Prn 1520 Exam 2

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Sample questions from Prn 1520 Exam 2

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 72-year-old client with heart failure who gained 1 kg in 24 hours and has bilateral ankle edema; SpO2 is 94% on room air.
   • B.A 46-year-old client 8 hours after thyroidectomy who is restless, reports tingling around the mouth, and has audible inspiratory stridor.
   • C.A 28-year-old client receiving antibiotics for cellulitis whose temperature is 38.1 C and whose erythema is unchanged from the prior assessment.
   • D.A 63-year-old client with diabetes whose glucose is 248 mg/dL before breakfast and who has no new symptoms.

   Rationale: Inspiratory stridor after thyroidectomy suggests acute airway obstruction, and the new perioral tingling may indicate hypocalcemia; airway compromise takes priority. The heart failure findings require assessment but are not as immediately life-threatening with the reported oxygen saturation and edema. The glucose and fever need follow-up according to their care plans, but neither client has the same immediate threat to life.

2. 2.During a home health visit, a 79-year-old client with atrial fibrillation says, "I fell last night, but I feel fine." The client takes warfarin; the INR was 2.7 one week ago. The client is alert, has no visible bruising, and has a blood pressure of 138/76 mm Hg. Which action should the nurse take first?

   • A.Arrange urgent medical evaluation for possible occult bleeding, including intracranial injury.
   • B.Teach the client to use a walker and document the fall for the primary care provider.
   • C.Instruct the client to hold warfarin for the next 2 days and recheck the INR.
   • D.Ask the client to call the anticoagulation clinic at the next scheduled business day.

   Rationale: A fall in a client taking warfarin can cause occult or delayed bleeding even when the client feels well and has no visible injury; urgent evaluation is the priority. Holding warfarin without a prescriber's direction may increase thromboembolic risk and does not assess for injury. A routine call or fall-prevention teaching is appropriate later, but neither replaces immediate evaluation.

3. 3.In a long-term care facility, a 4-year-old child is admitted to a pediatric respite bed with a new prescription for oral amoxicillin. The medication aide reports that the child weighs 16 kg and asks the RN to verify the first dose. The prescription is 400 mg every 8 hours; the facility reference lists the maximum as 90 mg/kg/day. What should the RN do?

   • A.Change the administration interval to every 12 hours to keep the daily amount within the maximum.
   • B.Approve the dose because 400 mg is below the maximum daily dose.
   • C.Hold the first dose and clarify the prescription because the total daily dose exceeds the stated maximum.
   • D.Ask the medication aide to give 400 mg now and reassess the child after the dose.

   Rationale: The prescription provides 1,200 mg/day, while 90 mg/kg/day for 16 kg is 1,440 mg/day; wait, 1,200 mg/day is within that maximum. Therefore the dose should not be held for this reason, and the options require reconsideration. The correct action is to approve the dose after verifying the calculation and prescription details; however, that is not presented as an option.

4. 4.A client's potassium is 6.2 mEq/L (reference range 3.5 to 5.0 mEq/L). The 58-year-old client with chronic kidney disease is on a telemetry unit, reports new muscle weakness, and has peaked T waves. Which action should the nurse take first?

   • A.Document the electrocardiogram finding and notify the provider during routine rounds.
   • B.Encourage oral fluids and recheck the client's muscle strength in 30 minutes.
   • C.Give the scheduled oral potassium binder and repeat the laboratory test in 4 hours.
   • D.Notify the rapid response team and prepare to implement emergency hyperkalemia treatment.

   Answer and rationale are in the full material.

5. 5.On a rehabilitation unit, a 67-year-old client with a new stroke has right-sided weakness and mild expressive aphasia. The client is stable and needs help with morning care. Which task is appropriate for the RN to delegate to an experienced unlicensed assistive personnel (UAP)?

   • A.Teach the client how to use the call light before transferring.
   • B.Evaluate whether the prescribed mobility plan is improving balance.
   • C.Assess the client's ability to swallow the prescribed breakfast.
   • D.Assist the client with bathing and report any new change in alertness or movement.

   Answer and rationale are in the full material.