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ADULT HEALTH EVALUATION EXAM 2025/2026 QUESTIONS WITH ANSWERS MARKED A+, Exams of Nursing

Liberty University (LU)Nursing

A nurse is assessing a client who is in skeletal traction. Which of the following findings should the nurse identify as an indication of infection at the pin sites? -Serosanguineous drainage -Mild erythema -Warmth -Fever - Fever A nurse is in a client's room when the client begins having a tonic clonic seizure. Which of the following actions should the nurse take first? -Turn the client's head to the side. -Check the client's motor strength. -Loosen the clothing around the client's waist. -Document the time the seizure began. - Turn the client's head to the side

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ADULT HEALTH EVALUATION EXAM 2025/2026
QUESTIONS WITH ANSWERS MARKED A+
✔✔A nurse is assessing a client who is in skeletal traction. Which of the following
findings should the nurse identify as an indication of infection at the pin sites?
-Serosanguineous drainage
-Mild erythema
-Warmth
-Fever - ✔✔Fever
✔✔A nurse is in a client's room when the client begins having a tonic clonic seizure.
Which of the following actions should the nurse take first?
-Turn the client's head to the side.
-Check the client's motor strength.
-Loosen the clothing around the client's waist.
-Document the time the seizure began. - ✔✔Turn the client's head to the side
✔✔A nurse is reviewing laboratory values for a client who has systemic lupus
erythematosus (SLE). Which of the following values should give the nurse the best
indication of the client's renal function?
- Serum creatinine
-Blood urea nitrogen (BUN)
-Serum sodium
-Urine-specific gravity - ✔✔Serum creatinine
✔✔A nurse in an allergy clinic is caring for a client who has a history of seasonal allergy
symptoms. The client had a RAST completed on a previous visit. The nurse should
recognize that an elevation in which of the following immunoglobulins indicates a
positive result?
-Immunoglobulin G (IgG)
-Immunoglobulin A (IgA)
- Immunoglobulin E (IgE)
-Immunoglobulin M (IgM) - ✔✔-Immunoglobulin E (IgE)
✔✔A nurse is caring for a client who is 4 days post op following a right radical
mastectomy. Which of the following activities should the nurse anticipate being the most
difficult for this client to perform with her right hand?
-Buttoning her blouse
-Eating her breakfast
-Combing her hair
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Download ADULT HEALTH EVALUATION EXAM 2025/2026 QUESTIONS WITH ANSWERS MARKED A+ and more Exams Nursing in PDF only on Docsity!

ADULT HEALTH EVALUATION EXAM 2025/

QUESTIONS WITH ANSWERS MARKED A+

✔✔A nurse is assessing a client who is in skeletal traction. Which of the following findings should the nurse identify as an indication of infection at the pin sites?

  • Serosanguineous drainage
  • Mild erythema
  • Warmth
  • Fever - ✔✔Fever ✔✔A nurse is in a client's room when the client begins having a tonic clonic seizure. Which of the following actions should the nurse take first?
  • Turn the client's head to the side.
  • Check the client's motor strength.
  • Loosen the clothing around the client's waist.
  • Document the time the seizure began. - ✔✔Turn the client's head to the side ✔✔A nurse is reviewing laboratory values for a client who has systemic lupus erythematosus (SLE). Which of the following values should give the nurse the best indication of the client's renal function?
  • Serum creatinine
  • Blood urea nitrogen (BUN)
  • Serum sodium
  • Urine-specific gravity - ✔✔Serum creatinine ✔✔A nurse in an allergy clinic is caring for a client who has a history of seasonal allergy symptoms. The client had a RAST completed on a previous visit. The nurse should recognize that an elevation in which of the following immunoglobulins indicates a positive result?
  • Immunoglobulin G (IgG)
  • Immunoglobulin A (IgA)
  • Immunoglobulin E (IgE)
  • Immunoglobulin M (IgM) - ✔✔-Immunoglobulin E (IgE) ✔✔A nurse is caring for a client who is 4 days post op following a right radical mastectomy. Which of the following activities should the nurse anticipate being the most difficult for this client to perform with her right hand?
  • Buttoning her blouse
  • Eating her breakfast
  • Combing her hair
  • Brushing her teeth - ✔✔Combing her hair ✔✔A nurse is completing discharge instructions with a client following an acute onset of gout. Which of the following client statements indicates an understanding of the treatment regimen?
  • "I will closely follow a high-purine diet."
  • "I will limit my fluid intake to 1 liter per day."
  • "I will take one aspirin every day."
  • "I will limit my alcohol intake." - ✔✔I will limit my alcohol intake ✔✔A nurse is caring for a client who is 1 day postop following a subtotal thyroidectomy. The client reports a tingling sensation in the hands, the soles of the feet, and around the lips. For which of the following findings should the nurse assess the client?
  • Chvostek's sign
  • Babinski's sign
  • Brudzinski's sign
  • Kernig's sign - ✔✔Chvostek's sign ✔✔. A nurse is assessing a client who is admitted for elective surgery and has a history of addison's disease. Which of the following findings should the nurse expect?
  • Hyperpigmentation
  • Intention tremors
  • Hirsutism
  • Purple striations - ✔✔Hyperpigmentation ✔✔A nurse is caring for a client who has Cushing's syndrome. The nurse should recognize which of the following are manifestations of Cushing's syndrome? SATA
  • Alopecia
  • Tremors
  • Moon face
  • Purple striations
  • Buffalo hump - ✔✔- Alopecia
  • Moon face
  • Purple striations
  • Buffalo hump ✔✔A nurse is reviewing d/c instructions with a client following a right cataract extraction. Which of the following instructions should the nurse include?
  • Sleep on the abdomen to facilitate wound healing.
  • Bend at the waist to pick objects up from the floor.
  • Increased blood pressure
  • Increased respiratory rate
  • Increase hematocrit
  • Increased temperature - ✔✔- Increased heart rate
  • Increased blood pressure
  • Increased respiratory rate ✔✔. A nurse is teaching a client who has acute kidney disease about fluid restrictions. Which of the following statements by the client should the nurse identify as understanding of the teaching?
  • "I should consume most of the fluid during the evening."
  • "I will make a list of my favorite beverages."
  • "I will put beverages in large containers to give the appearance of drinking a lot."
  • "I will not add ice cream to the amount of fluid intake." - ✔✔I will make a list of my favorite beverages ✔✔A nurse is caring for a client with a trach. The clients partner has been taught to perform suctioning. Which of the following actions by the partner should indicate to the nurse a readiness for the clients discharge?
  • Attending a class given about tracheostomy care
  • Verbalizing all steps in the procedure
  • Performing the procedure independently
  • Asking appropriate questions about suctioning - ✔✔Performing the procedure independently ✔✔A nurse is caring for a client who is unconscious and has a breathing pattern characterized by alternating periods of hyperventilation and apnea. The nurse should doc that the client has which of the following respiratory alterations?
  • Kussmaul respirations
  • Apneustic respirations
  • Cheyne-Stokes respirations
  • Stridor - ✔✔Cheyne- stokes ✔✔A nurse is teaching the partner of a client who had an acute MI about the reason blood was drawn from the client. Which of the following statements should the nurse make regarding cardiac enzyme studies?
  • "These tests help determine the degree of damage to the heart tissues."
  • "Cardiac enzymes will identify the location of the MI."
  • "These tests will enable the provider to determine the heart structure and mobility of the heart valves."
  • "Cardiac enzymes assist in diagnosing the presence of pulmonary congestion." - ✔✔"These test help determine the degree of damage to the heart tissues." ✔✔A nurse is caring for a middle adult female client who reports that her menstrual periods have become irregular and she has been having hot flashes. The nurse should expect the client to have the following manifestations associated with early menopause?
  • Urinary retention
  • Decreased blood pressure
  • Dryness with intercourse
  • Elevation in body temperature above 37.8° C (100° F) - ✔✔Dryness with intercourse ✔✔A nurse is providing d/c teaching for a client who is postop following a simple mastectomy. The client is to begin outpt radiation therapy the next day. Which of the following instructions about maintaining skin integrity should the nurse include?
  • Do not apply heat to the area of irradiation.
  • Do not wash the area of irradiation.
  • Use an antibiotic ointment to treat skin breakdown.
  • Lubricate the skin lubricated with hypoallergenic lotion. - ✔✔Do not apply heat to the area of irradiation ✔✔A nurse is admitting a client who has acute pancreatitis. Which of the following provider prescriptions should the nurse anticipate?
  • Initiate a low-residue diet.
  • Pantoprazole 80 mg IV bolus twice daily
  • Ambulate twice daily.
  • Pancrelipase 500 units/kg PO three times daily with meals - ✔✔Pantoprazole 80 mg IV bolus twice daily ✔✔A client who has a history of MI is prescribed aspirin 325 mg. The nurse recognizes that the aspirin is given due to which of the following actions of the medication?
  • analgesic
  • anti-inflammatory
  • antiplatelet aggregate
  • antipyretic - ✔✔antiplatelet aggregate ✔✔A nurse is caring for an adolescent who has hemophilia A and is scheduled for wisdom teeth extractions. Prior to the procedure, the nurse should anticipate that the client will receive which of the following products?
  • Recombinant
  • Packed RBCs
  • Evaluate the client for hypercalcemia.
  • Examine the client for hepatomegaly. - ✔✔Check the results of the clients most recent CBC ✔✔A nurse is caring for a client who has COPD. The client tells the nurse " i can feel the congestion in my lungs, and i certainly cough a lot, but i can't seem to bring anything up." Which of the following actions should the nurse take to help the client with tenacious bronchial secretions?
  • Maintaining a semi-Fowler's position as often as possible
  • Administering oxygen via nasal cannula at 2 L/min
  • Helping the client select a low-salt diet
  • Encouraging the client to drink 2 to 3 L of water daily - ✔✔Encouraging the client 2 to 3 L of water daily ✔✔While performing an admission assessment for a client, the nurse notes that the client has varicose veins with ulcerations and lower extremity edema with a report of a feeling of heaviness. Which of the following nursing diagnoses should the nurse identify as being the priority in the clients care?
  • Impaired tissue perfusion
  • Alteration in body image
  • Alteration in activity tolerance
  • Impaired skin integrity - ✔✔Impaired tissue perfusion ✔✔A nurse is caring for a client who is being admitted for an acute exacerbation of ulcerative colitis. Which of the following actions should the nurse take first?
  • Review the client's electrolyte values.
  • Check the client's perianal skin integrity.
  • Investigate the client's emotional concerns.
  • Obtain a dietary history from the client. - ✔✔Review the client's electrolytes values ✔✔A nurse is caring for a client who has a new diagnosis of urolithiasis. Which of the following should the nurse identify as an associated risk factor?
  • Hypocalcemia
  • BMI less than 25
  • Family history
  • Diuretic use - ✔✔Family history ✔✔. A nurse is planning care for a female client who has a T4 spinal cord injury and is at risk for acquiring urinary tract infections. Which of the following actions should the nurse include in the client's plan of care?
  • Cleanse the perineum from back to front.
  • Obtain a prescription for an indwelling urinary catheter.
  • Encourage fluid intake at and between meals.
  • Offer the client the bedpan every 2 hr. - ✔✔Encourage fluid intake at & between meals ✔✔A nurse is caring for a client who is scheduled to have a MRI scan. The client asks the nurse what to expect during the procedure, which of the following statements should the nurse take?
  • "An MRI scan is not distorted by movement, so you do not have to lie still."
  • "An MRI scan is a short procedure and should take no longer than 30 minutes."
  • "The MRI contrast dye contains iodine and can cause your skin to itch."
  • "An MRI scan is very noisy, and you will be allowed to wear earplugs while in the scanner." - ✔✔"An MRI scan is very noisy, and you will be allowed to wear earplugs while in the scanner." ✔✔A nurse is instructing a client who is newly diagnosed with pulmonary TB about the use of antitubercular meds. Which of the following info should the nurse include in the teaching?
  • Medications will need to be taken for the rest of the client's life, even if the client feels better.
  • Medications will need to be taken until the Mantoux test is negative.
  • A typical course of treatment involves 6 to 9 months of consistent medication use.
  • The client's family will also need to take medications to prevent infection. - ✔✔A typical course of treatment involves 6 to 9 months of consistent med use ✔✔A nurse is admitting a client who has active tuberculosis to a room on a med surg unit. Which of the following room assignments should the nurse make for the client?
  • A room with air exhaust directly to the outdoor environment
  • A room with another nonsurgical client
  • A room in the ICU
  • A room that is within view of the nurses' station - ✔✔A room with air exhaust directly to the outdoor environment ✔✔A nurse is observing the closed chest drainage system of a client who is 24 hr post thoracotomy. The nurse notes slow, steady bubbling in the suction control chamber. Which of the following actions should the nurse take?
  • Check the tubing connections for leaks.
  • Check the suction control outlet on the wall.
  • Clamp the chest tube.
  • Continue to monitor the client's respiratory status. - ✔✔Continue to monitor the client's respiratory status
  • Serum T
  • Serum T3 - ✔✔Thyroid stimulating hormone (TSH) ✔✔A nurse is caring for a client who is receiving a unit of packed red blood cells. Fifteen minutes following the start of the transfusion, the nurse notes that the client is febrile, with chills and red tinged urine. Which of the following transfusion reactions should the nurse suspect?
  • Febrile
  • Allergic
  • Acute pain
  • Hemolytic - ✔✔Hemolytic ✔✔A nurse is providing instructions for a 52- year old client who is scheduled for a colonoscopy. The client reports that he has not had the procedure before and is very anxious about feeling pain during the procedure. Which of the following responses by the nurse is appropriate?
  • "Don't worry; most clients dislike the prep more than the procedure itself."
  • "Before the examination, your provider will give you a sedative that will make you sleepy."
  • "I know you're anxious, but this procedure is recommended for people your age."
  • "After you have signed the consent form, we can talk more about this." - ✔✔"Before the examination, your provider will give you a sedative that will make you sleepy." ✔✔A nurse is caring for a client who has addison's disease and is at risk for addisonian crisis. Which of the following actions should the nurse take?
  • Provide a low-carbohydrate diet.
  • Weigh the client daily.
  • Administer oral corticosteroids.
  • Restrict fluid intake. - ✔✔Weigh the client daily. ✔✔A nurse is caring for a client following cataract surgery. Which of the following comments from the client should the nurse report to the clients provider?
  • "My eye really itches, but I'm trying not to rub it."
  • "I need something for the pain in my eye. I can't stand it."
  • "It's hard to see with a patch on one eye. I'm afraid of falling."
  • "The bright light in this room is really bothering me." - ✔✔"I need something for the pain in my eye. I can't stand it." ✔✔A nurse is caring for a client who has had a stroke involving the right hemisphere. Which of the following alterations in function should the nurse expect?
  • Difficulty reading
  • Inability to recognize his family members
  • Right hemiparesis
  • Aphasia - ✔✔Inability to recognize his family members ✔✔A rehab nurse is caring for a client who had a spinal cord injury that resulted in paraplegia. After a week on the unit, the nurse notes that the client is withdrawn and increasingly resistant to rehabilitative efforts by the staff. Which of the following actions should the nurse take?
  • Inform the client that privileges are related to participation in therapy.
  • Limit visiting hours until the client begins to participate in therapy.
  • Allow the client to control the timing and frequency of the therapy.
  • Establish a plan of care with the client that sets attainable goals. - ✔✔Establish a plan of care with the client that sets attainable goals. ✔✔A nurse is conducting a primary survey of a client who has sustained life threatening injuries due to a mvc. Identify the sequence of the actions the nurse should take. - ✔✔Open the airway using a jaw thrust maneuver. Determine effectiveness of ventilator efforts Establish iv access Perform a glasgow coma scale assessment Remove clothing for a thorough assessment ✔✔A nurse is caring for a client who is 1 day postop following a transsphenoidal hypophysectomy. While assessing the client, the nurse notes a large area of clear drainage seeping from the nasal packing. Which of the following should be the nurse's initial action?
  • Document the amount of drainage.
  • Obtain a culture of the drainage.
  • Check the drainage for glucose.
  • Notify the client's provider. - ✔✔Check the drainage for glucose. ✔✔A nurse is caring for a client who has expressive aphasia following a CVA. Which of the following parameters should the nurse use first in order to assess the client's pain level?
  • pulse and blood pressure findings
  • behavioral indicators and effect
  • scheduled treatments and client illness
  • a self-report pain rating scale - ✔✔a self-report pain rating scale

✔✔A nurse is monitoring a client who was admitted with a severe burn injury and is receiving IV fluid resuscitation therapy. The nurse should identify a decrease in which of the following findings as an indication of adequate fluid replacement?

  • BP
  • Heart rate
  • Urine output
  • Weight - ✔✔Heart rate ✔✔A nurse is assessing a client who is 48hr postop following abdominal surgery. Which of the following findings should the nurse report to the provider?
  • Blood pressure 102/66 mm Hg
  • Straw-colored urine from an indwelling urinary catheter
  • Yellow-green drainage on the surgical incision
  • Respiratory rate 18/min - ✔✔Yellow-green drainage on the surgical incision ✔✔A nurse is completing d/c teaching w a client following arthroscopic knee surgery. Which of the following instructions should the nurse include in the teaching?
  • Remain on bedrest for the first 24 hr.
  • Keep the leg in a dependent position.
  • Apply ice to the affected area.
  • Begin active range of motion. - ✔✔Apply ice to the affected area. ✔✔A nurse is caring for a client who is undergoing a lumbar puncture. Which of the following is the priority action for the nurse take to maintain privacy for the client?
  • Close the door to the client's room.
  • Pull the curtains around the client's bed.
  • Ask family members to leave the room.
  • Use sterile drapes to cover the client. - ✔✔Pull the curtains around the client's bed. ✔✔A nurse in an ophthalmology clinic is interviewing a client who was referred by his primary care provider for suspicion of cataracts. The nurse should expect the client to report
  • loss of central vision.
  • having a loss of peripheral vision.
  • seeing bright flashes of light and floaters.
  • having a decreased ability to perceive colors. - ✔✔Having a decreased ability to perceive colors.

✔✔A nurse is caring for a client who has parkinson's disease is taking diphenhydramine 25 mg po tid. Which of the following therapeutic outcomes should the nurse expect to see?

  • Delay in disease progression
  • Improved bladder function
  • Relief of depression
  • Decreased tremors - ✔✔Decreased tremors ✔✔A nurse is assessing a client who is receiving one unit packed RBC's to treat intraop blood loss. The client reports chills and back pain, and the client's bp is 80/64 mmhg. Which of the following actions should the nurse take first?
  • Stop the infusion of blood.
  • Inform the provider.
  • Obtain a urine specimen.
  • Notify the laboratory. - ✔✔Stop the infusion of blood. ✔✔A nurse is caring for a client who has a new diagnosis of myasthenia gravis. For which of the following manifestations should the nurse monitor?
  • Confusion
  • Weakness
  • Increased intracranial pressure
  • Increased urinary output - ✔✔Weakness ✔✔A nurse is caring for a client who is 5 hour postop following a TURP. The nurse notes that the client's indwelling urinary catheter has not drained in the past hour. Which of the following actions should the nurse take first?
  • Notify the provider.
  • Check the tubing for kinks.
  • Adjust the rate of the bladder irrigant.
  • Irrigate the catheter. - ✔✔Check the tubing for kinks. ✔✔. A nurse is reviewing the ABG values of a client who has chronic kidney disease. Which of the following sets of values should the nurse expect?
  • pH 7.25, HCO3- 19 mEq/L, PaCO2 30 mm Hg
  • pH 7.30, HCO3- 26 mEq/L, PaCO2 50 mm Hg
  • pH 7.50, HCO3- 20 mEq/L, PaCO2 32 mm Hg
  • pH 7.55, HCO3- 30 mEq/L, PaCO2 31 mm Hg - ✔✔pH 7.25, HCO3- 19 mEq/L, PaCO2 30 mm Hg
  • Administer vitamin K. - ✔✔Reduce the client's intake of protein. ✔✔A nurse is caring for an adult client who has dementia and handles anxiety by confabulating. The nurse should recognize confabulation when the client
  • displays compulsive and ritualistic behaviors.
  • reminisces about the past.
  • makes up stories when he is unable to remember actual events.
  • refuses to leave home to see a provider. - ✔✔makes up stories when he is unable to remember actual events. ✔✔A nurse is reviewing the lab data of a client who has acute pancreatitis. The nurse should expect to find an elevation of which of the following values?
  • Calcium
  • RBC count
  • Magnesium
  • Amylase - ✔✔Amylase ✔✔A nurse in the ED is caring for a client who has extensive partial and full thickness burns of the head, neck, and chest. While planning the clients care, the nurse should identify which of the following risks as the priority for the assessment and intervention?
  • Airway obstruction
  • Infection
  • Fluid imbalance
  • Paralytic ileus - ✔✔Airway obstruction ✔✔A nurse is caring for a client who was admitted with bleeding esophageal varices and has an esophagogastric balloon tamponade with a sengstaken-blakemore tube to control the bleeding. Which of the following actions should the nurse take?
  • Ambulate the client four times per day.
  • Encourage the client to consume clear liquids.
  • Provide frequent oral and nares care.
  • Keep the client in a supine position. - ✔✔Provide frequent oral and nares care. ✔✔A nurse is caring for a client who has a chest tube connected to a closed drainage system & needs to be transported to the x-ray dept. Which of the following actions should the nurse take?
  • Clamp the chest tube prior to transferring the client to a wheelchair.
  • Disconnect the chest tube from the drainage system during transport.
  • Keep the drainage system below the level of the client's chest at all times.
  • Empty the collection chamber prior to transport. - ✔✔Keep the drainage system below the level of the client's chest at all times. ✔✔ A nurse is providing teaching to a client who is postoperative following coronary artery bypass graft (CABG) surgery and is receiving opioid medications to manage discomfort. Aside from managing the pain, which of the following desired effects of medications should the nurse identify as most important for the client's recovery?
  • It decreases the client's level of anxiety.
  • It facilitates the client's deep breathing.
  • It enhances the client's ability to sleep.
  • It reduces the client's blood pressure. - ✔✔It facilitates the client's deep breathing ✔✔A nurse is caring for a client who is postoperative and is at risk for developing venous thromboembolism (VTE). The nurse should instruct the client to avoid which of the following unsafe actions?
  • Elevating her feet
  • Massaging her legs
  • Flexing her ankles
  • Ambulating soon after surgery - ✔✔Massaging her legs ✔✔A nurse is assessing a client who has a long history of smoking and is suspected of having laryngeal cancer. The nurse should anticipate that the client will report that her earliest manifestation was
  • dysphagia
  • hoarseness.
  • dyspnea.
  • weight loss - ✔✔hoarseness ✔✔A nurse is assessing a client who is admitted with hyperthyroidism. the client reports a weight loss of 5/4 kg (12lb) in the last 2 months, increased appetite, increased perspiration, fatigue, menstrual irregularity, and restlessness. which of the following actions should the nurse take to prevent a thyroid crisis?
  • Provide a quiet, low-stimulus environment.
  • Administer aspirin as prescribed for any sign of hyperthermia.
  • Keep the client NPO.
  • Observe the client carefully for signs of hypocalcemia. - ✔✔Provide a quiet, low- stimulus environment. ✔✔A nurse in the emergency department is monitoring a client who has a cervical spinal cord injury from a fall. The nurse should monitor the client for which of the following complications? SATA
  • Frequent mood changes
  • Weight gain of 10lbs in 3 weeks - ✔✔Frequent mood changes. ✔✔A nurse in an emergency department is caring for a client who had a seizure and became unresponsive after stating she had a sudden, severe headache and vomiting. The client's vital signs are as follows: blood pressure of 198/110 mm Hg, pulse of 82/min, respirations of 24/min, and a temperature of 38.2° C (100.8° F). Which of the following neurologic disorders should the nurse suspect? - ✔✔hemorrhagic stroke