Durham College

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Sample questions from Durham College

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, an RN receives report on four clients. Which client should the RN assess first?

   • A.A 68-year-old client with heart failure who is newly confused and has an SpO2 of 88% on room air
   • B.A 54-year-old client with diabetes whose blood glucose is 248 mg/dL and who is awaiting lunch
   • C.A 39-year-old client 1 day after appendectomy who reports incisional pain of 6/10
   • D.A 73-year-old client with a urinary tract infection whose temperature is 37.8 C and who is requesting acetaminophen

   Rationale: New confusion with an SpO2 of 88% may indicate acute hypoxemia, so this client needs immediate assessment and intervention. The elevated glucose, postoperative pain, and low-grade temperature require follow-up but do not take priority over impaired oxygenation. The RN should first verify the oxygen reading and assess respiratory status while initiating appropriate oxygen support according to protocol. Use airway and breathing priorities when deciding whom to assess first.

2. 2.In a pediatric clinic, a 4-year-old client with a mild upper respiratory infection is due for discharge. The RN asks an unlicensed assistive personnel (UAP) to help with care. Which task is appropriate to delegate to the UAP?

   • A.Determine whether the child's lung sounds have improved after coughing
   • B.Obtain the client's temperature and report the result to the RN
   • C.Evaluate whether the child is ready for discharge
   • D.Teach the caregiver how to use a prescribed metered-dose inhaler

   Rationale: Obtaining and reporting a routine temperature is a predictable task that can be delegated to a UAP. Assessing lung sounds, teaching inhaler technique, and evaluating discharge readiness require nursing judgment and remain the RN's responsibility. The RN should provide clear instructions about when and how promptly to report the measurement. Delegation transfers a task, not accountability for nursing assessment and evaluation.

3. 3.Refer to the client's chart. A 29-year-old client is 2 hours postpartum after a vaginal birth. Which actions should the RN take now? Select all that apply.

   • A.Document the findings and wait 30 minutes before reassessing
   • B.Assist the client to the bathroom alone to empty the bladder
   • C.Massage the fundus and reassess uterine tone
   • D.Maintain the prescribed oxytocin infusion and reassess bleeding
   • E.Notify the obstetric provider of the ongoing heavy bleeding and vital-sign changes

   Rationale: The chart shows a boggy fundus, increasing lochia, a rising heart rate, and a falling blood pressure, so fundal massage and continued prescribed oxytocin are appropriate immediate responses. The RN should also promptly notify the provider because the findings suggest worsening postpartum hemorrhage. The client should not walk to the bathroom alone while potentially unstable, and waiting 30 minutes would delay needed care. Reassess and document the response to interventions without postponing escalation.

4. 4.At a community health center, a 22-year-old client tells the RN that a medication dose was accidentally doubled at home and asks the RN not to tell anyone. Which response is most appropriate?

   • A.Advise the client to take the next dose as scheduled without further assessment
   • B.Promise to keep the information confidential and avoid documenting it unless symptoms occur
   • C.Tell the client that the event must be reported to the police before any assessment can occur
   • D.Assess the medication, dose, and time taken, then follow the center's medication-safety and reporting procedures

   Answer and rationale are in the full material.

5. 5.In a school-based clinic, a 16-year-old client requests contraception and asks that the discussion not be shared with a parent. Which action should the RN take first?

   • A.Contact the client's parent before asking about the client's concerns
   • B.Refuse to provide information until the client is accompanied by a parent
   • C.Explain the limits of confidentiality and assess the client's immediate safety and applicable consent rules
   • D.Promise that no information will ever be disclosed to anyone

   Answer and rationale are in the full material.