Exist

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Sample questions from Exist

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

1. 1.At change of shift on a medical unit, a 78-year-old client with mild dementia is found beside the secured exit wearing a coat and holding a packed bag. The client is calm, has stable vital signs, and says, "I need to catch the bus home." Which action should the nurse take first?

   • A.Ask security to escort the client back to the room without further discussion.
   • B.Call the family and request that someone come immediately to take the client home.
   • C.Ask the client to sit with the nurse in a quiet area and assess the reason for attempting to leave.
   • D.Apply a vest restraint until the client's family arrives.

   Rationale: A calm, immediate assessment can identify unmet needs, disorientation, or a misunderstanding and allows the nurse to use the least restrictive safe intervention. A restraint is not justified without an immediate danger and an appropriate assessment and order. Security or family may be needed later, but neither substitutes for first assessing and engaging the client.

2. 2.During a home visit, a 46-year-old client receiving home infusion therapy says the client plans to stop the infusion and leave town today. The client is alert, has a temperature of 38.4 C, and has a central venous catheter with new redness at the insertion site. Which response by the nurse is best?

   • A.Remove the central venous catheter before the client leaves to prevent infection.
   • B.Explain the immediate concern, assess the client's understanding and decision-making capacity, and notify the prescribing clinician about the findings and plan.
   • C.Document the client's decision and end the visit because an alert adult may refuse care.
   • D.Tell the client that leaving before the antibiotic course is complete is not permitted.

   Rationale: The fever and new catheter-site redness require prompt clinical communication, while an informed adult generally retains the right to refuse or discontinue treatment. The nurse should assess understanding, explain risks and alternatives without coercion, and communicate the clinical change and the client's plan. Prohibiting departure, removing the line without an order or indication, and ending the visit without addressing the new findings are unsafe responses.

3. 3.Refer to the client's chart. Which actions should the nurse take now to address the client's attempt to leave the emergency department? Select all that apply.

   • A.Ask an unlicensed assistive personnel to determine whether the client has decision-making capacity.
   • B.Notify the emergency provider promptly about the worsening findings and the client's stated intent to leave.
   • C.Apply physical restraints because the client has a history of a substance use disorder.
   • D.Stay with the client and use calm, direct communication to assess immediate needs and the reason for leaving.
   • E.Explain the specific concerns in understandable terms and offer to address barriers such as pain or contacting a support person.

   Rationale: The chart shows worsening tachycardia, hypotension, fever, and new confusion, so the nurse should remain with the client, promptly notify the provider, and communicate concerns while exploring needs and barriers. A substance use history alone does not justify restraints, which require a current safety indication and least-restrictive measures. Capacity assessment is not delegated to unlicensed assistive personnel; the nurse should escalate concerns about the client's ability to understand and decide.

4. 4.In a long-term care facility, an 82-year-old resident with a steady gait and no acute symptoms says the resident wants to leave permanently and return to an apartment. The resident accurately describes the risks of living alone and the available support services. Which action is most appropriate?

   • A.Notify the interdisciplinary team and collaborate with the resident on a safe transition plan that respects the resident's informed choice.
   • B.Prevent the resident from leaving until a formal cognitive evaluation is completed.
   • C.Ask the resident's adult child to sign the discharge paperwork because the resident is older.
   • D.Arrange transport immediately without reviewing medications or follow-up needs.

   Answer and rationale are in the full material.

5. 5.A provider enters a discharge order for a 6-year-old child after treatment for an asthma exacerbation. Before the family leaves the pediatric unit, the parent says the prescribed inhaler is not covered by insurance and the family has no transportation to the pharmacy. Which action should the nurse take?

   • A.Tell the parent to borrow another person's inhaler until the next clinic appointment.
   • B.Ask the parent to sign a statement accepting responsibility for obtaining the medication.
   • C.Complete the discharge because the child's oxygen saturation is 97% on room air.
   • D.Contact the provider and case manager or pharmacist to address an accessible medication plan and safe follow-up before discharge.

   Answer and rationale are in the full material.