Question 1

A client is receiving several adjunctive professional therapies while rehabilitating after a stroke.  Which client statements indicate an understanding of the services?  Select all that apply.

Accepted Answer

A) "Occupational therapy will help me learn how to properly use my walker." 
B) "Physical therapy will help me learn how to dress myself again." 
C) "Social services can help me find resources for affording my medications." 
D) "Speech therapy will teach me how to eat my meals properly." 
E) "Wound care will teach me how to properly dress this wound on my knee."

Question 2

The nurse caring for a client who had a femoral angioplasty finds the client's leg pale, cool, and pulseless.  The nurse calls the health care provider (HCP) at 2 AM, and the HCP begins to yell at the nurse, stating, "I'm sick and tired of you calling me in the middle of the night!"  What is the best response by the nurse?

Accepted Answer

A) "I am concerned that this client may lose a leg unless something is done immediately." 
B) "I am required to report all postoperative complications to the provider on call." 
C) "It is my job to report critical findings, just like it is your job to come see my client right now." 
D) "Yelling is unprofessional.  I will need to file a report with my supervisor once the client is stable."

Question 3

The nurse is caring for a client with chronic pain who just had surgery and is receiving patient-controlled analgesia (PCA) morphine.  The client is in severe pain, with a rating of 10/10, despite receiving the maximum ordered dose.  The nurse calls the health care provider, saying that the client is still having pain and recommending a higher PCA dose.  Which nursing role is being implemented in this situation?

Accepted Answer

A) Advocate 
B) Caregiver 
C) Educator 
D) Manager

Question 4

The registered nurse is caring for multiple clients on a medical-surgical unit and has finished the morning assessment.  Which task is appropriate for the nurse to delegate to unlicensed assistive personnel?

Accepted Answer

A) Apply a collagenase dressing to a client's pressure ulcer for wound debridement 
B) Assist a client 1 day postoperative hip fracture repair to the bathroom 
C) Feed a client through a gastrostomy tube after elevating the head of the bed 
D) Offer orange juice to a client if the blood glucose level is <70 mg/dL (<3.9 mmol/L)

Question 5

The office nurse receives 4 telephone messages from clients.  Which client should the nurse call back first?

Accepted Answer

A) 20-year-old college student who reports getting a ringlike, red bull's eye-shaped, itchy leg rash after hiking in the woods 2 days ago 
B) 65-year-old female with pneumonia taking antibiotics who reports white, curdlike vaginal discharge and itching 
C) 78-year-old prescribed warfarin who reports increasing headaches and gait disturbance after falling a month ago 
D) 86-year-old with gout who is prescribed colchicine and reports diarrhea and not feeling well

Question 6

A Native American client is hospitalized for depression and attempted suicide.  Family members have requested that they be allowed to bring in a medicine healer to perform a ritual on the client.  Which of the following is the bestaction by the nurse?

Accepted Answer

A) Explain that the client's depression is being treated with medications 
B) Explain that the client's depression will not be relieved by a ritual 
C) Plan a meeting with the health care provider (HCP), family, nurse, and medicine healer to make arrangements for the ceremony 
D) Tell the family that such practices are not allowed in the hospital

Question 7

A nurse is admitting a child who has leukemia.  Several rooms are available on the pediatric unit.  Which client could share a room with this child?

Accepted Answer

A) A client recovering from a ruptured appendix 
B) A client with cystic fibrosis 
C) A client with minimal change nephrotic syndrome 
D) A client with rheumatic fever

Question 8

A client with terminal cancer arrives in the emergency department unresponsive and in respiratory distress.  The client's sister is the legal medical power of attorney.  Both the client's spouse and sister are present.  Which action by the nurse is appropriate at this time?

Accepted Answer

A) Ask the spouse about the client's wishes 
B) Get directions about care from the client's sister 
C) Prepare for emergency intubation 
D) Request that the sister provide a living will

Question 9

The nurse prepares to administer the prescribed 8 AM medications to 4 clients.  The nurse should administer medication to which client first?

Accepted Answer

A) Client 2 days postoperative abdominal surgery who is to receive enoxaparin for venous thromboembolism prophylaxis 
B) Client with hypertension who has a blood pressure of 196/98 mm Hg and is to receive IV hydralazine 
C) Client with suspected sepsis who has a temperature of 102.3 F (39.1 
C)  and is to receive an initial dose of IV ceftazidime 
D) Client with type 2 diabetes mellitus and blood sugar of 500 mg/dL (27.8 mmol/L) who is to receive subcutaneous regular insulin and insulin glargine

Question 10

The nurse is reviewing new laboratory values.  Which client would be the priority to report to the health care provider?

Accepted Answer

A) Client 2 days after a hip arthroplasty with a white blood cell count of 12,000/mm3 (12x109/L) 
B) Client admitted for cocaine overdose with a creatine kinase of 30,000 U/L (501 µkat/L) 
C) Client admitted for end-stage renal disease with a creatinine of 3.6 mg/dL (274.5 mmol/L) 
D) Client in heart failure exacerbation with a brain natriuretic peptide of 600 pg/mL (600 pmol/L)

Question 11

After morning report, the nurse must perform which action first when caring for assigned clients?

Accepted Answer

A) Administer IV bumetanide to a client with heart failure who has bilateral crackles and dyspnea 
B) Hang the second unit of packed red blood cells for a client with a hemoglobin of 6 g/dL (60 g/L) 
C) Replace the empty IV opioid medication syringe in a patient-controlled analgesia pump 
D) Replace the heparin infusion bag that has 100 mL remaining and is infusing at 50 mL/hr

Question 12

The charge nurse is reviewing events that staff nurses experienced during the shift.  Which events require an incident/occurrence report to be completed?  Select all that apply.

Accepted Answer

A) Client determined brain dead was taken off life support 
B) Client with alcohol intoxication physically assaulted a nurse 
C) Serum troponin level was prescribed but never obtained 
D) Staff nurse did not present for work and did not notify management 
E) Visitor fell and refused care in the emergency department

Question 13

The nurse is caring for a 5-year-old client who is dehydrated and malnourished, and suspects that the client may be neglected.  Which information most strongly supports the nurse's suspicion of child neglect?

Accepted Answer

A) The parent cannot stay at the hospital due to potential job loss from absence 
B) The parent is in the process of a divorce and will soon be a single parent 
C) The parent is witnessed stealing food and drinks from the cafeteria 
D) The parent leaves the client's younger sibling to care for the client's newborn sibling

Question 14

The day shift nurse provides handoff of care report to the oncoming night shift nurse.  Which of the following statements by the nurse are appropriate to include in the report?  Select all that apply.

Accepted Answer

A) "A continuous IV heparin infusion was initiated at 18 units/kg/hr at 0800, and the infusion bag will need to be replaced at 2100." 
B) "I gave acetaminophen 500 mg PO to the client for a headache, with good relief." 
C) "The client had morphine 2 mg IV 30 minutes ago for chest pain and now reports 3 on a pain scale of 0-10." 
D) "The client's sisters visited today and were very rude, but they did bring the client's medication list." 
E) "The radiology department called to say that an ultrasound will be performed at 2100."

Question 15

The hospital nurse coming on duty notifies the unit of a delay due to a motor vehicle accident.  The off-going nurse has an important appointment and must leave on time.  How should the off-going nurse handle the situation?

Accepted Answer

A) Ask another nurse to watch the current assigned clients until the incoming nurse arrives 
B) Tape-record a report and leave a cell phone number to call if there are any questions 
C) Tell the charge nurse of the impending need to leave and that client coverage is required 
D) Write out a report about the clients for the incoming nurse prior to leaving

Question 16

Four clients were involved in a major highway motor vehicle accident.  Which client requires priority care?

Accepted Answer

A) Client with blood pressure of 90/70 mm Hg and deviated trachea 
B) Client with concussion who was unconscious for 5 minutes 
C) Client with grossly swollen upper thigh and blood pressure of 80/60 mm Hg 
D) Client with pain at the thoracic spine and complete paralysis of both legs

Question 17

All of these events are occurring at the same time.  Which one should the registered nurse deal with first?

Accepted Answer

A) A health care provider (HCP) is asking to speak to the nurse 
B) A visitor is seen lying on the hallway floor 
C) A client is requesting an analgesic for pain rated an "8" on a 1-10 scale 
D) The intravenous (IV) pump is beeping on a client who is receiving blood

Question 18

Which client is most appropriate for the charge nurse in the postpartum unit to assign to the float nurse from the intensive care unit?

Accepted Answer

A) Client experiencing fever and pain with mastitis 
B) Client preparing for discharge after cesarean birth 
C) Client showing disinterest in caring for the newborn 
D) Client with hysterectomy after postpartum hemorrhage

Question 19

When making assignments in the labor and delivery unit, the charge nurse should assign the most experienced newborn admit nurse to attend to the birth of which client?

Accepted Answer

A) Client with diet-controlled gestational diabetes 
B) Client with mild preeclampsia and blood pressure averaging 140/90 mm Hg 
C) Client with premature rupture of membranes 6 hours ago at 37 weeks gestation 
D) Client with spontaneous rupture of membranes with greenish amniotic fluid

Question 20

The nurse assesses and reviews the laboratory results for 4 clients.  Which client's fever is of highest priority and should be reported to the health care provider immediately?

Accepted Answer

A) Client newly diagnosed with Hodgkin lymphoma scheduled for chemotherapy who has a fever of 100.9 F (38.3 
C)  and white blood cell count of 6,000/mm3 (6.0 × 109/L) 
B) Client with acute cholecystitis scheduled for laparoscopic surgery who has a fever of 102 F (38.9 
C)  and white blood cell count of 13,000/mm3 (13.0 × 109/L) 
C) Client with Clostridium difficile infection receiving metronidazole who has a fever of 101 F (38.3 
C)  and white blood cell count of 18,000/mm3 (18.0 × 109/L) 
D) Client with colon cancer receiving chemotherapy who has a fever of 100.4 F (38 
C)  and white blood cell count of 1,500/mm3 (1.5 × 109/L)

Exam 5: Leadership & Management

A client is receiving several adjunctive professional therapies while rehabilitating after a stroke. Which client statements indicate an understanding of the services? Select all that apply.

The registered nurse is caring for multiple clients on a medical-surgical unit and has finished the morning assessment. Which task is appropriate for the nurse to delegate to unlicensed assistive personnel?

The office nurse receives 4 telephone messages from clients. Which client should the nurse call back first?

A Native American client is hospitalized for depression and attempted suicide. Family members have requested that they be allowed to bring in a medicine healer to perform a ritual on the client. Which of the following is the bestaction by the nurse?

A nurse is admitting a child who has leukemia. Several rooms are available on the pediatric unit. Which client could share a room with this child?

A client with terminal cancer arrives in the emergency department unresponsive and in respiratory distress. The client's sister is the legal medical power of attorney. Both the client's spouse and sister are present. Which action by the nurse is appropriate at this time?

The nurse prepares to administer the prescribed 8 AM medications to 4 clients. The nurse should administer medication to which client first?

The nurse is reviewing new laboratory values. Which client would be the priority to report to the health care provider?

After morning report, the nurse must perform which action first when caring for assigned clients?

The charge nurse is reviewing events that staff nurses experienced during the shift. Which events require an incident/occurrence report to be completed? Select all that apply.

The nurse is caring for a 5-year-old client who is dehydrated and malnourished, and suspects that the client may be neglected. Which information most strongly supports the nurse's suspicion of child neglect?

The day shift nurse provides handoff of care report to the oncoming night shift nurse. Which of the following statements by the nurse are appropriate to include in the report? Select all that apply.

The hospital nurse coming on duty notifies the unit of a delay due to a motor vehicle accident. The off-going nurse has an important appointment and must leave on time. How should the off-going nurse handle the situation?

Four clients were involved in a major highway motor vehicle accident. Which client requires priority care?

All of these events are occurring at the same time. Which one should the registered nurse deal with first?

Which client is most appropriate for the charge nurse in the postpartum unit to assign to the float nurse from the intensive care unit?

When making assignments in the labor and delivery unit, the charge nurse should assign the most experienced newborn admit nurse to attend to the birth of which client?

The nurse assesses and reviews the laboratory results for 4 clients. Which client's fever is of highest priority and should be reported to the health care provider immediately?