Group Performance Profile
NURS 480 Final TH AM SP 1 2025 WALLD
Question Analysis
NURS 480 Final TH AM SP 1 2025 WALLD
QUESTION SOURCE QUESTION ANSWER KEY/ % DISCRM
TYPE OPTION DISTRACTOR SELECTED
The nurse is caring for a client Educator Multiple Balancing fluids and Key 94.7% 0.16
following an adrenalectomy. Choice electrolytes
What is the highest priority in the
immediate postoperative period? Monitoring for signs of Distractor 5.3% -0.16
infection
Preventing emotional Distractor 0.0% N/A
disturbances
Protecting the patient’s skin Distractor 0.0% N/A
What is the best initial action by Educator Multiple Use an end-tidal CO2 Key 91.2% 0.30
the nurse to verify the correct Choice monitor.
placement of an oral
endotracheal tube (ET) after Obtain a portable chest x-ray Distractor 3.5% -0.32
insertion?
Auscultate for bilateral breath Distractor 3.5% 0.03
sounds.
Observe for symmetrical chest Distractor 1.8% -0.24
movement.
After surgery for an abdominal Educator Multiple Increase the IV fluid infusion Key 94.7% 0.14
aortic aneurysm, a client’s central Choice per protocol.
venous pressure (CVP) monitor
indicates low pressures. Which Administer IV diuretic Distractor 1.8% 0.04
action should the nurse take? medications.
Increase the infusion rate of IV Distractor 0.0% N/A
vasodilators.
Elevate the head of the Distractor 3.5% -0.19
patient’s bed to 45 degrees.
Which finding indicates to the Educator Multiple Fewer episodes of bleeding Key 91.2% 0.22
nurse that a client's transjugular Choice varices.
intrahepatic portosystemic shunt
(TIPS) placed 3 months ago has Increased serum albumin Distractor 1.8% -0.18
been effective? level.
Decreased indirect bilirubin Distractor 3.5% -0.16
level.
Improved alertness and Distractor 3.5% -0.05
orientation.
,Group Performance Profile
NURS 480 Final TH AM SP 1 2025 WALLD
QUESTION SOURCE QUESTION ANSWER KEY/ % DISCRM
TYPE OPTION DISTRACTOR SELECTED
Which assessment is most Educator Multiple arterial blood gas Key 45.6% 0.17
important for the nurse to make in Choice
order to evaluate whether heart rate Distractor 28.1% -0.11
treatment of a patient with
anaphylactic shock has been
effective? level of consciousness Distractor 15.8% -0.13
blood pressure Distractor 10.5% 0.05
A nurse is caring for a client who ATI Multiple Monitor the client for Key 98.2% -0.10
has type 1 diabetes mellitus. The Choice hypoglycemia.
nurse misread the client’s
morning blood glucose level as Give the client 15 to 20 g of Distractor 1.8% 0.10
210 mg/dL instead of 120 mg/dL. carbohydrate.
Based on this error, she
administered the insulin dose
appropriate for a reading over Complete an incident report. Distractor 0.0% N/A
200 mg/dL before the client’s
breakfast. Which of the following Notify the nurse manager. Distractor 0.0% N/A
is the nurse’s priority action upon
realizing the error?
The nurse is preparing to Educator Multiple Administer the medication Key 87.7% 0.45
administer the oral anticoagulant Choice as ordered.
warfarin (Coumadin) to a client in
CCU who has a PT: 22, PTT: 39 Assess the client for abnormal Distractor 7.0% -0.43
and an INR of 2.8. What action bleeding.
should the nurse implement?
Prepare to administer vitamin Distractor 5.3% -0.17
K (Aqua/Mephyton).
Notify the HCP to obtain an Distractor 0.0% N/A
order to increase the dose.
A client begins to complain of Educator Multiple Stop the transfusion and Key 100.0% N/A
chills and discomfort after about Choice maintain a patent line with
50 mL of blood has transfused normal saline solution and
from a unit of packed red blood new tubing.
cells. The best nursing action at
this time is to: Slow down the infusing blood Distractor 0.0% N/A
and dilute it with the normal
saline solution.
Compare the vital signs now Distractor 0.0% N/A
with what they were before the
blood transfusion began.
Discontinue the transfusion, Distractor 0.0% N/A
remove the IV catheter, and
restart the transfusion in
another site.
, Group Performance Profile
NURS 480 Final TH AM SP 1 2025 WALLD
QUESTION SOURCE QUESTION ANSWER KEY/ % DISCRM
TYPE OPTION DISTRACTOR SELECTED
The nurse is caring for a Educator Multiple Fluctuation of the fluid level Key 91.2% 0.23
postoperative client who has a Choice within the water seal
chest tube connected to suction chamber
and a water seal drainage
system. Which of the following Absence of fluid in the Distractor 0.0% N/A
indicates to the nurse that the drainage tubing
chest tube is functioning
properly? Continuous bubbling within the Distractor 8.8% -0.23
water seal chamber
Equal amounts of fluid Distractor 0.0% N/A
drainage in each collection
chamber
A nurse is discussing the care of Educator Multiple The client refuses breakfast Key 94.7% 0.13
a client who has type 1 diabetes Choice and requests to sleep.
mellitus with the unlicensed
assistive personnel (UAP). Which The client reports dizziness Distractor 5.3% -0.13
of the following situations should when standing.
the nurse instruct the UAP to
report immediately?
The client asks the AP to trim Distractor 0.0% N/A
his broken toenail.
The client reports urine that is Distractor 0.0% N/A
dark yellow in color.
The nurse is caring for a client Educator Multiple Enoxaparin (Lovenox) Key 82.5% 0.17
with a cerebral hemorrhage. Choice
Which of the following medication Simvastatin (Zocor) Distractor 1.8% -0.25
prescriptions should the nurse
clarify with the healthcare
provider? Mannitol (Osmitrol) Distractor 12.3% -0.04
Nitroprusside (Nipride) Distractor 3.5% -0.10
A nurse is caring for a client who Educator Multiple Restrict fluid intake to 1,000 Key 91.2% 0.00
has syndrome of inappropriate Choice mL per day.
antidiuretic hormone (SIADH)
and a sodium level of 125 mEq/L. Maintain an IV of 0.45% Distractor 3.5% 0.10
Which of the following sodium chloride.
prescriptions should the nurse
anticipate? Provide a diet containing 2 g of Distractor 5.3% -0.08
sodium per day.
Administer desmopressin Distractor 0.0% N/A
acetate 0.2 mg orally.
NURS 480 Final TH AM SP 1 2025 WALLD
Question Analysis
NURS 480 Final TH AM SP 1 2025 WALLD
QUESTION SOURCE QUESTION ANSWER KEY/ % DISCRM
TYPE OPTION DISTRACTOR SELECTED
The nurse is caring for a client Educator Multiple Balancing fluids and Key 94.7% 0.16
following an adrenalectomy. Choice electrolytes
What is the highest priority in the
immediate postoperative period? Monitoring for signs of Distractor 5.3% -0.16
infection
Preventing emotional Distractor 0.0% N/A
disturbances
Protecting the patient’s skin Distractor 0.0% N/A
What is the best initial action by Educator Multiple Use an end-tidal CO2 Key 91.2% 0.30
the nurse to verify the correct Choice monitor.
placement of an oral
endotracheal tube (ET) after Obtain a portable chest x-ray Distractor 3.5% -0.32
insertion?
Auscultate for bilateral breath Distractor 3.5% 0.03
sounds.
Observe for symmetrical chest Distractor 1.8% -0.24
movement.
After surgery for an abdominal Educator Multiple Increase the IV fluid infusion Key 94.7% 0.14
aortic aneurysm, a client’s central Choice per protocol.
venous pressure (CVP) monitor
indicates low pressures. Which Administer IV diuretic Distractor 1.8% 0.04
action should the nurse take? medications.
Increase the infusion rate of IV Distractor 0.0% N/A
vasodilators.
Elevate the head of the Distractor 3.5% -0.19
patient’s bed to 45 degrees.
Which finding indicates to the Educator Multiple Fewer episodes of bleeding Key 91.2% 0.22
nurse that a client's transjugular Choice varices.
intrahepatic portosystemic shunt
(TIPS) placed 3 months ago has Increased serum albumin Distractor 1.8% -0.18
been effective? level.
Decreased indirect bilirubin Distractor 3.5% -0.16
level.
Improved alertness and Distractor 3.5% -0.05
orientation.
,Group Performance Profile
NURS 480 Final TH AM SP 1 2025 WALLD
QUESTION SOURCE QUESTION ANSWER KEY/ % DISCRM
TYPE OPTION DISTRACTOR SELECTED
Which assessment is most Educator Multiple arterial blood gas Key 45.6% 0.17
important for the nurse to make in Choice
order to evaluate whether heart rate Distractor 28.1% -0.11
treatment of a patient with
anaphylactic shock has been
effective? level of consciousness Distractor 15.8% -0.13
blood pressure Distractor 10.5% 0.05
A nurse is caring for a client who ATI Multiple Monitor the client for Key 98.2% -0.10
has type 1 diabetes mellitus. The Choice hypoglycemia.
nurse misread the client’s
morning blood glucose level as Give the client 15 to 20 g of Distractor 1.8% 0.10
210 mg/dL instead of 120 mg/dL. carbohydrate.
Based on this error, she
administered the insulin dose
appropriate for a reading over Complete an incident report. Distractor 0.0% N/A
200 mg/dL before the client’s
breakfast. Which of the following Notify the nurse manager. Distractor 0.0% N/A
is the nurse’s priority action upon
realizing the error?
The nurse is preparing to Educator Multiple Administer the medication Key 87.7% 0.45
administer the oral anticoagulant Choice as ordered.
warfarin (Coumadin) to a client in
CCU who has a PT: 22, PTT: 39 Assess the client for abnormal Distractor 7.0% -0.43
and an INR of 2.8. What action bleeding.
should the nurse implement?
Prepare to administer vitamin Distractor 5.3% -0.17
K (Aqua/Mephyton).
Notify the HCP to obtain an Distractor 0.0% N/A
order to increase the dose.
A client begins to complain of Educator Multiple Stop the transfusion and Key 100.0% N/A
chills and discomfort after about Choice maintain a patent line with
50 mL of blood has transfused normal saline solution and
from a unit of packed red blood new tubing.
cells. The best nursing action at
this time is to: Slow down the infusing blood Distractor 0.0% N/A
and dilute it with the normal
saline solution.
Compare the vital signs now Distractor 0.0% N/A
with what they were before the
blood transfusion began.
Discontinue the transfusion, Distractor 0.0% N/A
remove the IV catheter, and
restart the transfusion in
another site.
, Group Performance Profile
NURS 480 Final TH AM SP 1 2025 WALLD
QUESTION SOURCE QUESTION ANSWER KEY/ % DISCRM
TYPE OPTION DISTRACTOR SELECTED
The nurse is caring for a Educator Multiple Fluctuation of the fluid level Key 91.2% 0.23
postoperative client who has a Choice within the water seal
chest tube connected to suction chamber
and a water seal drainage
system. Which of the following Absence of fluid in the Distractor 0.0% N/A
indicates to the nurse that the drainage tubing
chest tube is functioning
properly? Continuous bubbling within the Distractor 8.8% -0.23
water seal chamber
Equal amounts of fluid Distractor 0.0% N/A
drainage in each collection
chamber
A nurse is discussing the care of Educator Multiple The client refuses breakfast Key 94.7% 0.13
a client who has type 1 diabetes Choice and requests to sleep.
mellitus with the unlicensed
assistive personnel (UAP). Which The client reports dizziness Distractor 5.3% -0.13
of the following situations should when standing.
the nurse instruct the UAP to
report immediately?
The client asks the AP to trim Distractor 0.0% N/A
his broken toenail.
The client reports urine that is Distractor 0.0% N/A
dark yellow in color.
The nurse is caring for a client Educator Multiple Enoxaparin (Lovenox) Key 82.5% 0.17
with a cerebral hemorrhage. Choice
Which of the following medication Simvastatin (Zocor) Distractor 1.8% -0.25
prescriptions should the nurse
clarify with the healthcare
provider? Mannitol (Osmitrol) Distractor 12.3% -0.04
Nitroprusside (Nipride) Distractor 3.5% -0.10
A nurse is caring for a client who Educator Multiple Restrict fluid intake to 1,000 Key 91.2% 0.00
has syndrome of inappropriate Choice mL per day.
antidiuretic hormone (SIADH)
and a sodium level of 125 mEq/L. Maintain an IV of 0.45% Distractor 3.5% 0.10
Which of the following sodium chloride.
prescriptions should the nurse
anticipate? Provide a diet containing 2 g of Distractor 5.3% -0.08
sodium per day.
Administer desmopressin Distractor 0.0% N/A
acetate 0.2 mg orally.
