A client at 34 weeks of gestation is lying flat on her back for an examination. She says she feels dizzy and sick. She is pale and clammy, and her blood pressure is 90/50 mm Hg. Which action should the nurse take first?
Help the client turn onto her left side
Start an intravenous line for a fluid bolus
Raise the client's legs while she stays on her back
Give the client crackers and juice
Show the answer and explanation
Answer: A. Help the client turn onto her left side
Topic: supine hypotensive syndrome
In the supine position the heavy uterus compresses the inferior vena cava and aorta, reducing venous return and cardiac output (supine hypotensive syndrome). Moving the uterus off the vessels by turning the client to her side corrects the cause within minutes.
Why the others are wrong
B – An intravenous bolus is invasive and slower, and does not relieve the compression; it is considered only if repositioning fails.
C – Raising the legs while she remains supine leaves the vena cava compressed.
D – The cause is not low blood glucose; feeding a nauseated, hypotensive client delays the effective action.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
2Question
A client's scheduled dose of metoprolol is due. The cardiac monitor shows a regular rhythm at 44/min with one P wave before every QRS complex. The client reports feeling lightheaded, and the blood pressure is 84/50 mm Hg. Which action should the nurse take first?
Withhold the metoprolol, keep the client lying down, and notify the provider while preparing for atropine.
Give half of the metoprolol dose and recheck the heart rate in one hour.
Ask the client to bear down as if having a bowel movement to raise the heart rate.
Document the rhythm as sinus bradycardia and continue routine monitoring.
Show the answer and explanation
Answer: A. Withhold the metoprolol, keep the client lying down, and notify the provider while preparing for atropine.
Topic: symptomatic sinus bradycardia on a beta blocker
This is sinus bradycardia with signs of poor perfusion (lightheadedness and hypotension). A beta blocker would slow the heart further, so it is held; symptomatic bradycardia is treated, with atropine as the first-line drug in the adult bradycardia algorithm.
Why the others are wrong
B – Any dose of a beta blocker will further slow the rate and lower the pressure; nurses also do not alter a dose without a prescription.
C – Bearing down is a vagal maneuver that slows the heart rate; it is used for some fast rhythms, never for bradycardia.
D – Bradycardia may be left alone only when the client has no symptoms; here there is hypotension and lightheadedness.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
3Question
A client with acute respiratory distress syndrome is receiving mechanical ventilation. Thirty minutes after the positive end-expiratory pressure (PEEP) was increased, which finding requires the nurse's immediate action?
Oxygen saturation has risen from 86% to 91%.
Blood pressure has fallen from 116/70 to 84/48 mm Hg.
Fine crackles are still heard in both lungs.
Urine output for the last hour was 40 mL.
Show the answer and explanation
Answer: B. Blood pressure has fallen from 116/70 to 84/48 mm Hg.
Topic: ARDS and complications of PEEP
PEEP raises pressure inside the chest. Higher levels reduce venous return to the heart and so lower cardiac output and blood pressure; they can also cause barotrauma. A marked fall in pressure after an increase in PEEP must be acted on and reported at once.
Why the others are wrong
A – Improved saturation is the goal of raising PEEP.
C – Crackles are expected with the alveolar fluid of this syndrome and do not resolve quickly.
D – An output of 40 mL in an hour is within the acceptable range for an adult and shows adequate kidney perfusion at present.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
4Question
A 5-month-old infant with unrepaired tetralogy of Fallot becomes deeply cyanotic and breathes rapidly while crying during a blood draw. Which action should the nurse take first?
Lay the infant supine with the legs extended.
Place the infant in the knee-chest position.
Hold the infant upright over the shoulder and pat the back.
Offer a bottle and complete the blood draw quickly.
Show the answer and explanation
Answer: B. Place the infant in the knee-chest position.
Topic: tetralogy of Fallot hypercyanotic spell
In a hypercyanotic spell, more blood is shunted right to left past the lungs. Bringing the knees to the chest raises systemic vascular resistance, which reduces the shunt and sends more blood to the lungs; calming the infant and giving oxygen follow.
Why the others are wrong
A – Lying flat with the legs extended does nothing to raise systemic resistance and the spell continues.
C – An upright hold with back patting does not change the shunt and delays the effective position.
D – Continuing the painful procedure prolongs the crying that triggered the spell.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
5Question
A client sustained a spinal cord injury at C6 two hours ago. Blood pressure is 80/46 mm Hg, and the nurse suspects neurogenic shock. Which additional findings support this?
Heart rate 128/min with cool, clammy skin
Heart rate 118/min with distended neck veins and muffled heart sounds
Heart rate 50/min with warm, dry skin
Heart rate 122/min with hives and wheezing
Show the answer and explanation
Answer: C. Heart rate 50/min with warm, dry skin
Topic: shock types and expected findings
Neurogenic shock follows the loss of sympathetic nerve supply below a high spinal cord injury. Blood vessels dilate, so the skin is warm and dry and the pressure falls, and the unopposed vagus nerve slows the heart. It is the one form of shock in which hypotension comes with bradycardia rather than tachycardia.
Why the others are wrong
A – Tachycardia with cool, clammy skin is the compensated picture of hypovolemic shock, for example from hidden bleeding.
B – Distended neck veins and muffled heart sounds with hypotension point to cardiac tamponade, an obstructive shock.
D – Hives and wheezing with hypotension indicate anaphylactic shock.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
6Question
A client is admitted with left-sided heart failure. Which findings are caused directly by failure of the left ventricle?
Select all that apply.
Crackles in both lungs
Shortness of breath when lying flat
Distended neck veins
Fluid in the abdomen (ascites)
Pitting edema of both ankles
Show the answers and explanation
Answers: A and B.
A – Crackles in both lungs
B – Shortness of breath when lying flat
Topic: heart failure left versus right
When the left ventricle fails, blood backs up into the pulmonary veins and the lungs, which causes crackles, cough and breathlessness that is worse lying flat. When the right ventricle fails, blood backs up into the veins of the body, which causes distended neck veins, an enlarged liver, ascites and dependent edema.
Why the others are wrong
C – Neck veins fill when the right side of the heart cannot accept returning blood; this is a right-sided sign.
D – Ascites comes from venous congestion of the liver and abdomen in right-sided failure.
E – Dependent edema results from raised pressure in the systemic veins, a right-sided sign.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
7Question
Six hours after coronary artery bypass surgery, a client's chest tube drainage falls suddenly from 100 mL/hour to almost nothing. Blood pressure is 82/66 mm Hg, heart rate 126/min, the neck veins are distended and the heart sounds are faint. Which action does the nurse take?
Give the prescribed PRN IV furosemide for the distended neck veins
Turn the client onto the left side and recheck the drainage in 30 minutes
Record the drop in drainage as an expected sign of recovery
Notify the surgeon at once and prepare for emergency drainage of the pericardium
Show the answer and explanation
Answer: D. Notify the surgeon at once and prepare for emergency drainage of the pericardium
Topic: cardiac tamponade
A sudden stop in drainage with hypotension, a narrow pulse pressure, distended neck veins and muffled heart sounds means blood is collecting around the heart and squeezing it: cardiac tamponade. The heart cannot fill, output falls quickly, and the only treatment is to remove the blood, so the surgeon is called immediately.
Why the others are wrong
A – The neck veins are full because the heart is compressed, not because of fluid overload; a diuretic lowers filling further and can cause collapse.
B – Waiting 30 minutes in a client who is already hypotensive allows cardiac arrest.
C – Drainage that recovers normally tapers gradually and the client stays stable; a sudden stop with these signs is an emergency.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
8Question
A client becomes unresponsive. The monitor shows an organized rhythm at 70/min, but the nurse cannot feel a carotid pulse and the client is not breathing. The emergency team has been called. Which actions are appropriate?
Select all that apply.
Begin chest compressions immediately
Deliver an unsynchronized shock
Give epinephrine IV as directed by the resuscitation protocol
Look for reversible causes such as low blood volume and low oxygen
Deliver a synchronized shock
Show the answers and explanation
Answers: A, C and D.
A – Begin chest compressions immediately
C – Give epinephrine IV as directed by the resuscitation protocol
D – Look for reversible causes such as low blood volume and low oxygen
Topic: pulseless electrical activity
An organized rhythm without a pulse is pulseless electrical activity. The heart's electrical system is working but the heart is not moving blood, so a shock cannot help. Treatment is high-quality CPR, epinephrine, and a search for the cause, since the arrest ends only when the cause is corrected.
Why the others are wrong
B – Defibrillation is for ventricular fibrillation and pulseless ventricular tachycardia; an organized rhythm has nothing to reset.
E – Synchronized cardioversion is for unstable fast rhythms in a client who has a pulse; it has no role in cardiac arrest.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
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Nursing