A nurse is assessing pain in an older adult with advanced dementia who cannot reliably report it. Which observations suggest pain?
Select all that apply.
Grimacing when turned
Guarding the right hip during repositioning
Moaning and restlessness while at rest
Sleeping quietly with a relaxed face
Smiling and following staff with the eyes during care
Show the answers and explanation
Answers: A, B and C.
A – Grimacing when turned
B – Guarding the right hip during repositioning
C – Moaning and restlessness while at rest
Topic: nonverbal pain cues
When clients cannot self-report, behaviors such as facial grimacing, guarding, moaning, and restlessness serve as pain indicators. A relaxed face and calm engagement point away from pain.
Why the others are wrong
D – A relaxed face during quiet sleep argues against pain.
E – Smiling and engaged eye contact do not indicate pain.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
52Question
A nurse palpates the chest wall while the client repeats a phrase and finds markedly reduced vibration over the right base. Which conditions could explain the finding?
Select all that apply.
Pleural effusion
Pneumothorax
Lobar pneumonia with consolidation
A large emphysematous bulla at the right base
A bronchus blocked by a tumor, with the lung beyond it collapsed
Show the answers and explanation
Answers: A, B, D and E.
A – Pleural effusion
B – Pneumothorax
D – A large emphysematous bulla at the right base
E – A bronchus blocked by a tumor, with the lung beyond it collapsed
Topic: tactile fremitus findings
Fluid or air in the pleural space, air trapped in a large bulla, and a blocked bronchus all damp the transmission of voice vibration and decrease fremitus over the area. Consolidated lung with an open airway conducts vibration better and increases fremitus.
Why the others are wrong
C – Consolidated lung with an open airway conducts vibration better and increases fremitus.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
53Question
A client who had abdominal surgery has not voided for nine hours and reports lower abdominal fullness. On percussion the nurse finds dullness above the pubic bone. What is the most appropriate next action?
Give a laxative for suspected constipation.
Perform a bladder scan according to protocol.
Restrict oral fluids until the client voids.
Document the finding as an expected postoperative sound.
Show the answer and explanation
Answer: B. Perform a bladder scan according to protocol.
Topic: suprapubic dullness
A distended bladder produces a dull note above the pubic bone. Inability to void after surgery with suprapubic fullness suggests urinary retention, which is confirmed with a bladder scan before catheterization.
Why the others are wrong
A – Gas-filled bowel is tympanic, not dull, and a laxative does not address retention.
C – Restriction does not relieve the problem and risks dehydration.
D – Dullness above the pubic bone is not expected and suggests a distended bladder.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
54Question
A nurse measures blood pressure after the client lies flat for several minutes and again after standing for three minutes. Which results meet the criteria for orthostatic hypotension?
Supine 142/88, standing 134/84 mm Hg
Supine 138/80, standing 110/74 mm Hg
Supine 126/78, standing 120/80 mm Hg
Supine 130/76, standing 140/84 mm Hg
Show the answer and explanation
Answer: B. Supine 138/80, standing 110/74 mm Hg
Topic: orthostatic hypotension criteria
Orthostatic hypotension is a fall of at least 20 mm Hg in systolic or 10 mm Hg in diastolic pressure within three minutes of standing. Only the second set of readings shows a drop of 28 mm Hg systolic.
Why the others are wrong
A – The systolic drop is only 8 mm Hg and the diastolic drop is 4 mm Hg, below the thresholds.
C – The systolic drop is 6 mm Hg and the diastolic reading rose, so criteria are not met.
D – The pressures rose on standing.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
55Question
A client who stopped drinking a year ago comes to a clinic for a sprained ankle and says, 'I started drinking again last month.' Which response is best?
You were doing so well, and I am disappointed to hear that.
Thank you for telling me. What has been making things harder?
Drinking again will wreck your liver, so you have to stop now.
How could you throw away a year of sobriety?
Show the answer and explanation
Answer: B. Thank you for telling me. What has been making things harder?
Topic: responding to disclosure of relapse
Disclosure of relapse is a moment of trust, and a non-judgmental response that thanks the client and invites the story keeps the conversation open and supports readiness to change.
Why the others are wrong
A – Disappointment shames the client and discourages honesty.
C – A lecture or command ignores the client's experience.
D – A blaming question closes communication.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
56Question
A client at 24 weeks of gestation asks about changes in her skin. Which finding needs prompt evaluation by the provider?
A dark vertical line from the navel to the pubic area
Patches of darker pigment over the cheeks and forehead
Pink-red streaks across the abdomen and breasts
A dark mole that has recently enlarged and has an irregular border
Show the answer and explanation
Answer: D. A dark mole that has recently enlarged and has an irregular border
Topic: pregnancy skin changes
Linea nigra, melasma, and striae are expected in pregnancy. A mole that grows or has an irregular border is a warning sign of melanoma, which is not caused by pregnancy and needs evaluation.
Why the others are wrong
A – This is linea nigra, a normal pigment change of pregnancy.
B – This is melasma, a normal hormonal change.
C – These are striae gravidarum, which are common as the skin stretches.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
57Question
A client with long-standing diabetes describes burning, tingling feet with sudden electric-shock sensations at night. Which type of pain is this?
Neuropathic pain
Nociceptive pain
Referred pain
Acute inflammatory pain
Show the answer and explanation
Answer: A. Neuropathic pain
Topic: neuropathic pain
Burning, tingling, and electric-shock pain results from damage to or dysfunction of nerves, as in diabetic neuropathy, and is classified as neuropathic pain. It often responds better to certain anticonvulsants and antidepressants than to opioids.
Why the others are wrong
B – Nociceptive pain arises from tissue injury and is described as aching or throbbing.
C – Referred pain is felt in a site distant from its origin organ, such as shoulder pain from the diaphragm.
D – Acute inflammatory pain would come with swelling, warmth, and redness.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
58Question
A client reports new numbness in the right hand. Which additional questions belong in the neurologic health history?
Select all that apply.
Have you noticed weakness in your arms or legs?
Have you had episodes of fainting or blackouts?
Have you had changes in your balance or coordination?
When did you have your last mammogram?
How often do you visit the dentist?
Show the answers and explanation
Answers: A, B and C.
A – Have you noticed weakness in your arms or legs?
B – Have you had episodes of fainting or blackouts?
C – Have you had changes in your balance or coordination?
Topic: neurologic health history
A neurologic history explores weakness, loss of consciousness, balance, coordination, speech, vision, swallowing, and sensation. Screening and dental questions belong elsewhere in a general history.
Why the others are wrong
D – Breast screening history is unrelated to a neurologic complaint.
E – Dental visits are unrelated to a neurologic complaint.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
59Question
A client has an oxygen saturation of 86% by finger probe but is comfortable, with pink lips and a steady waveform on the monitor. The client is wearing dark blue nail polish. What should the nurse do next?
Start oxygen at 4 L/min by nasal cannula and notify the provider immediately.
Document the value and report acute hypoxemia to the rapid response team.
Remove the polish from one finger or turn the probe sideways, then recheck.
Wait for the polish to wear off before taking further readings.
Show the answer and explanation
Answer: C. Remove the polish from one finger or turn the probe sideways, then recheck.
Topic: pulse oximetry accuracy
Dark nail polish absorbs the light used by the sensor and can falsely lower the reading. Removing the polish or repositioning the probe to read through the side of the finger corrects the artifact.
Why the others are wrong
A – A reading that does not match the clinical picture should be verified before treating.
B – A discordant reading should be checked for technical errors first.
D – This may take days, and the monitoring need is now.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
60Question
A client with tinnitus says the ringing is worst at bedtime. Which statement shows that teaching was effective?
I will clean my ears with cotton swabs every day to clear the ringing.
I will sleep in a completely silent room so my ears can rest.
I will run a quiet fan or soft music while I fall asleep.
I will take extra aspirin whenever the ringing is loud.
Show the answer and explanation
Answer: C. I will run a quiet fan or soft music while I fall asleep.
Topic: tinnitus self-care
Low-level background sound masks tinnitus and eases sleep. Cotton swabs injure the canal, silence emphasizes the ringing, and large doses of aspirin are ototoxic.
Why the others are wrong
A – Tinnitus is rarely caused by wax, and swabs can injure the ear canal.
B – Silence makes tinnitus more noticeable.
D – Large doses of aspirin can cause or worsen tinnitus.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
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