REX PN STUDY GUIDE EXAMINATION QUESTIONS WITH
SOLUTIONS A+ 2025/2026
✔✔the nurse is caring for a client who has an adrenocortical adenoma and
hyperaldosteronism. which of the following actions should the nurse implement?
a. evaluate blood glucose level every 4 hours
b. monitor the blood pressure every 4 hours
c. maintain extremities in an elevated position
d. provide a potassium-restricted diet - ✔✔b. monitor the blood pressure every 4 hours
hypertension caused by sodium retention is a common complication of
hyperaldosteronism. hyperaldosteronism does not cause an elevation in blood glucose.
the client will be hypokalemic and require potassium supplementation before surgery.
edema does not usually occur hyperaldosteronism.
✔✔the nurse is caring for an older-adult client who is diagnosed with hypothyroidism
and has a prescription for levothyroxine. which of the following assessments is most
important for the nurse to make during initiation of thyroid replacement?
a. nutritional intake
b. apical pulse
c. orientation and alertness
d. intake and output - ✔✔b. apical pulse rate
in older clients. initiation of levothyroxine therapy can increase myocardial oxygen
demand and cause angina or dysrhythmias. the medication is also expected to improve
mental status and fluid balance and will increase metabolic rate and nutritional needs,
but these changes will not result in potentially life-threatening complications.
✔✔which of the following actions should be included in the plan of care for a male client
with bowel irregularity and a new diagnosis of irritable bowel syndrome (IBS)?
a. encourage the client to express feelings and ask questions about IBS
b. teach the client to avoid using nonsteroidal anti-inflammatory drugs (NSAIDs)
c. suggest that the client increase the intake of milk and other dairy products
d. educate the client about the use of tegaserod to reduce symptoms - ✔✔a. encourage
the client to express feelings and ask questions about IBS
because psychological and emotional can affect the symptoms for IBS, encouraging the
client to discuss emotions and ask questions is an important intervention. Tegaserod
(zelnorm) has been recently used to treat women with IBS whose primary bowel
symptom is constipation however, this question is making about a male client. although
yogurt may be beneficial, milk is avoided because lactose intolerance can contribute to
symptoms in some clients NSAIDs can be used by clients with IBS.
,✔✔which of the following nursing actions is important to include in the plan of care for a
client who had an abdominal-perineal resection the previous day?
a. assess the perineal drainage and incision
b. encourage acceptance of the colostomy stoma
c. teach about low-residue diet
d. monitor output from the stoma - ✔✔a. assess the perineal drainage incision
rationale: because the perineal wound is at high risk for infection, the initial care is
focused on assessment and care of this wound. teaching about diet is best done closer
to discharge from the hospital. there will be very little drainage into the colostomy until
peristalsis returns. the client will be encouraged to assist with the colostomy, but this is
not the highest priority in the immediate postoperative period
✔✔the nurse is caring for a client with diabetes who received 34 units of NPH insulin at
7:00 am and is away from the nursing unit awaiting diagnostic testing when the lunch
trays are distributed. which of the following actions is best to prevent hypoglycemia?
a. call the diagnostic testing area and ask that 5% dextrose IV be started
b. ensure that the client drinks a glass of orange juice at noon in the diagnostic testing
area
c. request that the client be returned to the unit to eat lunch if testing will not be
completed promptly
d. save the lunch tray to be provided upon the client's return to the unit. - ✔✔c. request
that the client be returned to the unit to eat lunch if testing will not be completed
promptly.
consistency for mealtimes assists with regulation of blood glucose, so the best option is
for the client to have lunch at the usual time. waiting to eat until after the procedure is
likely to cause hypoglycaemia. administration of an IV solution is unnecessarily invasive
for the client. a glass of juice will keep the client from becoming hypoglycaemic but will
cause a rapid rose on blood glucose because of the rapid absorption of the simple
carbohydrate in this item.
✔✔following assessments of a client with pneumonia, the nurse identifies a nursing
diagnosis of ineffective airway clearance. which of the following information best
supports this diagnosis?
a. large amounts of greenish sputum
b. resting pulse oximetry (SpO2) of 85%
c. weak, nonproductive cough effort
d. respiratory rate of 28 breaths/min - ✔✔c. weak, nonproductive cough effort
,the weak, nonproductive cough indicates that the client is unable to clear the airway
effectively. the other data would be used to support the diagnosis such as impaired gas
exchange and ineffective breathing pattern.
✔✔ms. G a 52 year old woman who is awaiting her total knee replacement surgery on
the surgical unit. due to emergency surgeries, she has been bumped from the surgical
list in the am to an afternoon surgical time. she has been NPO since midnight. the
patient is complaining of having a headache and being very thirsty. you as her nurse
understand that the priority action in this circumstance involves:
a. calling the anaesthetist
b. telling the patient she must remain NPO for her safety
c. getting the patient a small cup of water
d. increasing the IV infusion - ✔✔a. calling the anaesthetist
✔✔the nurse is caring for a client with COPD who is receiving oxygen. which of the
following actions is best for the nurse to implement to determine the appropriate oxygen
flow rate?
a. minimize oxygen use to avoid oxygen dependency
b. avoid administration of oxygen at a rate of more than 2L/minute
c. maintain the pulse oximetry level at 90% or greater
d. administer oxygen according tot he clients level of dyspnea - ✔✔c. maintain the pulse
oximetry level at 90% or greater
rationale: the best way to determine appropriate oxygen flow rate is by monitoring the
clients oxygenation either by ABGs or pulse oximetry; an oxygen saturation of 90%
indicates adequate blood oxygen level without the danger of suppressing the respiratory
drive. for clients with an exacerbation of COPD. an oxygen flow rate of 2L/min may not
be adequate. because oxygen use improves survival rate in clients with COPD, there is
not a concern about oxygen dependency. the clients prescribed dyspnea level may be
affected by other factors (such as anxiety) besides the blood oxygen levels.
✔✔which of the following information by the nurse when caring for a client who has
diabetes insipidus (DI) is most important to report to the health care provider?
a. history of recent head injury
b. confusion and lethargy
c. urine specific gravity is 1.003
d. urine output of 400ml/hour - ✔✔b. confusion and lethargy
the client's confusion and lethargy may indicate hypernatremia and should be
addressed quickly. in addition, clients with DI compensate for fluid losses by drinking
copious amounts of fluid, but a client who is lethargic will be unable to drink enough
fluids and become hypovolemic. a high urine output, low urine specific gravity and
, history of recent head injury are consistent with DI, but they do not require immediate
nursing action to avoid life threatening complications.
✔✔the nurse obtains the following assessment data for a client who has influenza.
which of the following information is most important to communicate to the health care
provider?
a. mygalia and persistent headache
b. diffuse crackles in the lungs
c. sore throat and frequent cough
d. temperature of 38 degrees C (100.4) - ✔✔b. diffuse crackles in the lungs
the crackles indicate that the client may be developing pneumonia, a common
complication of influenza which would require aggressive treatment. myalgia, headache,
mild temperature elevation and sore throat with cough are typical symptoms of influenza
and are treated with supportive care measures such as OTC pain relievers and
increased fluid intake.
✔✔which of the following nursing actions should the nurse perform when suctioning a
tracheostomy?
a. withdraw catheter in straight time while applying intermittent suction
b. insert tube 12-15 cm while suctioning
c. limit suction time to 10 seconds
d. oxygenate the client once all suctioning is completed - ✔✔c. limit suction time to 10
seconds
rationale: suction time should not exceed 10 seconds. the tube is inserted 13-15 cm but
not while suctioning. suction is done intermittently while withdrawing the catheter but not
in a straight line; the catheter should be rotated when withdrawing. oxygenating the
client after each tube insertion rather than when suctioning is completed.
✔✔a client with systemic lupus erthemalosus has a prescription for 2 weeks of high-
dose prednisone therapy. when teaching the client about prednisone, which of the
following information is most important for the nurse to include?
a. call the doctor if you experience any mood alterations with prednisone
b. do not stop taking prednisone suddenly; it should be decreased gradually
c. weigh yourself daily to monitor for weight gain caused by water or increased fat
d. a weight-bearing exercise program will help minimize the risk for osteoporosis. -
✔✔b. do not stop taking the prednisone suddenly; it should be decreased gradually
rationale: acute adrenal insufficiency may occur if exogenous corticosteroids are
suddenly stopped. mood alterations and weight gain are possible adverse effects of
corticosteroid use, but these are not life-threatening effects. osteoporosis occurs when
clients take corticosteroids for longer periods.
SOLUTIONS A+ 2025/2026
✔✔the nurse is caring for a client who has an adrenocortical adenoma and
hyperaldosteronism. which of the following actions should the nurse implement?
a. evaluate blood glucose level every 4 hours
b. monitor the blood pressure every 4 hours
c. maintain extremities in an elevated position
d. provide a potassium-restricted diet - ✔✔b. monitor the blood pressure every 4 hours
hypertension caused by sodium retention is a common complication of
hyperaldosteronism. hyperaldosteronism does not cause an elevation in blood glucose.
the client will be hypokalemic and require potassium supplementation before surgery.
edema does not usually occur hyperaldosteronism.
✔✔the nurse is caring for an older-adult client who is diagnosed with hypothyroidism
and has a prescription for levothyroxine. which of the following assessments is most
important for the nurse to make during initiation of thyroid replacement?
a. nutritional intake
b. apical pulse
c. orientation and alertness
d. intake and output - ✔✔b. apical pulse rate
in older clients. initiation of levothyroxine therapy can increase myocardial oxygen
demand and cause angina or dysrhythmias. the medication is also expected to improve
mental status and fluid balance and will increase metabolic rate and nutritional needs,
but these changes will not result in potentially life-threatening complications.
✔✔which of the following actions should be included in the plan of care for a male client
with bowel irregularity and a new diagnosis of irritable bowel syndrome (IBS)?
a. encourage the client to express feelings and ask questions about IBS
b. teach the client to avoid using nonsteroidal anti-inflammatory drugs (NSAIDs)
c. suggest that the client increase the intake of milk and other dairy products
d. educate the client about the use of tegaserod to reduce symptoms - ✔✔a. encourage
the client to express feelings and ask questions about IBS
because psychological and emotional can affect the symptoms for IBS, encouraging the
client to discuss emotions and ask questions is an important intervention. Tegaserod
(zelnorm) has been recently used to treat women with IBS whose primary bowel
symptom is constipation however, this question is making about a male client. although
yogurt may be beneficial, milk is avoided because lactose intolerance can contribute to
symptoms in some clients NSAIDs can be used by clients with IBS.
,✔✔which of the following nursing actions is important to include in the plan of care for a
client who had an abdominal-perineal resection the previous day?
a. assess the perineal drainage and incision
b. encourage acceptance of the colostomy stoma
c. teach about low-residue diet
d. monitor output from the stoma - ✔✔a. assess the perineal drainage incision
rationale: because the perineal wound is at high risk for infection, the initial care is
focused on assessment and care of this wound. teaching about diet is best done closer
to discharge from the hospital. there will be very little drainage into the colostomy until
peristalsis returns. the client will be encouraged to assist with the colostomy, but this is
not the highest priority in the immediate postoperative period
✔✔the nurse is caring for a client with diabetes who received 34 units of NPH insulin at
7:00 am and is away from the nursing unit awaiting diagnostic testing when the lunch
trays are distributed. which of the following actions is best to prevent hypoglycemia?
a. call the diagnostic testing area and ask that 5% dextrose IV be started
b. ensure that the client drinks a glass of orange juice at noon in the diagnostic testing
area
c. request that the client be returned to the unit to eat lunch if testing will not be
completed promptly
d. save the lunch tray to be provided upon the client's return to the unit. - ✔✔c. request
that the client be returned to the unit to eat lunch if testing will not be completed
promptly.
consistency for mealtimes assists with regulation of blood glucose, so the best option is
for the client to have lunch at the usual time. waiting to eat until after the procedure is
likely to cause hypoglycaemia. administration of an IV solution is unnecessarily invasive
for the client. a glass of juice will keep the client from becoming hypoglycaemic but will
cause a rapid rose on blood glucose because of the rapid absorption of the simple
carbohydrate in this item.
✔✔following assessments of a client with pneumonia, the nurse identifies a nursing
diagnosis of ineffective airway clearance. which of the following information best
supports this diagnosis?
a. large amounts of greenish sputum
b. resting pulse oximetry (SpO2) of 85%
c. weak, nonproductive cough effort
d. respiratory rate of 28 breaths/min - ✔✔c. weak, nonproductive cough effort
,the weak, nonproductive cough indicates that the client is unable to clear the airway
effectively. the other data would be used to support the diagnosis such as impaired gas
exchange and ineffective breathing pattern.
✔✔ms. G a 52 year old woman who is awaiting her total knee replacement surgery on
the surgical unit. due to emergency surgeries, she has been bumped from the surgical
list in the am to an afternoon surgical time. she has been NPO since midnight. the
patient is complaining of having a headache and being very thirsty. you as her nurse
understand that the priority action in this circumstance involves:
a. calling the anaesthetist
b. telling the patient she must remain NPO for her safety
c. getting the patient a small cup of water
d. increasing the IV infusion - ✔✔a. calling the anaesthetist
✔✔the nurse is caring for a client with COPD who is receiving oxygen. which of the
following actions is best for the nurse to implement to determine the appropriate oxygen
flow rate?
a. minimize oxygen use to avoid oxygen dependency
b. avoid administration of oxygen at a rate of more than 2L/minute
c. maintain the pulse oximetry level at 90% or greater
d. administer oxygen according tot he clients level of dyspnea - ✔✔c. maintain the pulse
oximetry level at 90% or greater
rationale: the best way to determine appropriate oxygen flow rate is by monitoring the
clients oxygenation either by ABGs or pulse oximetry; an oxygen saturation of 90%
indicates adequate blood oxygen level without the danger of suppressing the respiratory
drive. for clients with an exacerbation of COPD. an oxygen flow rate of 2L/min may not
be adequate. because oxygen use improves survival rate in clients with COPD, there is
not a concern about oxygen dependency. the clients prescribed dyspnea level may be
affected by other factors (such as anxiety) besides the blood oxygen levels.
✔✔which of the following information by the nurse when caring for a client who has
diabetes insipidus (DI) is most important to report to the health care provider?
a. history of recent head injury
b. confusion and lethargy
c. urine specific gravity is 1.003
d. urine output of 400ml/hour - ✔✔b. confusion and lethargy
the client's confusion and lethargy may indicate hypernatremia and should be
addressed quickly. in addition, clients with DI compensate for fluid losses by drinking
copious amounts of fluid, but a client who is lethargic will be unable to drink enough
fluids and become hypovolemic. a high urine output, low urine specific gravity and
, history of recent head injury are consistent with DI, but they do not require immediate
nursing action to avoid life threatening complications.
✔✔the nurse obtains the following assessment data for a client who has influenza.
which of the following information is most important to communicate to the health care
provider?
a. mygalia and persistent headache
b. diffuse crackles in the lungs
c. sore throat and frequent cough
d. temperature of 38 degrees C (100.4) - ✔✔b. diffuse crackles in the lungs
the crackles indicate that the client may be developing pneumonia, a common
complication of influenza which would require aggressive treatment. myalgia, headache,
mild temperature elevation and sore throat with cough are typical symptoms of influenza
and are treated with supportive care measures such as OTC pain relievers and
increased fluid intake.
✔✔which of the following nursing actions should the nurse perform when suctioning a
tracheostomy?
a. withdraw catheter in straight time while applying intermittent suction
b. insert tube 12-15 cm while suctioning
c. limit suction time to 10 seconds
d. oxygenate the client once all suctioning is completed - ✔✔c. limit suction time to 10
seconds
rationale: suction time should not exceed 10 seconds. the tube is inserted 13-15 cm but
not while suctioning. suction is done intermittently while withdrawing the catheter but not
in a straight line; the catheter should be rotated when withdrawing. oxygenating the
client after each tube insertion rather than when suctioning is completed.
✔✔a client with systemic lupus erthemalosus has a prescription for 2 weeks of high-
dose prednisone therapy. when teaching the client about prednisone, which of the
following information is most important for the nurse to include?
a. call the doctor if you experience any mood alterations with prednisone
b. do not stop taking prednisone suddenly; it should be decreased gradually
c. weigh yourself daily to monitor for weight gain caused by water or increased fat
d. a weight-bearing exercise program will help minimize the risk for osteoporosis. -
✔✔b. do not stop taking the prednisone suddenly; it should be decreased gradually
rationale: acute adrenal insufficiency may occur if exogenous corticosteroids are
suddenly stopped. mood alterations and weight gain are possible adverse effects of
corticosteroid use, but these are not life-threatening effects. osteoporosis occurs when
clients take corticosteroids for longer periods.
