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DHA Specialist Exam study materials
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DHA Specialist Exam practice questions

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Question 1Patient Care and Clinical Management

A patient's adult daughter asks for details of her mother's treatment plan. The patient is alert and has capacity. What is the most appropriate response?

  1. Provide the full plan because family members are always entitled to information
  2. Confirm the patient has consented to sharing information with the daughter before discussing anything Correct answer.
  3. Give only the medication list but withhold the diagnosis
  4. Refuse to speak to the daughter and ask her to leave the clinic

Explanation

Confidentiality belongs to the patient; disclosure to relatives requires the patient's permission unless a legal exception applies. Verifying consent first respects autonomy and privacy. The other choices either over-disclose or inappropriately withhold care from the patient herself.

Question 2Patient Care and Clinical Management

Which document allows a patient to name someone to make healthcare decisions if the patient later loses capacity?

  1. A durable power of attorney for healthcare Correct answer.
  2. A consent form for surgery
  3. A living will
  4. A do-not-resuscitate order

Explanation

A durable power of attorney for healthcare designates a surrogate decision-maker who acts when the patient cannot. A living will states treatment preferences but does not appoint an agent. DNR orders and surgical consents address specific interventions only.

Question 3Patient Care and Clinical Management

Before a procedure, a patient must give informed consent. Which element is essential for that consent to be valid?

  1. The patient understands the risks, benefits, and alternatives Correct answer.
  2. The patient has health insurance covering the procedure
  3. The patient's family agrees with the decision
  4. The patient signs the form in the presence of a witness

Explanation

Valid informed consent requires capacity, adequate disclosure, comprehension, and voluntariness. Understanding risks, benefits, and alternatives is the core informational element. Witnesses, insurance, and family agreement are not legal requirements for validity.

Question 4Patient Care and Clinical Management

A patient is found unresponsive with no pulse and no breathing. Which action should be taken first?

  1. Obtain a full medical history from relatives
  2. Place the patient in the recovery position
  3. Check a blood glucose level
  4. Activate the emergency response system and begin chest compressions Correct answer.

Explanation

In cardiac arrest, the priority is early recognition, activation of emergency response, and immediate high-quality chest compressions. Diagnostic testing and history-taking delay lifesaving care. The recovery position is for breathing, unresponsive patients.

Question 5Patient Care and Clinical Management

Which practice most effectively reduces transmission of infection from one patient to another via healthcare workers' hands?

  1. Using alcohol rub only when hands are visibly soiled
  2. Hand hygiene before and after every patient contact Correct answer.
  3. Wearing gloves for all patient interactions
  4. Changing uniforms daily

Explanation

Hand hygiene at the correct moments is the single most effective measure to prevent cross-transmission. Gloves do not replace hand hygiene and can spread contamination if not removed properly. Alcohol rub is preferred for non-soiled hands, while soap and water are used when visibly soiled.

Question 6Patient Care and Clinical Management

A patient reports a pain score of 8 out of 10. Which initial step best reflects a patient-centered approach?

  1. Document the score and reassess at the next scheduled round
  2. Ask the patient to describe the pain's location, quality, and aggravating factors Correct answer.
  3. Reassure the patient that the pain will pass without intervention
  4. Administer the strongest available analgesic immediately

Explanation

A thorough pain assessment characterizes location, quality, timing, and aggravating factors, guiding appropriate management. Dismissing pain or delaying reassessment is not patient-centered. Jumping to the strongest analgesic without assessment risks harm.

Question 7Patient Care and Clinical Management

What is the primary purpose of documenting care in the medical record?

  1. To protect staff from criticism by supervisors
  2. To satisfy billing requirements only
  3. To provide a legal and clinical record of care that supports continuity Correct answer.
  4. To replace verbal handover between clinicians

Explanation

Documentation creates a contemporaneous record that supports clinical continuity, legal defensibility, and quality review. It is not primarily defensive or financial. It complements, rather than replaces, verbal handover.

Question 8Patient Care and Clinical Management

Which statement best describes the principle of beneficence in clinical practice?

  1. Avoiding actions that cause harm
  2. Respecting the patient's right to make their own choices
  3. Distributing resources fairly across patients
  4. Acting in the patient's best interest to promote good Correct answer.

Explanation

Beneficence is the duty to act for the patient's benefit. Autonomy concerns self-determination, justice concerns fair distribution, and nonmaleficence concerns avoiding harm. Distinguishing these principles guides ethical reasoning.

Question 9Patient Care and Clinical Management

A patient with a known penicillin allergy is prescribed a cephalosporin. What is the most appropriate action before administration?

  1. Assess the nature and severity of the prior reaction and confirm the prescriber's risk assessment Correct answer.
  2. Give an antihistamine first and then proceed routinely
  3. Administer the drug because cross-reactivity is negligible
  4. Withhold all antibiotics until an allergy test is completed

Explanation

Cross-reactivity risk depends on the type and severity of the prior reaction, so clarifying the history and confirming the prescriber's assessment is essential. Assuming negligible risk is unsafe. Withholding all antibiotics is excessive, and premedication does not substitute for assessment.

Question 10Patient Care and Clinical Management

An older adult is admitted with confusion that developed over two days. Which factor most suggests delirium rather than dementia?

  1. Gradual decline in memory over years
  2. Acute onset with fluctuating attention Correct answer.
  3. Stable orientation to person and place
  4. Preserved ability to perform daily activities

Explanation

Delirium is characterized by acute onset and fluctuating attention and awareness. Dementia typically shows gradual, progressive cognitive decline with relatively preserved attention early on. The other options describe features more consistent with stable or dementing cognition.

Question 11Patient Care and Clinical Management

A patient is prescribed warfarin and reports starting a new herbal supplement. What is the most important nursing consideration?

  1. Increase the warfarin dose to compensate for the supplement
  2. Advise stopping warfarin until the supplement is finished
  3. Ask which supplement is used and check for interactions that may alter bleeding risk Correct answer.
  4. Reassure the patient that herbal products do not interact with prescription drugs

Explanation

Many herbal products alter warfarin metabolism or platelet function, increasing or decreasing bleeding risk. Identifying the specific supplement allows proper interaction review. Assuming safety or adjusting doses independently is unsafe.

Question 12Patient Care and Clinical Management

A patient with capacity refuses a recommended blood transfusion. What is the most appropriate response?

  1. Respect the refusal, document the discussion, and continue to provide other care Correct answer.
  2. Perform the transfusion because it is medically necessary
  3. Discharge the patient immediately for noncompliance
  4. Obtain consent from the spouse and proceed

Explanation

A competent patient may refuse any treatment, even life-sustaining care. The clinician should ensure the patient is informed, document the discussion, and continue non-refused care. Proceeding against refusal or relying on a relative's consent is unlawful.

Question 13Patient Care and Clinical Management

During shift handover, which approach best supports patient safety?

  1. Prioritize tasks completed over outstanding risks
  2. Rely on the written chart alone without verbal exchange
  3. Use a structured format that includes current status, recent changes, and pending actions Correct answer.
  4. Give a brief summary of only the most stable patients

Explanation

Structured handover improves information transfer by covering current condition, changes, and pending tasks, reducing omissions. Omitting unstable patients or relying solely on records increases risk. Outstanding risks deserve emphasis.

Question 14Patient Care and Clinical Management

A patient is receiving intravenous potassium chloride. Which practice is essential for safe administration?

  1. Give undiluted through a peripheral line
  2. Withhold cardiac monitoring during infusion
  3. Administer as a rapid bolus to correct deficiency quickly
  4. Confirm appropriate dilution and infusion rate using a pump Correct answer.

Explanation

Concentrated potassium can cause fatal arrhythmias if infused rapidly, so dilution, controlled rate, and pump use are essential. Bolus administration or undiluted delivery is dangerous. Cardiac monitoring is often required for higher doses.

Question 15Patient Care and Clinical Management

A patient has a new diagnosis of type 2 diabetes. Which educational approach best promotes self-management?

  1. Provide a dense textbook chapter to read at home
  2. Delegate all education to the family without involving the patient
  3. Teach skills such as glucose monitoring and tailor content to the patient's health literacy Correct answer.
  4. Delay education until the first follow-up visit

Explanation

Effective education builds practical skills and matches content to the patient's literacy and readiness. Dense written material or delayed education reduces engagement. The patient must be an active participant.

Question 16Patient Care and Clinical Management

Which action best demonstrates respect for patient autonomy during a care-planning meeting?

  1. Present options and support the patient's informed choice Correct answer.
  2. Ask the family to decide without the patient present
  3. Decide the plan for the patient to reduce burden
  4. Persuade the patient toward the clinician's preferred option

Explanation

Autonomy is honored when patients receive information about options and make an informed choice. Deciding for the patient, coercive persuasion, or excluding the patient from decisions undermines self-determination.

Question 17Patient Care and Clinical Management

A patient is at risk of falls. Which intervention has the strongest evidence for reducing fall risk in hospital?

  1. Keeping the bed rails up on both sides at all times
  2. Multifactorial assessment with targeted interventions such as bed height and call-bell access Correct answer.
  3. Sedating the patient at night to ensure sleep
  4. Restraining the patient to prevent movement

Explanation

Multifactorial fall prevention addressing individual risk factors is best supported by evidence. Restraints and sedation increase harm and are not recommended. Bed rails can increase injury risk from climbing over them.

Question 18Patient Care and Clinical Management

A patient with a pressure injury is being repositioned. Which factor most directly contributes to pressure injury development?

  1. Frequent position changes
  2. Increased dietary protein intake
  3. Sustained pressure over a bony prominence Correct answer.
  4. Use of a pressure-redistribution mattress

Explanation

Pressure injuries result from sustained pressure, often combined with shear and friction, over bony prominences. Adequate nutrition, redistribution surfaces, and repositioning are protective rather than causative.

Question 19Patient Care and Clinical Management

A patient's family asks about resuscitation status after the patient has lost capacity and has no advance directive. What is the most appropriate approach?

  1. Automatically choose full resuscitation regardless of prognosis
  2. Ask the family to sign a DNR without discussion
  3. Use the best-interest standard, involving the family to infer the patient's likely wishes Correct answer.
  4. Defer the decision indefinitely until capacity returns

Explanation

When a patient lacks capacity and has no directive, decisions should reflect the patient's values as far as known, using a best-interest standard with family involvement. Automatic full resuscitation ignores patient values, and coercing family signatures is inappropriate.

Question 20Patient Care and Clinical Management

A patient with a communicable respiratory infection is admitted. Which precaution set is appropriate for a suspected airborne pathogen such as tuberculosis?

  1. Standard precautions only
  2. Contact precautions with gloves and gown alone
  3. Droplet precautions with a surgical mask only
  4. Airborne precautions with a fit-tested respirator and negative-pressure room Correct answer.

Explanation

Airborne pathogens require a negative-pressure room and a fit-tested respirator (such as N95) to prevent inhalation of small infectious particles. Standard or contact precautions alone do not address airborne transmission. Droplet precautions are for larger droplets.

Question 21Patient Care and Clinical Management

A patient with chronic kidney disease is prescribed a nephrotoxic drug. Which monitoring plan best reflects safe prescribing?

  1. Proceed with standard dosing because renal function is irrelevant
  2. Monitor only if the patient reports symptoms
  3. Check renal function at baseline and at intervals, and adjust the dose accordingly Correct answer.
  4. Increase the dose to shorten the treatment course

Explanation

For nephrotoxic drugs, baseline and serial renal function guide dose adjustment and early detection of worsening function. Standard dosing ignores impaired clearance. Symptom-based monitoring is too late, and dose escalation increases harm.

Question 22Patient Care and Clinical Management

A patient with capacity is considering a high-risk procedure and asks whether the surgeon's complication rate matters. Which response best supports informed decision-making?

  1. Withhold outcome data to avoid causing anxiety
  2. Discuss the clinician's and institution's outcome data alongside the patient's individual risk factors Correct answer.
  3. Recommend the procedure without discussing risks
  4. State that complication rates are confidential

Explanation

Informed consent requires disclosure of material information, including outcome data relevant to the patient's decision, combined with individualized risk assessment. Withholding data or omitting risks undermines informed choice.

Question 23Patient Care and Clinical Management

A patient with sepsis is hypotensive and requires fluid resuscitation. Which principle best guides the choice between crystalloid and colloid in this setting?

  1. Use evidence-based first-line therapy, typically crystalloids, and reassess response Correct answer.
  2. Delay fluids until cultures return
  3. Choose colloids because they always expand volume more effectively
  4. Restrict fluids to avoid overload in all patients

Explanation

Current evidence supports crystalloids as first-line resuscitation for most septic patients, with reassessment of response. Colloids are not superior and carry additional cost and risk. Delaying fluids worsens outcomes, and blanket fluid restriction ignores individual need.

Question 24Patient Care and Clinical Management

A clinician notices a colleague consistently failing to perform hand hygiene before invasive procedures. What is the most appropriate first step?

  1. Discuss the colleague's performance with other staff members
  2. Report the colleague to the regulator immediately
  3. Speak with the colleague directly and respectfully about the observed behavior Correct answer.
  4. Ignore the behavior to avoid conflict

Explanation

Patient safety is best served by direct, respectful feedback to the colleague as a first step, escalating only if the behavior persists. Immediate regulatory reporting is disproportionate for a first observation, and ignoring or gossiping about the issue fails to protect patients.

Question 25Patient Care and Clinical Management

A patient with advanced cancer has worsening dyspnea and a prognosis of weeks. The family requests that the patient not be told. The patient asks directly about the prognosis. What is the most appropriate response?

  1. Give a falsely optimistic prognosis to protect the patient
  2. Explore the patient's understanding and provide information consistent with the patient's expressed wish to know Correct answer.
  3. Defer to the family's request and avoid the topic
  4. Refer all discussion to the family

Explanation

The patient's right to information takes precedence over family preferences when the patient directly asks. An individualized approach explores what the patient wants to know and responds honestly and compassionately. Deception or deferral to family violates the patient's autonomy.

Question 26Patient Care and Clinical Management

A patient is admitted with a suspected infectious diarrheal illness. Which transmission-based precaution is most appropriate while awaiting testing?

  1. Droplet precautions
  2. Airborne precautions
  3. No additional precautions beyond standard
  4. Contact precautions Correct answer.

Explanation

Infectious diarrheal illnesses spread primarily through direct and indirect contact with contaminated surfaces and hands, so contact precautions are indicated. Standard precautions alone are insufficient once a transmissible enteric pathogen is suspected. Airborne and droplet precautions target respiratory pathogens, not enteric spread.

Question 27Patient Care and Clinical Management

A patient is ordered a clear liquid diet. Which item is appropriate to serve?

  1. Whole-grain toast
  2. Clear broth Correct answer.
  3. Milk
  4. Orange juice with pulp

Explanation

A clear liquid diet includes items that are transparent and liquid at room temperature, such as clear broth, water, and gelatin. Pulp, dairy, and solid foods are excluded because they leave residue and require more digestion.

Question 28Patient Care and Clinical Management

A postoperative patient is drowsy but arousable and has a respiratory rate of 8 breaths per minute after receiving an opioid. What is the priority action?

  1. Document the finding and reassess in one hour
  2. Reposition the patient onto the side and continue monitoring
  3. Stimulate the patient and apply supplemental oxygen while escalating care Correct answer.
  4. Administer the next scheduled opioid dose

Explanation

Opioid-induced respiratory depression is a life-threatening emergency; the airway and breathing must be supported while help is summoned. Stimulation and oxygen are immediate supportive steps, and reversal agents may be needed. Continued opioid administration would worsen the depression.

Question 29Patient Care and Clinical Management

Which action best reduces the risk of transmitting microorganisms from a patient's indwelling urinary catheter?

  1. Irrigating the catheter routinely
  2. Maintaining a closed drainage system Correct answer.
  3. Changing the catheter every 48 hours
  4. Hanging the drainage bag above bladder level

Explanation

A closed drainage system prevents environmental organisms from entering the urinary tract, which is the cornerstone of catheter-associated infection prevention. Routine irrigation and frequent scheduled changes increase contamination risk. The bag must stay below bladder level to prevent backflow.

Question 30Patient Care and Clinical Management

A patient is prescribed oxygen at 2 L/min by nasal cannula. Which assessment finding indicates the therapy is effective?

  1. Oxygen saturation of 96% while receiving the oxygen Correct answer.
  2. Oxygen saturation of 94% on room air
  3. Use of accessory muscles during breathing
  4. Respiratory rate of 30 breaths per minute

Explanation

Effectiveness of supplemental oxygen is judged by adequate oxygenation while the therapy is in use, typically an oxygen saturation within the target range. Signs of respiratory distress such as tachypnea or accessory muscle use indicate inadequate response. Room-air saturation does not reflect the effect of the oxygen being delivered.

Question 31Patient Care and Clinical Management

Which practice is essential when transferring a patient from bed to a chair with a mechanical lift?

  1. Leaving the patient's brakes unlocked to allow movement
  2. Checking the sling size and weight capacity before lifting Correct answer.
  3. Raising the patient rapidly to save time
  4. Leaving the sling attached under the patient for the entire day

Explanation

Verifying sling size, weight capacity, and equipment integrity before lifting prevents falls and equipment failure. Lifts must be used with brakes engaged on the receiving surface and with slow, controlled movement. Slings should be removed after transfer per manufacturer guidance.

Question 32Patient Care and Clinical Management

A patient is receiving a blood transfusion and develops fever, chills, and flank pain shortly after it begins. What is the first action?

  1. Stop the transfusion and maintain intravenous access with normal saline Correct answer.
  2. Slow the transfusion and reassess in 15 minutes
  3. Give an antipyretic and continue the transfusion
  4. Document the reaction and complete the transfusion as ordered

Explanation

Fever, chills, and flank pain suggest an acute hemolytic transfusion reaction, which requires immediately stopping the transfusion while keeping the line patent with saline. The provider and blood bank must be notified and the unit returned for investigation. Continuing or slowing the transfusion risks severe harm.

Question 33Patient Care and Clinical Management

Which statement best describes the role of informed consent in patient care?

  1. It is required only for procedures performed under general anesthesia
  2. It replaces the need for ongoing discussion about risks
  3. It documents that the patient agreed to a procedure after receiving information Correct answer.
  4. It transfers legal responsibility for outcomes to the patient

Explanation

Informed consent is an ongoing process in which the patient receives information about a procedure and voluntarily agrees to it, documented in the record. It does not shift responsibility for outcomes to the patient and does not substitute for continued dialogue. Many procedures beyond general anesthesia require consent.

Question 34Patient Care and Clinical Management

A patient with a new colostomy asks how to care for the stoma at home. Which teaching approach best supports adaptation?

  1. Delay teaching until discharge day
  2. Demonstrate pouch changes and have the patient practice with return demonstration Correct answer.
  3. Tell the patient the ostomy nurse will handle all care
  4. Provide a written pamphlet only and end the session

Explanation

Psychomotor skills such as ostomy care are best learned through demonstration combined with supervised practice and return demonstration. This builds confidence and confirms competence before discharge. Written material alone or deferring teaching does not ensure the patient can perform self-care.

Question 35Patient Care and Clinical Management

A patient is prescribed enoxaparin subcutaneously. Which technique is correct?

  1. Inject into the fatty tissue of the abdomen without expelling the air bubble Correct answer.
  2. Massage the site firmly after injection
  3. Aspirate before injecting to check for blood
  4. Inject into the deltoid at a 90-degree angle

Explanation

Low-molecular-weight heparin is given into abdominal subcutaneous fat, and the air bubble is retained to deliver the full dose and seal the tract. Aspiration and massage increase bruising and hematoma risk and are avoided. The deltoid is not the preferred site for this medication.

Question 36Patient Care and Clinical Management

A patient with heart failure has gained 2 kg over two days and reports increasing shortness of breath when lying flat. Which nursing action is most appropriate?

  1. Withhold the prescribed diuretic until the next shift
  2. Restrict all oral fluids without an order
  3. Elevate the head of the bed and notify the provider Correct answer.
  4. Encourage the patient to ambulate vigorously

Explanation

Rapid weight gain and orthopnea suggest fluid overload, so positioning to ease breathing and promptly notifying the provider are appropriate. Diuretics are part of the treatment plan and should not be withheld. Independent fluid restriction and vigorous activity are not safe without orders.

Question 37Patient Care and Clinical Management

A patient has an order for a nasogastric tube feeding. Which action best prevents aspiration?

  1. Positioning the patient supine during the feeding
  2. Checking residual volume and discarding it routinely
  3. Keeping the head of the bed elevated during and after feeding Correct answer.
  4. Flushing the tube with air before each feeding

Explanation

Elevating the head of the bed during feeding and for a period afterward reduces the risk of gastric contents entering the airway. Supine positioning increases aspiration risk. Routine discarding of residual volume is no longer recommended and flushing with air does not prevent aspiration.

Question 38Patient Care and Clinical Management

A patient is admitted with severe dehydration and an order for intravenous fluids. Which assessment finding best indicates the fluid resuscitation is working?

  1. Heart rate increasing from 100 to 120 beats per minute
  2. Urine output of 10 mL per hour
  3. Improved skin turgor and urine output of 40 mL per hour Correct answer.
  4. Dry mucous membranes that remain unchanged

Explanation

Adequate urine output and improved skin turgor indicate restored intravascular volume and perfusion. Low urine output, worsening tachycardia, and persistent dry mucous membranes all suggest inadequate resuscitation. These parameters should be reassessed frequently during fluid therapy.

Question 39Patient Care and Clinical Management

A patient is receiving a continuous opioid infusion for pain. Which assessment is most important to perform regularly?

  1. Urine specific gravity
  2. Blood glucose level
  3. Sedation level and respiratory rate Correct answer.
  4. Daily weight

Explanation

The most serious adverse effect of opioid infusions is respiratory depression, which is preceded by increasing sedation. Regular assessment of sedation level and respiratory rate allows early detection. Blood glucose, weight, and urine specific gravity are not the priority monitoring for opioid safety.

Question 40Patient Care and Clinical Management

A patient with a tracheostomy is being suctioned. Which action is correct?

  1. Suctioning for 20 seconds on each pass
  2. Limiting each suction pass to 10 seconds or less Correct answer.
  3. Using the same catheter for the entire shift without cleaning
  4. Applying suction continuously while inserting the catheter

Explanation

Suction passes should be brief, generally 10 seconds or less, to limit hypoxemia and mucosal trauma. Suction should be applied only during withdrawal, not insertion, and catheters must be handled with sterile or clean technique as appropriate. Prolonged passes increase the risk of complications.

Question 41Patient Care and Clinical Management

A patient with a stage 2 pressure injury is being cared for. Which dressing characteristic best supports healing?

  1. A dressing that keeps the wound bed moist and protects surrounding skin Correct answer.
  2. A dressing that adheres tightly to the wound bed
  3. A dressing that dries the wound bed completely
  4. A dressing changed only when the wound appears infected

Explanation

A moist wound environment promotes granulation and epithelialization while protecting intact skin from maceration. A dry wound bed delays healing. Adherent dressings can cause trauma on removal, and changes should follow the care plan rather than waiting for signs of infection.

Question 42Patient Care and Clinical Management

A patient is scheduled for surgery and reports taking a daily aspirin. Why is this information important before the procedure?

  1. Aspirin increases bleeding risk and may need to be managed before surgery Correct answer.
  2. Aspirin prevents infection at the surgical site
  3. Aspirin has no effect on surgical bleeding
  4. Aspirin must always be doubled before surgery

Explanation

Aspirin irreversibly inhibits platelet function and increases bleeding risk during and after surgery. The surgical and anesthesia teams must know so the medication plan can be adjusted. Aspirin does not prevent surgical infection and is not doubled before procedures.

Question 43Patient Care and Clinical Management

A patient with chronic obstructive pulmonary disease is prescribed oxygen. Which target range is generally appropriate?

  1. 95% to 100% regardless of history
  2. 100% at all times
  3. 88% to 92% Correct answer.
  4. 70% to 80%

Explanation

In patients with COPD who are at risk of hypercapnia, oxygen is titrated to a target saturation of roughly 88% to 92%. Excessive oxygen can worsen carbon dioxide retention in some patients. The goal is adequate oxygenation without overshoot.

Question 44Patient Care and Clinical Management

A patient is at risk of pressure injury on the heels. Which intervention is most appropriate?

  1. Massaging the heels every shift
  2. Applying a heating pad to the heels
  3. Placing a pillow under the calves to float the heels Correct answer.
  4. Elevating the heels on a folded towel directly under the heel

Explanation

Floating the heels by supporting the calves relieves pressure on the heel and is a recommended preventive measure. Massaging bony prominences and applying heat can damage tissue. Supporting directly under the heel does not offload pressure.

Question 45Patient Care and Clinical Management

A patient is confused and repeatedly attempts to climb out of bed. Which initial intervention is most appropriate?

  1. Administer a sedative to keep the patient in bed
  2. Apply physical restraints without an order
  3. Raise all four side rails and leave the room
  4. Use the least restrictive measures such as a bed alarm and frequent checks Correct answer.

Explanation

Care should begin with the least restrictive measures, such as bed alarms, frequent rounding, and involving family, to protect the patient while preserving dignity. Restraints and sedation require specific justification and orders. Raising all four side rails is itself a form of restraint and increases injury risk.

Question 46Patient Care and Clinical Management

A patient with diabetes is being discharged after a foot ulcer. Which instruction is most important for preventing recurrence?

  1. Walk barefoot at home to let the feet breathe
  2. Cut corns and calluses with a sharp instrument
  3. Soak the feet daily in hot water
  4. Inspect the feet daily and wear properly fitted protective footwear Correct answer.

Explanation

Daily foot inspection and protective, well-fitted footwear prevent pressure and trauma that lead to ulceration in patients with neuropathy and poor circulation. Soaking in hot water, walking barefoot, and self-cutting calluses all increase injury risk.

Question 47Patient Care and Clinical Management

A patient with advanced illness reports severe pain and also has a history of substance use disorder. What is the most appropriate approach to pain management?

  1. Require the patient to prove pain with objective tests before treatment
  2. Give only non-opioid analgesics regardless of pain severity
  3. Provide adequate analgesia with structured monitoring and a clear plan Correct answer.
  4. Withhold opioids because of the substance use history

Explanation

Pain should be treated according to the patient's report, including in patients with a substance use history, using structured assessment, monitoring, and a clear plan to balance safety and comfort. Withholding analgesia based on history causes unnecessary suffering. Objective proof of pain is not required.

Question 48Patient Care and Clinical Management

A patient is recovering from a stroke and has dysphagia. Which intervention best reduces aspiration risk during meals?

  1. Providing thin liquids to improve hydration
  2. Encouraging rapid eating to finish the meal
  3. Allowing the patient to eat while lying back in bed
  4. Positioning upright and using recommended texture-modified foods Correct answer.

Explanation

Upright positioning and texture-modified foods and liquids based on a swallowing assessment reduce the risk of aspiration in dysphagia. Rapid eating, thin liquids, and reclined positions increase aspiration risk. A speech-language pathology assessment guides the safest diet.

Question 49Patient Care and Clinical Management

A patient on a medical unit has a do-not-attempt-resuscitation order. The patient becomes acutely short of breath and anxious. What is the most appropriate action?

  1. Begin chest compressions immediately
  2. Withhold all treatment because of the resuscitation order
  3. Avoid discussing the situation with the patient and family
  4. Provide comfort-focused treatment such as oxygen and positioning Correct answer.

Explanation

A do-not-attempt-resuscitation order applies to resuscitation in the event of cardiac arrest and does not limit other appropriate treatments. Comfort-focused interventions such as oxygen, positioning, and symptom management remain appropriate. Withholding all care or starting compressions contradicts the order.

Question 50Patient Care and Clinical Management

A patient is prescribed multiple medications and has impaired kidney function. Which action best supports medication safety?

  1. Administer all medications at standard doses regardless of renal function
  2. Increase fluid intake to flush the medications faster
  3. Review renally cleared medications and adjust doses with the prescriber and pharmacist Correct answer.
  4. Stop all medications until kidney function improves

Explanation

Impaired kidney function reduces clearance of many drugs, so renally cleared medications require dose review and adjustment with the prescriber and pharmacist. Administering standard doses risks toxicity. Stopping all medications or forcing fluids without orders is unsafe.