NUR 209 Midpoint Assessment

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Sample questions from NUR 209 Midpoint Assessment

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, a 68-year-old client with pneumonia has a new oxygen saturation of 84% on 2 L/min by nasal cannula, is using accessory muscles, and is difficult to arouse. Which action should the nurse take first?

   • A.Document the findings and recheck the oxygen saturation in 15 minutes
   • B.Request a prescription for a chest radiograph
   • C.Call the client's family to obtain the client's baseline mental status
   • D.Increase the oxygen per protocol and assess the client's respiratory status

   Rationale: The low saturation, increased work of breathing, and decreased alertness indicate acute respiratory compromise requiring immediate support and reassessment. Calling family or documenting does not address the threat to breathing, and waiting for imaging delays stabilization. Prioritize airway and breathing before diagnostic or routine actions.

2. 2.In the emergency department, a 7-year-old client with asthma has worsening wheezing despite home treatment. Refer to the client's chart. Which actions should the nurse take now? Select all that apply.

   • A.Administer the prescribed inhaled short-acting bronchodilator
   • B.Position the client upright and reassess respiratory effort frequently
   • C.Delay treatment until peak-flow testing is completed
   • D.Apply oxygen to maintain the prescribed target saturation
   • E.Encourage the client to lie flat to conserve energy

   Rationale: At 1400, the chart shows worsening retractions, SpO2 88% on room air, and poor air movement, so oxygen, upright positioning, and the prescribed bronchodilator are priorities. Lying flat can worsen ventilation, and peak-flow measurement must not delay treatment in a child with respiratory distress. Reassess response promptly after interventions.

3. 3.A 34-year-old client is scheduled for surgery and tells the preoperative nurse, "I signed the consent, but I still do not understand the risks." The client is alert and has received no sedative. What should the nurse do?

   • A.Ask the client's support person to explain the procedure
   • B.Reassure the client that the procedure is routine and proceed
   • C.Ask the surgeon to return and explain the procedure and risks
   • D.Explain the risks using the consent form, then witness the signature

   Rationale: The provider performing the procedure is responsible for explaining its risks, benefits, and alternatives, and the client's statement shows that informed consent may not be valid. The nurse may witness consent but should not replace the provider's explanation or pressure the client. Pause preparation until the client's questions are answered and consent is confirmed.

4. 4.On a rehabilitation unit, a 52-year-old client with a stable stroke-related weakness needs help bathing and dressing. Which task is appropriate for the registered nurse to delegate to an experienced unlicensed assistive personnel (UAP)?

   • A.Assist the client with bathing and dressing, and report any change in ability
   • B.Assess the client's skin for early pressure injury
   • C.Teach the client strategies for dressing with one hand
   • D.Evaluate whether the client's transfer technique is safe

   Answer and rationale are in the full material.

5. 5.In a pediatric clinic, a 5-year-old client with type 1 diabetes is alert and reports shakiness before lunch. The blood glucose is 58 mg/dL, and the client can swallow. Which action should the nurse take first?

   • A.Give a high-fat snack and recheck glucose in 1 hour
   • B.Give 15 g of a rapid-acting oral carbohydrate and recheck glucose in 15 minutes
   • C.Administer the scheduled rapid-acting insulin before the meal
   • D.Notify the provider before giving any treatment

   Answer and rationale are in the full material.