CNL Questions 1-50 with verified and
Updated Answers
*Af40-year-
oldfpostpartumfpatientfwithfchronicfHTNfandfgestationalfDMfwhofisfgravidaf5paraf4fisftransfe
rredffromfL&DftofthefpostpartumfunitfwithfLRfatf125fmL/hr.f*f*Uponfassessmentfoffthefpatient,
fthefnursefnoticesfthefpatient'sffundusfisfthreeffingerbreathsabovefumbilicusfandftofthefrightf
offmidlinefandfherfbladderfisfpalpable.fThefnursefalsofnotesfmoderateftofheavyfbleedingfandf
affullfbladderfandfnotifiesfthefCNL.fAsfafCNL,fthefmostfimportantfnursingfinterventionfisfto:*
A.fEncouragefthefnurseftofmassageftheffundusfandfheplockfthefpatient
B.fEncouragefthefnurseftofcallfthefphysicianfstatftoforderfMetherginef(methylergonovinefmal
eate)
C.fEncouragefthefnurseftofmonitorfthefpatientfoverfthefnextfhourfbecauseftherefarefnofriskffac
torsffor
afpostpartumfhemorrhage
D.fEncouragefthefnurseftofstraightfcatherizefthefpatientftofdecreaseftheflikelihoodfoffa
postpartumfhemorrhagef-fCORRECTfANSWER-
D.fEncouragefthefnurseftofstraightfcatherizefthefpatientftofdecreaseftheflikelihoodfoffa
postpartumfhemorrhage
Thefpatientfisfatfriskfforfafhemorrhagefdueftofbeingfafmultiparafandfhavingfaffull
bladder.fMetherginefisfcontraindicatedfinfpatientsfwithfhypertension.
*Af50fYOfFfwithfstagef3fCOPDfpresentsftotfhefEDfwithfincreasedfSOB.fBasedfonftheseflabfre
sults,fwhatfisfthefacid-basefdisorder*
pHf7.25f
PaCO2f50fmmHg
HCO3f22fmEq/Lf
PO2f75
SpO2f88%f
Naf+f136
BUNf18
a.funcompensatedfrespiratoryfacidosis
b.fmetabolicfacidosis
c.frespiratoryfacidosis
d.funcompensatedfrespiratoryfacidosisf-fCORRECTfANSWER-
a.funcompensatedfrespiratoryfacidosis
Basedfonfthefclinicalfscenario,fthefpHfisfdecreasedf(lessfthanf7.35);ftherefore,fthe
,patientfhasfacidosis.fThefPaCO2fisfelevatedf(morefthanf45fmmHg),fwhichfisfalsofconsistentf
withfthefpH.
ThefHCO3fisfwithinfnormalflimits,fwhichfsuggestsfthefkidneysfarefnotfcompensating.fCOPDfi
sfcommonly
associatedfwithfrespiratoryfacidosis.
*Af6-year-
oldfboyfisfinfcriticalfconditionffollowingfafcarfaccident.fThefpatientfhasfheadftraumafandfintern
alfbleeding.fThefpatient'sfparentsfhavefstatedfmultipleftimesfthatftheyfarefJehovah'sfWitness
esfandfdofnotfwantftheirfsonftofreceivefblood.fThefCNLfknowsfthatfthefbloodftransfusionfisfne
ededfimmediatelyfandfcouldfsavefthefboy'sflife.fWhichfofftheffollowingfstatementsfisfthefbestft
hingfforfthefCNLftofdo?*
A.fListenftofthefparents,fasfU.S.fminorsfhavefnoflegalfrightsfandfremainfunderfparentalfjurisdi
ction
B.fObtainfafcourtforderfinfthefbestfinterestfoffthefchildftofreceivefblood,fbasedfonfthe
avoidancefoffphysicalfharm
C.fBasedfonfreligiousfbeliefs,fdofnotfgivefblood
D.fFollowfthefphysician'sfdecisionftofgivefbloodfsincefthefphysician'sfdecisionfoverridesfthefp
arentalfdecisionf-fCORRECTfANSWER-
B.fObtainfafcourtforderfinfthefbestfinterestfoffthefchildftofreceivefblood,fbasedfonfthefavoidanc
efoffphysicalfharm
Thefchild'sfinterestsfasfwellfasfthefstatefpoliciesfoutweighfthefparentalfrightsftofrefusefmedic
alftreatmentfforfafminor.fAfcourtforderfisfneededftofenforcefthis.
*af65fYOfAAfmalefwasfadmittedftofyourfmicrosystemfwithfhyperglycemia.fThefpatientfhasfafh
istoryfoffHTN,fgout,fobesity,fandfsmoking.fThefpatientfhasfaffamilyfhistoryfoffDMfandfHTN.fW
hichfstatementfbyfthefpatientfdemonstratesfhisfunderstandingfoffmodifiablefriskffactorsfforfD
M?*
a.f"AsfIfgetfolder,fmyfriskfforfDMfincreases"
b.f"IfknowfthatfaffamilyfhistoryfoffDMfisfafriskffactor,fsofIfwillfeducatefmyfchildrenfonfDMfpreven
tion."
c.f"Ifwillfkeepfafrecordfoffallfmyfbloodfsugarsftoftakeftofmyfdoctor'sfappointments."
d.fIfwillfattendfafsmokingfcessationfclass,fbecausefIfknowfsmokingfincreasesfmyfriskfforfDM."f
-fCORRECTfANSWER-
d.fIfwillfattendfafsmokingfcessationfclass,fbecausefIfknowfsmokingfincreasesfmyfriskfforfDM."
Modifiablefriskffactorsfareflifestyleffactorsfthatfafpersonfcanfalterfinforderfto
preventfdisease.fSmokingfcessationfclassfisfanfinterventionfforfmodifyingfthefriskffactorfoffs
moking.
*Afclientfwithfcomplexfbehaviorfconcernsfisfgettingfreadyftofbefdischargedftofafskilledfnursin
gffacility.fHowever,fthefclientfhasfexpressedfthatfhefwishesftofstayfinfthefhospitalfandfnotfbefdi
scharged.fAsfthefCNL,fyourfbestfactionfwouldfbefto:*
, A.fInformfthefpatientfandfhisforfherffamilyfthatftheyfmustfgofandfremainingfonfthefunitfisfnotfanf
option
B.fAdvocateflettingfthefclientfstayfonfthefunitfonefextrafday,fthenfdischargeftomorrow
C.fIdentifyfthefclient'sfconcernsfandfcollaboratefwithfthefcarefteamftofseeftheyfarefaddressed
D.fAskftheffamilyftofhelpfencouragefthefclientftofdischargeftofthefskilledfnursingffacilityf-
fCORRECTfANSWER-
C.fIdentifyfthefclient'sfconcernsfandfcollaboratefwithfthefcarefteamftofseeftheyfarefaddressed
Clientsfcanfoftenfexperiencefapprehensionfwhenfchangingfcarefsettings.
Identifyingfspecificfconcernsfandfworkingfrapidlyftofensureftheyfarefaddressedfinfcollaborati
onfwithfother
membersfoffthefcarefteamfcanfgreatlyfreducefafclient'sfhesitation.fAdditionally,fsuchfcollabor
ation
ensuresfotherfmembersfoffthefcarefteamfarefawarefoffthefclients'fconcerns,fpossiblyfprovidin
gfadditional
informationfandfinsightfregardingfthefclientsfandftheirfcarefneeds
*AfCNLfevaluatesfaf17YOfpatientfwhofhasfbeenfafvictimfoffrape.fThefpatientfhasfvisible
bruisingfandfafheadflaceration.fAfterfthefCNL'sfassessment,flawfenforcementfofficialsfhavefc
ontactedfthefCNLfrequesting*f*informationfregardingfthefattackfandfthefvisiblefinjuriesfseenf
duringfthefvisit.fThefCNLfknowsfshefmustffirst:*
a.ftakefpicturesfandfcompletefthefrapefkit
b.fprovideflawfenforcementfwithfrecordsfasfrequested
c.fcallfthefpatient'sfparentsffirst
d.fexplainftofthefpatientfinforderftofobtainfconsentfforfreleasefoffrecordsf-
fCORRECTfANSWER-
d.fexplainftofthefpatientfinforderftofobtainfconsentfforfreleasefoffrecords
Rationale:fLegally,ftherefmustfbefconsentffromfthefpatientftofsharefinformationfwithflaw
enforcementfandftofabidefbyfHealthfInsurancefPortabilityfandfAccountabilityfActf(HIPAA)fre
gulations.
*AfCNLfinfthefEDfisfauditingfstrokefpatients'fchartsfandfthefadministrationfofftPAfandfnoticesft
hatfonlyf83%foffpatientsfwhofarefeligibleftofreceiveftPAfarefreceivingfit.fThefCNLfknowsfthatfth
ef83%fadministrationfratefisfbelowfthefnationalfbenchmark.fThefCNLfidentifiesfthatftherefisfaft
imeflagfinfMRI.fThefCNLfcreatesfafstrokefteamftofdevelopfafguidelinefimplementationfactionf
planftofimprovefthefprocessfofftimingfoffthefMRI.fWhatfisfthefbestftoolfutilizedfbyfthefCNLfinfim
plementingfchange?*
A.fResearchfstudy
B.fMeta-analysis
C.fPlan-Do-Study-Actf(PDSA)
D.fStandardize-Do-Study-Actf(SDSA)f-fCORRECTfANSWER-C.fPlan-Do-Study-
Actf(PDSA)
Updated Answers
*Af40-year-
oldfpostpartumfpatientfwithfchronicfHTNfandfgestationalfDMfwhofisfgravidaf5paraf4fisftransfe
rredffromfL&DftofthefpostpartumfunitfwithfLRfatf125fmL/hr.f*f*Uponfassessmentfoffthefpatient,
fthefnursefnoticesfthefpatient'sffundusfisfthreeffingerbreathsabovefumbilicusfandftofthefrightf
offmidlinefandfherfbladderfisfpalpable.fThefnursefalsofnotesfmoderateftofheavyfbleedingfandf
affullfbladderfandfnotifiesfthefCNL.fAsfafCNL,fthefmostfimportantfnursingfinterventionfisfto:*
A.fEncouragefthefnurseftofmassageftheffundusfandfheplockfthefpatient
B.fEncouragefthefnurseftofcallfthefphysicianfstatftoforderfMetherginef(methylergonovinefmal
eate)
C.fEncouragefthefnurseftofmonitorfthefpatientfoverfthefnextfhourfbecauseftherefarefnofriskffac
torsffor
afpostpartumfhemorrhage
D.fEncouragefthefnurseftofstraightfcatherizefthefpatientftofdecreaseftheflikelihoodfoffa
postpartumfhemorrhagef-fCORRECTfANSWER-
D.fEncouragefthefnurseftofstraightfcatherizefthefpatientftofdecreaseftheflikelihoodfoffa
postpartumfhemorrhage
Thefpatientfisfatfriskfforfafhemorrhagefdueftofbeingfafmultiparafandfhavingfaffull
bladder.fMetherginefisfcontraindicatedfinfpatientsfwithfhypertension.
*Af50fYOfFfwithfstagef3fCOPDfpresentsftotfhefEDfwithfincreasedfSOB.fBasedfonftheseflabfre
sults,fwhatfisfthefacid-basefdisorder*
pHf7.25f
PaCO2f50fmmHg
HCO3f22fmEq/Lf
PO2f75
SpO2f88%f
Naf+f136
BUNf18
a.funcompensatedfrespiratoryfacidosis
b.fmetabolicfacidosis
c.frespiratoryfacidosis
d.funcompensatedfrespiratoryfacidosisf-fCORRECTfANSWER-
a.funcompensatedfrespiratoryfacidosis
Basedfonfthefclinicalfscenario,fthefpHfisfdecreasedf(lessfthanf7.35);ftherefore,fthe
,patientfhasfacidosis.fThefPaCO2fisfelevatedf(morefthanf45fmmHg),fwhichfisfalsofconsistentf
withfthefpH.
ThefHCO3fisfwithinfnormalflimits,fwhichfsuggestsfthefkidneysfarefnotfcompensating.fCOPDfi
sfcommonly
associatedfwithfrespiratoryfacidosis.
*Af6-year-
oldfboyfisfinfcriticalfconditionffollowingfafcarfaccident.fThefpatientfhasfheadftraumafandfintern
alfbleeding.fThefpatient'sfparentsfhavefstatedfmultipleftimesfthatftheyfarefJehovah'sfWitness
esfandfdofnotfwantftheirfsonftofreceivefblood.fThefCNLfknowsfthatfthefbloodftransfusionfisfne
ededfimmediatelyfandfcouldfsavefthefboy'sflife.fWhichfofftheffollowingfstatementsfisfthefbestft
hingfforfthefCNLftofdo?*
A.fListenftofthefparents,fasfU.S.fminorsfhavefnoflegalfrightsfandfremainfunderfparentalfjurisdi
ction
B.fObtainfafcourtforderfinfthefbestfinterestfoffthefchildftofreceivefblood,fbasedfonfthe
avoidancefoffphysicalfharm
C.fBasedfonfreligiousfbeliefs,fdofnotfgivefblood
D.fFollowfthefphysician'sfdecisionftofgivefbloodfsincefthefphysician'sfdecisionfoverridesfthefp
arentalfdecisionf-fCORRECTfANSWER-
B.fObtainfafcourtforderfinfthefbestfinterestfoffthefchildftofreceivefblood,fbasedfonfthefavoidanc
efoffphysicalfharm
Thefchild'sfinterestsfasfwellfasfthefstatefpoliciesfoutweighfthefparentalfrightsftofrefusefmedic
alftreatmentfforfafminor.fAfcourtforderfisfneededftofenforcefthis.
*af65fYOfAAfmalefwasfadmittedftofyourfmicrosystemfwithfhyperglycemia.fThefpatientfhasfafh
istoryfoffHTN,fgout,fobesity,fandfsmoking.fThefpatientfhasfaffamilyfhistoryfoffDMfandfHTN.fW
hichfstatementfbyfthefpatientfdemonstratesfhisfunderstandingfoffmodifiablefriskffactorsfforfD
M?*
a.f"AsfIfgetfolder,fmyfriskfforfDMfincreases"
b.f"IfknowfthatfaffamilyfhistoryfoffDMfisfafriskffactor,fsofIfwillfeducatefmyfchildrenfonfDMfpreven
tion."
c.f"Ifwillfkeepfafrecordfoffallfmyfbloodfsugarsftoftakeftofmyfdoctor'sfappointments."
d.fIfwillfattendfafsmokingfcessationfclass,fbecausefIfknowfsmokingfincreasesfmyfriskfforfDM."f
-fCORRECTfANSWER-
d.fIfwillfattendfafsmokingfcessationfclass,fbecausefIfknowfsmokingfincreasesfmyfriskfforfDM."
Modifiablefriskffactorsfareflifestyleffactorsfthatfafpersonfcanfalterfinforderfto
preventfdisease.fSmokingfcessationfclassfisfanfinterventionfforfmodifyingfthefriskffactorfoffs
moking.
*Afclientfwithfcomplexfbehaviorfconcernsfisfgettingfreadyftofbefdischargedftofafskilledfnursin
gffacility.fHowever,fthefclientfhasfexpressedfthatfhefwishesftofstayfinfthefhospitalfandfnotfbefdi
scharged.fAsfthefCNL,fyourfbestfactionfwouldfbefto:*
, A.fInformfthefpatientfandfhisforfherffamilyfthatftheyfmustfgofandfremainingfonfthefunitfisfnotfanf
option
B.fAdvocateflettingfthefclientfstayfonfthefunitfonefextrafday,fthenfdischargeftomorrow
C.fIdentifyfthefclient'sfconcernsfandfcollaboratefwithfthefcarefteamftofseeftheyfarefaddressed
D.fAskftheffamilyftofhelpfencouragefthefclientftofdischargeftofthefskilledfnursingffacilityf-
fCORRECTfANSWER-
C.fIdentifyfthefclient'sfconcernsfandfcollaboratefwithfthefcarefteamftofseeftheyfarefaddressed
Clientsfcanfoftenfexperiencefapprehensionfwhenfchangingfcarefsettings.
Identifyingfspecificfconcernsfandfworkingfrapidlyftofensureftheyfarefaddressedfinfcollaborati
onfwithfother
membersfoffthefcarefteamfcanfgreatlyfreducefafclient'sfhesitation.fAdditionally,fsuchfcollabor
ation
ensuresfotherfmembersfoffthefcarefteamfarefawarefoffthefclients'fconcerns,fpossiblyfprovidin
gfadditional
informationfandfinsightfregardingfthefclientsfandftheirfcarefneeds
*AfCNLfevaluatesfaf17YOfpatientfwhofhasfbeenfafvictimfoffrape.fThefpatientfhasfvisible
bruisingfandfafheadflaceration.fAfterfthefCNL'sfassessment,flawfenforcementfofficialsfhavefc
ontactedfthefCNLfrequesting*f*informationfregardingfthefattackfandfthefvisiblefinjuriesfseenf
duringfthefvisit.fThefCNLfknowsfshefmustffirst:*
a.ftakefpicturesfandfcompletefthefrapefkit
b.fprovideflawfenforcementfwithfrecordsfasfrequested
c.fcallfthefpatient'sfparentsffirst
d.fexplainftofthefpatientfinforderftofobtainfconsentfforfreleasefoffrecordsf-
fCORRECTfANSWER-
d.fexplainftofthefpatientfinforderftofobtainfconsentfforfreleasefoffrecords
Rationale:fLegally,ftherefmustfbefconsentffromfthefpatientftofsharefinformationfwithflaw
enforcementfandftofabidefbyfHealthfInsurancefPortabilityfandfAccountabilityfActf(HIPAA)fre
gulations.
*AfCNLfinfthefEDfisfauditingfstrokefpatients'fchartsfandfthefadministrationfofftPAfandfnoticesft
hatfonlyf83%foffpatientsfwhofarefeligibleftofreceiveftPAfarefreceivingfit.fThefCNLfknowsfthatfth
ef83%fadministrationfratefisfbelowfthefnationalfbenchmark.fThefCNLfidentifiesfthatftherefisfaft
imeflagfinfMRI.fThefCNLfcreatesfafstrokefteamftofdevelopfafguidelinefimplementationfactionf
planftofimprovefthefprocessfofftimingfoffthefMRI.fWhatfisfthefbestftoolfutilizedfbyfthefCNLfinfim
plementingfchange?*
A.fResearchfstudy
B.fMeta-analysis
C.fPlan-Do-Study-Actf(PDSA)
D.fStandardize-Do-Study-Actf(SDSA)f-fCORRECTfANSWER-C.fPlan-Do-Study-
Actf(PDSA)
