AS Associate Of Science In Nursing 2 — Questions and Answers
Question 1: A patient's SpO2 drops to 88% while on 2L/min nasal cannula. What is the nurse's priority action?
- Document the finding and continue monitoring
- Increase oxygen flow rate and reassess (Correct answer)
- Notify the physician immediately without intervention
- Reposition the patient to Trendelenburg
Correct answer: Increase oxygen flow rate and reassess
The nurse should increase oxygen delivery and reassess SpO2 before escalating to the physician.
Question 2: Which electrolyte imbalance is most commonly associated with prolonged nasogastric suctioning?
- Hyperkalemia
- Hypernatremia
- Hypokalemia (Correct answer)
- Hypermagnesemia
Correct answer: Hypokalemia
Prolonged NG suctioning removes gastric acid rich in potassium, leading to hypokalemia.
Question 3: A nurse is preparing to administer heparin subcutaneously. Which technique is correct?
- Aspirate before injection to confirm no blood return
- Massage the site after injection to enhance absorption
- Inject into the abdomen at least 2 inches from the umbilicus (Correct answer)
- Use a 1.5-inch needle for subcutaneous administration
Correct answer: Inject into the abdomen at least 2 inches from the umbilicus
Heparin is injected into abdominal fat at least 2 inches from the umbilicus; aspiration and massage are contraindicated.
Question 4: Which finding in a postoperative patient requires the most immediate nursing intervention?
- Urine output of 35 mL/hour
- Temperature of 37.8°C (100°F)
- Blood pressure of 88/54 mmHg with diaphoresis (Correct answer)
- Pain rated 6/10 at the incision site
Correct answer: Blood pressure of 88/54 mmHg with diaphoresis
Hypotension with diaphoresis signals hemodynamic instability and requires immediate assessment and intervention.
Question 5: When teaching a patient about a low-sodium diet, which food should the nurse advise the patient to avoid?
- Fresh apples
- Unsalted almonds
- Canned soup (Correct answer)
- Brown rice
Correct answer: Canned soup
Canned soups are high in sodium due to preservatives and should be avoided on a low-sodium diet.
Question 6: A nurse observes a colleague administering the wrong medication to a patient. The correct first action is to:
- Report the incident to the charge nurse immediately
- Stop the administration if still in progress, then assess the patient (Correct answer)
- Document the error in the patient's chart first
- Contact the pharmacy to verify the order
Correct answer: Stop the administration if still in progress, then assess the patient
Patient safety requires stopping the error if ongoing and assessing for harm before reporting or documenting.
Question 7: Which assessment finding indicates that a patient's nasogastric tube is correctly placed in the stomach?
- Aspiration of clear fluid with pH of 7.4
- Auscultation of air over the epigastric area after injection
- pH of aspirate between 1 and 4 (Correct answer)
- Tube length markings at the nostril unchanged from insertion
Correct answer: pH of aspirate between 1 and 4
Gastric aspirate pH of 1–4 is the most reliable bedside confirmation of gastric tube placement.
AS Associate Of Science In Nursing 2
A patient's SpO2 drops to 88% while on 2L/min nasal cannula.
What is the nurse's priority action?