1Question
A nurse in a prenatal clinic has four telephone messages from pregnant clients. Which client should the nurse call back first?
- A client at 10 weeks who feels nauseated every morning but is keeping fluids and small meals down
- A client at 36 weeks whose ankles swell by evening and are back to normal in the morning
- A client at 32 weeks with a severe headache that acetaminophen has not relieved and blurred vision
- A client at 28 weeks who has noticed more thin, white vaginal discharge without itching or odor
Show the answer and explanation
Answer: C. A client at 32 weeks with a severe headache that acetaminophen has not relieved and blurred vision
Topic: antepartum danger signs triage
A severe, persistent headache with visual changes after 20 weeks is a danger sign of preeclampsia with severe features and needs same-day evaluation of blood pressure and urine. The other three reports describe expected changes of pregnancy.
Why the others are wrong
- A – Nausea with retained fluids and food is an expected first-trimester discomfort; concern begins when the client cannot keep fluids down or loses weight.
- B – Dependent ankle edema that resolves with rest is physiological; edema of the face and hands or sudden weight gain would be the concern.
- D – Increased thin white discharge without itching, odor or a gush of fluid is normal leukorrhea.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
2Question
A nurse in the newborn nursery receives report on four newborns. Which newborn should the nurse assess first?
- A 1-hour-old with bluish hands and feet and a pink trunk
- A 6-hour-old with a respiratory rate of 50/min and occasional pauses of about 5 seconds
- A 2-hour-old who is grunting with each breath and has nasal flaring
- A 12-hour-old with a heart rate of 160/min while crying
Show the answer and explanation
Answer: C. A 2-hour-old who is grunting with each breath and has nasal flaring
Topic: newborn respiratory distress
Expiratory grunting and nasal flaring are signs of respiratory distress: the newborn is working to keep the alveoli open and to move more air. The other findings are within normal limits for a newborn in transition.
Why the others are wrong
- A – Acrocyanosis with a pink trunk is normal in the first 24 to 48 hours and reflects immature peripheral circulation.
- B – A rate of 50/min with brief pauses is normal periodic breathing; apnea is a pause of 20 seconds or more or one with color or heart rate change.
- D – The heart rate rises with crying; 160/min is at the upper end of normal.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
3Question
After receiving the shift report, which client should the nurse see first?
- A client with chronic obstructive pulmonary disease whose oxygen saturation is 90% on 2 L/min by nasal cannula and who is asking for breakfast
- A client 1 day after total thyroidectomy who reports tingling around the mouth and has new noisy breathing
- A client with type 2 diabetes mellitus whose blood glucose before breakfast is 210 mg/dL
- A client 2 days after abdominal surgery who rates incisional pain 6 on a 0 to 10 scale and asks for an analgesic
Show the answer and explanation
Answer: B. A client 1 day after total thyroidectomy who reports tingling around the mouth and has new noisy breathing
Topic: whom to see first
Tingling around the mouth after thyroidectomy suggests hypocalcemia from parathyroid injury, and noisy breathing signals laryngeal spasm or swelling: a threat to the airway. Airway comes first, and this finding is new and unexpected, so this client is the least stable.
Why the others are wrong
- A – An oxygen saturation of 90% on low-flow oxygen is an expected, acceptable finding in chronic obstructive pulmonary disease.
- C – A glucose of 210 mg/dL needs treatment as prescribed but is not immediately life-threatening.
- D – Pain needs prompt relief but does not come before a threatened airway.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
4Question
A nurse is planning care for four clients. Which client should the nurse assess first?
- A client with a leg cast applied 4 hours ago who reports increasing pain not relieved by an opioid and numb toes
- A client with chronic kidney disease whose serum creatinine is 3.1 mg/dL and who is scheduled for hemodialysis this morning
- A client with heart failure who has 2+ edema of both ankles
- A client with pneumonia who has a temperature of 38.3 C (100.9 F) and is receiving IV antibiotics
Show the answer and explanation
Answer: A. A client with a leg cast applied 4 hours ago who reports increasing pain not relieved by an opioid and numb toes
Topic: acute over chronic
Pain that increases and is not relieved by opioids, together with numbness, suggests compartment syndrome, an acute limb-threatening problem that can cause permanent damage within hours. Acute, unexpected findings take priority over chronic or expected ones.
Why the others are wrong
- B – An elevated creatinine is expected in chronic kidney disease, and treatment is already scheduled.
- C – Ankle edema is a chronic, expected finding in heart failure with no sign of acute change.
- D – Fever is expected in pneumonia and treatment is in progress.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
5Question
A nurse has four matters needing attention at the same time. Which should the nurse address first?
- A client who is anxious about surgery tomorrow and wants to talk
- An infusion pump that is alarming for occlusion on a maintenance infusion of 0.9% sodium chloride
- A family waiting for discharge instructions before driving home
- A client whose first dose of an IV antibiotic was started 10 minutes ago and who reports an itchy throat that feels tight
Show the answer and explanation
Answer: D. A client whose first dose of an IV antibiotic was started 10 minutes ago and who reports an itchy throat that feels tight
Topic: Maslow and ABCs
Throat tightness soon after a first dose of an antibiotic suggests an anaphylactic reaction that threatens the airway. Physiological needs that threaten life come before safety, psychosocial and teaching needs; the nurse stops the infusion and assesses the airway.
Why the others are wrong
- A – Anxiety is a psychosocial need and can wait until physiological emergencies are dealt with.
- B – A short interruption of a maintenance infusion does not endanger the client.
- C – Discharge teaching is important but not urgent.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
6Question
A hospital activates its disaster plan and needs beds for incoming casualties. The charge nurse reviews the unit's clients. Which clients are appropriate to recommend for early discharge?
Select all that apply.
- A client 2 days after laparoscopic cholecystectomy who is eating a regular diet and walking independently
- A client with new atrial fibrillation who is receiving a continuous heparin infusion
- A client with cellulitis of the leg who has been afebrile for 24 hours since changing to oral antibiotics
- A client admitted 6 hours ago with diabetic ketoacidosis who is receiving an insulin infusion
- A client with heart failure who has crackles, an oxygen saturation of 91% on oxygen and is receiving IV furosemide
Show the answers and explanation
Answers: A and C.
- A – A client 2 days after laparoscopic cholecystectomy who is eating a regular diet and walking independently
- C – A client with cellulitis of the leg who has been afebrile for 24 hours since changing to oral antibiotics
Topic: stable versus unstable
In a disaster the clients recommended for discharge are those who are stable and whose remaining care can be given safely at home. Clients who need continuous infusions, frequent monitoring or who still have unresolved acute findings must stay.
Why the others are wrong
- B – A continuous heparin infusion needs laboratory monitoring and dose adjustment in hospital.
- D – Early diabetic ketoacidosis with an insulin infusion is unstable and needs frequent glucose and electrolyte checks.
- E – Crackles and a low oxygen saturation on oxygen show unresolved fluid overload that still needs IV treatment.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
7Question
A nurse in the emergency department is responsible for four clients. Which client should the nurse see first?
- A client with gastrointestinal bleeding whose blood pressure of 100/60 mm Hg and heart rate of 104/min are unchanged from 1 hour ago, with a blood transfusion infusing
- A client with a fractured femur in traction who rates pain 7 on a 0 to 10 scale
- A client with a seizure disorder who had a seizure 1 hour ago and is sleepy but rousable, lying on the side
- A client rescued from a house fire who has a hoarse voice and singed nasal hairs, with an oxygen saturation of 96%
Show the answer and explanation
Answer: D. A client rescued from a house fire who has a hoarse voice and singed nasal hairs, with an oxygen saturation of 96%
Topic: airway before circulation
Hoarseness and singed nasal hairs indicate inhalation injury; airway swelling can progress quickly to complete obstruction even while the oxygen saturation is still normal. Airway takes priority over circulation, and this client's problem is not yet being treated.
Why the others are wrong
- A – This client has a circulation problem that needs close monitoring, but treatment is under way and the airway comes first.
- B – Pain is a priority for comfort but is not life-threatening.
- C – Sleepiness after a seizure is expected, and the client is positioned to protect the airway.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
8Question
A nurse returning from a break receives four messages. Which should the nurse respond to first?
- A client using patient-controlled analgesia with morphine is hard to rouse and has a respiratory rate of 8/min
- A client at risk for falls is asleep, and the bed alarm was found switched off
- A client's scheduled IV antibiotic is 30 minutes late
- A client is asking when the biopsy result will be available
Show the answer and explanation
Answer: A. A client using patient-controlled analgesia with morphine is hard to rouse and has a respiratory rate of 8/min
Topic: actual over potential
A respiratory rate of 8/min with difficulty rousing is actual opioid-induced respiratory depression, a present threat to breathing. Actual, life-threatening problems come before potential problems and routine tasks.
Why the others are wrong
- B – The fall risk is a potential problem; the client is asleep, and the alarm can be reset right after the emergency.
- C – A short delay in a scheduled antibiotic does not threaten life.
- D – A request for information is a psychosocial need that can wait.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
9Question
A nurse on a surgical unit receives reports on four clients. Which client needs the nurse's attention first?
- A client 4 hours after transurethral resection of the prostate who has pink urine with a few small clots during continuous bladder irrigation
- A client 1 day after a colostomy whose stoma is red and moist
- A client 5 days after abdominal surgery who says, 'I felt something give way in my incision when I coughed'
- A client 12 hours after chest tube insertion whose water-seal chamber fluid rises and falls with breathing
Show the answer and explanation
Answer: C. A client 5 days after abdominal surgery who says, 'I felt something give way in my incision when I coughed'
Topic: unexpected over expected
A sensation of something giving way after coughing signals wound dehiscence, which can progress to evisceration; it is an unexpected finding that needs immediate assessment. The other findings are expected for the stage of recovery.
Why the others are wrong
- A – Pink urine with small clots is expected in the first hours after this surgery while irrigation is running.
- B – A red, moist stoma shows good blood supply and is the expected finding.
- D – Rise and fall of fluid in the water-seal chamber with breathing (tidaling) shows the system is working normally.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
10Question
A nurse receives updates on four clients. Which client should the nurse see first?
- A client with pneumonia who has a cough with yellow sputum and an oxygen saturation of 93%
- A client with asthma whose loud wheezing has stopped, who now has very faint breath sounds and can speak only one or two words at a time
- A client with deep vein thrombosis who reports calf pain and is receiving an anticoagulant
- A client with a serum potassium of 3.3 mEq/L who is taking an oral potassium supplement
Show the answer and explanation
Answer: B. A client with asthma whose loud wheezing has stopped, who now has very faint breath sounds and can speak only one or two words at a time
Topic: recognizing the unstable client
In a severe asthma attack, the disappearance of wheezing with faint breath sounds and inability to speak in sentences means so little air is moving that respiratory failure is close. A change that looks like improvement but comes with worsening effort is an unstable, unexpected finding.
Why the others are wrong
- A – Productive cough and a saturation of 93% are expected in pneumonia and are not an acute change.
- C – Calf pain is expected with deep vein thrombosis, and treatment is in progress.
- D – A potassium level slightly below normal that is already being replaced is not urgent.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
11Question
Thirty minutes before the end of a shift a registered nurse still has an IV antibiotic that is due now for one client, discharge teaching for a client whose ride has arrived, and intake and output totals to record for four clients. The unlicensed assistive personnel (UAP) then reports that a client 2 days after hip surgery is newly confused and has an oxygen saturation of 88%. Which plan is best?
- Hang the antibiotic first because it is time-critical, then go to the confused client
- Ask the LPN/LVN to assess the confused client and report back while the nurse completes the discharge teaching
- Assess the confused client at once, ask the UAP to total the intake and output, and complete or hand over the antibiotic and the teaching once the client is stable
- Ask the UAP to apply oxygen and recheck the saturation in 15 minutes while the nurse hangs the antibiotic
Show the answer and explanation
Answer: C. Assess the confused client at once, ask the UAP to total the intake and output, and complete or hand over the antibiotic and the teaching once the client is stable
Topic: end-of-shift priorities with delegation
New confusion with a low oxygen saturation after hip surgery is an acute change that may signal hypoxemia from a pulmonary or fat embolism, and it needs the registered nurse's immediate assessment. Totalling intake and output is a routine task for the UAP, and a short delay in an antibiotic or in discharge teaching does not endanger anyone.
Why the others are wrong
- A – A scheduled antibiotic can be a few minutes late; hypoxemia with new confusion cannot wait.
- B – The initial assessment of a client whose condition has changed belongs to the registered nurse, and discharge teaching is the least urgent task.
- D – Deciding on and evaluating treatment for an unstable client is not a UAP task, and 15 minutes without a nursing assessment is unsafe.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
12Question
Four clients arrive at the emergency department triage desk within 5 minutes. Which client should the triage nurse send to a treatment room first?
- A 62-year-old who is alert, with a facial droop and slurred speech that began 45 minutes ago
- A 45-year-old with flank pain rated 9 out of 10, vomiting and blood in the urine
- A 19-year-old with a temperature of 38.9 C (102 F), a productive cough and an oxygen saturation of 95%
- A 28-year-old stung by a wasp 10 minutes ago who has hives, swollen lips and a hoarse voice
Show the answer and explanation
Answer: D. A 28-year-old stung by a wasp 10 minutes ago who has hives, swollen lips and a hoarse voice
Topic: emergency department triage
Hives with lip swelling and hoarseness minutes after a sting indicate anaphylaxis with swelling of the upper airway, which can close completely within minutes; the client needs epinephrine immediately. The client with a possible stroke is the next priority and is time-critical, but is alert and maintaining an airway at present.
Why the others are wrong
- A – A possible stroke within the treatment window is the second priority; the client is alert with an open airway, while the other client's airway is closing now.
- B – Severe pain needs prompt relief, but renal colic does not threaten life in the next minutes.
- C – Fever and cough with a saturation of 95% indicate an infection that is currently compensated.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
13Question
A registered nurse is about to give the 0900 medications to four clients when a client 1 day after abdominal surgery reports sudden shortness of breath and chest pain. The oxygen saturation is 86% and the heart rate is 124/min. Which actions should the nurse take?
Select all that apply.
- Stay with the client, raise the head of the bed and apply oxygen
- Activate the rapid response team
- Ask the unlicensed assistive personnel (UAP) to stay with the client while the nurse completes the medications that are due
- Ask the charge nurse to have another nurse give the time-critical medications to the other clients
- Finish documenting the morning assessments before calling, so that the information is complete
- Ask the LPN/LVN to take over the assessment of this client so that the nurse stays on schedule
Show the answers and explanation
Answers: A, B and D.
- A – Stay with the client, raise the head of the bed and apply oxygen
- B – Activate the rapid response team
- D – Ask the charge nurse to have another nurse give the time-critical medications to the other clients
Topic: deteriorating client while tasks are due
Sudden dyspnea, chest pain, hypoxemia and tachycardia after surgery suggest a pulmonary embolism. The registered nurse stays with the unstable client, supports breathing, calls for the rapid response team and arranges for a colleague to cover the other clients' time-critical medications. The care of an unstable client is not handed to the UAP or the LPN/LVN.
Why the others are wrong
- C – The UAP cannot assess or intervene; leaving an unstable client to complete routine medications reverses the priority.
- E – Documentation never comes before calling for help for a deteriorating client.
- F – An unstable client needs the registered nurse's continuous assessment and judgment; this is outside the LPN/LVN role.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
14Question
After a train derailment a hospital activates its disaster plan and asks each unit to identify clients who could be discharged safely to free beds. Which clients should the charge nurse recommend?
Select all that apply.
- A client 1 day after a laparoscopic cholecystectomy who is eating, walking and taking oral analgesics
- A client with cellulitis who was changed to oral antibiotics yesterday and has had no fever for 24 hours
- A client with new atrial fibrillation who was started on a heparin infusion this morning
- A client admitted last night with gastrointestinal bleeding whose hemoglobin is being checked every 6 hours
- A client with pneumonia who is receiving IV antibiotics and oxygen at 4 L/min, with an oxygen saturation of 91%
Show the answers and explanation
Answers: A and B.
- A – A client 1 day after a laparoscopic cholecystectomy who is eating, walking and taking oral analgesics
- B – A client with cellulitis who was changed to oral antibiotics yesterday and has had no fever for 24 hours
Topic: disaster discharge to free beds
In a disaster the clients recommended for early discharge are those who are stable and whose remaining care can be given safely at home: treatment by mouth, no need for frequent monitoring and no IV therapy that requires titration. Clients with a new, unstable or closely monitored condition keep their beds.
Why the others are wrong
- C – A newly started heparin infusion for a new arrhythmia needs monitoring and dose adjustment in hospital.
- D – Serial hemoglobin checks mean the bleeding is not yet known to have stopped.
- E – Oxygen at 4 L/min with a saturation of 91% and IV antibiotics shows an acute illness that is not yet controlled.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
15Question
At 0715 a nurse on a medical-surgical unit finishes report on six clients. Two are asleep with stable overnight vital signs. Which of the remaining four clients should the nurse assess first?
- A client 2 days after total hip replacement who rates incision pain 6 out of 10 and is asking for the scheduled analgesic
- A client with chronic obstructive pulmonary disease whose oxygen saturation is 90% on 2 L/min by nasal cannula, the same as the last three shifts
- A client 14 hours after total thyroidectomy who reports tingling around the mouth and whose hand cramped when the blood pressure cuff was inflated
- A client with type 1 diabetes whose fasting glucose is 248 mg/dL and whose breakfast insulin is due
Show the answer and explanation
Answer: C. A client 14 hours after total thyroidectomy who reports tingling around the mouth and whose hand cramped when the blood pressure cuff was inflated
Topic: first client after report
Tingling around the mouth and carpal spasm with cuff inflation after thyroidectomy point to hypocalcemia from parathyroid injury. Untreated, it can progress to tetany and laryngospasm, which threatens the airway. This is a new, potentially life-threatening change, so it outranks pain, a chronic baseline finding and a moderately high glucose.
Why the others are wrong
- A – Pain needs prompt relief, but it is expected at this stage and does not threaten life; it follows the client with an airway risk.
- B – A saturation of 90% is this client's stable baseline, a chronic finding rather than an acute change.
- D – The glucose is high but not an emergency, and the treatment is already prescribed and due; it can wait a few minutes.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
16Question
A nurse has received report on four clients: (1) a client 1 day after surgical repair of a hip fracture who is newly restless, keeps pulling off the oxygen, and has an oxygen saturation of 89% with small red spots across the chest; (2) a client 2 hours after cardiac catheterization through the femoral artery who has a new 2-cm hematoma at the site with unchanged vital signs; (3) a client 6 hours after laparoscopic cholecystectomy who reports right shoulder pain of 4 out of 10; (4) a client on a heparin infusion whose next clotting test is due in 1 hour. In which order should the nurse see the first two clients?
- The client with the hip fracture repair, then the client with the groin hematoma
- The client with the groin hematoma, then the client with the hip fracture repair
- The client with the hip fracture repair, then the client on the heparin infusion
- The client with the groin hematoma, then the client with shoulder pain
Show the answer and explanation
Answer: A. The client with the hip fracture repair, then the client with the groin hematoma
Topic: first and second client
New restlessness, hypoxemia and petechiae on the chest after a long-bone fracture suggest fat embolism, an acute breathing problem that comes first. A new hematoma at an arterial puncture site is a circulation problem that may be the start of bleeding; with stable vital signs it comes second. Referred shoulder pain after laparoscopy and a blood test due in an hour are expected and scheduled.
Why the others are wrong
- B – The hematoma needs early attention, but vital signs are unchanged, while the other client already has hypoxemia and altered behavior.
- C – The first choice is right, but a routine clotting test due in an hour does not outrank a new hematoma at an arterial site.
- D – This puts a potential bleed ahead of actual hypoxemia and then chooses an expected, mild post-laparoscopy finding.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
17Question
Four call lights come on at once. Unlicensed assistive personnel (UAP) who is free reports the requests to the nurse: a client at high risk for falls who took furosemide an hour ago needs the bathroom urgently; a client whose first unit of packed red blood cells was started 10 minutes ago reports itching and low back pain; an infusion pump with maintenance fluid is alarming for an occlusion; a family member wants to talk about discharge plans. Which response by the nurse is best?
- Assist the client to the bathroom personally because a fall is preventable, and ask the UAP to stay with the client receiving blood
- Ask the UAP to take vital signs on the client receiving blood while the nurse clears the pump alarm
- Go to the client receiving blood and ask the UAP to tell the other three that the nurse will come as soon as possible
- Go to the client receiving blood and send the UAP to assist the client to the bathroom
Show the answer and explanation
Answer: D. Go to the client receiving blood and send the UAP to assist the client to the bathroom
Topic: simultaneous call lights
Itching and low back pain minutes into a transfusion suggest a transfusion reaction; the nurse must stop the transfusion and assess at once, and this cannot be delegated. Toileting a client at fall risk is a routine task within the UAP's role and is urgent in its own right, so sending the UAP there handles two safety problems at the same time.
Why the others are wrong
- A – It leaves a possible transfusion reaction with a person who cannot assess or stop the infusion.
- B – Vital signs alone do not manage a reaction, and a pump alarm on maintenance fluid is far less urgent than stopping the blood.
- C – The nurse's own choice is right, but leaving a client at high fall risk waiting when the UAP is free invites a fall.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
18Question
A nurse is about to give a scheduled analgesic to a client who had knee surgery yesterday, rates pain 7 out of 10, and is angry about waiting. The unlicensed assistive personnel (UAP) stops the nurse to say that an 82-year-old client admitted yesterday with a urinary tract infection 'seems different, sleepier, and just asked what day it is.' The UAP's readings are temperature 96.9 F (36.1 C), heart rate 104/min, respirations 24/min and blood pressure 102/58 mm Hg; this morning the blood pressure was 118/70 mm Hg. What should the nurse do first?
- Give the analgesic, because it takes only two minutes and the client has waited
- Go to assess the 82-year-old client now
- Ask the UAP to repeat the vital signs in 30 minutes and report back
- Call the provider to report the UAP's observations before seeing the client
Show the answer and explanation
Answer: B. Go to assess the 82-year-old client now
Topic: request versus early deterioration
New confusion, a faster heart and breathing rate, a falling blood pressure and a low temperature in an older adult with an infection are early signs of sepsis. Older adults often show a subtle change in mental status and no fever. The nurse must assess immediately; a stable client's pain, though real, is not life-threatening.
Why the others are wrong
- A – The pain is a legitimate need but not unstable; an interruption of 'only two minutes' tends to grow, and possible sepsis cannot wait.
- C – The readings already show a worrying trend; waiting 30 minutes delays recognition, and judging the change is not a UAP task.
- D – The provider must be called, but with the nurse's own assessment; a secondhand report gives an incomplete picture.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
19Question
Four clients return to the unit from procedures within the same half hour. Which client should the nurse assess first?
- A client who had a colonoscopy under moderate sedation, is drowsy but wakes to voice, and reports cramping and passing gas
- A client who had a bronchoscopy 1 hour ago, has no gag reflex yet, and is asking for a drink
- A client who had a percutaneous liver biopsy 1 hour ago and now has right shoulder pain, respirations of 26/min and a heart rate of 118/min
- A client who had a cardiac catheterization through the radial artery, has a compression band in place, and has a warm hand with brisk capillary refill
Show the answer and explanation
Answer: C. A client who had a percutaneous liver biopsy 1 hour ago and now has right shoulder pain, respirations of 26/min and a heart rate of 118/min
Topic: post-procedure returns
After a liver biopsy, pain referred to the right shoulder with tachycardia and tachypnea suggests bleeding or a pneumothorax, the two serious complications of the procedure. This client is showing signs of actual compromise. The other three clients have findings that are expected after their procedures and need routine monitoring only.
Why the others are wrong
- A – Drowsiness that responds to voice, cramping and passing gas are expected after colonoscopy with sedation.
- B – An absent gag is expected for a short time; the need is to keep the client from drinking, a quick instruction rather than an emergency.
- D – Warmth and brisk capillary refill show the hand is well perfused under the compression band.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
20Question
A nurse reviews morning laboratory results for four clients. Which result should the nurse report to the provider first?
- Potassium 3.3 mEq/L in a client taking furosemide who is in normal sinus rhythm without ectopy
- Platelet count 96,000/mm3 in a client on day 6 of a heparin infusion whose count was 220,000/mm3 on admission
- Glucose 262 mg/dL in a client taking prednisone who has correction insulin prescribed
- White blood cell count 12,500/mm3 in an afebrile client 1 day after abdominal surgery
Show the answer and explanation
Answer: B. Platelet count 96,000/mm3 in a client on day 6 of a heparin infusion whose count was 220,000/mm3 on admission
Topic: which result to report first
A fall in platelets of more than half, 5 to 10 days after heparin was started, suggests heparin-induced thrombocytopenia. The condition causes clotting rather than bleeding and continues as long as heparin runs, so the provider must be told at once in order to stop heparin and choose another anticoagulant. The other results are mild, expected, or already covered by a prescription.
Why the others are wrong
- A – A potassium of 3.3 is mildly low and the rhythm is normal; it needs reporting and replacement, but not first.
- C – Hyperglycemia with steroids is expected, and the nurse already has a prescription to treat it.
- D – A modest rise in white cells the day after surgery, without fever, is a normal stress response.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
21Question
A client is admitted with diabetic ketoacidosis. Glucose is 520 mg/dL, potassium is 3.0 mEq/L, blood pressure is 92/58 mm Hg and heart rate is 124/min. The provider enters four prescriptions together. Which prescription should the nurse carry out first?
- Infuse 1 L of 0.9% sodium chloride as a bolus
- Begin the regular insulin infusion
- Insert an indwelling urinary catheter for hourly output
- Draw a repeat basic metabolic panel in 2 hours
Show the answer and explanation
Answer: A. Infuse 1 L of 0.9% sodium chloride as a bolus
Topic: which prescription first
The client is volume-depleted and hypotensive, so restoring circulating volume with isotonic fluid is the first step in diabetic ketoacidosis. Insulin drives potassium into cells; with a potassium below 3.5 mEq/L (2024 consensus threshold), insulin is held until potassium has been replaced, so the nurse would start the fluid and clarify potassium replacement with the provider before beginning insulin.
Why the others are wrong
- B – Insulin is essential but not first; given with a potassium of 3.0 mEq/L it can cause life-threatening hypokalemia.
- C – Measuring output helps guide therapy but does nothing to correct the low blood pressure.
- D – This is a timed task for later and does not treat the client now.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
22Question
A day-shift nurse receives the following report at 0700. Which client should the nurse see first?
- A client who has had nothing by mouth since midnight for surgery at 1100 and whose consent form is signed
- A client receiving morphine by patient-controlled analgesia who has respirations of 14/min and rates pain 3 out of 10
- A client admitted yesterday with gastrointestinal bleeding whose last two hemoglobin values were both 9.1 g/dL after transfusion
- A client with a tracheostomy placed 2 days ago who 'has needed suctioning every 30 minutes since 0500' and whose last oxygen saturation was 91%
Show the answer and explanation
Answer: D. A client with a tracheostomy placed 2 days ago who 'has needed suctioning every 30 minutes since 0500' and whose last oxygen saturation was 91%
Topic: priority after handoff report
A new tracheostomy that needs more and more frequent suctioning with a falling saturation signals an airway that may be obstructing with secretions or a displaced tube. Airway problems come before all others. The other three clients are described as stable and need routine care.
Why the others are wrong
- A – Preparation is complete and surgery is four hours away; nothing is unstable.
- B – A respiratory rate of 14 and pain of 3 show the analgesia is working safely.
- C – Two equal hemoglobin values after transfusion show the bleeding is not continuing at present.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
23Question
At 1000 a nurse has four things waiting: an intravenous antibiotic due at 1000; discharge teaching for a client whose ride arrives at 1100; an admission assessment for a stable client who has just arrived from the clinic; and a report from the unlicensed assistive personnel that a client 1 day after bowel resection has had 80 mL of urine in the past 4 hours. What should the nurse do first?
- Hang the antibiotic, because it is the only time-critical task
- Assess the client who had the bowel resection
- Begin the discharge teaching so that the client is not rushed
- Start the admission assessment while the new client is settling in
Show the answer and explanation
Answer: B. Assess the client who had the bowel resection
Topic: time management with a change in condition
Eighty mL in 4 hours is 20 mL per hour, below the minimum of about 30 mL per hour expected in an adult. After major abdominal surgery this may mean hypovolemia from bleeding or fluid shifting out of the circulation, or a blocked catheter. It is a change in condition that needs the nurse's assessment before any scheduled task.
Why the others are wrong
- A – The antibiotic matters but can safely be given a few minutes later, within the usual window for a scheduled dose.
- C – There is still an hour, and teaching is not as urgent as a possible drop in circulating volume.
- D – The new client is described as stable; an admission assessment can wait a short time.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
24Question
A nurse in an oncology clinic has four telephone messages to return. Which client does the nurse call first?
- A client receiving chemotherapy whose hair began coming out in clumps this morning
- A client with breast cancer that has spread to bone who has new mid-back pain that is worse when lying down and whose legs have felt heavy on the stairs since yesterday
- A client in the third week of radiation therapy who feels too tired to do housework
- A client taking an opioid who has not had a bowel movement for 2 days and is passing gas
Show the answer and explanation
Answer: B. A client with breast cancer that has spread to bone who has new mid-back pain that is worse when lying down and whose legs have felt heavy on the stairs since yesterday
Topic: spinal cord compression recognition
New back pain that worsens when lying down, together with leg weakness, in a client with bone metastases signals spinal cord compression. It is an oncologic emergency: without imaging and treatment within hours the weakness can become permanent paralysis with loss of bladder and bowel control.
Why the others are wrong
- A – Hair loss is an expected, distressing but not dangerous effect of chemotherapy.
- C – Fatigue is the most common expected effect of radiation therapy and is managed with pacing and rest.
- D – Opioid constipation needs a bowel regimen, but passing gas makes obstruction unlikely and it can wait for the emergency call.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
25Question
A nurse in an eye clinic has four telephone messages. Which client does the nurse call back first?
- A client who had cataract surgery yesterday and reports a mild scratchy, itchy feeling in the eye
- A client with dry macular degeneration who needs a brighter lamp than before to read
- A client who had cataract surgery a week ago and reports a sudden shower of floaters, flashes of light and a shadow like a curtain over part of the vision in that eye
- A client with conjunctivitis who wakes with crusting on the eyelids
Show the answer and explanation
Answer: C. A client who had cataract surgery a week ago and reports a sudden shower of floaters, flashes of light and a shadow like a curtain over part of the vision in that eye
Topic: retinal detachment warning signs after cataract surgery
A sudden increase in floaters, flashes of light and a curtain or shadow across the visual field are the warning signs of retinal detachment, which is painless and is a recognized complication after cataract surgery. The client needs to be seen urgently, because sight is lost permanently if the detachment reaches the macula before it is repaired.
Why the others are wrong
- A – Mild itching and a scratchy feeling are expected soon after cataract surgery; severe pain or loss of vision would be urgent.
- B – A slowly increasing need for light is the expected course of dry macular degeneration and is not an emergency.
- D – Crusting on waking is an expected finding in conjunctivitis and needs teaching on hygiene, not an urgent call.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
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Nursing