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Worksheets2121 Exam 2 OT 2
Total questions: 96
Worksheet time: 48mins
A nurse is reviewing ECG results for a client with a potassium level of 6.4 mEq/L. Which ECG finding should the nurse expect?
Flattened T waves
Prominent U waves
Peaked T waves
Prolonged QT interval
A nurse is caring for a client receiving spironolactone. Which assessment finding requires the nurse to hold the medication and notify the provider?
Blood pressure 110/68 mm Hg
Potassium 5.8 mEq/L
Heart rate 76/min
Sodium 138 mEq/L
A client with hyperkalemia secondary to acute kidney injury is receiving sodium polystyrene sulfonate. Which finding indicates the medication is having its intended effect?
Increased urine output
Decreased serum potassium level
Decreased blood glucose level
Improved ECG rhythm immediately
A nurse is teaching a client about medications that increase potassium levels. Which medication should the nurse include as a potassium-sparing diuretic?
Hydrochlorothiazide
Furosemide
Spironolactone
Mannitol
A nurse is assessing a client who is most at risk for developing peripheral artery disease (PAD). Which history finding is the strongest risk factor?
Long-term cigarette smoking
Daily oral contraceptive use
Sedentary job with 8-hr shifts
Family history of varicose veins
A nurse is identifying modifiable risk factors for PAD in a client with intermittent claudication. Which finding is the priority contributor to PAD progression?
Body mass index of 29
Long-standing diabetes mellitus
Smoking 1 pack per day
Age older than 60 years
A nurse is screening clients for PAD risk. Which client has the highest risk profile?
30-year-old with asthma using an inhaler
52-year-old with migraines and normal BP
41-year-old who exercises daily with LDL 90 mg/dL
67-year-old with diabetes, hypertension, and hyperlipidemia
A nurse is teaching a client with PAD about long-term risk reduction. Which instruction targets a major PAD risk factor?
Increase potassium-rich foods daily
Begin daily hot foot soaks
Keep legs elevated above the heart when resting
Maintain blood pressure, glucose, and lipid control as prescribed
A nurse is differentiating arterial insufficiency from venous insufficiency. Which finding is most consistent with arterial disease?
Brown discoloration at the ankles
Warm legs with edema that improves with elevation
Diminished pedal pulses with cool skin
Weeping drainage from a shallow ulcer near the medial malleolus
A client reports leg pain that worsens when the legs are elevated and improves when dangling at the bedside. Which disorder is most consistent with this report?
Peripheral arterial disease
Peripheral venous disease
Cellulitis
Lymphedema
A nurse assesses a client with chronic venous insufficiency. Which manifestation is most expected?
Pain that improves with dependency
Ulcer on the tip of the toe
Cool, pale skin with hair loss
Edema with aching that improves with leg elevation
A client has a shallow, irregular ulcer near the medial malleolus with moderate drainage. Which underlying disorder is most likely?
Arterial insufficiency
Venous insufficiency
Acute arterial occlusion
Neuropathy only
A nurse is assessing a client for PAD manifestations. Which finding most strongly supports PAD?
Warm skin temperature and bounding pulses
Bilateral ankle edema that improves with elevation
Shiny, hairless lower legs with diminished pedal pulses
Calf tenderness with redness along a vein
A client reports calf pain while walking that is relieved by rest. Which interpretation is most consistent with this pattern?
Venous stasis pain
Intermittent claudication
Neuropathic pain
Musculoskeletal strain
A client with PAD reports severe foot pain at night. Which nursing instruction is most appropriate to improve perfusion?
Elevate the legs above heart level
Apply a heating pad to the feet
Keep legs dependent at the bedside
Apply compression stockings tightly
A nurse is teaching a client with PAD about foot care. Which instruction is most appropriate?
Soak feet in hot water daily
Inspect feet daily using a mirror if needed
Use a heating pad if feet feel cold
Trim toenails into rounded corners to prevent ingrown nails
A nurse is assessing for manifestations of peripheral venous disease. Which finding is most expected?
Pain that worsens with walking and improves with rest
Pallor and dependent rubor
Cool, thin skin with absent pulses
Aching heaviness with edema that improves with elevation
A nurse is differentiating venous disease from PAD. Which assessment finding most supports venous insufficiency?
Ulcer on toes with minimal drainage
Brown discoloration and edema near the ankles
Decreased capillary refill with cool extremity
Pain worse with leg elevation
A client has chronic venous insufficiency. Which report is most consistent with venous disease rather than PAD?
"My pain gets worse when I elevate my legs."
"My toes look pale when I lift my leg."
A client has venous stasis ulcers. Which intervention is most appropriate to promote healing?
Keep legs dependent for comfort
Apply heating pads to improve blood flow
Restrict ambulation to prevent pain
Encourage frequent leg elevation and use prescribed compression
A nurse is performing neurovascular checks after a lower-extremity procedure. Which finding requires immediate provider notification?
Capillary refill 2 seconds
Warm skin temperature
Absent pedal pulse in the affected extremity
Mild tingling that resolves after repositioning
A nurse is trending neurovascular status. Which assessment set is the priority for early identification of acute ischemia?
Bowel sounds, urine output, temperature
Pain, pallor, pulses, paresthesia
Respiratory rate, lung sounds, oxygen saturation
Appetite, nausea, bowel movements
A client reports increasing leg pain after cast application and says the leg “feels tight,” with new numbness in the toes. Which action is the nurse’s priority?
Elevate the extremity and apply ice
Give prescribed analgesic and reassess in 30 minutes
Encourage ambulation to improve circulation
Perform an immediate full neurovascular assessment and notify the provider
A nurse is documenting reassessment after an intervention for impaired perfusion. Which finding best indicates improved tissue perfusion?
Capillary refill improving from 5 seconds to 2 seconds
Increasing numbness in toes
Skin becoming cooler to touch
Increased pain with passive movement
A nurse is completing a history on a client at highest risk for developing peripheral artery disease (PAD). Which finding is the most significant risk factor?
Long-term cigarette smoking
History of seasonal allergies
Daily yoga practice
Calcium supplement use
A nurse is reinforcing teaching to a client with PAD about risk reduction. Which change is the priority to slow disease progression?
Increase potassium intake
Stop smoking completely
Increase fluid intake to 3 L/day
Use heating pads on the legs daily
A nurse is evaluating risk factors in four clients. Which client is at greatest risk for PAD?
24-year-old with asthma using an inhaler
39-year-old with migraines
61-year-old with diabetes and hypertension
52-year-old with lactose intolerance
A nurse is planning discharge teaching for a client with PAD. Which statement by the client indicates a need for further teaching?
“I’ll check my feet every day.”
“I’ll wear cotton socks.”
“I’ll avoid walking barefoot.”
“I’ll use a heating pad if my feet feel cold.”
A nurse is assessing a client with a history of peripheral vascular disorders. Which assessment finding is most consistent with arterial insufficiency rather than venous insufficiency?
Brown discoloration at the ankles
Warm skin with edema
Diminished pedal pulses
Weeping drainage from a leg ulcer
A nurse is caring for a client with peripheral vascular disorder and new numbness in the foot. Which action is the priority?
Place the client in Trendelenburg position
Apply compression stockings
Perform a neurovascular assessment immediately
Massage the calf to improve circulation
A client reports calf pain when walking that resolves with rest. Which condition should the nurse suspect?
Venous stasis
Intermittent claudication from PAD
Cellulitis
Deep vein thrombosis
A nurse is planning care for a client with peripheral vascular disorder. Which intervention is most appropriate for a client with arterial insufficiency?
Elevate legs above the heart for long periods
Apply sequential compression devices continuously
Encourage dangling legs in a dependent position to relieve pain
Apply tight elastic bandages from toes upward
A nurse is assessing a client who reports leg pain when walking and relief with rest. Which additional finding supports PAD?
Bounding pulses
Warm, reddened lower legs
Shiny, hairless skin on lower extremities
Bilateral ankle swelling that improves with elevation
A client with PAD has foot pain at night. Which position should the nurse recommend to improve tissue perfusion?
Elevate legs on pillows above heart level
Keep legs dependent at the bedside
Lie flat with legs straight
Apply cold packs to reduce pain
A nurse is assessing a client’s lower extremities. Which finding is the priority indicator of decreased arterial tissue perfusion?
2+ pitting edema at ankles
Warm skin temperature
Capillary refill of 6 seconds in toes
Brown discoloration at the gaiter area
A nurse is teaching a client with PAD about foot care. Which instruction is most appropriate?
“Use a heating pad to warm your feet.”
“Soak feet in hot water daily.”
“Trim toenails into rounded corners.”
“Inspect feet daily using a mirror if needed.”
A nurse is assessing a client with peripheral venous disease. Which finding is most expected?
Pain worse with leg elevation
Pallor with dependent positioning
Cold, numb toes with absent pulses
Edema and aching that improves with elevation
A nurse is differentiating venous vs arterial disease. Which finding supports peripheral venous disease rather than PAD?
Intermittent claudication
Thin, shiny skin with hair loss
Ulcer on the tips of toes
Brown discoloration near the ankles
A client has heaviness in legs, ankle swelling, and a shallow ulcer near the medial malleolus. Which nursing instruction is the priority?
Avoid compression because it decreases arterial flow
Keep legs in a dependent position at rest
Wear prescribed compression stockings consistently
Apply heating pads to increase circulation
A nurse performs a neurovascular check on a post-procedure client. Which finding requires immediate provider notification?
Capillary refill 2 seconds
Warm skin temperature
Tingling in toes with palpable pulses
Absent pedal pulse in the affected extremity
A nurse is completing neurovascular checks after a lower-extremity procedure. Which assessment components are priority to trend for early ischemia?
Bowel sounds and urine output
Pain, pallor, pulses, paresthesia
Lung sounds and respiratory rate
Blood glucose and skin turgor
A nurse notes increasing pain in a client’s leg after a cast application. The client reports numbness and “tightness.” Which action is the priority?
Elevate the leg and apply ice
Administer prescribed pain medication
Perform an immediate full neurovascular assessment
Encourage the client to ambulate
A nurse is documenting neurovascular reassessment findings. Which finding best indicates improvement in tissue perfusion?
Increased pain with passive movement
Capillary refill improving from 5 seconds to 2 seconds
Increasing numbness in the toes
Skin becoming cooler to touch
A nurse is reviewing a client’s history: BP 148/92, waist circumference increased, triglycerides 280 mg/dL, HDL 32 mg/dL, fasting glucose 110 mg/dL. Which teaching is the priority to reduce progression to type 2 diabetes and cardiovascular disease?
Begin a low-carb diet and stop all fats
Increase physical activity and focus on weight reduction
Start insulin therapy now to prevent complications
Restrict fluids to reduce blood pressure
A client with metabolic syndrome asks why the provider is “so worried” even though they “don’t have diabetes yet.” Which nurse response is best?
“Metabolic syndrome usually resolves on its own.”
“It means your pancreas has already stopped making insulin.”
“It signals insulin resistance and raises your risk for heart disease and diabetes.”
“It only increases risk if your A1c is already above 7%.”
A client has metabolic syndrome and takes a thiazide diuretic for hypertension. The nurse notes fasting glucose has increased over the last month. What is the nurse’s best action?
Teach the client to skip breakfast to lower glucose
Reinforce lifestyle changes and notify the provider of the trend
Treat the client for hypoglycemia immediately
Instruct the client to stop the diuretic abruptly
A client receives lispro at 0730 but their breakfast tray is delayed until 0815. Which action is the nurse’s priority?
Give the client a carbohydrate source immediately
Hold the next dose of long-acting insulin
Encourage the client to ambulate until the tray arrives
Administer regular insulin instead
A nurse is evaluating a client’s understanding of long vs short acting insulin. Which statement indicates correct understanding?
“Regular insulin starts working immediately, so I can take it after meals.”
“Glargine peaks strongly, so I need a snack at its peak time.”
“NPH is cloudy and has a peak, so I watch for lows later on.”
“Lispro lasts all day, so I only need it once daily.”
A nurse receives an order to give an IV insulin infusion for rapid glucose reduction. Which insulin type is appropriate for IV administration?
NPH insulin
Regular insulin
Insulin glargine U-100
Premixed 70/30 insulin
A nurse is reconciling home meds for a client with diabetes. Which order is most consistent with a long-acting (basal) insulin?
Insulin lispro (Humalog) 6 units subcut before each meal
Regular insulin 8 units subcut 30 min before breakfast
NPH insulin 10 units subcut at 0700 and 1900
Insulin glargine U-100 (Lantus) 18 units subcut at bedtime
A client is NPO for a procedure at 1000. The provider orders the client’s usual insulin regimen. Which insulin is the nurse most likely to question holding because it is short/rapid acting and meal-related?
Insulin lispro
Insulin glargine U-100
Insulin detemir
Insulin degludec
A nurse is teaching a client how to identify which insulin is “meal-time” versus “all-day.” Which client statement shows correct understanding?
“Glargine is my mealtime insulin because it works fast.”
“Regular insulin is my basal insulin because it lasts 24 hours.”
“Lispro is a mealtime insulin because it starts working quickly.”
“NPH is mealtime insulin because it has no peak.”
A client with atrial fibrillation is being discharged on warfarin. The nurse is reviewing home meds and finds the client also takes levothyroxine daily. Which instruction is most important to include?
“Have your INR checked more often when a new medication is added.”
“Take warfarin with food to prevent stomach upset.”
“Increase foods high in vitamin K to prevent bleeding.”
“Stop levothyroxine until your INR stabilizes.”
A client on a continuous heparin infusion suddenly develops bleeding at the IV site and gums. The provider prescribes the antidote. Which medication should the nurse prepare to administer?
Vitamin K (phytonadione)
Protamine sulfate
Alteplase
Fresh frozen plasma (FFP)
A client is receiving anticoagulant therapy after a DVT. Which assessment finding requires the nurse’s priority action?
Heart rate 96/min after ambulation
Mild bruising at venipuncture sites
Dark, concentrated urine after poor intake
Black, tarry stools
A client on warfarin has an INR 5.2 and reports “my gums bleed when I brush.” Which action is the nurse’s priority?
Hold the next dose and notify the provider
Give the scheduled dose and recheck INR tomorrow
Encourage more leafy greens for the next week
Administer protamine sulfate per protocol
A client receiving heparin develops sudden shortness of breath and their platelet count drops from 220,000/mm3 to 88,000/mm3. Which action is most appropriate?
Give aspirin to prevent clot formation
Continue heparin and recheck platelets in 6 hr
Start warfarin immediately at a loading dose
Stop heparin and notify the provider (possible HIT)
A client on warfarin says they started an “anti-inflammatory natural supplement” for joint pain. Which is the best nursing response based on bleeding risk?
“That’s fine—supplements don’t affect warfarin.”
“Take it only at night to reduce interaction.”
“Stop it and call your provider—some supplements increase bleeding.”
“Increase vitamin K foods to balance it out.”
Which discharge statement shows a client on anticoagulant therapy needs further teaching?
“I’ll use a soft toothbrush.”
“I’ll call if I notice blood in my urine.”
“I’ll avoid contact sports.”
“I’ll take ibuprofen for headaches instead of acetaminophen.”
A client on warfarin reports they are starting CoQ10. Which outcome is the nurse most concerned about?
Increased sedation and falls
Decreased warfarin effect leading to higher clot risk
Severe hypoglycemia
Acute kidney injury
The nurse is titrating an IV heparin infusion. Which lab is used to evaluate and adjust the infusion?
INR
aPTT
Hemoglobin A1c
Troponin
A client taking warfarin for chronic atrial fibrillation asks how to handle diet. Which instruction is best?
Avoid all foods with vitamin K completely
Increase vitamin K foods to “protect the blood”
Keep vitamin K intake consistent from day to day
Eat vitamin K foods only on days you skip warfarin
A client on anticoagulant therapy calls the clinic reporting new symptoms. Which symptom is most concerning and requires immediate evaluation?
Mild gum bleeding after flossing
Small ecchymosis on forearm
Sudden severe headache
Occasional nausea after meals
A client on warfarin says they’ve started resveratrol and saw palmetto supplements. What is the nurse’s priority concern?
Reduced warfarin effectiveness causing clotting
Hyperkalemia
Increased blood glucose
Increased bleeding risk from additive antiplatelet effects
A client on IV heparin develops excessive bleeding after a recent dose increase. Before administering the antidote, which action is most appropriate?
Give vitamin K IM
Increase the infusion rate to maintain therapeutic levels
Stop/hold the heparin infusion and notify the provider
Switch the client to aspirin immediately
A client on warfarin has an INR that has been stable for months. They suddenly develop easy bruising and epistaxis. Which “new change” is most likely to contribute and should be reported?
Starting a daily multivitamin without iron
Eating the same salad every night like usual
Taking warfarin at bedtime instead of morning
Adding levothyroxine after a new hypothyroidism diagnosis
A client receiving anticoagulant therapy asks what “counts” as dangerous bleeding. Which instruction is best?
“Only heavy bleeding matters—small bleeding is expected.”
“Bleeding is only dangerous if your blood pressure drops.”
“If you have bruising, stop the medication immediately.”
“Report bleeding that doesn’t stop, black stools, vomiting blood, or severe headache.”
A client on warfarin asks which herbal products can increase bleeding risk. Which list is most correct?
Feverfew, garlic, ginger, ginkgo
Iron, calcium, magnesium, zinc
Echinacea, melatonin, vitamin C, niacin
CoQ10, folic acid, riboflavin, biotin
The nurse is monitoring a client on IV heparin. Which assessment finding requires holding the infusion and notifying the provider?
aPTT slightly below goal range
Active bleeding with hypotension
Mild pain at IV site without swelling
Platelets 210,000/mm3
A client on warfarin says, “I’m switching to a supplement for inflammation—glucosamine.” What is the best nursing action?
Tell the client it’s safe because it’s not a prescription medication
Tell the client to double their warfarin dose for 3 days
Teach to consult the provider/pharmacist and monitor INR closely
Instruct the client to take glucosamine at least 4 hours apart from warfarin
A client is receiving anticoagulant therapy and is scheduled for a procedure the next morning. Which nursing action is most appropriate to reduce harm?
Give the morning dose early so levels “wear off”
Verify which anticoagulant is ordered and clarify hold parameters with the provider
Stop all anticoagulants permanently
Replace the anticoagulant with aspirin without an order
A client with fatigue and weight gain has a TSH of 12 mIU/L. The provider prescribes levothyroxine. Which follow-up lab is the nurse’s priority to evaluate whether the dose is working?
TSH
Troponin
CK-MB
BNP
A client started levothyroxine 2 weeks ago. They ask if they should “get my TSH checked tomorrow to see if it’s working.” What is the best nurse response?
Recheck TSH in 6–8 weeks after starting therapy to assess response
Check TSH tomorrow to adjust the dose quickly
Stop the medication and recheck TSH in 2 days
Double the dose for 1 week and then measure TSH
A client with hypothyroidism is taking levothyroxine. Which assessment finding most strongly suggests the client may be over-replaced (dose too high), requiring provider notification?
Bradycardia and constipation
Cold intolerance and weight gain
Palpitations and heat intolerance
Dry skin and menorrhagia
A client’s TSH is very low after a recent levothyroxine dose increase. The nurse should anticipate which complication is most important to screen for in an older adult?
Atrial fibrillation
Hypoglycemia
Neutropenia
Pulmonary embolism
A client asks why TSH is used to "track thyroid meds." Which explanation is most accurate?
TSH rises when the body has too much thyroid hormone.
TSH rises when the body has too little thyroid hormone.
TSH is made in the thyroid gland and directly measures T4.
TSH is only useful in hyperthyroidism, not hypothyroidism.
A client has suspected hyperthyroidism. Which lab pattern best supports this?
High TSH, low T4
Low TSH, high T4
High TSH, high T4
Low TSH, low T4
A client has suspected primary hypothyroidism. Which lab pattern best supports this?
High TSH, low T4
Low TSH, high T4
Low TSH, low T4
Normal TSH, high T4
A client has a pituitary disorder and symptoms of hypothyroidism. Which pattern is most consistent with secondary hypothyroidism (pituitary problem)?
High TSH, low T4
Low TSH, high T4
Low/normal TSH, low T4
High TSH, high T4
A client’s TSH is normal but they still have classic thyroid symptoms. The provider orders free T4 rather than total T4. Why is free T4 the better "real-time" indicator?
Free T4 reflects the hormone available to tissues, not protein-bound hormone.
Free T4 is only used in thyroid cancer.
Total T4 is never accurate in any situation.
Free T4 rises only when the thyroid gland is removed.
A client is being evaluated for thyroid function. Which situation can make thyroid labs misleading unless the provider interprets carefully?
Eating a high-protein breakfast
Taking binding agents like iron/calcium close to levothyroxine
Drinking caffeine with water
Using acetaminophen weekly
A client with hypothyroidism says, "I take my levothyroxine with breakfast and my multivitamin because it’s easier." What is the nurse’s best instruction?
"That’s perfect—food improves absorption."
"Take levothyroxine on an empty stomach, and separate it from iron/calcium by about 4 hours."
"Switch to nighttime only if you also take antacids."
"Crush the tablet and mix it into milk."
A client taking levothyroxine reports chest pain and a racing heartbeat. What is the nurse’s priority action?
Tell the client this is expected for the first month
Instruct the client to stop the medication permanently
Assess vital signs/apical pulse and notify the provider (possible overmedication/cardiac stress)
Give PRN insulin to prevent hyperglycemia
Which client statement indicates correct understanding of levothyroxine therapy?
"Once I feel better, I can stop it."
"I should take it only on days I feel tired."
"If my brand changes, I should tell my provider because my dose may need adjustment."
"This medication is used mainly for weight loss."
The nurse reviews a medication list for a client newly prescribed levothyroxine. Which concurrent medication requires the most immediate monitoring plan because levothyroxine can increase its effect?
Warfarin
Furosemide
Metformin
Albuterol
A client with hypothyroidism is also diabetic. After starting levothyroxine, which change should the nurse anticipate may be needed?
Lower insulin requirements because metabolism slows
Higher insulin requirements because metabolism increases with thyroid replacement
Stop insulin because thyroid replacement corrects diabetes
Switch to only sliding-scale insulin permanently
A client arrives with chest pressure and diaphoresis. Which lab is the priority to evaluate for myocardial injury?
BNP
Troponin
Potassium
D-dimer
A client’s troponin is normal on arrival but the provider still suspects MI. What is the nurse’s best understanding?
One normal troponin completely rules out MI
Troponin must be repeated because early values can be negative depending on timing
Troponin is only elevated in heart failure, not MI
CK-MB is always elevated before symptoms start
A client has chest pain after a cardiac procedure yesterday. Troponin is mildly elevated, but the provider is most concerned about reinfarction. Which lab is most useful for detecting a new MI when troponin may still be elevated from the prior injury?
CK-MB
Sodium
WBC
HbA1c
A client with crushing chest pain has ST changes and is anxious. Which set of findings is most concerning for progression to cardiogenic shock (low cardiac output)?
Warm skin, bounding pulses, BP 148/92
Cool clammy skin, weak pulses, decreasing urine output
Pink frothy sputum with BP 150/88
Bradycardia with BP 132/84 and no symptoms
A client with suspected MI asks why they keep drawing "heart labs." Which explanation is best?
"Troponin and CK-MB rise only with dehydration."
"These labs help show whether heart muscle cells were injured and are leaking proteins into blood."
"These labs only diagnose angina, not MI."
A client is scheduled for coronary angiography. Which nursing action is the priority before the procedure?
Encourage potassium-rich foods
Assess for iodine/contrast allergy and check kidney function (risk for contrast nephropathy)
Give high-dose diuretics to prevent fluid overload
Hold all blood pressure medications for 72 hours
After coronary angiography via femoral access, which assessment finding requires immediate intervention?
Mild tenderness at insertion site
Small bruise at insertion site
Cool, pale leg with weak distal pulses on the affected side
Heart rate 88 and BP 128/76
A client is going for a cardiac catheterization. Which provider order should the nurse question first if the client has significant renal impairment?
IV 0.9% sodium chloride
Iodinated contrast administration without a renal-risk plan
NPO status prior to procedure
Baseline creatinine draw
A nurse is monitoring a client after angiography who reports sudden back/flank pain and has falling BP and rising HR. Which complication is the nurse most concerned about?
Hyperthyroidism
Retroperitoneal bleeding
Hypoglycemia
Pulmonary embolism
A client is getting a cardiac stress test tomorrow and asks what it’s for. Which response is best?
“It directly removes coronary plaque.”
“It helps evaluate how your heart responds to increased workload and can suggest ischemia.”
“It replaces the need for ECGs and troponins.”
“It’s only used to diagnose pericardial effusion.”
