NURS480 West Coast University Ontario

Free preview · Original latest version

Sample questions from NURS480 West Coast University Ontario

This material has 75 questions with answers and rationales. Here are the first 5.

1. 1.At change of shift on a medical-surgical unit, a 72-year-old client with chronic kidney disease has a potassium level of 6.2 mEq/L (reference range 3.5-5.0), new peaked T waves, and a heart rate of 48/min. Another client is due for a routine dressing change, and a third is waiting for discharge instructions. Which action should the nurse take first?

   • A.Ask the unlicensed assistive personnel to recheck the client's potassium level.
   • B.Begin discharge teaching so the waiting client can leave on time.
   • C.Complete the routine dressing change before the next medication pass.
   • D.Place the client with hyperkalemia on a cardiac monitor and notify the provider immediately.

   Rationale: The potassium level, bradycardia, and peaked T waves indicate potentially life-threatening cardiac instability, requiring immediate monitoring and provider notification. The dressing change and discharge teaching can wait until the unstable client is addressed. Unlicensed assistive personnel cannot obtain or interpret laboratory results, and a repeat potassium level would not replace acting on the current critical result.

2. 2.In the emergency department, a 67-year-old client taking warfarin for atrial fibrillation is being evaluated after a fall. The client is alert, reports a mild headache, and has a blood pressure of 158/86 mm Hg and heart rate of 92/min. The client's INR is 4.8 (target range 2.0-3.0). Which actions should the nurse take? Select all that apply.

   • A.Initiate fall precautions and assist the client with all mobility.
   • B.Perform and document focused neurologic assessments while awaiting further orders.
   • C.Give the scheduled warfarin dose because the client is alert and has no visible bleeding.
   • D.Give an over-the-counter aspirin for the headache.
   • E.Arrange for the client to leave with written instructions to return if symptoms worsen.
   • F.Notify the provider promptly about the fall, headache, and elevated INR.

   Rationale: The fall, headache, and INR of 4.8 create concern for occult or evolving intracranial bleeding, so prompt provider notification and serial neurologic assessments are appropriate. Fall precautions reduce the risk of another injury while the client is evaluated. Giving warfarin or aspirin could worsen bleeding, and discharge before assessment of possible head injury is unsafe even if the client is currently alert.

3. 3.During a home visit, a 4-year-old child with asthma has an oxygen saturation of 95% on room air, mild expiratory wheezing, and no retractions. The caregiver says, "I give the controller inhaler only when the wheezing starts." Which response by the nurse best supports safe ongoing care?

   • A.Ask the caregiver to demonstrate the inhaler technique and review the written asthma action plan with the prescribing clinician.
   • B.Advise the caregiver to stop the controller medication and use only the rescue inhaler.
   • C.Tell the caregiver to use the controller inhaler every hour until the wheezing stops.
   • D.Arrange emergency transport because any wheezing in a child requires hospital treatment.

   Rationale: The child is stable at this assessment, and the caregiver's statement identifies a need to clarify the prescribed controller regimen, technique, and action plan with the clinician. Increasing a controller medication to hourly use is not an appropriate independent adjustment. Stopping controller therapy or sending a stable child for emergency transport without signs of severe distress does not address the identified care-management need.

4. 4.A primigravida at 32 weeks is admitted to a community hospital with blood pressure 168/112 mm Hg, severe headache, and new visual spots. The fetal heart rate is 140/min. Magnesium sulfate is prescribed, but the first dose has not yet arrived from the pharmacy. Which action should the nurse take first?

   • A.Ask the client to walk to the bathroom to assess for worsening symptoms.
   • B.Wait for the medication to arrive before taking additional action.
   • C.Initiate seizure precautions and urgently notify the provider that severe features are present.
   • D.Provide routine prenatal teaching about fetal movement counting.

   Answer and rationale are in the full material.

5. 5.Refer to the client's chart. Which actions should the nurse take now for this 67-year-old postoperative client? Select all that apply.

   • A.Reassess the client and prepare to communicate the trend in respiratory rate, oxygen saturation, and level of alertness.
   • B.Ask the unlicensed assistive personnel to obtain another set of vital signs and report the results.
   • C.Apply oxygen as needed to address the falling oxygen saturation while help is coming.
   • D.Notify the rapid response team or provider about the acute change in condition.
   • E.Administer the next prescribed opioid dose to treat the client's pain before further assessment.

   Answer and rationale are in the full material.