NSG 1545

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Sample questions from NSG 1545

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

1. 1.At change of shift on a medical unit, the RN reviews a 72-year-old client's worsening condition. Refer to the client's chart. Which action has the highest priority?

   • A.Request a physical therapy evaluation.
   • B.Activate the rapid response team.
   • C.Reassess blood pressure in 30 minutes.
   • D.Administer the prescribed oral acetaminophen.

   Rationale: The falling blood pressure to 84/48 mm Hg, new confusion, oliguria, and lactate of 4.2 mmol/L indicate impaired perfusion requiring immediate escalation. A physical therapy evaluation does not address this instability, and oral acetaminophen will not correct the circulatory problem. Waiting 30 minutes risks progression of shock. Prioritize acute deterioration over routine or symptom-focused care.

2. 2.On a rehabilitation unit, an RN coordinates care for a stable 68-year-old client recovering from hip surgery. The client is alert, has an established transfer plan, and has BP 128/74 mm Hg. Which activities may the RN delegate to trained assistive personnel? Select all that apply.

   • A.Assess new unilateral calf tenderness.
   • B.Assist with transfer using the established plan.
   • C.Teach the client how to use a walker.
   • D.Obtain routine vital signs and report results.
   • E.Measure and record oral fluid intake.

   Rationale: Measuring intake and obtaining routine vital signs are predictable tasks that trained assistive personnel may perform for a stable client. Assisting with a transfer is also appropriate when the RN has established the method and assessed safety. New calf tenderness requires nursing assessment because it may indicate thrombosis. Initial walker teaching requires licensed nursing judgment; delegation transfers a task, not responsibility for assessment and evaluation.

3. 3.Before surgery in an ambulatory center, a 46-year-old client states, 'I signed the consent, but I still do not understand why this operation is necessary.' No sedative has been given. What should the RN do next?

   • A.Ask the spouse to confirm that the procedure is necessary.
   • B.Administer the preoperative sedative to reduce anxiety.
   • C.Explain the procedure's risks and obtain a new signature.
   • D.Notify the surgeon that the client needs further explanation.

   Rationale: The procedural provider must explain the procedure, alternatives, and material risks so the client can make an informed decision. The RN can reinforce information but should not replace the surgeon's explanation or obtain a signature without understanding. A spouse cannot supply informed consent for a capable adult. Sedation should wait until questions are addressed and consent is valid.

4. 4.During a home hospice visit, a 79-year-old client with metastatic cancer is alert and states, 'I do not want to go back to the hospital.' The client's daughter requests ambulance transport despite the client's documented comfort-focused plan. Which response is most appropriate?

   • A.Ask the daughter to sign a refusal of treatment form.
   • B.Explain that hospice clients cannot return to a hospital.
   • C.Support the client's decision and review options for symptom relief at home.
   • D.Arrange transport because the daughter is the emergency contact.

   Answer and rationale are in the full material.

5. 5.At the start of an evening shift, an RN receives reports on four hospital clients. Which client should the RN assess first?

   • A.A 63-year-old with heart failure who has new pink, frothy sputum and SpO2 86%
   • B.An 82-year-old awaiting placement who is asking to speak with a social worker
   • C.A 24-year-old with appendicitis reporting pain of 6/10 before a scheduled analgesic
   • D.A 51-year-old with diabetes whose premeal glucose is 218 mg/dL

   Answer and rationale are in the full material.