Nace Nln

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Sample questions from Nace Nln

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.At change of shift on a medical-surgical unit, a 72-year-old client's condition has changed. Refer to the client's chart. Which action should the RN take first?

   • A.Complete the scheduled discharge medication review.
   • B.Administer the prescribed oral acetaminophen.
   • C.Activate the rapid response team.
   • D.Request a routine physical therapy evaluation.

   Rationale: The fall in BP to 86/48 mm Hg, new confusion, tachypnea, and hypoxemia indicate acute deterioration requiring rapid response activation. Acetaminophen may reduce fever but does not address impaired perfusion and oxygenation. Physical therapy and discharge medication review are inappropriate while the client is unstable. Prioritize immediate rescue over routine care.

2. 2.On a rehabilitation unit, a 68-year-old client recovering from a stroke has stable vital signs and an established swallowing plan. Which task is appropriate for the RN to delegate to experienced unlicensed assistive personnel?

   • A.Assist with a meal using the prescribed positioning and food consistency.
   • B.Teach the family how to recognize aspiration.
   • C.Evaluate new coughing that occurs during the meal.
   • D.Determine whether the swallowing plan remains appropriate.

   Rationale: Assisting a stable client with a meal according to an established plan is an appropriate delegated task. Determining whether the plan remains appropriate and evaluating new coughing require nursing assessment. Teaching aspiration precautions is an RN responsibility. Delegation transfers task performance, not nursing judgment or accountability.

3. 3.Before elective surgery, a 46-year-old client in the preoperative area says, 'I signed the consent, but I do not understand what the surgeon will remove.' No sedative has been administered. Which actions should the RN take? Select all that apply.

   • A.Explain the procedure's major risks in place of the surgeon.
   • B.Document the client's expressed concern and the actions taken.
   • C.Notify the surgeon that the client needs additional explanation.
   • D.Pause preparation that would advance the client to surgery.
   • E.Ask the spouse to authorize surgery instead.

   Rationale: Preparation that advances the procedure should pause because the client's statement raises concern about informed consent. The surgeon must clarify the proposed procedure, and the RN should document the concern and response. The RN may reinforce information but should not replace the surgeon's procedure-specific informed consent discussion. A spouse cannot override the decision-making authority of a capable adult.

4. 4.During discharge planning, a 59-year-old client newly prescribed insulin says, 'My refrigerator stopped working, and I cannot afford food this week.' Glucose is 184 mg/dL, and the client has no acute symptoms. Which response best addresses the immediate discharge barrier?

   • A.Tell the client to keep every insulin product at room temperature indefinitely.
   • B.Coordinate with social work and pharmacy to arrange food access and safe medication storage.
   • C.Ask the provider to discontinue insulin permanently.
   • D.Provide a standard diabetes brochure and proceed with discharge.

   Answer and rationale are in the full material.

5. 5.In a long-term care facility, a 79-year-old resident with decision-making capacity declines a scheduled dressing change because it is painful. Which action should the RN take?

   • A.Perform the dressing change because it is prescribed.
   • B.Document that the resident is noncompliant without further discussion.
   • C.Ask family members to persuade the resident to comply immediately.
   • D.Explain the risks, explore pain-control options, and respect the informed refusal.

   Answer and rationale are in the full material.