Accelerated Challenge Exam

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Sample questions from Accelerated Challenge Exam

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

   • A.A 68-year-old with chronic obstructive pulmonary disease whose SpO2 is 90% on the prescribed 2 L/min oxygen and who is speaking comfortably
   • B.A 42-year-old receiving an antibiotic who reports mild nausea but has no rash or breathing difficulty
   • C.A 54-year-old 6 hours after thyroidectomy who reports new throat tightness and has a hoarse voice
   • D.A 73-year-old with heart failure who has bilateral ankle edema and a 1-kg weight gain over 3 days

   Rationale: New throat tightness and hoarseness after thyroid surgery may signal an expanding hematoma and impending airway obstruction, so immediate assessment is necessary. The client's airway risk takes priority over the stable oxygenation, gradual edema, and mild nausea described for the other clients. The nurse should not delay assessment to gather routine data on the other clients. Postoperative airway changes are unexpected and potentially rapidly fatal.

2. 2.In a community clinic, an RN is assigning tasks to a licensed practical nurse (LPN) and an experienced unlicensed assistive personnel (UAP). Which task is appropriate to assign to the UAP?

   • A.Teach a 70-year-old newly prescribed warfarin how to respond to bleeding
   • B.Evaluate whether a 5-year-old's fever has improved after an antipyretic
   • C.Assess a 9-year-old's respiratory effort after the child received a rescue inhaler
   • D.Obtain a repeat blood pressure for a stable 16-year-old after the initial reading was 148/92 mm Hg, and report the result promptly

   Rationale: Obtaining and reporting a repeat blood pressure for a stable client is a routine data-collection task appropriate for a trained UAP. Warfarin teaching, respiratory assessment, and evaluation of a medication response require nursing judgment and cannot be delegated to the UAP. The RN must specify that an abnormal or concerning reading be reported promptly. Delegation does not transfer the RN's accountability for follow-up.

3. 3.Refer to the client's chart. Which actions should the nurse take now to coordinate safe care for this client? Select all that apply.

   • A.Request an order to hold the next gentamicin dose pending review of the trough and renal function
   • B.Review the medication plan with the pharmacist because the trough exceeds the stated therapeutic range
   • C.Continue the current dose because the client is afebrile and the white blood cell count is improving
   • D.Ask the UAP to assess for new tinnitus and determine whether the hearing has changed
   • E.Notify the provider promptly about the decreasing urine output and rising creatinine

   Rationale: The chart shows urine output falling from 35 to 18 mL/hr, creatinine rising from 0.9 to 1.6 mg/dL, and a gentamicin trough of 3.2 mcg/mL, above the stated range, so the provider and pharmacist need prompt notification and review before another dose. Asking the UAP to assess tinnitus is inappropriate because this is a focused clinical assessment that requires a licensed nurse. Continuing the dose based only on improved fever and white blood cell count ignores evidence of possible drug toxicity. The nurse should coordinate a safe medication plan while preserving effective infection treatment.

4. 4.A client states, "I want to leave the hospital now," while awaiting evaluation for chest pain. The 47-year-old is alert, oriented, and has a blood pressure of 138/84 mm Hg, HR 88/min, RR 16/min, and SpO2 98% on room air. Which action should the nurse take first?

   • A.Notify security to prevent the client from leaving before the evaluation is finished
   • B.Determine the client's understanding of the risks and reason for wanting to leave
   • C.Ask the client to sign the facility's discharge-against-medical-advice form
   • D.Ask a family member to persuade the client to remain until the tests are complete

   Answer and rationale are in the full material.

5. 5.During a home visit, an RN reviews medications with a 79-year-old client who takes digoxin and furosemide for heart failure. The client reports nausea and "yellow halos" around lights; the apical pulse is 54/min and irregular, and the potassium level is 3.0 mEq/L. The next digoxin dose is due now. What should the nurse do?

   • A.Withhold the digoxin and contact the provider promptly
   • B.Encourage a potassium-rich snack and administer both medications
   • C.Give the furosemide first to reduce the client's ankle edema
   • D.Give the digoxin with food and reassess the pulse in 1 hour

   Answer and rationale are in the full material.