Chamberlain Latest Exit Exam

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Sample questions from Chamberlain Latest Exit Exam

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

1. 1.In the emergency department, a client with type 1 diabetes reports nausea and abdominal pain. The client is drowsy, has deep rapid respirations, and has a blood glucose of 486 mg/dL. Which prescription should the nurse implement first?

   • A.Give oral potassium chloride
   • B.Administer intravenous sodium bicarbonate
   • C.Administer intravenous regular insulin
   • D.Begin an intravenous infusion of 0.9% sodium chloride

   Rationale: The findings suggest diabetic ketoacidosis with significant fluid volume depletion, so isotonic fluid resuscitation is the first intervention to support perfusion. Insulin is essential but is generally started after initial fluid therapy and evaluation of potassium. Bicarbonate is not routinely indicated and can cause harm, while oral potassium is inappropriate for a drowsy client and should not be given without assessing the serum level and renal status.

2. 2.Refer to the client's chart. Which actions should the nurse take now in response to the client's changing condition? Select all that apply.

   • A.Prepare to administer regular insulin with dextrose as prescribed
   • B.Hold the next dose of lisinopril and notify the provider
   • C.Encourage the client to drink orange juice
   • D.Prepare to administer intravenous calcium gluconate as prescribed
   • E.Place the client on continuous cardiac monitoring

   Rationale: The potassium of 6.1 mEq/L, peaked T waves, and widening QRS indicate life-threatening hyperkalemia with cardiac effects; continuous monitoring and prescribed calcium gluconate are priorities to stabilize the myocardium. Insulin with dextrose shifts potassium into cells, and lisinopril should be held while the provider is notified because it can contribute to hyperkalemia. Orange juice contains potassium and would worsen the client's condition.

3. 3.A client states, "I have chest pressure, but it is not as bad as when I came in." The client is receiving a heparin infusion for a non-ST-elevation myocardial infarction. The nurse notes new diaphoresis and a blood pressure decrease from 138/82 to 92/58 mm Hg. Which action is the priority?

   • A.Reassess the client's pain after administering the prescribed analgesic
   • B.Obtain a repeat 12-lead ECG and activate the rapid response system
   • C.Decrease the heparin infusion and recheck the aPTT
   • D.Assist the client to sit upright and coach slow breathing

   Rationale: New diaphoresis and hypotension during treatment for acute coronary syndrome may signal worsening ischemia, dysrhythmia, or cardiogenic shock and require immediate escalation and ECG assessment. Analgesia and positioning may be appropriate later but do not address the possible acute deterioration. Adjusting heparin without an order or a relevant result is unsafe and would delay evaluation.

4. 4.At change of shift, the nurse receives report on four clients. Which client should the nurse assess first?

   • A.A client with heart failure who has bilateral ankle edema and a weight increase of 0.5 kg over 2 days
   • B.A client with a fractured hip who reports pain of 8 on a 0-to-10 scale after physical therapy
   • C.A client 6 hours after thyroidectomy who is restless and has new inspiratory stridor
   • D.A client with COPD whose oxygen saturation is 90% on the prescribed 2 L/min and who is speaking in full sentences

   Answer and rationale are in the full material.

5. 5.A client receiving warfarin for atrial fibrillation reports black, tarry stools and dizziness when standing. The INR is 5.6. Which action should the nurse take first?

   • A.Withhold warfarin and notify the provider of suspected bleeding
   • B.Encourage the client to increase dietary intake of leafy greens
   • C.Assist the client to ambulate to determine whether dizziness resolves
   • D.Administer the scheduled warfarin dose with food

   Answer and rationale are in the full material.