246 Concepts of Nursing 1

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Sample questions from 246 Concepts of Nursing 1

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

1. 1.In the emergency department, a 13-year-old with type 1 diabetes is awaiting evaluation for abdominal pain. The client is alert, reports nausea, and has a glucose of 368 mg/dL, respirations of 30/min with a fruity odor, and BP 104/66 mm Hg. Another client is requesting a meal tray. Which action should the charge nurse take first?

   • A.Have the nurse obtain a urine sample before changing the assignment.
   • B.Assign a nurse to assess the adolescent immediately for diabetic ketoacidosis and notify the provider.
   • C.Ask dietary services to bring the waiting client a meal tray.
   • D.Ask the adolescent to drink water while waiting for the provider.

   Rationale: The adolescent's hyperglycemia, fruity breath, and tachypnea suggest possible diabetic ketoacidosis, which can progress to life-threatening fluid and electrolyte disturbances. Immediate assessment and escalation are needed; obtaining urine may be useful later but must not delay evaluation. Encouraging oral fluids without assessing the client's condition is insufficient, and addressing the meal request is a lower priority.

2. 2.Refer to the client's chart. The charge nurse is reviewing the change in condition and coordinating the plan of care. Which actions should the charge nurse take now? Select all that apply.

   • A.Notify the rapid response team because the client's condition is deteriorating.
   • B.Ask the unlicensed assistive personnel to repeat the blood pressure while the charge nurse remains with the client.
   • C.Delegate assessment of the client's new confusion to the experienced practical nurse.
   • D.Ensure that the provider is notified of the increasing oxygen requirement and new crackles.
   • E.Wait for the next scheduled vital-sign round because the oxygen saturation is still above 90%.

   Rationale: The oxygen requirement has increased, crackles have appeared, and the client is newly confused, so activating rapid response and promptly notifying the provider are appropriate. The unlicensed assistive personnel may obtain and report a blood pressure, but the registered nurse must interpret the findings and assess the client. Assessment of a new change in condition cannot be delegated to the practical nurse, and waiting is unsafe despite an SpO2 of 92% on supplemental oxygen.

3. 3.During a home visit, a 4-year-old with asthma is playful and has an SpO2 of 97% on room air. The parent asks the visiting nurse to administer the child's prescribed inhaled medication because the parent is leaving briefly. Which task is appropriate for the nurse to delegate to a trained home health aide?

   • A.Teach the parent how to recognize worsening respiratory distress.
   • B.Assess breath sounds and determine whether the medication is needed.
   • C.Remind the parent to keep the medication and spacer in the usual location.
   • D.Administer the inhaled medication and document the response.

   Rationale: A trained aide may provide a reminder about an established routine, but medication administration, assessment, and teaching require licensed nursing judgment. Administering the inhaler would exceed the aide's role, and the nurse must assess respiratory status and provide education. The client's current stability does not make those nursing functions delegable.

4. 4.A client states, 'I signed the consent, but I still do not understand the risks of the operation.' The client is scheduled for surgery in 30 minutes and is alert and oriented. What should the nurse do?

   • A.Pause preoperative preparation and contact the surgeon to discuss the client's questions.
   • B.Explain the risks in detail and ask the client to reaffirm the consent.
   • C.Ask the client's spouse to explain the procedure and risks.
   • D.Document that the client signed the consent and proceed with transport.

   Answer and rationale are in the full material.

5. 5.At change of shift on a pediatric unit, a 2-day-old newborn is due for a feeding, a 26-year-old postpartum client requests help with breastfeeding, and a 51-year-old client with a new tracheostomy has noisy respirations and an SpO2 decrease from 96% to 89%. Which client should the nurse assess first?

   • A.The newborn who is due for a feeding.
   • B.The postpartum client requesting breastfeeding assistance.
   • C.The client whose family is asking when discharge paperwork will be ready.
   • D.The client with the new tracheostomy and decreasing oxygen saturation.

   Answer and rationale are in the full material.