2 mEq/L
**C.** Sodium 150 mEq/L
**D.** Calcium 8.5 mg/dL
**Answer:** B
**Rationale:** Normal potassium: 3.5–5.0 mEq/L. 3.2 is low
(hypokalemia).
---
### 5. A client with a tracheostomy has thick, dried secretions around
the stoma. Which action is best?
**A.** Clean with hydrogen peroxide
**B.** Use sterile cotton swabs dry
**C.** Clean with normal saline and gauze
**D.** Apply alcohol wipe
**Answer:** C
**Rationale:** Normal saline is gentle and loosens dried secretions;
hydrogen peroxide and alcohol can irritate skin/tracheal tissue.
---
, ### 6. Which client is at highest risk for falls?
**A.** 25-year-old post-op day 2
**B.** 75-year-old with history of stroke and confusion
**C.** 40-year-old with ankle sprain
**D.** 60-year-old with controlled hypertension
**Answer:** B
**Rationale:** Older age + stroke + confusion are major fall risk factors
(use a fall risk scale like Morse).
---
### 7. What is the priority action when a client’s pulse oximetry drops
to 88%?
**A.** Call rapid response
**B.** Apply oxygen
**C.** Reposition and reassess
**D.** Suction airway
**Answer:** B
**Rationale:** Apply O2 first per protocol; SpO2 <90% is hypoxemia.
After O2, reassess, then suction if needed.
