West Coast University

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Sample questions from West Coast University

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 temperature of 38.4 C, HR 112, RR 30, BP 86/50, and SpO2 89% on 2 L/min nasal cannula. A second client is requesting pain medication, and a third is awaiting discharge teaching. Which action should the nurse take first?

   • A.Ask the nursing assistant to obtain routine vital signs for all three clients.
   • B.Begin discharge teaching with the client who is scheduled to leave within the hour.
   • C.Administer the requested pain medication to the client reporting pain of 8 on a 0-to-10 scale.
   • D.Assess the client with pneumonia and initiate immediate interventions for respiratory and circulatory instability.

   Rationale: The client with pneumonia has hypoxemia, tachypnea, tachycardia, and hypotension, indicating possible respiratory failure and sepsis; immediate assessment and escalation are the priority. Pain treatment is important but can wait while a potentially life-threatening problem is addressed. Discharge teaching and routine vital signs do not take priority over the unstable findings. The exam takeaway is to prioritize airway, breathing, and circulation and respond to acute deterioration.

2. 2.In a home health visit, a 74-year-old client with heart failure says, "I have been taking an extra water pill whenever my ankles look swollen." The client reports dizziness when standing; BP is 104/66 mm Hg sitting and 86/54 mm Hg standing, and the medication list includes furosemide 40 mg daily. Which action is most appropriate?

   • A.Assess the client's medication use and symptoms, then contact the prescribing clinician about the unscheduled doses and orthostatic hypotension.
   • B.Tell the client to stop furosemide until the next scheduled appointment.
   • C.Ask a family member to decide whether the client should take the medication each day.
   • D.Instruct the client to take an additional furosemide dose whenever swelling occurs.

   Rationale: The unscheduled diuretic doses and symptomatic orthostatic blood pressure change require assessment and timely communication with the prescriber. Advising extra doses could worsen volume depletion, while independently stopping a prescribed medication is not appropriate. A family member should not replace the clinician's medication plan. The exam takeaway is to reconcile medication use, identify adverse effects, and communicate findings rather than change prescriptions independently.

3. 3.During a community clinic visit, a 16-year-old client who is 10 weeks pregnant asks for help obtaining prenatal care and says, "Please do not tell my parent yet." The client is alert, has no abdominal pain or bleeding, and has a BP of 112/70 mm Hg and HR of 84/min. Which actions should the nurse take? Select all that apply.

   • A.Provide information about confidential prenatal services and how to access them, consistent with local law and clinic policy.
   • B.Explain the limits of confidentiality and assess the client's immediate safety and support needs.
   • C.Assess for coercion, abuse, or immediate danger in a private, nonjudgmental conversation.
   • D.Promise that nothing the client says will ever be shared with anyone.
   • E.Contact the client's parent immediately because the client is a minor.
   • F.Arrange follow-up for prenatal assessment and discuss options for involving a trusted support person.

   Rationale: The nurse should explain confidentiality limits, assess safety privately, provide access to appropriate confidential services within applicable law and policy, and plan timely follow-up. A promise of absolute confidentiality is inappropriate because safety concerns or mandatory reporting requirements may require disclosure. Automatically notifying a parent may violate applicable confidentiality protections and could compromise the client's safety. The exam takeaway is to protect privacy while clearly explaining legal limits and ensuring access to care.

4. 4.A provider prescribes IV potassium chloride for a 52-year-old client with a potassium level of 2.9 mEq/L. The client is on a medical unit, has a peripheral IV, and the prescription reads, "Potassium chloride 10 mEq IV push now." What should the nurse do?

   • A.Dilute the potassium in a small syringe and administer it over 10 minutes.
   • B.Clarify the prescription with the provider before administering the medication.
   • C.Ask another nurse to verify the dose and then give it by IV push.
   • D.Administer the potassium slowly through the peripheral IV.

   Answer and rationale are in the full material.

5. 5.In a long-term care facility, a 9-month-old infant is staying temporarily with a grandparent who is receiving respite services. The infant is due for a bottle while the grandparent attends an appointment. Which task may the registered nurse delegate to an experienced nursing assistant?

   • A.Assess the infant's feeding readiness and determine whether the infant can safely suck and swallow.
   • B.Evaluate the infant for dehydration based on the number of wet diapers.
   • C.Feed the infant the prepared bottle after the nurse has assessed the infant and provided the feeding plan.
   • D.Teach the grandparent how to recognize aspiration during feeding.

   Answer and rationale are in the full material.