Complex CMS 2 Question & Answers
, 1- A nurse is assessing a client who has a new diagnosis of colon cancer. Which of the
follow findings should the nurse report?
Answer: Hematochezia
2- A nurse is assessing a client admitted with peripheral vascular disease. Which of the
following findings indicates a venous vascular disorder?
Answer: Edema of the ankle
3- A nurse is assessing a client who has pericarditis. In which of the following area of the
client’s chest should the nurse place the stethoscope to best hear a pericardial
friction rub?
Answer: D (on the picture)
4- A nurse is caring for a client who has a chest tube. The client asks why the fluid in the
water seal chamber rises and fails. Which of the following statements should the nurse
make?
Answer: You’re breathing pattern causes this
5- A community health nurse is reviewing home care instructions with an older adult
client who has a new diagnosis of heart failure. Which of the following is the
priority topic for the nurse to review with the client?
Answer: Changes weight
6- A nurse is planning care for syndrome of inappropriate antidiuretic hormone. Which of
the following interventions should the nurse include?
Answer: Check for increased urine specific gravity
7- A nurse is caring for a client who has a new onset of hyperglycemia hyperosmolar state
(HHS). Which of the following interventions by the nurse is the highest priority?
Answer: initiate IV fluid replacement
8- A nurse finds a client in bed, unresponsive and breathing. Which of the following
actions should the nurse take first?
Answer: Palpate for the client’s carotid pulse
9- A nurse is caring for a client who is experiencing a hypertensive crisis. Which of the
following actions should the nurse take?
, 1- A nurse is assessing a client who has a new diagnosis of colon cancer. Which of the
follow findings should the nurse report?
Answer: Hematochezia
2- A nurse is assessing a client admitted with peripheral vascular disease. Which of the
following findings indicates a venous vascular disorder?
Answer: Edema of the ankle
3- A nurse is assessing a client who has pericarditis. In which of the following area of the
client’s chest should the nurse place the stethoscope to best hear a pericardial
friction rub?
Answer: D (on the picture)
4- A nurse is caring for a client who has a chest tube. The client asks why the fluid in the
water seal chamber rises and fails. Which of the following statements should the nurse
make?
Answer: You’re breathing pattern causes this
5- A community health nurse is reviewing home care instructions with an older adult
client who has a new diagnosis of heart failure. Which of the following is the
priority topic for the nurse to review with the client?
Answer: Changes weight
6- A nurse is planning care for syndrome of inappropriate antidiuretic hormone. Which of
the following interventions should the nurse include?
Answer: Check for increased urine specific gravity
7- A nurse is caring for a client who has a new onset of hyperglycemia hyperosmolar state
(HHS). Which of the following interventions by the nurse is the highest priority?
Answer: initiate IV fluid replacement
8- A nurse finds a client in bed, unresponsive and breathing. Which of the following
actions should the nurse take first?
Answer: Palpate for the client’s carotid pulse
9- A nurse is caring for a client who is experiencing a hypertensive crisis. Which of the
following actions should the nurse take?
