NUR 225 EXAM 1 PRACTICE QUESTIONS
SOLUTIONS WITH COMPLETE UPDATE
a client has developed atrial fibrilation, which has a ventricular rate of 150 beats per min. a nurse
assesses the client for
A- hypotension and dizziness
B- nausea and vomiting
C- hypertension and headache
D- flat neck veins - CORRECT - ANSWERS A
a nurse is caring for a pt who had an asthma attack. 10 min after administering an inhaled
bronchodilator to the client, the nurse returns to ask if the client's breathing is easier. The nurse is
engaging in which phase of the nursing process?
A- assessment
B- diagnosis
C- planning
D- implementing
E- evaluation - CORRECT - ANSWERS E
a nurse is caring for a pt with chronic lung disease who is receiving O2 through a NC. what nursing action
is performed correctly?
A- nurse assures that the O2 mask is humidified
B- the nurse adjusts the fit of the NC so it fits snug and tight against skin
C- nurse encourages the pt to breathe through the nose with mouth closed
D- nurse adjusts the flow rate to 6L/min or more - CORRECT - ANSWERS C
a nurse is completing a pt assessment for the purpose of determining factors that place the pt at risk for
falls. which factor should cause the MOST concern when completing the assessment?
A- uses a walker
, B- has a history of falls
C- takes a diuretic once a day
D- has a urinary retention catheter in place and 2 IVs - CORRECT - ANSWERS B
a nurse is conducting an assessment of an American Indian women who has come to the clinic
complaining of a headache. pt tells the nurse that the meds prescribed by the tribal leader have done
some good. What is the appropriate response?
A- tell me about these meds and how often you take them
B- I advise you from taking them
C- could these meds be the cause of your headaches?
D- maybe you should increase the frequency of the healer's meds - CORRECT - ANSWERS A
a nurse is performing an assessment on a pt admitted to the unit with visual deficits. the nurse's priority
intervention would be which of the following?
A- orienting the pt to the room to reduce anxiety and prevent injury
B- identifying hazards in the pt's home living environment
C- discussing proper application of eye drops for discharge
C- reinforcing eye safety in activities at work - CORRECT - ANSWERS A
a pt is recovering from surgery. the pt is very restless, HR is 120 BPM and BP is 70/53, skin is cool and
clammy. what is the best nursing action?
A- continue to monitor the patient
B- notify the medical team
C- obtain an EKG
D- check the pt's blood glucose - CORRECT - ANSWERS B
a pt with COPD is unable to perform personal hygiene without becoming exhausted. What nursing
intervention would be appropriate for this pt?
A- assist with bathing and hygiene even if the pt feels capable of performing them alone
B- teach the pt not to talk about the procedure, just to perform it at the best of their ability
SOLUTIONS WITH COMPLETE UPDATE
a client has developed atrial fibrilation, which has a ventricular rate of 150 beats per min. a nurse
assesses the client for
A- hypotension and dizziness
B- nausea and vomiting
C- hypertension and headache
D- flat neck veins - CORRECT - ANSWERS A
a nurse is caring for a pt who had an asthma attack. 10 min after administering an inhaled
bronchodilator to the client, the nurse returns to ask if the client's breathing is easier. The nurse is
engaging in which phase of the nursing process?
A- assessment
B- diagnosis
C- planning
D- implementing
E- evaluation - CORRECT - ANSWERS E
a nurse is caring for a pt with chronic lung disease who is receiving O2 through a NC. what nursing action
is performed correctly?
A- nurse assures that the O2 mask is humidified
B- the nurse adjusts the fit of the NC so it fits snug and tight against skin
C- nurse encourages the pt to breathe through the nose with mouth closed
D- nurse adjusts the flow rate to 6L/min or more - CORRECT - ANSWERS C
a nurse is completing a pt assessment for the purpose of determining factors that place the pt at risk for
falls. which factor should cause the MOST concern when completing the assessment?
A- uses a walker
, B- has a history of falls
C- takes a diuretic once a day
D- has a urinary retention catheter in place and 2 IVs - CORRECT - ANSWERS B
a nurse is conducting an assessment of an American Indian women who has come to the clinic
complaining of a headache. pt tells the nurse that the meds prescribed by the tribal leader have done
some good. What is the appropriate response?
A- tell me about these meds and how often you take them
B- I advise you from taking them
C- could these meds be the cause of your headaches?
D- maybe you should increase the frequency of the healer's meds - CORRECT - ANSWERS A
a nurse is performing an assessment on a pt admitted to the unit with visual deficits. the nurse's priority
intervention would be which of the following?
A- orienting the pt to the room to reduce anxiety and prevent injury
B- identifying hazards in the pt's home living environment
C- discussing proper application of eye drops for discharge
C- reinforcing eye safety in activities at work - CORRECT - ANSWERS A
a pt is recovering from surgery. the pt is very restless, HR is 120 BPM and BP is 70/53, skin is cool and
clammy. what is the best nursing action?
A- continue to monitor the patient
B- notify the medical team
C- obtain an EKG
D- check the pt's blood glucose - CORRECT - ANSWERS B
a pt with COPD is unable to perform personal hygiene without becoming exhausted. What nursing
intervention would be appropriate for this pt?
A- assist with bathing and hygiene even if the pt feels capable of performing them alone
B- teach the pt not to talk about the procedure, just to perform it at the best of their ability
