1Question
An 83-year-old resident has had two falls this month and new nighttime confusion. The medication list includes acetaminophen as needed, diphenhydramine at bedtime for sleep, lorazepam at bedtime, oxybutynin for urinary urgency, and levothyroxine daily. For which medications should the nurse ask the prescriber to review the need?
Select all that apply.
- Acetaminophen as needed
- Diphenhydramine at bedtime
- Lorazepam at bedtime
- Oxybutynin for urgency
- Levothyroxine daily
Show the answers and explanation
Answers: B, C and D.
- B – Diphenhydramine at bedtime
- C – Lorazepam at bedtime
- D – Oxybutynin for urgency
Topic: Potentially inappropriate medicines in older adults
Strongly anticholinergic drugs (diphenhydramine, oxybutynin) and benzodiazepines are on the AGS Beers list of medicines to avoid or use with great caution in older adults, especially with falls, cognitive impairment or delirium. They cause sedation, confusion, impaired balance, constipation and urinary retention.
Why the others are wrong
- A – Acetaminophen is a preferred analgesic in older adults and does not explain falls or confusion.
- E – Levothyroxine is replacement hormone and is not linked to falls or confusion at an appropriate dose.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
2Question
An 84-year-old resident with heart failure and reduced kidney function has a new order for scheduled ibuprofen for knee pain. The resident also takes lisinopril and furosemide. What is the best nursing action?
- Give the ibuprofen with meals and continue the order
- Encourage extra fluids and then give the ibuprofen
- Contact the prescriber to request a safer option such as scheduled acetaminophen or a topical agent
- Give the ibuprofen but hold the furosemide that day
Show the answer and explanation
Answer: C. Contact the prescriber to request a safer option such as scheduled acetaminophen or a topical agent
NSAIDs can cause kidney injury, fluid retention, raised blood pressure and gastrointestinal bleeding, and the risk is higher with heart failure, reduced kidney function and an ACE inhibitor plus a diuretic. Beers concepts advise avoiding them in this setting. The nurse advocates for a safer analgesic plan.
Why the others are wrong
- A – Food may reduce stomach irritation but does not remove kidney, fluid or bleeding risks.
- B – Extra fluids are unsuitable in heart failure and do not make the NSAID safe.
- D – Holding a diuretic without an order is outside nursing practice and would worsen heart failure.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
3Question
An 86-year-old resident with type 2 diabetes eats unpredictably and is ordered regular insulin by sliding scale before meals and at bedtime, with no other diabetes regimen. Glucose readings swing widely, and one reading last week was very low. What is the best action?
- Continue the order and add a bedtime snack
- Give extra insulin when a reading is high to bring it near normal
- Stop giving insulin until the next provider visit
- Contact the prescriber to review the regimen, aiming to avoid hypoglycemia and wide swings rather than reactive-only coverage
Show the answer and explanation
Answer: D. Contact the prescriber to review the regimen, aiming to avoid hypoglycemia and wide swings rather than reactive-only coverage
Topic: Sliding-scale insulin in long-term care
Sliding-scale insulin used alone in older adults is on the AGS Beers list of practices to avoid because it increases hypoglycemia risk without improving control. Older residents usually need individualized, relaxed glucose targets and a simpler, steadier regimen. The nurse reports the pattern and requests a review.
Why the others are wrong
- A – A snack does not fix the regimen and may worsen later high readings.
- B – Giving extra insulin goes beyond the order and raises hypoglycemia risk.
- C – Stopping a prescribed drug without the prescriber's direction is outside scope.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
4Question
A resident with Alzheimer disease started a cholinesterase inhibitor last week. Which finding should the nurse report first?
- Mild nausea after the morning dose
- Vivid dreams
- Pulse of 46 with dizziness and near-fainting
- Slightly reduced appetite
Show the answer and explanation
Answer: C. Pulse of 46 with dizziness and near-fainting
Topic: Cholinesterase inhibitor effects
Cholinesterase inhibitors increase cholinergic activity. Common effects are nausea, diarrhea, anorexia and vivid dreams, but they can also cause bradycardia and syncope, which are more dangerous and need prompt reporting.
Why the others are wrong
- A – Mild nausea is common and often settles; report but not first.
- B – Vivid dreams are a known, benign effect.
- D – Reduced appetite is common and should be monitored, but is less urgent than bradycardia.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
5Question
A nurse cannot draw blood from a central venous catheter, and flushing meets resistance. Which actions does the nurse take?
Select all that apply.
- Check for closed clamps and kinked tubing
- Ask the client to change position, raise the arm, cough or take a deep breath
- Force the flush with a small-barrel syringe to clear the clot
- Notify the provider about a possible clot if the problem persists, since a thrombolytic may be ordered
- Pull the catheter back several inches to free the tip
- Use a 1 mL syringe to build more pressure
Show the answers and explanation
Answers: A, B and D.
- A – Check for closed clamps and kinked tubing
- B – Ask the client to change position, raise the arm, cough or take a deep breath
- D – Notify the provider about a possible clot if the problem persists, since a thrombolytic may be ordered
Topic: troubleshooting a catheter occlusion
The first steps for a sluggish catheter are to check for external causes such as clamps and kinks, and to reposition the client or have the client cough or breathe deeply, since the tip may be against the vessel wall. If the problem persists, a clot is suspected and the provider is notified about a thrombolytic. Force or small syringes can rupture the catheter, and a catheter is never withdrawn by the nurse.
Why the others are wrong
- C – Forced flushing can dislodge a clot into the circulation or rupture the catheter.
- E – Moving a catheter in or out is outside the nurse's role here and risks infection and malposition.
- F – A small syringe produces high pressure that can rupture the catheter.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
6Question
While the nurse is changing the tubing on a client's central venous catheter, the client suddenly becomes short of breath, anxious and reports chest pain. The catheter is found unclamped and open to air. Which action should the nurse take first?
- Sit the client upright in high Fowler's position and give oxygen
- Clamp the catheter and place the client on the left side with the head lower than the feet
- Obtain a 12-lead electrocardiogram
- Flush the catheter with 0.9% sodium chloride to check that it is patent
Show the answer and explanation
Answer: B. Clamp the catheter and place the client on the left side with the head lower than the feet
Topic: air embolism
Sudden dyspnea and chest pain with a central line open to air indicate air embolism. Clamping stops more air entering, and the left side-lying, head-down position holds the air in the right side of the heart, away from the outflow to the lungs. Oxygen is then given and the provider called.
Why the others are wrong
- A – Upright positioning allows the air to move into the pulmonary outflow; oxygen is given after clamping and positioning.
- C – A diagnostic test delays the action that limits harm.
- D – Flushing can push the air in the catheter into the circulation.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
7Question
The nurse is caring for a client with a central venous catheter. Which actions help prevent a central line-associated bloodstream infection?
Select all that apply.
- Perform hand hygiene before touching the catheter or the dressing
- Scrub the needleless connector with an antiseptic pad and let it dry before each access
- Replace the central catheter on a fixed schedule even when it works well and shows no sign of infection
- Change the dressing with sterile technique and chlorhexidine skin antisepsis, and whenever it is damp, loose or soiled
- Review with the team each day whether the catheter is still needed
- Leave a damp but intact dressing in place until its next scheduled change
Show the answers and explanation
Answers: A, B, D and E.
- A – Perform hand hygiene before touching the catheter or the dressing
- B – Scrub the needleless connector with an antiseptic pad and let it dry before each access
- D – Change the dressing with sterile technique and chlorhexidine skin antisepsis, and whenever it is damp, loose or soiled
- E – Review with the team each day whether the catheter is still needed
Topic: CLABSI prevention
Bloodstream infection from a central line is prevented by keeping organisms away from the hub and the insertion site and by removing the line as soon as it is no longer needed. Hand hygiene, disinfecting the connector before every access, sterile dressing changes with chlorhexidine, and a daily review of need are the core measures. Routine replacement of a working central line does not lower infection and adds insertion risk.
Why the others are wrong
- C – Central catheters are not replaced routinely to prevent infection; they are removed when no longer needed or when a complication occurs.
- F – A damp dressing no longer protects the site and is changed promptly.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
8Question
The charge nurse observes a newly licensed nurse caring for a client with a peripherally inserted central catheter (PICC) in the right arm. Which action requires the charge nurse to intervene?
- Measuring the blood pressure on the left arm
- Scrubbing the needleless connector and letting it dry before attaching a syringe
- Preparing to flush the catheter with a 3-mL syringe
- Comparing the length of catheter outside the skin with the length recorded at insertion
Show the answer and explanation
Answer: C. Preparing to flush the catheter with a 3-mL syringe
Topic: PICC care
A small syringe produces a much higher pressure than a large one and can rupture a PICC. A syringe with a barrel of 10 mL or larger is used to flush and to check patency. The other actions are correct care: the PICC arm is not used for blood pressure, the connector is disinfected, and the external length is checked for migration.
Why the others are wrong
- A – Using the opposite arm for blood pressure is correct.
- B – Disinfecting the connector before access is correct.
- D – A change in external length suggests the catheter has moved and is correctly checked.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
9Question
A client arrives at an urgent care center and sits quietly with crossed arms. The nurse begins the interview. Which opening question is most likely to bring out the client's own account of the problem?
- What has brought you in to see us today?
- Are you here because of your stomach pain?
- Why did you wait so long to come in?
- Is the pain mild, moderate or severe?
Show the answer and explanation
Answer: A. What has brought you in to see us today?
Topic: open-ended opening question
Open-ended questions invite clients to describe their concern in their own words and to set the direction of the interview. Leading, closed and 'why' questions limit information or can feel accusing.
Why the others are wrong
- B – This leading closed question puts words in the client's mouth.
- C – 'Why' questions can sound judgmental and put the client on the defensive.
- D – This closed question limits the answer and assumes pain is the problem.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
10Question
A client's INR has varied widely, and the nurse suspects the client is not taking warfarin as prescribed. Which statement should the nurse use?
- You do take your warfarin exactly as prescribed, don't you?
- Why haven't you been following the dosing instructions we gave you?
- Do you ever forget a dose?
- Walk me through how you take your medicines on a typical day.
Show the answer and explanation
Answer: D. Walk me through how you take your medicines on a typical day.
Topic: exploring possible medication nonadherence
An open, nonjudgmental request to describe the routine encourages honest disclosure and reveals timing, missed doses, food or supplement use and misunderstandings. Leading, accusing or closed questions limit the information obtained.
Why the others are wrong
- A – A leading question invites a socially acceptable 'yes'.
- B – 'Why' and an accusing tone make clients defensive and less truthful.
- C – A closed question can be answered with a quick 'no' and gives little detail.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
11Question
During an admission interview, a client mentions occasional dizzy spells. Which response is best for the nurse to make next?
- Do you have low blood pressure?
- Make sure you stand up slowly when you get out of bed.
- Describe what happens when you feel dizzy.
- Dizzy spells are common and usually nothing to worry about.
Show the answer and explanation
Answer: C. Describe what happens when you feel dizzy.
Topic: exploring a vague symptom
The first step with a vague symptom is to explore it: onset, character, triggers and associated signs. An open prompt gives the client room to describe it, which guides further assessment before any teaching or reassurance.
Why the others are wrong
- A – A closed question that assumes a cause.
- B – Advice before assessment may miss the cause.
- D – False reassurance closes the discussion without assessment.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
12Question
A nurse is about to take a client's blood pressure for the first time. Which introduction is most appropriate?
- Good afternoon, I'm Priya, your nurse today. I'd like to check your blood pressure with an arm cuff. Is that all right?
- I need to take your vital signs now, so please roll up your sleeve and stay still for me.
- Hello, I'm a nurse from the unit, and the doctor asked me to come in and get your vital signs now.
- Hi, sweetie, I'm just going to wrap this cuff around your arm and get your numbers, nice and quick.
Show the answer and explanation
Answer: A. Good afternoon, I'm Priya, your nurse today. I'd like to check your blood pressure with an arm cuff. Is that all right?
Topic: introduction and consent before touch
A professional introduction gives the nurse's name and role, explains what will be done, and asks permission before touching the client. This builds trust, respects autonomy and supports informed consent.
Why the others are wrong
- B – No name, role or explanation is given, and the statement is a command.
- C – No name is given and the client is not asked for permission to be touched.
- D – Terms of endearment are not professional, and no name, role or consent is offered.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
13Question
A nurse is ambulating a client with a gait belt in the hallway when the client's knees buckle and the client begins to fall. Which action should the nurse take?
- Hold the gait belt tightly and try to keep the client standing until help arrives
- Grab the client under both arms and lift the client back up to standing
- Release the belt and step away so that the client does not pull the nurse over
- Widen the stance and ease the client to the floor along the nurse's leg
Show the answer and explanation
Answer: D. Widen the stance and ease the client to the floor along the nurse's leg
Topic: responding to a fall in progress
One person cannot safely hold up a falling adult. With a wide base of support and a grip on the belt, the nurse guides the client down along the nurse's own body, which slows the fall, protects the client's head and avoids a back injury to the nurse. The nurse then stays with the client, calls for help and assesses before anyone moves the client.
Why the others are wrong
- A – Trying to hold a client who is losing support can wrench the nurse's back and may drop the client suddenly and more harshly.
- B – Lifting a client who is already falling puts the nurse's back at risk and can injure the client's shoulders and arms.
- C – Letting go leaves the client to fall unprotected and may cause head injury; the nurse should stay in contact and guide the descent.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
14Question
A nurse must take an occupied bed down a long corridor to the radiology department. Which technique best protects the nurse from back injury?
- Push the bed with the back straight, knees slightly bent, and body weight behind the movement
- Pull the bed while walking backward, because pulling gives the nurse better control than pushing does
- Push the bed with the knees locked, leaning forward from the waist to add force to the push
- Pull the bed with one hand and twist the trunk to steer it around the corners of the corridor
Show the answer and explanation
Answer: A. Push the bed with the back straight, knees slightly bent, and body weight behind the movement
Topic: pushing versus pulling heavy equipment
Pushing is safer than pulling because the nurse can use body weight and the large leg muscles, while pulling loads the back and shoulders and blocks the nurse's view. Keeping the back straight, knees slightly flexed, and the load close reduces strain.
Why the others are wrong
- B – Pulling strains the back and shoulders, and walking backward is a hazard for both nurse and client.
- C – Locked knees and bending at the waist load the lumbar spine.
- D – One-handed pulling with trunk twisting is a classic cause of back injury.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
15Question
A nurse and a colleague are about to move a client up in bed. Which action by the nurse shows correct use of body mechanics?
- Keeping the bed in its lowest position so the client cannot fall far
- Bending forward at the waist with the knees straight to reach the client
- Raising the bed to about waist height, standing with feet apart and shifting weight from one leg to the other while using a friction-reducing sheet
- Reaching across the bed and lifting the client by the shoulders on the count of three
Show the answer and explanation
Answer: C. Raising the bed to about waist height, standing with feet apart and shifting weight from one leg to the other while using a friction-reducing sheet
Topic: body mechanics when repositioning
Safe body mechanics keep the work close to the body at a comfortable height, use a wide base of support and the large leg muscles, and replace lifting with sliding on a friction-reducing device. This keeps the spine in neutral alignment and reduces the load on the lower back.
Why the others are wrong
- A – The lowest position is for when the client is left alone; working at a low bed forces the nurse to bend and strain the back.
- B – Bending at the waist with straight knees puts the load on the back muscles rather than the legs.
- D – Reaching across the bed puts the load far from the body, and pulling on the shoulders can injure both the client and the nurse.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
16Question
A client who had a stroke cannot bear weight on either leg and is unable to follow instructions consistently. The client is to sit in a chair for meals. Which method should the nurse use to transfer the client from the bed to the chair?
- A gait belt and a stand-pivot transfer with one staff member
- A sliding board with the help of unlicensed assistive personnel (UAP)
- Two staff members lifting the client under the arms
- A full-body sling mechanical lift with the number of staff the device requires
Show the answer and explanation
Answer: D. A full-body sling mechanical lift with the number of staff the device requires
Topic: choosing lift equipment
Safe patient handling guidance matches the transfer method to the client's ability to bear weight and cooperate: a client who cannot bear weight and cannot reliably assist requires a full-body mechanical lift. Manual lifting exposes staff to injury and the client to falls and shoulder trauma.
Why the others are wrong
- A – A stand-pivot transfer requires the client to bear at least some weight and follow directions.
- B – A sliding board requires upper-body strength, sitting balance and cooperation, which this client lacks.
- C – Lifting under the arms can injure the client's shoulders and is a leading cause of staff back injury.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
17Question
A nurse at a rural clinic treats a man for a hand injury sustained at work. He says his employer keeps his passport 'for safekeeping' and that the amount he owes for transportation and housing grows every week. These findings suggest which concern?
- A routine arrangement common to seasonal workers that requires no further follow-up
- A language barrier that the clinic can resolve by simply providing written instructions
- A workers' compensation paperwork issue that the billing office can handle independently
- Possible labor trafficking involving debt bondage and confiscated identification
Show the answer and explanation
Answer: D. Possible labor trafficking involving debt bondage and confiscated identification
Topic: recognizing labor trafficking
Employer retention of identity documents and a debt that increases beyond the client's ability to repay are classic indicators of labor trafficking. Recognizing them lets the nurse follow the facility protocol and involve trained responders.
Why the others are wrong
- A – Holding identification documents and a growing debt are recognized indicators of trafficking, not routine practice.
- B – Nothing here shows a language problem, and written instructions do not address control by an employer.
- C – The concern is the client's safety and freedom, which is not a billing matter.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
18Question
A teenager with a urinary tract infection arrives with an adult who answers every question and says the teen speaks little English. The teen avoids eye contact and carries no identification. The nurse suspects trafficking. Which action should the nurse take first?
- Tell the adult that the staff suspect trafficking and ask for an explanation of the situation
- Ask the adult to interpret so that the teen's symptoms can be assessed without delay
- Call immigration authorities at once so that the teen can be removed from the situation
- Arrange time alone with the teen and a qualified interpreter, using a routine reason such as collecting a urine sample
Show the answer and explanation
Answer: D. Arrange time alone with the teen and a qualified interpreter, using a routine reason such as collecting a urine sample
Topic: responding to suspected trafficking
Victims are often controlled by the person who accompanies them. The first step is a safe, private conversation using a qualified interpreter and a natural pretext, followed by the facility's trafficking protocol and the hotline.
Why the others are wrong
- A – Confronting the adult may endanger the teen and allow the pair to leave before help is arranged.
- B – The adult may be the controlling party, and interpretation by an accompanying person can silence the teen.
- C – Immigration involvement can frighten the teen and is not the first step; a victim-centered approach comes first.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
19Question
A nurse works at a syringe services program. A client who injects opioids asks for sterile supplies and says he is not ready to stop using. Which response is best?
- Withhold the supplies until the client agrees to enter a treatment program for opioid use
- Explain that supplying syringes encourages drug use and suggest that the client seek help elsewhere
- Give the sterile supplies, offer HIV and hepatitis C testing and naloxone, and discuss treatment options without requiring abstinence
- Provide a pamphlet about treatment and decline to give supplies until the client returns another day
Show the answer and explanation
Answer: C. Give the sterile supplies, offer HIV and hepatitis C testing and naloxone, and discuss treatment options without requiring abstinence
Topic: harm reduction for injection drug use
Harm reduction meets clients where they are, reduces infection and overdose risk and keeps them connected to care. Sterile supplies, testing, naloxone and an open offer of treatment follow current public health guidance.
Why the others are wrong
- A – Requiring abstinence first defeats the aim of harm reduction and keeps the client at risk of infection.
- B – Evidence shows that these programs do not increase drug use and they link clients to care.
- D – Delay increases the chance of sharing needles and loses a chance to connect the client to care.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
20Question
A community coalition wants to reduce tobacco and vaping among teenagers in a town. Which strategy is supported by the strongest evidence for lowering youth use?
- A single school assembly showing graphic photographs of the effects of smoking
- Mailing pamphlets about health risks to every household that has a teenager
- Asking parents to watch for signs of use and to speak to their children about it
- Higher prices, enforced age-of-sale laws and smoke-free policies, plus media campaigns
Show the answer and explanation
Answer: D. Higher prices, enforced age-of-sale laws and smoke-free policies, plus media campaigns
Topic: preventing youth tobacco use
Comprehensive programs that combine price, enforced age-of-sale laws, smoke-free policies and counter-marketing have the strongest evidence for reducing youth tobacco use. Single, information-only efforts are weaker.
Why the others are wrong
- A – One-time fear-based events have little lasting effect on youth tobacco use.
- B – Printed information alone changes behavior little.
- C – Parental involvement helps but is weaker than population-level measures.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
21Question
A client with newly diagnosed cancer rates their pain 7 out of 10 and says, 'I'm sure this pain means the cancer is spreading, so there's no point taking the medicine.' Which dimension of the pain experience does this statement most clearly represent?
- Behavioural
- Sociocultural
- Cognitive
- Physiological
Show the answer and explanation
Answer: C. Cognitive
Topic: cognitive dimension of pain
The cognitive dimension covers beliefs, attitudes and the meaning a person gives to pain. A belief that pain signals disease progression, and that treatment is useless, is a cognitive appraisal and can reduce adherence to pain control.
Why the others are wrong
- A – This dimension covers observable actions such as grimacing, guarding or moaning.
- B – This dimension covers family, role and cultural influences, which the statement does not describe.
- D – This dimension covers measurable body responses such as heart rate and blood pressure.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
22Question
A client with a fractured femur lies rigid, groans loudly and refuses to move when staff approach. Which dimension of the pain experience do these observations represent?
- Behavioural
- Sociocultural
- Cognitive
- Physiological
Show the answer and explanation
Answer: A. Behavioural
Topic: behavioural dimension of pain
The behavioural dimension includes observable responses to pain such as groaning, guarding, rigidity, grimacing and avoidance of movement. These cues are especially important when a client cannot give a numeric rating.
Why the others are wrong
- B – This dimension involves cultural and family influences, which are not described.
- C – This dimension is about thoughts and beliefs, which are not described.
- D – This dimension is measured by body responses such as heart rate and blood pressure.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
23Question
A nurse gave an oral analgesic to a client whose pain was 8 out of 10 forty-five minutes ago. Which question best evaluates the effectiveness of the medication?
- Do you think you will need another dose soon?
- What number from 0 to 10 would you give your pain now?
- Can you describe what the pain feels like?
- Are you feeling better, since that medicine usually works well?
Show the answer and explanation
Answer: B. What number from 0 to 10 would you give your pain now?
Topic: evaluating analgesic response
Evaluation requires the same measure used before treatment. Asking the client to rate pain on the same numeric scale allows direct comparison with the earlier 8 out of 10 and shows whether the intervention worked.
Why the others are wrong
- A – This predicts future need but does not measure the response to the dose given.
- C – Quality is useful for the initial assessment but does not allow comparison with the baseline rating.
- D – A leading question encourages a positive answer and gives no measurable data.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
24Question
A client who fell from a ladder rates new abdominal pain 9 out of 10. Which vital sign changes are consistent with the body's early response to acute pain?
Select all that apply.
- Increased blood pressure
- Increased respiratory rate
- Increased heart rate
- Heart rate below 50 beats/min
- Respiratory rate decreasing to 8 breaths/min
- Core temperature falling below 95 °F (35 °C)
Show the answers and explanation
Answers: A, B and C.
- A – Increased blood pressure
- B – Increased respiratory rate
- C – Increased heart rate
Topic: vital signs in acute pain
Acute pain activates the sympathetic nervous system, which raises heart rate, blood pressure and respiratory rate. These changes are expected early but may be absent in chronic pain, so vital signs never replace the client's self-report.
Why the others are wrong
- D – Bradycardia is not the usual early response to acute pain.
- E – A rapidly falling rate is a concerning sign, not the typical early pain response.
- F – Pain does not normally cause hypothermia.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
25Question
The nurse observes unlicensed assistive personnel (UAP) providing denture care for a client. Which action by the UAP requires the nurse to intervene?
- Lining the sink with a washcloth before cleaning the dentures over it
- Rinsing the dentures under hot running water
- Brushing the dentures with a soft brush and denture cleanser
- Storing the dentures overnight in water in a labeled denture cup
Show the answer and explanation
Answer: B. Rinsing the dentures under hot running water
Topic: denture care
Hot water can warp the denture material so that the dentures no longer fit, which causes sore gums and poor eating. Dentures are cleaned and rinsed in cool or tepid water.
Why the others are wrong
- A – A washcloth or water in the sink cushions the dentures if they are dropped; this is correct.
- C – A soft brush and denture cleanser clean without scratching; this is correct.
- D – Dentures are kept moist in a labeled container so they do not dry, warp or get lost; this is correct.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
NCLEX-RN is a registered trademark of the National Council of State Boards of Nursing, Inc. (NCSBN). This site is not affiliated with, sponsored by or endorsed by the owner of that mark.
Nursing