Nightingale BSN 246

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Sample questions from Nightingale BSN 246

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, an RN receives reports on four clients. Which client should the RN assess first?

   • A.A 56-year-old client with a urinary tract infection who has a temperature of 38.1 C and is due for an antibiotic
   • B.A 68-year-old client with heart failure who has gained 1 kg in 24 hours and has bilateral ankle edema
   • C.A 45-year-old client 2 hours after thyroidectomy who has new inspiratory stridor and an SpO2 of 89%
   • D.A 72-year-old client with diabetes whose premeal glucose is 248 mg/dL and who is requesting insulin

   Rationale: New stridor and oxygen saturation of 89% after thyroid surgery suggest airway obstruction, which requires immediate assessment and intervention. The heart failure client needs prompt follow-up, but edema and weight gain do not indicate an immediate airway threat. The elevated glucose and fever require care, but neither takes priority over a compromised airway. Use the ABC framework to identify and respond first to threats to airway and breathing.

2. 2.In a long-term care facility, an RN is assigning morning care for a stable 81-year-old resident with osteoarthritis who needs help bathing and dressing. Which task is appropriate to delegate to an unlicensed assistive personnel (UAP)?

   • A.Teach the resident how to use a walker safely
   • B.Evaluate whether the prescribed analgesic relieved the resident's pain
   • C.Assess the resident's pain before assisting with the bath
   • D.Assist the resident with bathing and report any new skin redness

   Rationale: Assisting a stable resident with routine bathing is within the UAP role, and reporting new skin redness provides useful information to the RN. Pain assessment, teaching, and evaluation of a medication's effect require nursing judgment and remain the RN's responsibility. The RN should communicate clear reporting expectations before delegating. Delegate predictable tasks, not assessment, teaching, or evaluation.

3. 3.Refer to the client's chart. In the emergency department, a 14-year-old client being treated for diabetic ketoacidosis becomes increasingly drowsy. Which actions should the RN take now? Select all that apply.

   • A.Reassess neurologic status and vital signs frequently and communicate the trends
   • B.Notify the rapid response team or emergency provider about the acute change in neurologic status
   • C.Increase the insulin infusion rate without a prescription to lower the glucose more quickly
   • D.Give oral fluids to correct dehydration while the client is drowsy
   • E.Maintain airway support and elevate the head of the bed while preparing for urgent evaluation

   Rationale: The change from alertness at 0800 to increasing drowsiness at 1000, together with tachycardia and persistent hyperglycemia, requires urgent escalation and close reassessment. Supporting the airway and elevating the head of the bed are appropriate while the client receives urgent evaluation. Increasing the insulin infusion without an order is unsafe, and oral fluids are inappropriate for a drowsy client with an aspiration risk. Escalate acute deterioration promptly and do not independently change prescribed infusions.

4. 4.During a home visit, a public health RN assesses a 7-month-old infant whose caregiver reports missed immunizations after a recent move. The infant is afebrile, has no acute illness, and has no documented vaccine contraindication. What is the best action?

   • A.Review the immunization record and arrange catch-up vaccination using the recommended schedule
   • B.Wait until the infant is 12 months old before giving any additional vaccines
   • C.Ask the caregiver to obtain antibody testing before scheduling vaccines
   • D.Restart the entire vaccine series because several doses were missed

   Answer and rationale are in the full material.

5. 5.On an inpatient unit, a 76-year-old client with pneumonia has a new prescription for IV ceftriaxone. The client tells the RN, "Penicillin made my throat swell." The client is febrile at 38.6 C, HR 108, RR 24, BP 118/70, and SpO2 94% on 2 L/min. What should the RN do first?

   • A.Give an antihistamine before the antibiotic without contacting the prescriber
   • B.Hold the antibiotic and clarify the allergy history and prescription with the prescriber or pharmacist
   • C.Ask the UAP to check the client's allergy band before administration
   • D.Administer the ceftriaxone and observe the client closely for a reaction

   Answer and rationale are in the full material.