Med Clinicals

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Sample questions from Med Clinicals

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A 72-year-old client on a medical unit reports sudden shortness of breath and chest pressure. The client is restless, respiratory rate is 30/min, oxygen saturation is 86% on room air, and heart rate is 118/min. Which action should the nurse take first?

   • A.Apply oxygen and assess respiratory status
   • B.Obtain a 12-lead electrocardiogram
   • C.Notify the health care provider
   • D.Ask the client to rate the chest pressure

   Rationale: Hypoxemia and acute respiratory distress require immediate support of oxygenation while the nurse continues assessment. An ECG and provider notification are important but should not delay oxygen for an oxygen saturation of 86%. Asking for a pain rating does not address the immediate threat to breathing; prioritize airway and breathing.

2. 2.A 68-year-old client with heart failure is admitted to a medical unit with a 2.5-kg weight gain in 3 days, crackles, and bilateral ankle edema. Blood pressure is 146/84 mm Hg, and oxygen saturation is 93% on room air. Which assessment is most useful for evaluating response to treatment?

   • A.Daily weight measured at the same time on the same scale
   • B.Ankle circumference measured once each shift
   • C.Blood pressure measured after each meal
   • D.Serum sodium measured every 2 hours

   Rationale: Consistent daily weights provide a sensitive measure of fluid balance in heart failure. Ankle circumference and blood pressure can add information but are less reliable indicators of overall fluid change. Sodium does not need to be checked every 2 hours in this stable presentation; trend weight along with symptoms and intake and output.

3. 3.A 59-year-old client with type 2 diabetes is alert on a medical unit and reports shakiness and sweating. Capillary glucose is 54 mg/dL; the client can swallow safely. Which action should the nurse take?

   • A.Give 15 g of a rapid-acting oral carbohydrate and recheck glucose in 15 minutes
   • B.Administer the scheduled rapid-acting insulin and recheck glucose in 1 hour
   • C.Give glucagon intramuscularly and place the client supine
   • D.Offer a high-protein snack and recheck glucose in 1 hour

   Rationale: A conscious client who can swallow should receive about 15 g of rapid-acting carbohydrate, followed by a glucose recheck in 15 minutes. Insulin would worsen the hypoglycemia, and glucagon is generally used when oral treatment is not safe or possible. Protein alone acts too slowly to correct an acute low glucose; treat first, then provide a longer-acting snack if appropriate.

4. 4.A 76-year-old client with pneumonia is receiving oxygen at 2 L/min by nasal cannula. The client becomes confused; temperature is 38.5 C, respiratory rate is 32/min, blood pressure is 88/52 mm Hg, and oxygen saturation is 89%. Which action is the priority?

   • A.Activate the rapid response system and support oxygenation
   • B.Collect a sputum specimen before any further intervention
   • C.Administer the next scheduled oral antibiotic
   • D.Encourage oral fluids and reassess in 30 minutes

   Answer and rationale are in the full material.

5. 5.A 64-year-old client with a new prescription for warfarin is being discharged from a medical unit. The client asks how to reduce the risk of bleeding. Which instruction is most appropriate?

   • A.Use a soft toothbrush and report unusual bleeding or black stools
   • B.Avoid all foods containing vitamin K
   • C.Take an extra dose if a dose is missed
   • D.Stop the medication when bruising first appears

   Answer and rationale are in the full material.