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Critical Thinking and Clinical Judgment Questions and Answers | Latest Version | 2025/2026 | Correct & Verified
A nurse is assessing a client who has recently been started on a new antihypertensive medication.The client reports dizziness when standing. What should the nurse do first?✔✔ A. Assess the client’s blood pressure in both sitting and standing positions
- Encourage the client to take the medication with food
- Decrease the medication dose as ordered
- Suggest that the client drink more water to alleviate the symptoms
A nurse is caring for a client with a history of stroke who is now experiencing weakness in one arm. What is the nurse’s priority action?
- Administer the prescribed anticoagulant
- Place the client in a comfortable position
- Encourage the client to use the affected arm for activities
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✔✔ B. Assess the client for signs of acute stroke, such as facial drooping
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A nurse is caring for a client who is post-operative following a hip replacement surgery. The client reports pain at the surgical site. What should the nurse do first?✔✔ A. Assess the pain level and administer prescribed pain medication
- Encourage the client to use a pillow for comfort
- Reposition the client to reduce pressure on the surgical site
- Check for any signs of infection or swelling
A nurse is caring for a client with diabetes who is receiving insulin therapy. The client’s blood glucose level is 40 mg/dL. What is the nurse’s first action?✔✔ A. Administer a fast-acting carbohydrate
- Recheck the blood glucose level in 15 minutes
- Contact the healthcare provider immediately
- Encourage the client to drink a sugary beverage
A nurse is assessing a client who has been started on an opioid medication for pain management.The nurse notices the client is drowsy with a respiratory rate of 8 breaths per minute. What should the nurse do first?✔✔ A. Administer naloxone and monitor the client’s vital signs
- Increase the oxygen flow rate via nasal cannula 2 / 3
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- Continue to monitor the client’s respiratory status
- Reassure the client that drowsiness is expected
A nurse is caring for a client who is post-operative following abdominal surgery. The client’s abdomen is distended, and the nurse suspects a bowel obstruction. What is the nurse’s first priority?✔✔ A. Assess the client’s bowel sounds and abdominal girth
- Administer prescribed analgesics for pain relief
- Increase the client’s IV fluids to prevent dehydration
- Notify the healthcare provider for further instructions
A nurse is caring for a client who is receiving a blood transfusion. The nurse observes that the client is experiencing chills and back pain. What should the nurse do first?✔✔ A. Stop the transfusion and assess the client’s vital signs
- Administer acetaminophen to manage the fever
- Continue the transfusion and monitor the client
- Notify the healthcare provider immediately
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