Version B Questions With Correct Answers
(Verified Answers) Plus Rationales 2026 Q&A |
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1.
A nurse is assessing a client with left-sided heart failure. Which finding
is most expected?
A. Peripheral edema
B. Jugular vein distention
C. Crackles in the lungs
D. Ascites
Correct answer: C
Rationale: Left-sided heart failure causes pulmonary congestion
because the left ventricle cannot effectively pump blood into systemic
circulation, leading to fluid backing up into the lungs. This results in
crackles, dyspnea, and orthopnea. Peripheral edema, JVD, and ascites
are more commonly associated with right-sided heart failure.
,2.
A client is prescribed warfarin. Which lab value should the nurse
monitor?
A. aPTT
B. INR
C. Platelet count
D. Bleeding time
Correct answer: B
Rationale: Warfarin therapy is monitored using the INR (International
Normalized Ratio), which evaluates the extrinsic clotting pathway. The
therapeutic range is typically 2–3 for most indications.
3.
A nurse is teaching a client with diabetes mellitus about hypoglycemia.
Which symptom should be included?
A. Fruity breath odor
B. Kussmaul respirations
,C. Diaphoresis
D. Slow deep breathing
Correct answer: C
Rationale: Hypoglycemia triggers sympathetic nervous system
activation, leading to diaphoresis, tremors, tachycardia, and anxiety.
Fruity breath and Kussmaul respirations are signs of ketoacidosis.
4.
A post-op client suddenly develops chest pain, dyspnea, and
tachycardia. What is the priority action?
A. Administer oral fluids
B. Encourage coughing and deep breathing
C. Notify the provider immediately
D. Obtain a urine sample
Correct answer: C
Rationale: These symptoms suggest pulmonary embolism, a medical
emergency. Immediate provider notification and rapid intervention
are required.
, 5.
Which electrolyte imbalance is most associated with loop diuretics?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia
Correct answer: B
Rationale: Loop diuretics increase potassium excretion, leading to
hypokalemia. Monitoring potassium levels is essential.
6.
A nurse is caring for a client with tuberculosis. Which isolation
precaution is required?
A. Contact precautions
B. Droplet precautions
C. Airborne precautions
D. Protective environment
Correct answer: C