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Question 1

When performing a physical assessment on a patient, which technique should be performed LAST to avoid altering bowel sounds?

Accepted Answer

Palpation

Answer

Palpation should be performed last in abdominal assessments because it can alter bowel sounds that would be detected during auscultation.

Question 2

Which vital sign finding in an adult patient should be reported to the healthcare provider immediately?

Accepted Answer

Respiratory rate 28 breaths/min

Answer

A respiratory rate of 28 breaths/min in an adult is significantly above the normal range of 12–20 breaths/min and indicates respiratory distress requiring immediate attention.

Question 3

A nurse is preparing to insert a urinary catheter. What is the correct sequence after opening the sterile field?

Accepted Answer

Don sterile gloves, then cleanse the meatus

Answer

Sterile gloves must be donned before any sterile procedure begins, including cleansing the meatus, to maintain sterility throughout catheter insertion.

Question 4

When administering oxygen via a simple face mask, what is the minimum flow rate required to prevent CO2 rebreathing?

Accepted Answer

5–6 L/min

Answer

A minimum flow rate of 5–6 L/min is required with a simple face mask to flush exhaled CO2 from the mask and prevent rebreathing.

Question 5

Which action best prevents venous thromboembolism (VTE) in a postoperative patient?

Accepted Answer

Encouraging early ambulation and leg exercises

Answer

Early ambulation and leg exercises promote venous return, reduce venous stasis, and are the most effective non-pharmacologic measures to prevent VTE.

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