A client at 33 weeks of gestation is admitted with painless, bright red vaginal bleeding. Her uterus is soft and nontender and the fetal heart rate is 145/min. Which prescription should the nurse question?
Continuous electronic fetal monitoring
Intravenous access with blood type and screen
Bed rest with weighing of perineal pads
Digital examination of the cervix to assess dilation
Show the answer and explanation
Answer: D. Digital examination of the cervix to assess dilation
Topic: placenta previa precautions
Painless bright red bleeding with a soft uterus in the third trimester suggests placenta previa. A finger passed through the cervix can tear the placenta and cause massive hemorrhage, so no digital vaginal examination is done until ultrasound has shown where the placenta lies.
Why the others are wrong
A – Fetal monitoring is needed to detect compromise from maternal blood loss.
B – Venous access and blood typing prepare for possible hemorrhage and transfusion.
C – Rest and pad weights reduce bleeding and quantify blood loss; both are appropriate.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
2Question
Two hours after cardiac catheterization through the right femoral artery, a client reports new low back pain and seems restless. The heart rate has risen from 84 to 112/min and the blood pressure has changed from 124/76 to 106/68 mm Hg. The groin dressing is dry with no swelling. Which action should the nurse take first?
Turn the client onto the side with a pillow behind the back and give the prescribed analgesic.
Keep the client flat with the right leg straight and notify the provider immediately of possible bleeding.
Reassure the client that back discomfort from lying flat is common because the dressing is dry.
Raise the head of the bed to 45 degrees and encourage oral fluids.
Show the answer and explanation
Answer: B. Keep the client flat with the right leg straight and notify the provider immediately of possible bleeding.
Topic: retroperitoneal bleeding after cardiac catheterization
Bleeding from a femoral puncture can track behind the peritoneum, where it is hidden from view. Back or flank pain with tachycardia, restlessness and a falling pressure are early signs of hypovolemia from retroperitoneal bleeding, so the limb is kept still and the provider is called at once.
Why the others are wrong
A – Turning and analgesia treat the pain as positional and may mask a bleed while the leg is moved.
C – Retroperitoneal bleeding is concealed, so a dry site with changing vital signs is not reassuring.
D – Raising the head of the bed flexes the hip at the puncture site and can worsen bleeding; oral fluids do not address blood loss.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
3Question
A client has a mature arteriovenous fistula in the left forearm for hemodialysis and is admitted to a medical unit. Which measures does the nurse include in the plan of care?
Select all that apply.
Take blood pressure readings on the right arm only.
Do not draw blood or start an IV line in the left arm.
Feel for a thrill and listen for a bruit over the fistula every shift.
Have the client wear the identification band and wristwatch snugly on the left wrist.
Reassure the client that loss of the vibration over a mature fistula is expected.
Show the answers and explanation
Answers: A, B and C.
A – Take blood pressure readings on the right arm only.
B – Do not draw blood or start an IV line in the left arm.
C – Feel for a thrill and listen for a bruit over the fistula every shift.
Topic: hemodialysis access care
A fistula is the client's lifeline and is lost if it clots or becomes infected. Anything that compresses the arm or punctures the vessel is avoided - blood pressure cuffs, venipuncture, IV lines, tight bands and clothing - and patency is confirmed by a palpable thrill and an audible bruit. Their absence means the access may have clotted and is reported at once.
Why the others are wrong
D – Anything tight around the access arm reduces flow and can cause the fistula to clot.
E – A patent fistula always has a thrill; its absence suggests clotting and is reported immediately.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
4Question
A client is in the third week of external beam radiation therapy to the chest wall. Which statement by the client shows a need for further teaching about skin care?
'I wash the area gently with lukewarm water and a mild soap and pat it dry.'
'I wear a loose, soft cotton shirt over the treated area.'
'When the skin feels hot and itchy, I hold an ice pack on it.'
'I keep the treated skin covered from the sun when I go outside.'
Show the answer and explanation
Answer: C. 'When the skin feels hot and itchy, I hold an ice pack on it.'
Topic: external radiation skin care
Irradiated skin is fragile and has a reduced ability to tolerate extremes of temperature, so neither ice nor heat is applied to the treatment field. Gentle washing, loose soft clothing and sun protection are all correct care.
Why the others are wrong
A – Gentle washing with lukewarm water and mild soap and patting dry is recommended care.
B – Loose, soft clothing prevents friction on the treated skin; this is correct.
D – Irradiated skin burns easily and must be protected from the sun; this is correct.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
5Question
The parent of a 3-week-old infant telephones the clinic. A new long-leg cast was applied this morning for clubfoot. The parent reports that the toes look dusky and feel cool, and that they have not turned pink after the leg was raised on a pillow for 30 minutes. Which instruction should the nurse give?
"Bring her to the clinic or the emergency department now so that the cast can be checked."
"Keep the leg raised overnight and look at the toes again in the morning."
"Wrap the toes in a warm blanket and give the pain reliever you were told about."
"Trim the top edge of the cast with scissors to give the leg more room."
Show the answer and explanation
Answer: A. "Bring her to the clinic or the emergency department now so that the cast can be checked."
Topic: clubfoot cast - neurovascular compromise
Cool, dusky toes that do not recover with elevation mean the cast is compromising circulation. Tissue damage follows quickly, so the cast must be assessed, and split or removed, without delay.
Why the others are wrong
B – Hours of reduced blood flow can cause permanent tissue injury; elevation has already been tried and failed.
C – Warming masks one sign without restoring circulation, and analgesia does not treat the cause.
D – Cutting the cast at home does not relieve pressure along its length, leaves sharp edges and ruins the corrective position.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
6Question
A 9-year-old child had a cast applied to the arm six hours ago for a fracture just above the elbow. The child received a prescribed opioid 40 minutes ago, yet the pain is increasing, and the child screams when the nurse gently straightens the fingers. The fingers are pale. Which action is the nurse's priority?
Raise the arm on pillows above the level of the heart and apply ice
Give the next dose of the opioid early
Tell the child and parent that pain is expected for the first two days, and reassess in an hour
Notify the provider immediately and keep the arm at the level of the heart
Show the answer and explanation
Answer: D. Notify the provider immediately and keep the arm at the level of the heart
Topic: compartment syndrome after fracture
Pain that is out of proportion, is not relieved by opioids and is made worse by passive stretching of the fingers is the early picture of compartment syndrome, a known risk of fractures above the elbow. Pressure must be released within hours - by splitting the cast and, if needed, fasciotomy - to prevent permanent muscle and nerve damage. The limb is kept at heart level because raising it higher lowers arterial flow into the compartment.
Why the others are wrong
A – Raising the limb above the heart and applying cold both reduce arterial inflow to tissue that is already short of blood.
B – More opioid hides the most important warning sign and does nothing about the pressure.
C – Pain that worsens despite opioids is not the expected course; an hour's delay risks irreversible damage.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
7Question
A client had a cast applied to the lower leg for a tibial fracture 8 hours ago. The client rates the pain at 9 on a 0 to 10 scale 45 minutes after an IV opioid, cries out when the nurse gently moves the toes, and says the foot feels tight and tingling. Which action is the nurse's priority?
Raise the leg on two pillows above the level of the heart and apply ice
Give the next prescribed dose of opioid and reassess in one hour
Notify the surgeon immediately and keep the leg at the level of the heart
Reassure the client that strong pain is expected on the first day after a fracture
Show the answer and explanation
Answer: C. Notify the surgeon immediately and keep the leg at the level of the heart
Topic: compartment syndrome under a cast
Pain out of proportion to the injury that is not relieved by opioids, pain on passive stretch and paresthesia are the early signs of acute compartment syndrome. It is a limb-threatening emergency that requires urgent release of pressure; the limb is kept at heart level because raising it higher lowers arterial inflow, and ice constricts vessels.
Why the others are wrong
A – Elevation above heart level reduces arterial flow into the compartment and ice causes vasoconstriction; both worsen ischemia.
B – Pain that does not respond to an opioid is itself the warning sign; another dose and an hour's wait lets tissue die.
D – Fracture pain is expected, but pain unrelieved by opioids with pain on passive movement is not, and must not be normalized.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
8Question
A client has a chest tube connected to a water-seal drainage system with suction after a right lower lobectomy yesterday. Which findings require the nurse to intervene?
Select all that apply.
New continuous bubbling in the water-seal chamber, which showed no bubbling earlier in the shift
The water level in the water-seal chamber rises and falls with breathing
250 mL of bright red drainage in the past hour
Gentle continuous bubbling in the suction-control chamber
The drainage unit is standing upright on the floor, below the level of the chest
Show the answers and explanation
Answers: A and C.
A – New continuous bubbling in the water-seal chamber, which showed no bubbling earlier in the shift
C – 250 mL of bright red drainage in the past hour
Topic: chest tube troubleshooting
New continuous bubbling in a water-seal chamber that was previously quiet indicates a new air leak in the system or from the client and must be traced. A large amount of bright red drainage in one hour indicates hemorrhage and is reported at once. Tidaling, gentle bubbling in the suction-control chamber and a unit kept below the chest are all expected.
Why the others are wrong
B – Tidaling shows that the tube is open and in the pleural space; it is expected.
D – Gentle continuous bubbling in the suction-control chamber is the normal sign that suction is working.
E – Keeping the unit upright and below chest level is correct; it prevents drainage from flowing back.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
9Question
A client with a tracheostomy suddenly becomes restless. The nurse hears loud, gurgling breath sounds and the oxygen saturation has fallen from 96% to 86%. Which action should the nurse take first?
Call the respiratory therapist to assess the client
Suction the tracheostomy
Change the tracheostomy ties
Increase the humidity delivered through the tracheostomy collar
Show the answer and explanation
Answer: B. Suction the tracheostomy
Topic: tracheostomy airway obstruction
Gurgling sounds, restlessness and a falling oxygen saturation indicate that secretions are obstructing the airway. Suctioning is the direct, immediate action that clears the airway and is within the nurse's own scope.
Why the others are wrong
A – Waiting for another clinician delays clearing an airway that the nurse can clear immediately.
C – Changing the ties does nothing for the obstruction and risks dislodging the tube in a restless client.
D – Humidification helps keep secretions thin over time, but does not remove secretions that are blocking the airway now.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
10Question
Ten minutes after the first intravenous dose of an antibiotic is started, a client says, "I feel strange." Which finding should the nurse act on first?
Itching with a few scattered hives on both forearms
Hoarse voice, swollen lips and noisy breathing
Mild nausea without vomiting
Temperature of 99.6°F (37.6°C)
Show the answer and explanation
Answer: B. Hoarse voice, swollen lips and noisy breathing
Topic: airway edema during an infusion reaction
A hoarse voice, lip swelling and noisy breathing signal airway edema from a severe allergic reaction, which can progress to complete obstruction. The nurse stops the infusion, keeps the line open with normal saline, calls for help, and prepares for intramuscular epinephrine as ordered. Skin changes, mild nausea and a low-grade temperature do not threaten the airway.
Why the others are wrong
A – Hives and itching are allergic signs that need attention, but they do not threaten the airway yet.
C – Mild nausea is a common drug effect and is not a sign of airway compromise.
D – A temperature just under 100°F is minor and does not outrank an airway problem.
Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.
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