1Question
A 2-day-old newborn whose mother took a prescribed opioid throughout pregnancy has a high-pitched cry, tremors, frequent sneezing and poor feeding. Which interventions should the nurse include in the plan of care?
Select all that apply.
- Swaddle the newborn snugly with the arms flexed
- Keep the room quiet and the lights dim
- Give naloxone to reverse the effect of the opioid
- Offer small, frequent feedings
- Encourage the mother to room in and hold the newborn skin-to-skin
- Stimulate the newborn with frequent handling to keep the newborn alert
Show the answers and explanation
Answers: A, B, D and E.
- A – Swaddle the newborn snugly with the arms flexed
- B – Keep the room quiet and the lights dim
- D – Offer small, frequent feedings
- E – Encourage the mother to room in and hold the newborn skin-to-skin
Topic: neonatal opioid withdrawal
Neonatal opioid withdrawal is managed first with non-drug care: low stimulation, swaddling, small frequent feedings and keeping mother and newborn together, with scoring to decide whether medication is needed. Naloxone is not given to an opioid-exposed newborn because it can cause sudden severe withdrawal and seizures.
Why the others are wrong
- C – Naloxone can precipitate abrupt, severe withdrawal and seizures in an opioid-exposed newborn.
- F – Extra handling and stimulation worsen irritability, tremors and energy use; care is clustered and gentle.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
2Question
A client with pneumonia and no chronic lung disease is alert and breathing spontaneously at 32 breaths/min. Oxygen saturation is 84% on 6 L/min by nasal cannula. While the provider is being called, which oxygen delivery device should the nurse apply?
- A simple face mask at 3 L/min.
- A Venturi mask set to deliver 28% oxygen.
- A nonrebreather mask at 15 L/min with the reservoir bag kept inflated.
- The same nasal cannula with the flow raised to 10 L/min.
Show the answer and explanation
Answer: C. A nonrebreather mask at 15 L/min with the reservoir bag kept inflated.
Topic: choosing an oxygen delivery device
A nonrebreather mask delivers the highest oxygen concentration available to a spontaneously breathing client without advanced equipment, provided the flow is high enough to keep the reservoir bag inflated. Severe hypoxemia on the maximum nasal cannula flow calls for stepping up to it.
Why the others are wrong
- A – A simple mask needs at least 5 L/min to flush exhaled carbon dioxide; at 3 L/min the client rebreathes it and gets too little oxygen.
- B – A Venturi mask is chosen for precise, controlled low concentrations; 28% is less than the client is already receiving.
- D – A standard nasal cannula is used up to 6 L/min; higher flow dries the mucosa and adds little oxygen.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
3Question
A 20-year-old college student is admitted from the emergency department with fever, severe headache, a stiff neck and sensitivity to light. Bacterial meningitis is suspected and an IV antibiotic has been prescribed. Which actions does the nurse include in the client's care?
Select all that apply.
- Place the client on droplet precautions.
- Draw the prescribed blood cultures and then start the antibiotic without delay.
- Keep the room dim and quiet.
- Wait for the cerebrospinal fluid culture result before giving the first antibiotic dose.
- Institute seizure precautions.
- Teach the client to flex the neck toward the chest several times an hour to ease stiffness.
Show the answers and explanation
Answers: A, B, C and E.
- A – Place the client on droplet precautions.
- B – Draw the prescribed blood cultures and then start the antibiotic without delay.
- C – Keep the room dim and quiet.
- E – Institute seizure precautions.
Topic: bacterial meningitis initial care
Suspected bacterial meningitis is treated as an emergency: cultures are taken and the antibiotic is started at once, because delay raises mortality. Droplet precautions are used until the organism is known and effective therapy has been given for 24 hours. Low stimulation eases the headache and photophobia, and seizure precautions are needed because meningeal irritation and raised intracranial pressure can provoke seizures.
Why the others are wrong
- D – Culture results take days; the antibiotic is started as soon as cultures are drawn because every hour of delay worsens the outcome.
- F – Neck flexion stretches the inflamed meninges and increases pain; the client is kept in a position of comfort.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
4Question
A client with Graves disease is admitted with weight loss, tremor, heat intolerance and bulging eyes that do not close fully. Which interventions does the nurse include in the plan of care?
Select all that apply.
- Provide high-calorie, high-protein meals with between-meal snacks.
- Keep the room cool and quiet.
- Offer coffee or tea with meals to relieve fatigue.
- Apply lubricating eye drops and raise the head of the bed.
- Supply extra blankets and keep the room warm.
- Restrict fluids to reduce sweating.
Show the answers and explanation
Answers: A, B and D.
- A – Provide high-calorie, high-protein meals with between-meal snacks.
- B – Keep the room cool and quiet.
- D – Apply lubricating eye drops and raise the head of the bed.
Topic: hyperthyroidism nursing care
Excess thyroid hormone raises the metabolic rate: calories are burned quickly, heat is poorly tolerated and the nervous system is overstimulated. Care supplies extra calories and protein, a cool and calm environment, and protection for corneas that are exposed because the lids cannot close, with lubrication and head elevation to reduce swelling around the eyes.
Why the others are wrong
- C – Caffeine is a stimulant and worsens tachycardia, tremor and restlessness.
- E – The client already produces excess heat; warmth adds to the discomfort and sweating.
- F – Sweating and a high metabolic rate increase fluid needs; restriction risks dehydration.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
5Question
A 32-year-old client is admitted with acute glomerulonephritis two weeks after a streptococcal throat infection. The client has cola-colored urine, puffy eyelids, a reduced urine output and a blood pressure of 168/100 mm Hg. Which actions does the nurse include in the plan of care?
Select all that apply.
- Weigh the client each day at the same time on the same scale.
- Maintain the prescribed sodium and fluid limits and monitor the blood pressure.
- Encourage at least 3 liters of fluid a day to flush the kidneys.
- Offer high-potassium foods such as bananas and oranges at each meal.
- Supply a salt substitute so that the client can season food.
Show the answers and explanation
Answers: A and B.
- A – Weigh the client each day at the same time on the same scale.
- B – Maintain the prescribed sodium and fluid limits and monitor the blood pressure.
Topic: acute glomerulonephritis care
Inflamed glomeruli filter poorly, so sodium and water are retained; this produces edema, low urine output and hypertension. Care centers on tracking fluid status with daily weights and intake and output, limiting sodium and fluid as prescribed, and watching the blood pressure. Potassium can build up when output is low, so it is not added.
Why the others are wrong
- C – The kidneys cannot excrete the extra fluid; forcing fluids worsens the edema and hypertension.
- D – With reduced urine output potassium is retained, so high-potassium foods risk hyperkalemia.
- E – Most salt substitutes contain potassium chloride and are avoided when kidney function is reduced.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
6Question
A nurse has finished teaching a client newly diagnosed with pernicious anemia. Which statement by the client shows that the teaching was understood?
- 'Eating more red meat and leafy greens will correct this over time.'
- 'Taking my iron tablet with orange juice will help me absorb it.'
- 'Once my blood count is normal I can stop the treatment.'
- 'I will need vitamin B12 replacement for the rest of my life.'
Show the answer and explanation
Answer: D. 'I will need vitamin B12 replacement for the rest of my life.'
Topic: pernicious versus iron-deficiency anemia
In pernicious anemia the stomach no longer produces intrinsic factor, so vitamin B12 from food cannot be absorbed however much is eaten. The deficiency is permanent, so replacement continues for life; stopping it lets the anemia and nerve damage return.
Why the others are wrong
- A – Dietary B12 cannot be absorbed without intrinsic factor, so diet alone does not correct pernicious anemia.
- B – This is correct advice for iron-deficiency anemia, not for a vitamin B12 deficiency.
- C – The lack of intrinsic factor is permanent; stopping replacement lets the anemia and neurologic damage recur.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
7Question
A client is on a burn unit 6 days after partial-thickness burns to both arms and the chest. The nurse is preparing for the daily wound cleansing and dressing change. Which action by the nurse is appropriate?
- Give the prescribed analgesic early enough that it is working when the old dressings are removed
- Leave the previous layer of antimicrobial cream in place and spread the new layer over it
- Keep the room cool during the procedure to lower the client's metabolic rate
- Use the same pair of gloves to remove the soiled dressings and to apply the new cream
Show the answer and explanation
Answer: A. Give the prescribed analgesic early enough that it is working when the old dressings are removed
Topic: burn wound care in the acute phase
Burn wound care is one of the most painful procedures a client experiences, so the analgesic is timed to be at its peak when the procedure starts. Old cream and exudate are removed before the new application, the room is kept warm to prevent heat loss through the wounds, and gloves are changed between removing soiled dressings and applying new cream using sterile technique.
Why the others are wrong
- B – Old cream and exudate must be washed off first; layering new cream over it holds bacteria and debris against the wound.
- C – Burned skin cannot conserve heat; the room is kept warm and exposure brief to prevent hypothermia and extra metabolic demand.
- D – Gloves used on soiled dressings are contaminated; they are changed, and sterile gloves are used to apply the new cream and dressings.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
8Question
A 3-month-old infant is admitted with bronchiolitis caused by respiratory syncytial virus. The infant has nasal congestion, mild retractions and is feeding poorly. Which interventions should the nurse include in the plan of care?
Select all that apply.
- Suction the nares before feedings and as needed.
- Place the infant on contact precautions.
- Request a prescription for a routine course of antibiotics.
- Monitor intake and the number of wet diapers.
- Perform chest physiotherapy every 4 hours.
- Give supplemental oxygen as prescribed if oxygen saturation stays low.
Show the answers and explanation
Answers: A, B, D and F.
- A – Suction the nares before feedings and as needed.
- B – Place the infant on contact precautions.
- D – Monitor intake and the number of wet diapers.
- F – Give supplemental oxygen as prescribed if oxygen saturation stays low.
Topic: bronchiolitis and RSV
Care for bronchiolitis is supportive: keeping the nose clear so the infant can breathe and feed, maintaining hydration, and giving oxygen for persistent hypoxemia. The virus spreads by contact with secretions and contaminated surfaces, so contact precautions are used in addition to standard precautions.
Why the others are wrong
- C – Bronchiolitis is viral; antibiotics are used only for a proven or strongly suspected bacterial infection.
- E – Chest physiotherapy has not been shown to help in bronchiolitis and is not recommended by the AAP.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
9Question
A nurse is teaching the parents of a 5-year-old child with cystic fibrosis about home care. Which instructions should the nurse include?
Select all that apply.
- Give the pancreatic enzymes with every meal and every snack.
- Offer a low-fat, low-calorie diet to reduce fatty stools.
- Do airway clearance before meals rather than right after eating.
- Give extra salt and fluids in hot weather and during vigorous exercise.
- Give a cough suppressant at bedtime so the child can sleep.
Show the answers and explanation
Answers: A, C and D.
- A – Give the pancreatic enzymes with every meal and every snack.
- C – Do airway clearance before meals rather than right after eating.
- D – Give extra salt and fluids in hot weather and during vigorous exercise.
Topic: cystic fibrosis home care
In cystic fibrosis thick secretions block the pancreatic ducts and the airways, and sweat carries excess sodium and chloride. Enzymes are needed whenever food is eaten, airway clearance is scheduled away from a full stomach to prevent vomiting, and salt is replaced when sweating is heavy.
Why the others are wrong
- B – Children with cystic fibrosis need a high-calorie, high-protein diet with fat; enzymes, not fat restriction, control the fatty stools.
- E – The cough moves thick mucus out of the airways; suppressing it leads to retained secretions and infection.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
10Question
A 12-year-old child with sickle cell disease is admitted in vaso-occlusive crisis and is receiving IV fluids and opioid analgesia. Which finding should the nurse act on first?
- Leg pain rated 7 out of 10 one hour after an analgesic dose.
- A hemoglobin level unchanged from the child's usual low baseline.
- A yellow tinge to the sclerae.
- New chest pain with cough and an oxygen saturation that has dropped to 90%.
Show the answer and explanation
Answer: D. New chest pain with cough and an oxygen saturation that has dropped to 90%.
Topic: sickle cell crisis priorities
New chest pain, cough and falling oxygen saturation in a child with sickle cell disease indicate acute chest syndrome, a leading cause of death in this disease. It needs immediate oxygen, notification of the provider and rapid treatment, so it takes priority over pain that is being treated.
Why the others are wrong
- A – Uncontrolled pain needs prompt reassessment of the analgesic plan, but it is not an immediate threat to oxygenation.
- B – A chronically low hemoglobin at the child's own baseline is expected in sickle cell anemia.
- C – Scleral jaundice results from ongoing red cell breakdown and is a usual finding.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
11Question
A 10-year-old child with type 1 diabetes comes to the school nurse before lunch feeling shaky and sweaty. The child is alert, and the blood glucose is 58 mg/dL. Which action should the nurse take first?
- Give 4 ounces (120 mL) of fruit juice and recheck the glucose in 15 minutes.
- Give glucagon by injection.
- Give the child's prescribed lunchtime rapid-acting insulin and send the child to eat.
- Give peanut butter on crackers and have the child rest.
Show the answer and explanation
Answer: A. Give 4 ounces (120 mL) of fruit juice and recheck the glucose in 15 minutes.
Topic: type 1 diabetes hypoglycemia
An alert child with hypoglycemia who can swallow is treated with about 15 grams of fast-acting carbohydrate, and the glucose is rechecked in 15 minutes. Once the glucose has recovered, a snack or meal with protein and complex carbohydrate keeps it from falling again.
Why the others are wrong
- B – Glucagon is for a child who is unconscious, seizing or unable to swallow safely.
- C – Insulin given now would lower the glucose further.
- D – Fat and protein slow absorption; this kind of snack follows the fast-acting sugar, it does not replace it.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
12Question
A school nurse is preparing classroom staff for a 9-year-old child with type 1 diabetes who uses insulin. Which points should be part of the school plan?
Select all that apply.
- A fast-acting carbohydrate is kept within reach in the classroom, in the gymnasium and on the bus
- A child who seems shaky or pale is sent to the nurse's office alone so that the lesson is not interrupted
- The child may check blood glucose and treat a low value wherever the child happens to be
- An extra snack may be needed before or during prolonged physical activity, as the child's plan directs
- The child is excused from physical education and field trips
- Staff learn the signs of low blood glucose, and designated staff are trained to give emergency glucagon
Show the answers and explanation
Answers: A, C, D and F.
- A – A fast-acting carbohydrate is kept within reach in the classroom, in the gymnasium and on the bus
- C – The child may check blood glucose and treat a low value wherever the child happens to be
- D – An extra snack may be needed before or during prolonged physical activity, as the child's plan directs
- F – Staff learn the signs of low blood glucose, and designated staff are trained to give emergency glucagon
Topic: type 1 diabetes at school
A child with type 1 diabetes takes full part in school life. Safety depends on immediate access to glucose and monitoring, extra carbohydrate around exercise, and adults who recognize hypoglycemia and can give glucagon. A child whose glucose may be low is never left or sent anywhere alone.
Why the others are wrong
- B – A child with a falling glucose can become confused or collapse on the way; the child is treated where they are and is accompanied.
- E – Activity is encouraged in type 1 diabetes; exclusion is unnecessary and discriminatory. Glucose and food are adjusted instead.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
13Question
An 11-year-old child with asthma comes to the school nurse with a cough and a mild wheeze and is speaking in full sentences. The peak flow reading is 70% of the child's personal best. The child's written asthma action plan is on file. What should the nurse do first?
- Call emergency services
- Give the child's quick-relief inhaler with a spacer as the plan directs, then recheck the symptoms and peak flow
- Have the child take a dose of the daily inhaled corticosteroid controller
- Send the child back to class to rest and recheck the peak flow after lunch
Show the answer and explanation
Answer: B. Give the child's quick-relief inhaler with a spacer as the plan directs, then recheck the symptoms and peak flow
Topic: asthma action plan zones
A peak flow of 50% to 80% of personal best with cough or wheeze is the yellow (caution) zone of an asthma action plan. The response is the quick-relief bronchodilator and reassessment; a good response returns the child to the green zone, and a poor one moves the child to the red-zone steps.
Why the others are wrong
- A – Emergency services are needed in the red zone - peak flow under half of personal best, difficulty speaking or no response to the reliever - which is not the picture here.
- C – An inhaled corticosteroid controller prevents inflammation over days and does not relieve bronchospasm now.
- D – Leaving yellow-zone symptoms untreated allows the airway narrowing to progress to a severe episode.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
14Question
A client with chronic obstructive pulmonary disease is admitted with an exacerbation. The client is leaning forward on the overbed table, and oxygen saturation is 84% on room air. Which action does the nurse take?
- Withhold oxygen, because oxygen will stop the client's drive to breathe
- Apply a nonrebreather mask at high flow to bring the saturation to 100%
- Give low-flow oxygen and adjust it to keep the saturation at 88% to 92%
- Lay the client flat to make breathing easier
Show the answer and explanation
Answer: C. Give low-flow oxygen and adjust it to keep the saturation at 88% to 92%
Topic: COPD oxygen and positioning
Hypoxemia is always treated. In a client with chronic obstructive pulmonary disease who may retain carbon dioxide, oxygen is given in a controlled way and titrated to a saturation of 88% to 92%, which corrects the dangerous hypoxemia without the rise in carbon dioxide that too much oxygen can cause.
Why the others are wrong
- A – Leaving a saturation of 84% untreated risks dysrhythmia and organ damage; oxygen is controlled, never refused.
- B – High-concentration oxygen aimed at 100% can raise carbon dioxide and cause drowsiness and respiratory acidosis in this client.
- D – Lying flat lets the abdomen press on the diaphragm and increases the work of breathing; upright and leaning forward is best.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
15Question
A client with cirrhosis and hepatic encephalopathy has been taking lactulose for 3 days. Which finding shows that the medication is having its intended effect?
- Abdominal girth is 2 cm smaller
- The client passes one formed stool every other day
- The skin is less itchy and less yellow
- The client is oriented, the hand flapping has stopped and there are two to three soft stools a day
Show the answer and explanation
Answer: D. The client is oriented, the hand flapping has stopped and there are two to three soft stools a day
Topic: hepatic encephalopathy
Lactulose makes the bowel contents acidic, which traps ammonia in the stool, and its laxative action carries the ammonia out. It is working when the brain is clearing: orientation returns and asterixis stops. The dose is adjusted to give two to three soft stools a day.
Why the others are wrong
- A – Girth reflects ascites, which is treated with diuretics, sodium restriction or paracentesis.
- B – One formed stool every 2 days is too little to remove ammonia; the dose needs review.
- C – Itching and jaundice come from bile salts and bilirubin and are not changed by lactulose.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
16Question
A client with Addison's disease stopped taking prednisone 4 days ago because of vomiting. The client is now weak and confused, with blood pressure 76/42 mm Hg, sodium 126 mEq/L, potassium 5.9 mEq/L and glucose 62 mg/dL. Which prescription does the nurse expect to carry out first?
- IV potassium chloride added to the maintenance fluid
- IV furosemide
- IV hydrocortisone with a rapid infusion of 0.9% sodium chloride with dextrose
- Oral fludrocortisone with fluid restriction
Show the answer and explanation
Answer: C. IV hydrocortisone with a rapid infusion of 0.9% sodium chloride with dextrose
Topic: Addisonian crisis
This is an adrenal (Addisonian) crisis: with no cortisol and aldosterone the client loses sodium and water, keeps potassium and cannot maintain blood glucose or blood pressure. Treatment is immediate IV glucocorticoid replacement with rapid saline to restore volume and dextrose to correct the glucose; the potassium falls as the hormone and fluid are replaced.
Why the others are wrong
- A – The potassium is already high; adding more risks a fatal dysrhythmia.
- B – A diuretic removes more sodium and water from a client who is in shock from volume loss.
- D – An oral drug cannot be relied on in a vomiting client in shock, and restricting fluid worsens the hypovolemia.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
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