Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
The nurse is assessing the apical pulse. Where should the stethoscope be placed?
A. Between the fourth and fifth intercostal space.
The apical pulse is located at the fifth intercostal space at the left midclavicular line.
B. Between the third and fourth intercostal space.
C. Between the second and third intercostal space.
D. Between the first and second intercostal space.
This question is an excerpt from Nurse Dive's nursing test bank - ATI Med Surg Nur214 proctored exam. Take the full exam now
Full Explanation
Choice A rationale
The apical pulse is located at the fifth intercostal space at the left midclavicular line.
Similar Questions
Which of the following actions is specific to the Health Information Technology for Economic and Clinical Health (HITECH) Act?
A. The nurse assures that no protected health information is posted on social media.
The HITECH Act established a regulatory framework for EHRs that imposed security and privacy requirements not only on medical providers, but also on other companies and organizations they did business with that might also handle EHR data. This includes ensuring that no protected health information is posted on social media.
B. Unlicensed assistive personnel close all paper charts when not in use.
C. The unit secretary verifies patient information prior to delivering mail.
D. The nurse requests a specific password prior to meeting with patient family members.
Full Explanation
Choice A rationale
The HITECH Act established a regulatory framework for EHRs that imposed security and privacy requirements not only on medical providers, but also on other companies and organizations they did business with that might also handle EHR data. This includes ensuring that no protected health information is posted on social media.
The nurse reviews morning lab results on his patients.
Based on these lab results which patient should the nurse see first?
A. Sodium 130 mEq/L.
B. Potassium 6.4 mmol/K.
A potassium level of 6.4 mmol/K is above the normal range (3.5-5.0 mmol/L) and can be life- threatening. High potassium levels can lead to dangerous heart rhythms.
C. Hgb 8.6 g/dL.
D. Fasting Glucose 145 mg/dL.
Full Explanation
Choice B rationale
A potassium level of 6.4 mmol/K is above the normal range (3.5-5.0 mmol/L) and can be life- threatening. High potassium levels can lead to dangerous heart rhythms.
The nurse is assessing a patient being cared for at the end of life. Which of the following respiratory patterns would be expected?
A. Bradypnea.
B. Hyperpnea.
C. Kussmal’s Respirations.
D. Cheyne-Stokes Respirations.
Cheyne-Stokes respirations, a pattern of breathing characterized by a gradual increase in depth and sometimes in rate to a maximum depth, followed by a decrease resulting in apnea, are commonly observed in patients nearing the end of life.
Full Explanation
Choice D rationale
Cheyne-Stokes respirations, a pattern of breathing characterized by a gradual increase in depth and sometimes in rate to a maximum depth, followed by a decrease resulting in apnea, are commonly observed in patients nearing the end of life.