🚨 Who Comes First?
A nurse is caring for four patients. Which patient should be assessed first?
A. A patient with hypertension reporting a mild headache
B. A patient with COPD requesting assistance with breakfast
C. A patient with asthma experiencing difficulty speaking and severe shortness of breath
D. A patient with heart failure reporting mild ankle swelling
Correct Answer: C
Rationale: Difficulty speaking and severe dyspnea indicate significant respiratory distress. Airway and breathing take priority.
A patient with heart failure reports needing three pillows to sleep comfortably because breathing becomes difficult when lying flat. Which term describes this finding?
A. Apnea
B. Orthopnea
C. Tachypnea
D. Stridor
Correct Answer: B
Rationale: Orthopnea is shortness of breath that worsens when lying flat and is associated with pulmonary congestion.
A patient with asthma receives albuterol for wheezing and shortness of breath. Which finding best indicates the medication is effective?
A. Improved air movement and decreased wheezing
B. Increased heart rate
C. Increased anxiety
D. Decreased urine output
Correct Answer: A
Rationale: Albuterol relaxes bronchial smooth muscle, improving airflow and relieving bronchospasm.
A patient reports wheezing, chest tightness, and shortness of breath after exposure to a known trigger. Which condition is most consistent with these findings?
A. Primary hypertension
B. Atrial fibrillation
C. Asthma exacerbation
D. Peripheral arterial disease
Correct Answer: C
Rationale: Asthma involves airway inflammation and bronchoconstriction, which can cause episodic wheezing, chest tightness, and dyspnea.
A patient with heart failure is instructed to record daily weights. What is the primary purpose of this intervention?
A. Evaluate muscle strength
B. Determine nutritional intake
C. Monitor for fluid retention
D. Assess medication allergies
Correct Answer: C
Rationale: Daily weight trends help identify fluid accumulation that may indicate worsening heart failure.
A patient with heart failure reports increasing shortness of breath. The nurse auscultates new crackles bilaterally. What is the priority nursing action?
A. Encourage increased oral fluids
B. Place the patient in an upright position and assess oxygenation
C. Assist the patient to ambulate
D. Obtain the patient's daily weight before intervening
Correct Answer: B
Rationale: Upright positioning supports ventilation, and oxygenation must be assessed promptly. New crackles and worsening dyspnea suggest pulmonary congestion.
A patient reports loud snoring, frequent nighttime awakenings, and excessive daytime sleepiness. Which condition should the nurse suspect?
A. Atrial flutter
B. Left-sided heart failure
C. Obstructive sleep apnea
D. Peripheral arterial disease
Correct Answer: C
Rationale: Repeated upper airway obstruction during sleep can interrupt breathing and produce daytime fatigue.
A nurse prepares to administer metoprolol to a patient with hypertension. Which assessments are most important before administration?
A. Temperature and respiratory rate
B. Oxygen saturation and pain score
C. Heart rate and blood pressure
D. Weight and bowel sounds
Correct Answer: C
Rationale: Metoprolol can decrease heart rate and blood pressure. These measurements help determine whether administration is safe.
A patient with heart failure develops crackles, orthopnea, and increasing dyspnea. Which condition is most likely responsible?
A. Left-sided heart failure
B. Obstructive sleep apnea
C. Peripheral arterial disease
D. Sinus bradycardia
Correct Answer: A
Rationale: Left-sided heart failure commonly causes pulmonary congestion, leading to crackles and orthopnea.
A patient with obstructive sleep apnea is prescribed CPAP. Which finding best indicates that treatment is effective?
A. Increased daytime sleepiness
B. Fewer nighttime breathing interruptions and improved daytime alertness
C. Increased episodes of snoring and awakening
D. Increased dependence on sedating medications
Correct Answer: B
Rationale: CPAP maintains positive airway pressure to help prevent upper airway collapse during sleep, improving breathing and daytime symptoms.
A patient with atrial fibrillation has a heart rate of 148 beats/min, blood pressure of 82/48 mmHg, and new confusion. Which action is most appropriate?
A. Encourage oral fluids and reassess in one hour
B. Document the findings as expected with atrial fibrillation
C. Administer the scheduled oral medication and continue routine care
D. Initiate an urgent response and assess perfusion
Correct Answer: D
Rationale: Hypotension and altered mental status suggest hemodynamic instability and decreased tissue perfusion. Immediate evaluation and intervention are necessary.
A patient with left-sided heart failure develops worsening dyspnea and bilateral crackles. Which underlying process best explains these findings?
A. Increased pressure in the pulmonary circulation
B. Decreased blood flow to the lower extremities
C. Increased airflow through narrowed bronchioles
D. Decreased systemic vascular resistance alone
Correct Answer: A
Rationale: Left ventricular dysfunction increases pulmonary vascular pressure, contributing to congestion and impaired gas exchange.
A patient with COPD is prescribed tiotropium and albuterol. Which statement indicates a need for additional teaching?
A. "I should use my maintenance inhaler as prescribed."
B. "I will monitor for worsening shortness of breath."
C. "I should make sure I understand how to use each inhaler."
D. "I will use tiotropium for immediate relief when I suddenly cannot breathe."
Correct Answer: D
Rationale: Tiotropium is a long-acting maintenance bronchodilator, not a rescue medication. Albuterol is used for rapid relief of bronchospasm.
A patient with COPD has worsening shortness of breath and an elevated PaCO₂. Which physiologic problem best explains the elevated PaCO₂?
A. Increased cardiac output
B. Increased renal elimination of bicarbonate
C. Excessive elimination of carbon dioxide
D. Inadequate alveolar ventilation
Correct Answer: D
Rationale: Inadequate ventilation prevents effective CO₂ elimination, causing carbon dioxide retention.
A patient receiving oxygen through a nonrebreather mask has a reservoir bag that completely collapses during inspiration. What should the nurse do?
A. Check the oxygen flow and equipment setup immediately
B. Remove the mask and leave the patient without oxygen
C. Decrease the oxygen flow
D. Document the finding as expected
Correct Answer: A
Rationale: The reservoir bag should remain at least partially inflated. Complete collapse indicates that oxygen delivery may be inadequate and requires immediate equipment assessment.
A patient with COPD receiving oxygen becomes increasingly lethargic. The respiratory rate decreases from 20 to 9 breaths/min. What should the nurse do first?
A. Assess ventilation and activate an urgent response
B. Remove the oxygen and leave the patient resting
C. Encourage the patient to drink water
D. Document the change as an expected COPD finding
Correct Answer: A
Rationale: Decreasing respiratory effort and lethargy suggest inadequate ventilation and possible CO₂ retention. This requires immediate assessment and escalation.
A patient with COPD has the following arterial blood gas results:
pH: 7.30
PaCO₂: 60 mmHg
HCO₃⁻: 28 mEq/L
Which acid–base disturbance is present?
A. Respiratory alkalosis
B. Metabolic alkalosis
C. Metabolic acidosis
D. Respiratory acidosis
Correct Answer: D
Rationale: The low pH indicates acidemia, while the elevated PaCO₂ identifies a respiratory cause. The elevated bicarbonate suggests compensation.
A patient taking spironolactone for heart failure is being monitored for adverse effects. Which laboratory finding is most concerning?
A. Potassium 4.0 mEq/L
B. Potassium 5.9 mEq/L
C. Sodium 139 mEq/L
D. Hemoglobin 13.8 g/dL
Correct Answer: B
Rationale: Spironolactone is potassium-sparing and can cause hyperkalemia. An elevated potassium level increases the risk of cardiac dysrhythmias.
A patient with chronic heart failure and COPD reports worsening shortness of breath. Which additional finding most strongly suggests worsening heart failure rather than isolated bronchospasm?
A. Expiratory wheezing
B. Rapid weight gain with new dependent edema
C. Increased coughing after activity
D. Shortness of breath during exertion
Correct Answer: B
Rationale: Rapid weight gain and dependent edema suggest fluid retention, supporting worsening heart failure. Dyspnea and wheezing can occur with respiratory conditions and may overlap with cardiac problems.
A patient with atrial fibrillation becomes hypotensive and dizzy. The nurse recognizes that the dysrhythmia may be affecting cardiac output. Which explanation best supports this concern?
A. Atrial fibrillation always increases ventricular filling
B. An irregular rhythm guarantees adequate tissue perfusion
C. Atrial fibrillation prevents all ventricular contractions
D. Rapid or irregular ventricular activity may impair ventricular filling and cardiac output
Correct Answer: D
Rationale: Rapid or irregular ventricular responses can reduce ventricular filling time and cardiac output, potentially causing hypotension, dizziness, and reduced tissue perfusion.
The nurse receives reports on four patients. Which patient requires immediate intervention?
A. A patient with chronic heart failure and unchanged bilateral ankle edema
B. A patient with hypertension whose blood pressure is 152/88 mmHg
C. A patient with COPD whose oxygen saturation is 90% within the prescribed target range
D. A patient with sudden stridor, retractions, and rapidly worsening respiratory distress
Correct Answer: D
Rationale: Stridor with increased work of breathing indicates potentially life-threatening upper airway obstruction. Maintaining airway patency is the highest priority.
A patient with heart failure has gained 4 pounds over three days, reports worsening shortness of breath, and has new crackles. Which interpretation is most appropriate?
A. The patient is experiencing expected age-related changes
B. The patient may be developing worsening fluid overload
C. The patient's cardiac function has improved
D. The patient is experiencing a medication allergy
Correct Answer: B
Rationale: Rapid weight gain, dyspnea, and crackles are concerning for fluid retention and worsening heart failure. These findings require prompt evaluation.
A nurse is providing discharge education to a patient with atrial fibrillation who is prescribed apixaban and metoprolol. Which statements should the nurse include?
A. "Report unusual bleeding or bruising."
B. "Monitor your heart rate and blood pressure as instructed."
C. "Stop apixaban whenever your heart rhythm feels normal."
D. "Take your medications as prescribed, even when you feel well."
Correct Answers: A, B, D
Rationale: Apixaban reduces thromboembolic stroke risk but increases bleeding risk. Metoprolol requires monitoring of heart rate and blood pressure. Patients should not independently discontinue prescribed medications.
A patient with a history of both COPD and heart failure arrives with worsening dyspnea. Which findings should the nurse recognize as possible signs of clinical deterioration requiring prompt assessment?
A. New confusion
B. Increasing work of breathing
C. Rapidly decreasing oxygen saturation
D. Stable daily weight and unchanged activity tolerance
Correct Answers: A, B, C
Rationale: Altered mental status, increased respiratory effort, and falling oxygen saturation can indicate worsening oxygenation or ventilation. These findings require prompt evaluation regardless of whether the underlying cause is cardiac or respiratory.
A patient with heart failure is receiving treatment for worsening pulmonary congestion. Which findings suggest that the patient's condition is improving?
A. Decreased work of breathing
B. Improved oxygen saturation
C. Reduced crackles on lung auscultation
D. Increasing confusion and lethargy
Correct Answers: A, B, C
Rationale: Improved respiratory effort, oxygenation, and breath sounds suggest reduced pulmonary congestion and improved gas exchange. Increasing confusion or lethargy indicates possible deterioration.