NSG520

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Sample questions from NSG520

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, the nurse receives report on four clients. Which client should the nurse assess first?

   • A.A 61-year-old 6 hours after thyroidectomy who reports incisional pain of 6/10 and has a hoarse voice unchanged since the postanesthesia unit
   • B.A 35-year-old receiving antibiotics for cellulitis who has a temperature of 38.1 C and a marked border that has not expanded
   • C.A 48-year-old with diabetes who is diaphoretic and confused, with a point-of-care glucose of 48 mg/dL
   • D.A 72-year-old with heart failure who has gained 1 kg in 24 hours and reports needing two pillows to sleep

   Rationale: The confused, diaphoretic client has symptomatic hypoglycemia, an immediate threat that requires prompt glucose treatment and reassessment. The heart failure client's weight gain and orthopnea require timely assessment, but do not take priority over altered mentation with a glucose of 48 mg/dL. The stable hoarseness and pain after thyroidectomy warrant assessment, but no new airway change is reported. The low-grade fever with a nonexpanding cellulitis border is the least urgent finding.

2. 2.During a home visit, an RN is planning care for a 79-year-old client with heart failure, chronic kidney disease, and a new prescription for warfarin. The client lives alone, has poor vision, and reports taking medications from several unlabeled bottles. Which actions should the RN take to reduce immediate medication-related risk? Select all that apply.

   • A.Teach the client to use an over-the-counter NSAID for arthritis pain instead of calling the prescriber
   • B.Ask the client to demonstrate how each medication is selected and taken
   • C.Reconcile the medications by comparing the bottles with the current prescription list and contacting the prescriber or pharmacist about discrepancies
   • D.Arrange an appropriate medication organization method and confirm that the client can read and use it safely
   • E.Tell the client to stop warfarin until the next clinic appointment because of the risk of bleeding
   • F.Ask a neighbor to administer all medications without obtaining the client's consent or assessing the neighbor's ability

   Rationale: Comparing actual medication containers with the current list can identify omissions, duplications, and unsafe dosing, especially with warfarin and kidney disease. A return demonstration reveals whether poor vision or confusion interferes with safe administration, and any organizational aid must be matched to the client's abilities. The RN should not independently stop prescribed warfarin or delegate medication administration to an unassessed neighbor without consent. NSAIDs can worsen kidney function and increase bleeding risk with warfarin, so the client should consult the prescriber before using them.

3. 3.The charge nurse on a long-term care unit is assigning tasks at the start of the evening shift. Which task is appropriate to delegate to an experienced unlicensed assistive personnel (UAP)?

   • A.Evaluate whether a prescribed PRN analgesic relieved a 65-year-old resident's pain
   • B.Obtain and record the routine premeal weight of a stable 70-year-old resident with chronic heart failure
   • C.Assess a newly admitted 84-year-old resident who reports dizziness when standing
   • D.Teach a 76-year-old resident how to use a walker after a recent fall

   Rationale: Obtaining a routine weight for a stable resident is a predictable task that a competent UAP may perform, with results reported to the nurse. Assessing new dizziness requires nursing judgment and evaluation of potential orthostatic changes. Teaching walker use and evaluating a medication's effect also require the nurse's assessment and clinical judgment. Delegation does not transfer the RN's responsibility to interpret findings and follow up.

4. 4.A client's potassium is 6.2 mEq/L (reference range 3.5-5.0 mEq/L). In the emergency department, the 56-year-old client with chronic kidney disease has peaked T waves on the ECG and a heart rate of 52/min. Which action should the nurse take first?

   • A.Ask the client to drink water and ambulate to increase renal potassium excretion
   • B.Document the ECG changes and repeat the potassium level with the next scheduled laboratory draw
   • C.Administer the prescribed sodium polystyrene sulfonate and recheck potassium in 4 hours
   • D.Place the client on continuous cardiac monitoring and notify the provider immediately

   Answer and rationale are in the full material.

5. 5.A 32-year-old primigravida at 32 weeks is being discharged from the obstetric triage unit after evaluation for preterm contractions. The contractions have stopped, the cervix is unchanged, and fetal monitoring is reassuring. Which statement by the client requires the nurse to clarify the discharge instructions?

   • A.I will wait until my next appointment if I develop a severe headache with spots in my vision.
   • B.I will take my prescribed medication and follow the activity instructions we discussed.
   • C.I will call if I have a gush of fluid or vaginal bleeding.
   • D.I will return if I notice that the baby is moving less than usual.

   Answer and rationale are in the full material.