COMPLETE QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) WITH RATIONALES|ALREADY
GRADED A+||BRAND NEW VERSION!!
1. Medications should be given through what?- CORRECT ANSWER ✔✔ - Central line
2. The nurse working on a medical surgical unit is delegating tasks to un- licensed
personnel. Which of the following delegated task would REQUIRE FOLLOW UP by the
charge nurse?- CORRECT ANSWER ✔✔ - A. Assisting a client who had a paracentesis 2 hours ago to get out
of bed for the first time.
Rationale - anytime a client is doing something for the first time the RN needs to do it
3. The nurse is prioritizing patient care after a change of shift report. The nurse should first
plan to see the patient who- CORRECT ANSWER ✔✔ -- B. Had an endoscopic retrograde cholangiopancreatog-
raphy 30 minutes ago and is reporting diflculty swallowing Rationale - Diflculty swallowing - ABC's!
4. The nurse working on the mom/baby unit has become aware of the follow- ing client
situations. Which of the following clients should the nurse INITIALLY assess?- CORRECT
ANSWER ✔✔ - C. a neonate who is 4 hours old, whose resting HR is 95 BPM.
Rationale - Normal HR for a newborn is 120-140 BPM - 95 is a LOW BPM
5. A nurse working on a medical surgical unit has just received a handoff report on the
following clients. The nurse should FIRST plan to assess the client who has- CORRECT ANSWER
✔✔ - - CORRECT ANSWER ✔✔ - D. Acute pancreatitis and is reporting the development of pain on deep inspiration
Rationale - "acute" if not caught early, will possible burst and patient will become septic
6. The nurse working on a pediatric unit is caring for the following children who have
been admitted in the past 12 hours. It would be a priority goal for the nurse to initiate
an interdisciplinary conference for the child who- CORRECT ANSWER ✔✔ - -
CORRECT ANSWER ✔✔ - A. 5 yr old with diagnosed cystic fibrosis at birth and has been hospitalized 4 times
in the past 2 months
Rationale - This is conferencing everyone!!! PT, dietary, spiritual guidance, everyone should be conferenced for this patient. This
question is asking - WHO / WHICH child is requiring the MOST help and resources???
7. The nurse working in the ED has received the following prescriptions for
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, a newly admitted client. Which prescriptions should the nurse implement FIRST?-
CORRECT ANSWER ✔✔ - D. Initiate IV sodium and potassium for a client admitted with diarrhea and dehydration who has a
serum potassium level of 2.9.
Rationale - serum potassium of 2.9 is CRITICAL -this is a critical lab value and should be addressed first!
8. A nurse is working in a community health clinic is assessing clients who are waiting
to be seen. Which client should the nurse have the primary health care provider see
FIRST?- CORRECT ANSWER ✔✔ - A. a 57 year old with graves disease with a temperature of 100.5
Rationale - Thyroid issue
9. A nurse is working on a pediatric cardiac unit is reviewing the telemetry monitors
for assigned clients. Which client should the nurse INITIALLY plan to assess?-
CORRECT ANSWER ✔✔ - A. 2 year old toddler who is walking in the hallway and has a HR of 160 BPM
Rationale - Abnormal HR - all the other choices were normal for the child
10. A nurse is caring for a male client who has a deep partial thickness and a full
thickness burn to 45 % of the lower body. It would be a PRIORITY for the nurse to notify
the primary health care physician if the client has- CORRECT ANSWER ✔✔ - - CORRECT
ANSWER ✔✔ - D. A urinary output of 45 ml over the past two hours
Rationale - Normal urinary output per hour is 30 ml.hr. This question really has nothing to do with "burn" and more know your
normal values.
11. The nurse is assessing clients at the scene of a mass casualty disaster
and is prioritizing care based on the disaster triage tag system. Which of the following clients
should be transported to the health care facility FIRST?- CORRECT ANSWER ✔✔ - C.
the client who has multiple compound fractures and is reporting chest pain Rationale - patient is reporting chest pain
12. The charge nurse in the ED is reviewing the care provided for recently ad-
mitted clients. which of the following reflects implementation of an accepted standard of
care?- CORRECT ANSWER ✔✔ - B. placing the client who has suspected Hemophilus influenza on droplet
precautions Rationale - influenza = droplet
13. A charge nurse is planning to admit several clients in the medical unit. It
would be necessary for the nurse to admit which client to a PRIVATE room?- CORRECT
ANSWER ✔✔ - B. Has a fever of unknown origin
14. Sequence for "doffing" (removing) personal protective equipment (PPE)-
CORRECT ANSWER ✔✔ - Gloves
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