RN Leadership Online Practice 2023 A|
Questions and Answers, 100% Correct|
Updated 2024
There has been a community disaster and stable clients must be discharged from a facility to prepare
for the influx of new casualties. A nurse should identify that which of the following clients is safe to
discharge?
a client who has multiple sclerosis and reports ataxia
A nurse on a medical-surgical unit is caring for four clients. The nurse should recognize that which of
the following clients is the priority?
A client who has peripheral vascular disease and has an absent pulse in the right foot
A nurse finds that a new IV pump has infused 400 mL of solution over 2 hr when the rate was set at
100 mL/hr. After notifying the provider and verifying that the pump was properly programmed, which
of the following is the nurse's priority?
Tag the pump for maintenance and acquire a new pump for the client
A charge nurse is planning care for a group of clients. Which of the following tasks should be delegated
to an assistive personnel (AP)? select all that apply
ambulating a client who uses a walker, adding thickener to thin liquids on a client's food tray
A nurse is caring for a client. Which of the following tasks should the nurse delegate to an assistive
personnel (AP)? select all that apply
Place an absorbent pad on the client's bed, report the client's blood pressure to the nurse, apply barrier
cream to the client's buttocks, document the client's vital signs
NB 1 0600: NB is 6 hr old born precipitous vagi deliv at 36 wks of gestation.
0730: RR 80, grunting, mild nasal flaring, retractions
NB 2 0600: NB is 26 hr old post vag birth. NB had circm. proced 4 hr ago.
0745: Guardian reports small spots of blood on the gauze when diaper was changed.
NB 3 0600: NB is 4 hr old following a repeat cesarean birth. Maternal hx GDM, insulin dependent. NB
wt 4649 g (10 lb 4 oz).
0740: Axi T 97°. Serum BG 35 mg/dL (greater than 40 to 45 mg/dL).
NB 4 0645: NB is 4 hr old following an ER c-sec for abruptio placenta. NBA feeding when V/S were due
to be taken. Guardian requests AP come back after.
, 0700: Guardian notified RN feeding done, ready for V/S.
NB 5 0600: NB is 23 hr old following a repeat cesarean birth. The newborn has not BF since birth w/ no
void or stool.
0745: Guardian notified RN of needing assistance with bf and concern baby is not getting anything.
Which 3 NB need prio
Newborn 5, Newborn 3, Newborn 1
When prioritizing hypotheses using the urgent vs. non-urgent approach to newborn care, the charge
nurse should identify newborn 1, newborn 3, and newborn 5 as requiring priority care based on acuity.
Newborn 1 has manifestations of respiratory distress including tachypnea, grunting, nasal flaring, and
retractions. The charge nurse should further determine if newborn 1 requires prompt interventions.
Newborn 3 presents with manifestations of hypoglycemia including blood glucose below the expected
range, hypothermia, and maternal history of gestational diabetes insulin dependent. Newborn 5 is 23
hours of age and has not had a successful feeding. The newborn additionally has not voided or passed
their first meconium stool. Newborns are expected to have at least one void during the first 24 hours of
life, and one meconium stool with in the first 24 to 48 hours of life. While newborns are sleepier during
the first 48 hours after birth, the newborn should be awoken for feedings at least every 3 hours. These
finding indicate that further intervention by the nurse is needed.
A nurse manager is assessing incident reports for the unit. Which of the following client's medical
records indicate professional negligence? Select 2 clients that the nurse manager should recognize
have charts that indicate professional negligence.
Client 4, Client 5
A charge nurse is assisting with the care of a client. Which of the following findings should the charge
nurse identify that the client is experiencing an adverse reaction and requires notification of provider
and updating the client's plan of care? Select 6 findings that indicate that client is having an adverse
reaction.
blood pressure, temperature, heart rate, respiratory rate, pain level, report by the client
A nurse is caring for a client who has acute diverticulitis and is scheduled for surgery within the next 2
hr. The client tells the nurse that they are leaving the hospital. After notifying the surgeon, which of
the following actions should the nurse take next?
Inform the client about the risks they may encounter by leaving the facility
A nurse is reviewing the plan of care for a client following a total hip arthroplasty. Which of the
following actions should the nurse plan to take?
Inform the assistive personnel (AP) of the client's weight-bearing status
A nurse case manager is planning a teaching session on the use of critical pathways with a group of
newly licensed nurses. Which of the following information should the nurse include in the teaching?
Questions and Answers, 100% Correct|
Updated 2024
There has been a community disaster and stable clients must be discharged from a facility to prepare
for the influx of new casualties. A nurse should identify that which of the following clients is safe to
discharge?
a client who has multiple sclerosis and reports ataxia
A nurse on a medical-surgical unit is caring for four clients. The nurse should recognize that which of
the following clients is the priority?
A client who has peripheral vascular disease and has an absent pulse in the right foot
A nurse finds that a new IV pump has infused 400 mL of solution over 2 hr when the rate was set at
100 mL/hr. After notifying the provider and verifying that the pump was properly programmed, which
of the following is the nurse's priority?
Tag the pump for maintenance and acquire a new pump for the client
A charge nurse is planning care for a group of clients. Which of the following tasks should be delegated
to an assistive personnel (AP)? select all that apply
ambulating a client who uses a walker, adding thickener to thin liquids on a client's food tray
A nurse is caring for a client. Which of the following tasks should the nurse delegate to an assistive
personnel (AP)? select all that apply
Place an absorbent pad on the client's bed, report the client's blood pressure to the nurse, apply barrier
cream to the client's buttocks, document the client's vital signs
NB 1 0600: NB is 6 hr old born precipitous vagi deliv at 36 wks of gestation.
0730: RR 80, grunting, mild nasal flaring, retractions
NB 2 0600: NB is 26 hr old post vag birth. NB had circm. proced 4 hr ago.
0745: Guardian reports small spots of blood on the gauze when diaper was changed.
NB 3 0600: NB is 4 hr old following a repeat cesarean birth. Maternal hx GDM, insulin dependent. NB
wt 4649 g (10 lb 4 oz).
0740: Axi T 97°. Serum BG 35 mg/dL (greater than 40 to 45 mg/dL).
NB 4 0645: NB is 4 hr old following an ER c-sec for abruptio placenta. NBA feeding when V/S were due
to be taken. Guardian requests AP come back after.
, 0700: Guardian notified RN feeding done, ready for V/S.
NB 5 0600: NB is 23 hr old following a repeat cesarean birth. The newborn has not BF since birth w/ no
void or stool.
0745: Guardian notified RN of needing assistance with bf and concern baby is not getting anything.
Which 3 NB need prio
Newborn 5, Newborn 3, Newborn 1
When prioritizing hypotheses using the urgent vs. non-urgent approach to newborn care, the charge
nurse should identify newborn 1, newborn 3, and newborn 5 as requiring priority care based on acuity.
Newborn 1 has manifestations of respiratory distress including tachypnea, grunting, nasal flaring, and
retractions. The charge nurse should further determine if newborn 1 requires prompt interventions.
Newborn 3 presents with manifestations of hypoglycemia including blood glucose below the expected
range, hypothermia, and maternal history of gestational diabetes insulin dependent. Newborn 5 is 23
hours of age and has not had a successful feeding. The newborn additionally has not voided or passed
their first meconium stool. Newborns are expected to have at least one void during the first 24 hours of
life, and one meconium stool with in the first 24 to 48 hours of life. While newborns are sleepier during
the first 48 hours after birth, the newborn should be awoken for feedings at least every 3 hours. These
finding indicate that further intervention by the nurse is needed.
A nurse manager is assessing incident reports for the unit. Which of the following client's medical
records indicate professional negligence? Select 2 clients that the nurse manager should recognize
have charts that indicate professional negligence.
Client 4, Client 5
A charge nurse is assisting with the care of a client. Which of the following findings should the charge
nurse identify that the client is experiencing an adverse reaction and requires notification of provider
and updating the client's plan of care? Select 6 findings that indicate that client is having an adverse
reaction.
blood pressure, temperature, heart rate, respiratory rate, pain level, report by the client
A nurse is caring for a client who has acute diverticulitis and is scheduled for surgery within the next 2
hr. The client tells the nurse that they are leaving the hospital. After notifying the surgeon, which of
the following actions should the nurse take next?
Inform the client about the risks they may encounter by leaving the facility
A nurse is reviewing the plan of care for a client following a total hip arthroplasty. Which of the
following actions should the nurse plan to take?
Inform the assistive personnel (AP) of the client's weight-bearing status
A nurse case manager is planning a teaching session on the use of critical pathways with a group of
newly licensed nurses. Which of the following information should the nurse include in the teaching?
