MISC Priority Exam Questions with correct
Answers 2025/2026 A+ Graded 100%
Verified
1324
(Tumor lysis syndrome is an emergency involving electrolyte imbalances and potential renal
failure. A patient scheduled for surgery should be assessed and prepared for surgery. A patient
with breakthrough pain needs assessment, and the physician may need to be contacted for a
change of dosage or medication. Anticipatory nausea and vomiting has a psychogenic
component that requires assessment, teaching, reassurance, and administration of antiemetics.
Focus: Prioritization) - ANS-You have just received the morning report from the night shift
nurse. List the order of priority for assessing and caring for the following patients.
1. A patient who developed tumor lysis syndrome around 5:00 am
2. A patient who reports breakthrough pain since last dose of pain medication
3. A patient scheduled for exploratory laparotomy this morning
4. A patient with anticipatory nausea and vomiting for the past 24 hours _______, _______,
_______, _______
1
( Morphine elixir is the therapy of choice because it is thought to reduce anxiety and the
subjective sensation of air hunger. It also increases venous capacitance. End-of-life-care should
not include aggressive measures such as intubation or resuscitation. Support and comfort are
always welcome, but in this case you should not sit quietly because there is an option that
would offer some physical relief for the patient. Focus: Prioritization) - ANS-You are providing
end-of-life-care for a patient with terminal liver cancer. The patient is weak and restless. Her
skin is cool and mottled. Dyspnea develops and the patient appears anxious and frightened.
What should you do?
1. Obtain an order for morphine elixir.
2. Alert the rapid response team and call the physician for orders.
3. Deliver breaths at 20/min with a bag-valve mask and prepare for intubation.
4. Sit quietly with the patient and offer emotional support and comfort.
3
( Explain that you are not chemotherapy certified so that the charge nurse can quickly rearrange
the patient assignments. You can assess the patient, site, and infusion; however, you do not
have the expertise to recognize the side effects of the medication or to give specialized care
that may be needed. Asking the nurse to stay is not the best solution, because the care of the
patient and the effects of the medication continue after the infusion has been completed.
,Looking up the side effects of the drug is okay for your own information, but you are still not
qualified to deal with this situation. In addition, knowing how to properly discontinue the infusion
and dispose of the equipment are essential for your own safety and the safety of others. Focus:
Prioritization) - ANS-You are asked to float to a different nursing unit. During report, you are told
that the patient is receiving IV administration of vincristine (Oncovin) that should be completed
within the next 15 minutes. The IV site is intact, and the patient is not having any problems with
the infusion. You are not certified in chemotherapy administration. What is your priority action?
1. Ask the nurse to stay until the infusion is finished, because you are not certified.
2. Assess the IV site; check the progress of the infusion and the patient's condition.
3. Contact the charge nurse and explain that you are not chemotherapy certified.
4. Look up drug side effects and monitor, because the infusion is almost complete.
2
( If the radiation implant has obviously been expelled (i.e., is on the bed linens), use a pair of
forceps to place the radiation source in a lead container. The other options would be appropriate
after safety of the patient and personnel are ensured. Focus: Prioritization, supervision) -
ANS-You are caring for a patient with uterine cancer who is being treated with intracavitary
radiation therapy. The UAP reports that the patient insisted on ambulating to the bathroom and
now "something feels like it is coming out." What is the priority action?
1. Assess the UAP's knowledge; explain the rationale for strict bed rest.
2. Assess for dislodgment; use forceps to retrieve and a lead container to store as needed.
3. Assess the patient's knowledge of the treatment plan and her willingness to participate.
4. Notify the physician about the potential or confirmed dislodgment of the radiation implant.
3
( Epinephrine is the initial drug of choice for treatment of anaphylaxis. Giving epinephrine rapidly
at the onset of an anaphylactic reaction may prevent or reverse cardiovascular collapse as well
as airway narrowing caused by bronchospasm and inflammation. Oxygen use is also
appropriate, but oxygen would be administered using a nonrebreather mask in order to achieve
a fraction of inspired oxygen closer to 100%. Albuterol may also be administered to decrease
airway narrowing but would not be the first therapy used for anaphylaxis. IV access will take
longer to establish and should not be the first intervention. Focus: Prioritization) - ANS-A few
minutes after you have given an intradermal injection of an allergen to a patient who is
undergoing skin testing for allergies, the patient reports feeling anxious, short of breath, and
dizzy. Which action included in the emergency protocol should you take first?
1. Start oxygen at 4 L/min using a nasal cannula.
2. Obtain IV access with a large-bore IV catheter.
3. Give epinephrine (Adrenalin) 0.3 mL intramuscularly.
4. Administer 3 mL of nebulized albuterol (Proventil) 0.083%
4
( Pentamidine can cause fatal hypoglycemia, so the low blood glucose level indicates a need for
a change in therapy. The low blood pressure suggests that the pentamidine infusion rate may
need to be slowed. The other responses indicate a need for independent nursing actions (such
,as establishing a new IV site and encouraging oral intake) but are not associated with
pentamidine infusion. Focus: Prioritization) - ANS-You are evaluating an HIV-positive patient
who is receiving IV pentamidine (Pentam) as a treatment for Pneumocystis jiroveci (PCP)
pneumonia. Which information is most important to communicate to the physician?
1. The patient is reporting pain at the site of the infusion.
2. The patient is not taking in an adequate amount of oral fluids.
3. Blood pressure is 104/76 mm Hg after pentamidine administration.
4. Blood glucose level is 55 mg/dL after medication administration.
1
( Patients with severe immunodeficiency may be unable to produce an immune response, so a
negative TB skin test result does not completely rule out a TB diagnosis for this patient. The
next steps in diagnosis are chest radiography and sputum culture. Teaching about isoniazid and
follow-up TB testing may be required, depending on the radiographic findings and sputum
culture results. Focus: Prioritization) - ANS-A patient with newly diagnosed acquired
immunodeficiency syndrome (AIDS) has a negative result on a skin test for tuberculosis (TB).
Which action will you anticipate taking next?
1. Obtain a chest radiograph and sputum smear.
2. Tell the patient that the TB test results are negative.
3. Teach the patient about the anti-TB drug isoniazid.
4. Schedule TB testing again in 12 months.
3
( Albuterol is the most rapidly acting of the medications listed. Corticosteroids are helpful in
preventing allergic reactions but are not rapidly acting. Cromolyn is used as a prophylactic
medication to prevent asthma attacks but not to treat acute attacks. Aminophylline is not a
first-line treatment for bronchospasm. Focus: Prioritization) - ANS-A patient with wheezing and
coughing caused by an allergic reaction to penicillin is admitted to the emergency department.
Which medication do you anticipate administering first?
1. Methylprednisolone (Solu-Medrol) 100 mg IV
2. Cromolyn (Intal) 20 mg via nebulizer
3. Albuterol (Proventil) 3 mL via nebulizer
4. Aminophylline (Theophylline) 500 mg IV
4
( A major purpose of HIV testing for asymptomatic patients is to ensure that HIV-positive
individuals are aware of their HIV status, take actions to prevent HIV transmission, and
effectively treat the HIV infection. According to current national guidelines, the other actions are
also appropriate. Rapid HIV testing must be confirmed by another test, usually the Western blot
test. Antiretroviral therapy is recommended for all HIV-positive patients. Risk factor information
will be used in tracking patient contacts and in teaching the patient how to reduce the risk for
transmission to others. Focus: Prioritization) - ANS-A patient seen in the sexually-transmitted
disease clinic has just tested positive for HIV with a rapid HIV test. Which action will you take
next?
, 1. Ask about patient risk factors for HIV infection.
2. Send a blood specimen for Western blot testing.
3. Provide information about antiretroviral therapy.
4. Discuss the positive test results with the patient.
4
( Bilateral moist crackles indicate fluid-filled alveoli, which interferes with gas exchange.
Furosemide is a potent loop diuretic that will help mobilize the fluid in the lungs. The other
orders are important, but are not urgent. Focus: Prioritization) - ANS-The health care provider
has written all of these orders for a client with a diagnosis of Excess Fluid Volume. The client's
morning assessment reveals bounding peripheral pulses, weight gain of 2 lb, pitting ankle
edema, and moist crackles bilaterally. Which order takes priority at this time?
1. Weigh the client every morning.
2. Maintain accurate intake and output records.
3. Restrict fluids to 1500 mL/day.
4. Administer furosemide (Lasix) 40 mg IV push
2
( A positive Chvostek sign (facial twitching of one side of the mouth, nose, and cheek in
response to tapping the face just below and in front of the ear) is a neurologic manifestation of
hypocalcemia. The LPN/LVN is experienced and possesses the skills to accurately measure
vital signs. Focus: Prioritization) - ANS-An experienced LPN/LVN reports to you that a client's
blood pressure and heart rate have decreased, and when his face is assessed, one side
twitches. What action should you take at this time?
1. Reassess the client's blood pressure and heart rate.
2. Review the client's morning calcium level.
3. Request a neurologic consult today.
4. Check the client's pupillary reaction to light.
4
( Clients with low calcium levels should be encouraged to eat dairy products, seafood, nuts,
broccoli, and spinach, which are all good sources of dietary calcium. Focus: Prioritization) -
ANS-You are preparing to discharge a client whose calcium level was low but is now just barely
within the normal range (9 to 10.5 mg/dL). Which statement by the client indicates to you the
need for additional teaching?
1. "I will call my doctor if I experience muscle twitching or seizures."
2. "I will make sure to take my vitamin D with my calcium each day."
3. "I will take my calcium citrate pill every morning before breakfast."
4. "I will avoid dairy products, broccoli, and spinach when I eat."
4
( Although all of these laboratory values are outside of the normal range, the magnesium level is
furthest from normal. With a magnesium level this low, the client is at risk for ECG changes and
Answers 2025/2026 A+ Graded 100%
Verified
1324
(Tumor lysis syndrome is an emergency involving electrolyte imbalances and potential renal
failure. A patient scheduled for surgery should be assessed and prepared for surgery. A patient
with breakthrough pain needs assessment, and the physician may need to be contacted for a
change of dosage or medication. Anticipatory nausea and vomiting has a psychogenic
component that requires assessment, teaching, reassurance, and administration of antiemetics.
Focus: Prioritization) - ANS-You have just received the morning report from the night shift
nurse. List the order of priority for assessing and caring for the following patients.
1. A patient who developed tumor lysis syndrome around 5:00 am
2. A patient who reports breakthrough pain since last dose of pain medication
3. A patient scheduled for exploratory laparotomy this morning
4. A patient with anticipatory nausea and vomiting for the past 24 hours _______, _______,
_______, _______
1
( Morphine elixir is the therapy of choice because it is thought to reduce anxiety and the
subjective sensation of air hunger. It also increases venous capacitance. End-of-life-care should
not include aggressive measures such as intubation or resuscitation. Support and comfort are
always welcome, but in this case you should not sit quietly because there is an option that
would offer some physical relief for the patient. Focus: Prioritization) - ANS-You are providing
end-of-life-care for a patient with terminal liver cancer. The patient is weak and restless. Her
skin is cool and mottled. Dyspnea develops and the patient appears anxious and frightened.
What should you do?
1. Obtain an order for morphine elixir.
2. Alert the rapid response team and call the physician for orders.
3. Deliver breaths at 20/min with a bag-valve mask and prepare for intubation.
4. Sit quietly with the patient and offer emotional support and comfort.
3
( Explain that you are not chemotherapy certified so that the charge nurse can quickly rearrange
the patient assignments. You can assess the patient, site, and infusion; however, you do not
have the expertise to recognize the side effects of the medication or to give specialized care
that may be needed. Asking the nurse to stay is not the best solution, because the care of the
patient and the effects of the medication continue after the infusion has been completed.
,Looking up the side effects of the drug is okay for your own information, but you are still not
qualified to deal with this situation. In addition, knowing how to properly discontinue the infusion
and dispose of the equipment are essential for your own safety and the safety of others. Focus:
Prioritization) - ANS-You are asked to float to a different nursing unit. During report, you are told
that the patient is receiving IV administration of vincristine (Oncovin) that should be completed
within the next 15 minutes. The IV site is intact, and the patient is not having any problems with
the infusion. You are not certified in chemotherapy administration. What is your priority action?
1. Ask the nurse to stay until the infusion is finished, because you are not certified.
2. Assess the IV site; check the progress of the infusion and the patient's condition.
3. Contact the charge nurse and explain that you are not chemotherapy certified.
4. Look up drug side effects and monitor, because the infusion is almost complete.
2
( If the radiation implant has obviously been expelled (i.e., is on the bed linens), use a pair of
forceps to place the radiation source in a lead container. The other options would be appropriate
after safety of the patient and personnel are ensured. Focus: Prioritization, supervision) -
ANS-You are caring for a patient with uterine cancer who is being treated with intracavitary
radiation therapy. The UAP reports that the patient insisted on ambulating to the bathroom and
now "something feels like it is coming out." What is the priority action?
1. Assess the UAP's knowledge; explain the rationale for strict bed rest.
2. Assess for dislodgment; use forceps to retrieve and a lead container to store as needed.
3. Assess the patient's knowledge of the treatment plan and her willingness to participate.
4. Notify the physician about the potential or confirmed dislodgment of the radiation implant.
3
( Epinephrine is the initial drug of choice for treatment of anaphylaxis. Giving epinephrine rapidly
at the onset of an anaphylactic reaction may prevent or reverse cardiovascular collapse as well
as airway narrowing caused by bronchospasm and inflammation. Oxygen use is also
appropriate, but oxygen would be administered using a nonrebreather mask in order to achieve
a fraction of inspired oxygen closer to 100%. Albuterol may also be administered to decrease
airway narrowing but would not be the first therapy used for anaphylaxis. IV access will take
longer to establish and should not be the first intervention. Focus: Prioritization) - ANS-A few
minutes after you have given an intradermal injection of an allergen to a patient who is
undergoing skin testing for allergies, the patient reports feeling anxious, short of breath, and
dizzy. Which action included in the emergency protocol should you take first?
1. Start oxygen at 4 L/min using a nasal cannula.
2. Obtain IV access with a large-bore IV catheter.
3. Give epinephrine (Adrenalin) 0.3 mL intramuscularly.
4. Administer 3 mL of nebulized albuterol (Proventil) 0.083%
4
( Pentamidine can cause fatal hypoglycemia, so the low blood glucose level indicates a need for
a change in therapy. The low blood pressure suggests that the pentamidine infusion rate may
need to be slowed. The other responses indicate a need for independent nursing actions (such
,as establishing a new IV site and encouraging oral intake) but are not associated with
pentamidine infusion. Focus: Prioritization) - ANS-You are evaluating an HIV-positive patient
who is receiving IV pentamidine (Pentam) as a treatment for Pneumocystis jiroveci (PCP)
pneumonia. Which information is most important to communicate to the physician?
1. The patient is reporting pain at the site of the infusion.
2. The patient is not taking in an adequate amount of oral fluids.
3. Blood pressure is 104/76 mm Hg after pentamidine administration.
4. Blood glucose level is 55 mg/dL after medication administration.
1
( Patients with severe immunodeficiency may be unable to produce an immune response, so a
negative TB skin test result does not completely rule out a TB diagnosis for this patient. The
next steps in diagnosis are chest radiography and sputum culture. Teaching about isoniazid and
follow-up TB testing may be required, depending on the radiographic findings and sputum
culture results. Focus: Prioritization) - ANS-A patient with newly diagnosed acquired
immunodeficiency syndrome (AIDS) has a negative result on a skin test for tuberculosis (TB).
Which action will you anticipate taking next?
1. Obtain a chest radiograph and sputum smear.
2. Tell the patient that the TB test results are negative.
3. Teach the patient about the anti-TB drug isoniazid.
4. Schedule TB testing again in 12 months.
3
( Albuterol is the most rapidly acting of the medications listed. Corticosteroids are helpful in
preventing allergic reactions but are not rapidly acting. Cromolyn is used as a prophylactic
medication to prevent asthma attacks but not to treat acute attacks. Aminophylline is not a
first-line treatment for bronchospasm. Focus: Prioritization) - ANS-A patient with wheezing and
coughing caused by an allergic reaction to penicillin is admitted to the emergency department.
Which medication do you anticipate administering first?
1. Methylprednisolone (Solu-Medrol) 100 mg IV
2. Cromolyn (Intal) 20 mg via nebulizer
3. Albuterol (Proventil) 3 mL via nebulizer
4. Aminophylline (Theophylline) 500 mg IV
4
( A major purpose of HIV testing for asymptomatic patients is to ensure that HIV-positive
individuals are aware of their HIV status, take actions to prevent HIV transmission, and
effectively treat the HIV infection. According to current national guidelines, the other actions are
also appropriate. Rapid HIV testing must be confirmed by another test, usually the Western blot
test. Antiretroviral therapy is recommended for all HIV-positive patients. Risk factor information
will be used in tracking patient contacts and in teaching the patient how to reduce the risk for
transmission to others. Focus: Prioritization) - ANS-A patient seen in the sexually-transmitted
disease clinic has just tested positive for HIV with a rapid HIV test. Which action will you take
next?
, 1. Ask about patient risk factors for HIV infection.
2. Send a blood specimen for Western blot testing.
3. Provide information about antiretroviral therapy.
4. Discuss the positive test results with the patient.
4
( Bilateral moist crackles indicate fluid-filled alveoli, which interferes with gas exchange.
Furosemide is a potent loop diuretic that will help mobilize the fluid in the lungs. The other
orders are important, but are not urgent. Focus: Prioritization) - ANS-The health care provider
has written all of these orders for a client with a diagnosis of Excess Fluid Volume. The client's
morning assessment reveals bounding peripheral pulses, weight gain of 2 lb, pitting ankle
edema, and moist crackles bilaterally. Which order takes priority at this time?
1. Weigh the client every morning.
2. Maintain accurate intake and output records.
3. Restrict fluids to 1500 mL/day.
4. Administer furosemide (Lasix) 40 mg IV push
2
( A positive Chvostek sign (facial twitching of one side of the mouth, nose, and cheek in
response to tapping the face just below and in front of the ear) is a neurologic manifestation of
hypocalcemia. The LPN/LVN is experienced and possesses the skills to accurately measure
vital signs. Focus: Prioritization) - ANS-An experienced LPN/LVN reports to you that a client's
blood pressure and heart rate have decreased, and when his face is assessed, one side
twitches. What action should you take at this time?
1. Reassess the client's blood pressure and heart rate.
2. Review the client's morning calcium level.
3. Request a neurologic consult today.
4. Check the client's pupillary reaction to light.
4
( Clients with low calcium levels should be encouraged to eat dairy products, seafood, nuts,
broccoli, and spinach, which are all good sources of dietary calcium. Focus: Prioritization) -
ANS-You are preparing to discharge a client whose calcium level was low but is now just barely
within the normal range (9 to 10.5 mg/dL). Which statement by the client indicates to you the
need for additional teaching?
1. "I will call my doctor if I experience muscle twitching or seizures."
2. "I will make sure to take my vitamin D with my calcium each day."
3. "I will take my calcium citrate pill every morning before breakfast."
4. "I will avoid dairy products, broccoli, and spinach when I eat."
4
( Although all of these laboratory values are outside of the normal range, the magnesium level is
furthest from normal. With a magnesium level this low, the client is at risk for ECG changes and
