RN Concept Based Level 1

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Sample questions from RN Concept Based Level 1

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

1. 1.At change of shift in a medical-surgical unit, the charge nurse receives report on four clients. Which client should the charge nurse assess first?

   • A.A 39-year-old receiving antibiotics for cellulitis who has a temperature of 38.1 C and unchanged erythema
   • B.A 54-year-old 6 hours after thyroidectomy who is restless and has new inspiratory stridor
   • C.A 72-year-old with diabetes whose premeal glucose is 68 mg/dL and who is alert and requesting breakfast
   • D.A 68-year-old with heart failure who has gained 0.8 kg in 24 hours and reports needing an extra pillow to sleep

   Rationale: New stridor after thyroid surgery can signal airway obstruction from edema or bleeding, so this client needs immediate assessment and intervention. The heart failure symptoms require prompt follow-up but do not indicate the same immediate threat to airway. The alert client with mild hypoglycemia can receive a rapid carbohydrate while being monitored, and the stable cellulitis finding can be addressed after higher-priority needs. Prioritize an acute airway threat over less immediate concerns.

2. 2.In a pediatric clinic, a 7-year-old with a new seizure disorder has been prescribed oral medication. Which task is appropriate for the RN to delegate to an experienced unlicensed assistive personnel (UAP)?

   • A.Measure and document the child's weight before the appointment
   • B.Teach the parent how to respond to a seizure at home
   • C.Determine whether the child is experiencing medication adverse effects
   • D.Evaluate the parent's ability to administer the medication safely

   Rationale: Measuring and documenting weight is a routine, predictable task that can be delegated to a trained UAP, with the RN reviewing the result. Teaching seizure response, assessing for adverse effects, and evaluating caregiver learning require nursing judgment and remain the RN's responsibility. The RN should consider the child's weight when reviewing the medication plan, but that does not make the measurement itself an assessment-only task. Delegate tasks, not clinical judgment.

3. 3.Refer to the client's chart. A 10-year-old is admitted to the pediatric unit with suspected infection. Which actions should the RN take now? Select all that apply.

   • A.Wait for the next scheduled vital-sign assessment before contacting the provider
   • B.Delegate interpretation of the changing vital signs to the UAP who obtained them
   • C.Obtain the ordered blood cultures before the first antibiotic dose if this does not delay treatment
   • D.Administer the prescribed isotonic fluid bolus and reassess perfusion
   • E.Activate the facility's rapid response process for acute deterioration

   Rationale: The chart shows worsening tachycardia, hypotension, delayed capillary refill, and decreased responsiveness, which require immediate escalation and treatment of possible sepsis-related shock. The prescribed fluid bolus should be given promptly, with reassessment of perfusion and response. Cultures should be collected before antibiotics when feasible, but treatment must not be delayed to obtain them. Waiting for routine observations delays care, and interpreting deterioration is an RN responsibility rather than a UAP task.

4. 4.Before a 16-year-old undergoes an elective procedure, the parent says, "I signed the form, but my child does not understand what is going to happen." The adolescent is quiet and avoids eye contact. What should the nurse do?

   • A.Explain the procedure in detail and ask the parent to confirm the adolescent's understanding
   • B.Ask the adolescent to sign the form as well so the procedure can continue
   • C.Pause preparation and notify the procedural provider that further explanation is needed
   • D.Proceed because the parent has already signed the consent form

   Answer and rationale are in the full material.

5. 5.A client receiving warfarin for a mechanical heart valve has an INR of 5.8 (target 2.5-3.5). The client has no visible bleeding, and the next dose is due now. Which action should the nurse take?

   • A.Encourage foods high in vitamin K and administer the scheduled dose
   • B.Give half the dose and repeat the INR in 1 week
   • C.Administer the dose because the client has a mechanical valve
   • D.Hold the dose and promptly notify the prescribing clinician

   Answer and rationale are in the full material.