#1
Which of the following vital signs is measured first when assessing a patient?
Temperature
ExplanationTemperature is typically the first vital sign assessed to gain initial insight into a patient's condition.
#2
What is the recommended position for a patient experiencing difficulty breathing?
Sitting upright
ExplanationSitting upright helps optimize lung expansion and ease breathing for patients experiencing difficulty.
#3
What is the primary nursing intervention for a patient experiencing acute respiratory distress?
Administering oxygen therapy
ExplanationAdministering oxygen therapy is essential for improving oxygenation and supporting respiratory function in patients experiencing acute respiratory distress.
#4
Which of the following complications is commonly associated with prolonged immobility in hospitalized patients?
Deep vein thrombosis
ExplanationProlonged immobility predisposes patients to deep vein thrombosis (DVT) due to stagnant blood flow and increased risk of clot formation.
#5
Which of the following is a common sign of respiratory distress in infants?
Tachypnea
ExplanationTachypnea, or rapid breathing, is a common sign of respiratory distress in infants and may indicate various underlying conditions.
#6
Which medication is commonly administered to treat anaphylaxis?
Epinephrine
ExplanationEpinephrine is the primary medication used in the treatment of anaphylaxis due to its rapid reversal of severe allergic reactions.
#7
Which of the following is a priority nursing intervention for a patient experiencing acute pain?
Administering analgesic medication as ordered
ExplanationAdministering analgesic medication promptly and as ordered is a priority nursing intervention to alleviate acute pain and improve patient comfort.
#8
Which of the following is a symptom of hypoglycemia?
Diaphoresis
ExplanationDiaphoresis, or excessive sweating, is a common symptom of hypoglycemia due to the body's stress response.
#9
What is the first step in the nursing management of a patient experiencing a seizure?
Ensuring patient safety
ExplanationThe primary concern during a seizure is ensuring the safety of the patient and those around them.
#10
Which electrolyte imbalance is associated with muscle weakness and cardiac arrhythmias?
Hypokalemia
ExplanationHypokalemia, or low potassium levels, can lead to muscle weakness and cardiac arrhythmias due to its role in muscle and nerve function.
#11
In which type of shock does the body's response lead to widespread inflammation and tissue damage?
Distributive shock
ExplanationDistributive shock, such as septic shock, results from widespread vasodilation and increased capillary permeability, leading to systemic inflammation and tissue damage.
#12
What is the primary goal of wound irrigation in the nursing care of a patient with a contaminated wound?
To remove debris and bacteria
ExplanationWound irrigation helps to mechanically remove debris and bacteria from the wound, reducing the risk of infection and promoting healing.
#13
What is the recommended method for assessing capillary refill in a patient?
Applying pressure to a nail bed and observing the time it takes for color to return
ExplanationCapillary refill time is assessed by applying pressure to a nail bed and observing the time it takes for the normal color to return, typically within 2 seconds.
#14
What is the main purpose of suctioning in airway management?
To remove excess secretions
ExplanationSuctioning helps clear the airway by removing excess secretions, blood, or other fluids that may obstruct breathing.
#15
Which medication is commonly used as an antidote for opioid overdose?
Naloxone
ExplanationNaloxone is an opioid antagonist used to rapidly reverse the effects of opioid overdose.
#16
What is the primary purpose of administering thrombolytic therapy to a patient with a myocardial infarction?
To dissolve blood clots
ExplanationThrombolytic therapy is aimed at rapidly dissolving blood clots in the coronary arteries to restore blood flow and minimize heart damage during a heart attack.
#17
Which of the following is a common symptom of urinary tract infection (UTI) in elderly patients?
Confusion
ExplanationConfusion is a common symptom of UTI in elderly patients, often presenting as acute or worsening confusion or delirium.
#18
What is the primary purpose of using a sequential compression device (SCD) in hospitalized patients?
To prevent venous stasis and thrombosis
ExplanationSequential compression devices (SCDs) help prevent venous stasis and thrombosis by promoting blood flow in the lower extremities, reducing the risk of deep vein thrombosis (DVT).
#19
Which of the following actions is appropriate when caring for a patient with a suspected spinal cord injury?
Immobilizing the patient's head and neck
ExplanationImmobilizing the patient's head and neck helps prevent further spinal cord injury by minimizing movement and maintaining spinal alignment.
#20
Which of the following is a common side effect of opioid analgesics?
Respiratory depression
ExplanationRespiratory depression is a common side effect of opioid analgesics, particularly in high doses, due to their central nervous system depressant effects.