NUR 242 Exam 2 Galen College

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Sample questions from NUR 242 Exam 2 Galen College

This material has 75 questions with answers and rationales. Here are the first 5.

1. 1.At change of shift on a medical-surgical unit, the nurse receives report on four clients. Which client should the nurse assess first?

   • A.A 44-year-old 1 day after appendectomy who reports incisional pain of 7/10 and has a temperature of 37.6 C
   • B.A 57-year-old awaiting discharge whose transportation has arrived and who needs medication instructions
   • C.A 73-year-old with chronic kidney disease who has a potassium level of 5.4 mEq/L and no ECG changes
   • D.A 68-year-old admitted with heart failure who has new confusion, SpO2 88% on 2 L/min oxygen, and crackles that were absent at the previous assessment

   Rationale: The new confusion, hypoxemia despite supplemental oxygen, and newly present crackles suggest acute respiratory deterioration requiring immediate assessment and intervention. The postoperative pain needs timely treatment, but the client is not showing an immediate airway or breathing threat. The mildly elevated potassium without ECG changes requires follow-up, while discharge teaching can wait until urgent needs are addressed. Prioritize acute changes in oxygenation over stable or expected concerns.

2. 2.During a home-care visit, a 76-year-old client with heart failure takes digoxin and furosemide and reports poor appetite and nausea. The client is alert, with HR 52/min and BP 104/66 mm Hg; the most recent potassium is 3.0 mEq/L. Which actions should the nurse take? Select all that apply.

   • A.Recommend an over-the-counter antacid containing magnesium without checking with the clinician.
   • B.Withhold the scheduled digoxin dose and contact the prescribing clinician promptly.
   • C.Review the medication schedule and determine whether the client has taken extra doses.
   • D.Arrange urgent evaluation if the client develops syncope, chest pain, or worsening bradycardia.
   • E.Advise the client to take the next dose with food and call only if symptoms persist.
   • F.Ask about visual changes and assess the apical pulse for a full minute.

   Rationale: Nausea, poor appetite, bradycardia, and hypokalemia raise concern for digoxin toxicity, so the dose should be held and the clinician notified; the apical pulse and visual symptoms are important assessment cues. Reviewing actual dosing can identify an accidental extra dose and informs safe management. Syncope, chest pain, or worsening bradycardia requires urgent evaluation, whereas waiting while continuing digoxin risks harm. Recommending an unreviewed antacid or simply taking the next dose with food does not address the potentially serious toxicity.

3. 3.In a long-term care facility, a 9-year-old resident with cerebral palsy is scheduled for a gastrostomy feeding. The RN is supervising an experienced assistive personnel (AP) who reports that the child is coughing and has a wet-sounding voice after a sip of water. Which action should the RN take first?

   • A.Ask the AP to document the coughing and continue with the feeding as scheduled.
   • B.Stop oral intake and assess the child's respiratory status and swallowing safety.
   • C.Delegate a thickened-liquid trial to the AP to determine whether the cough resolves.
   • D.Notify the provider that the child needs a new feeding-tube prescription.

   Rationale: Coughing and a wet voice after swallowing suggest aspiration risk, so the RN should stop oral intake and assess the child's breathing and ability to swallow before proceeding. Documentation is appropriate after immediate safety is addressed, but continuing the feeding could cause aspiration. The AP cannot assess swallowing safety or conduct a diagnostic trial, and a new tube prescription is not the first response to these cues. The RN retains responsibility for assessment and clinical decisions.

4. 4.A provider prescribes a heparin infusion for a 63-year-old client with a pulmonary embolism. The electronic order specifies 18 units/kg/hr, but the smart-pump library is set to 18 units/hr. The client is alert, HR 112/min, RR 26/min, BP 118/72 mm Hg, and SpO2 91% on room air. What should the nurse do?

   • A.Clarify the order and pump programming discrepancy before starting the infusion.
   • B.Start the infusion at 18 units/hr and adjust it after the first aPTT result.
   • C.Calculate the dose from the client's weight and override the pump library without contacting the provider.
   • D.Ask another nurse to independently verify the 18 units/hr setting, then begin the infusion.

   Answer and rationale are in the full material.

5. 5.At 1530 in a rehabilitation unit, a 15-year-old client with type 1 diabetes is waiting for a meal tray and reports feeling shaky. The client is awake and able to swallow; capillary glucose is 58 mg/dL, HR 108/min, and BP 112/68 mm Hg. Which action is the nurse's priority?

   • A.Give glucagon intramuscularly before offering anything by mouth.
   • B.Ask the AP to bring the meal tray and reassess the client after the meal.
   • C.Give 15 g of a rapid-acting carbohydrate and recheck glucose in 15 minutes.
   • D.Administer the scheduled rapid-acting insulin because the glucose is below the target range.

   Answer and rationale are in the full material.