RN Concept-Based Assessment Level 3 with NGN

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Sample questions from RN Concept-Based Assessment Level 3 with NGN

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

1. 1.During morning rounds on a medical unit, a 40-year-old client's condition changes. Refer to the client's chart. Which actions should the RN take immediately? Select all that apply.

   • A.Activate the rapid response team.
   • B.Delay escalation until the prescribed acetaminophen takes effect.
   • C.Establish a second peripheral IV access.
   • D.Delegate an independent respiratory assessment to the assistive personnel.
   • E.Apply supplemental oxygen.

   Rationale: The new confusion, BP of 84/48 mm Hg, SpO2 of 88%, and lactate of 4.2 mmol/L indicate acute deterioration requiring rapid response activation. Supplemental oxygen addresses hypoxemia, and a second IV facilitates urgent fluids and medications. An independent respiratory assessment requires an RN and cannot be delegated to assistive personnel. Waiting for acetaminophen would delay treatment of possible septic shock.

2. 2.On a postoperative unit, a 41-year-old client is alert, has stable vital signs, and has already ambulated safely with the RN after an uncomplicated appendectomy. Which task is appropriate to delegate to trained assistive personnel?

   • A.Determine whether the client is ready for discharge.
   • B.Assist the client with the next scheduled hallway walk.
   • C.Evaluate the response to the first oral opioid dose.
   • D.Teach the client how to inspect the incision.

   Rationale: Assisting with an established ambulation plan for a stable client is appropriate for trained assistive personnel. Discharge readiness and evaluation of an opioid response require nursing judgment. Initial incision-care teaching is an RN responsibility. Delegate predictable tasks while retaining assessment and evaluation.

3. 3.Before surgery, a 42-year-old client in the preoperative holding area states, 'I signed the consent, but I still do not understand why the entire kidney might be removed.' The client has not received sedation. What should the RN do first?

   • A.Notify the surgeon that further explanation is needed before proceeding.
   • B.Ask the spouse to confirm that the surgery was discussed.
   • C.Administer the prescribed anxiolytic to reduce uncertainty.
   • D.Explain the surgical alternatives using the consent form.

   Rationale: The surgeon must address the client's unresolved questions so consent is informed before surgery proceeds. The RN may reinforce information but should not substitute for the surgeon's explanation of operative alternatives. A spouse's understanding does not establish the competent client's informed consent. Giving an anxiolytic before clarification could impair decision-making.

4. 4.Following a motor vehicle crash, a 43-year-old client arrives in the emergency department with active intra-abdominal bleeding, BP 78/42 mm Hg, and altered consciousness. A signed, valid directive specifically refuses blood products, and the spouse asks staff to transfuse anyway. Which action is appropriate?

   • A.Transfuse because emergency care always overrides written refusals.
   • B.Delay all resuscitation until an ethics consultant arrives.
   • C.Follow the spouse's request because the client cannot currently speak.
   • D.Notify the team of the directive and continue acceptable nonblood resuscitation.

   Answer and rationale are in the full material.

5. 5.A telemetry handoff concerns a 44-year-old client receiving anticoagulation. Refer to the client's chart. Which concern should the RN communicate first using SBAR?

   • A.The next routine hemoglobin level should be collected earlier tomorrow.
   • B.The client needs additional teaching about anticoagulation.
   • C.The client may have internal bleeding with hemodynamic instability.
   • D.The client needs an alternative medication for back pain.

   Answer and rationale are in the full material.