NUR 620

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Sample questions from NUR 620

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

1. 1.A 68-year-old client is admitted to the medical unit with pneumonia. The client is newly confused, has a respiratory rate of 32/min, oxygen saturation of 86% on room air, and blood pressure of 88/54 mm Hg. Which action should the nurse take first?

   • A.Apply oxygen and activate the rapid response team
   • B.Obtain a sputum specimen before treatment
   • C.Administer the prescribed oral antipyretic
   • D.Assist the client to ambulate to the bathroom

   Rationale: The client has hypoxemia, hypotension, tachypnea, and acute mental status change, indicating possible respiratory failure and sepsis; oxygen and rapid escalation are priorities. A sputum specimen is useful but must not delay stabilization. An oral antipyretic does not address the immediate threat, and ambulation is unsafe with this instability. The exam takeaway is to prioritize airway, breathing, circulation, and rapid deterioration.

2. 2.A 24-year-old client with type 1 diabetes is in the emergency department with vomiting, abdominal pain, and deep rapid respirations. Glucose is 540 mg/dL, potassium is 5.4 mEq/L, and pH is 7.18. Which prescribed intervention should the nurse implement first?

   • A.Begin isotonic IV fluid replacement
   • B.Administer IV regular insulin
   • C.Give IV sodium bicarbonate
   • D.Add potassium chloride to the IV solution

   Rationale: Initial isotonic fluid replacement restores circulating volume and supports perfusion in diabetic ketoacidosis. Insulin is essential but is started after initial fluid therapy and assessment of potassium. Bicarbonate is not routinely indicated at this pH, and potassium should not be added while the serum level is elevated. The exam takeaway is to restore volume first and monitor potassium closely during DKA treatment.

3. 3.A 72-year-old client on a telemetry unit reports sudden chest pressure and shortness of breath. The client is diaphoretic, with blood pressure 92/60 mm Hg, heart rate 118/min, and oxygen saturation 91%. Which action is the nurse's priority?

   • A.Obtain a 12-lead ECG and notify the provider immediately
   • B.Give the prescribed sublingual nitroglycerin
   • C.Ask the client to rate the pain again in 15 minutes
   • D.Encourage slow deep breathing to reduce anxiety

   Rationale: Sudden chest pressure with diaphoresis and hemodynamic changes requires rapid ECG evaluation and urgent provider notification for possible acute coronary syndrome. Nitroglycerin may worsen hypotension and should not be given before the blood pressure and contraindications are considered. Delaying reassessment or focusing on anxiety risks missing myocardial ischemia. The exam takeaway is to rapidly assess and escalate suspected cardiac ischemia while avoiding interventions that can worsen hypotension.

4. 4.A 79-year-old client with heart failure is admitted with worsening dyspnea. The client has crackles, jugular venous distention, oxygen saturation of 88%, and blood pressure of 156/88 mm Hg. Which action should the nurse take first?

   • A.Place the client upright and apply prescribed oxygen
   • B.Obtain a daily weight before giving medications
   • C.Encourage oral fluids to improve cardiac output
   • D.Place the client flat and elevate the legs

   Answer and rationale are in the full material.

5. 5.A 58-year-old client arrives at the emergency department 45 minutes after sudden onset of right-sided weakness and slurred speech. Blood glucose is 104 mg/dL, blood pressure is 178/96 mm Hg, and oxygen saturation is 97%. Which action is most important?

   • A.Activate the stroke response and prepare for urgent brain imaging
   • B.Administer aspirin before imaging
   • C.Lower the blood pressure rapidly with an IV antihypertensive
   • D.Offer water to assess swallowing

   Answer and rationale are in the full material.