VERIFIED ANSWERS 2026 | Latest Questions | A+
• A nurse is verifying nasogastric tube placement by the pH of aspirated gastric fluid.
Which of the following pH values provides a good indication of correct tube placement?
A. 2
B. 5
C. 7
D. 9 -✓✓A. 2
Rationale: A good indication of appropriate placement is obtaining gastric contents with
a pH between 0 and 4.
• A nurse is caring for a client with a closed head injury. When pressure is applied to
client's nail beds, the client's eyes open and adduction of the arms with flexion of the
elbows and wrists is noted. The client also moans with stimulation. What is the client's
Glascow Coma Score?
A. 4
B. 7
C. 9
D. 10 -✓✓B. 7 (comatose)
Rationale:
Eye Opening (ranges from 4-1)
4 = spontaneous
3 = to voice
2 = to pain
1 = none
Verbal (ranges from 5-1)
5 = oriented
4 = confused
3 = inappropriate words
2 = incomprehensible sounds
1= none
Motor (raged from 6-1)
6 = obeys command
5 = localizes pain
4 = withdraws
3 = flexion (decorticate posturing)
2 = extension (decerebrate posturing)
1 = none
• A nurse should teach which of the following clients requiring crutches about how to
use a three-point gait?
A. A client who is able to bear full weight on both lower extremities.
B. A client who has bilateral leg braces due to paralysis of the lower extremities.
C. A client who has a right femur fracture with no weight bearing on the affected leg.
, D. A client who has bilateral knee-replacements with partial weight bearing on both legs.
-✓✓C. A client who has a right femur fracture with no weight bearing on the affected leg.
Rationale: A three-point gait requires the client to bear all of his weight on one foot. With
a three-point gait, the client bears weight on both crutches and then on the uninvolved
leg, repeating the sequence. The affected leg does not touch the ground.
• A nurse is providing teaching about the Mediterranean diet to a client who has a new
diagnosis if hypertension. Which of the following statements by the client indicates a
need for further teaching?
A. "I will limit my intake of red meat to twice weekly."
B. "I can have dairy in moderate portions daily."
C. "I can have fish two times a week."
D. "I can drink wine in moderation." -✓✓A. "I will limit my intake of red meat to twice
weekly."
Rationale: Following the Mediterranean diet, red meat should be limited to two times
monthly. The client should have dairy in moderate portions daily to weekly. The intake
of fish and seafood is at least two times per week. Drinking wine is acceptable in
moderation.
• A nurse is providing dietary education to a client with cholecystitis who has been
prescribed a low-fat diet. Which of the following meal selections by the client indicates
understanding of education?
A. Roast beef with gravy, mashed potatoes, ice cream
B. Macaroni and cheese, salad, pudding
C. Creamed chicken on a roll with peas
D. Roast turkey, rice pilaf, green beans -✓✓D. Roast turkey, rice pilaf, green beans
Rationale: Roast turkey is a low-fat protein option that would be an excellent choice for
a low-fat diet.
• A client with a cystocele is encouraged to exercise to strengthen pelvic floor muscles
and prevent pelvis organ prolapse. What exercise will the client need to perform?
A. Kegel exercises
B. Isometric exercises
C. Circumduction exercises
D. Uterine extension exercises -✓✓A. Kegel exercises
Rationale: Kegel exercises strengthen the pelvic floor muscles, which results in
reduction or prevention of pelvic prolapse and stress urinary incontinence. The other
mentioned exercises have no direct effect on prevention or reduction of a cystocele.
• A nurse is caring for an older adult client with delirium. Which intervention will most
effectively reduce the client's risk for falls?
A. Use of a night-light.
B. Demonstrate how to use the call light.
C. Place bedside table in close proximity.
D. Hourly rounding by the nurse. -✓✓D. Hourly rounding by the nurse.