RN Exist Exam

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Sample questions from RN Exist Exam

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

1. 1.A 68-year-old client on a medical-surgical unit is 6 hours postoperative after a total hip arthroplasty. The client is restless, has an oxygen saturation of 86% on room air, respirations of 30/min, and a heart rate of 118/min. Which action should the nurse take first?

   • A.Apply oxygen and assess respiratory status
   • B.Administer the prescribed opioid for pain
   • C.Reinforce the hip precautions
   • D.Document the findings and recheck in 30 minutes

   Rationale: Applying oxygen and promptly assessing breathing addresses the immediate threat of hypoxemia. Opioids may worsen respiratory depression, hip teaching does not address the acute change, and delaying reassessment is unsafe. The exam takeaway is to prioritize airway and breathing before pain or routine teaching.

2. 2.A 54-year-old client with type 1 diabetes is admitted to the emergency department with nausea, abdominal pain, and deep rapid respirations. The client is alert, blood glucose is 486 mg/dL, potassium is 5.4 mEq/L, and arterial pH is 7.18. Which prescription should the nurse implement first?

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

   Rationale: Initial isotonic fluid replacement supports circulation and is the first intervention for diabetic ketoacidosis. Insulin is required but generally follows initial fluid resuscitation; potassium is not indicated with an elevated serum level, and bicarbonate is not routine at this pH. The exam takeaway is to restore volume first while monitoring potassium and preparing insulin therapy.

3. 3.A 72-year-old client on a telemetry unit reports sudden shortness of breath and pleuritic chest pain 2 days after abdominal surgery. The client is anxious, has a heart rate of 126/min, respirations of 32/min, and oxygen saturation of 88% on room air. Which action should the nurse take first?

   • A.Apply oxygen and activate the rapid response system
   • B.Massage the client's lower legs
   • C.Assist the client to walk to improve circulation
   • D.Obtain a sputum specimen

   Rationale: The sudden hypoxemia and pleuritic pain suggest a possible pulmonary embolism, requiring immediate oxygen and emergency escalation. Leg massage could dislodge a clot, ambulation is unsafe during acute instability, and a sputum specimen does not address the threat. The exam takeaway is to stabilize oxygenation and call for urgent help when embolism is suspected.

4. 4.A 79-year-old client in a long-term care facility has new confusion and dysuria. Temperature is 38.6 C (101.5 F), blood pressure is 84/48 mm Hg, heart rate is 124/min, and lactate is 4.1 mmol/L. Which action should the nurse take first?

   • A.Activate the sepsis response and begin prescribed isotonic fluid resuscitation
   • B.Give an antipyretic and reassess the temperature in an hour
   • C.Collect a clean-catch urine specimen before notifying the provider
   • D.Encourage oral fluids and assist the client back to bed

   Answer and rationale are in the full material.

5. 5.A 64-year-old client arrives at the emergency department 45 minutes after sudden onset of right arm weakness and slurred speech. Blood pressure is 178/96 mm Hg, blood glucose is 112 mg/dL, and oxygen saturation is 97%. Which action should the nurse anticipate first?

   • A.Prepare the client for an urgent noncontrast head CT
   • B.Administer aspirin immediately
   • C.Lower the blood pressure rapidly with an IV antihypertensive
   • D.Offer water to assess swallowing

   Answer and rationale are in the full material.