Updated Q&A Resource with Verified Answers for Exam
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A nurse is working in the emergency department when there is an explosion in a local
chemical plant. Multiple victims are expected at the facility. Which of the following
should be the nurse's priority intervention upon client arrival? - :answers :Isolate the
clients and irrigate with water
When using the urgent vs. nonurgent approach to care, the nurse determines the
priority action is to reduce mortality and morbidity.
A nurse is planning discharge care for a client who had a stroke and now has left-sided
weakness. Which of the following interventions should the nurse include in the plan of
care? - :answers :Advise the client to install grab bars in the bathroom at home
The nurse should advise the client to install grab bars in the bathroom at home to
reduce the risk for falls.
A charge nurse has been asked to determine staff adherence to establish standards for
postoperative vital sign measurement. Which of the following actions should the nurse
take to collect information? - :answers :Conduct a retrospective chart audit of all
surgical clients for the past 6 months
A retrospective chart audit is an effective method of collecting objective performance
data from formal records that can be used for outcome measurement.
An RN is working on the surgical unit when a client who has abdominal pain is
admitted. Which of the following activities must be performed by the RN? - :answers
:Completing the client's initial admission assessment
,Completing the client's initial admission assessment is within the RN's scope of practice.
A home health nurse is planning daily visits and receives laboratory results for 4 adult
clients. Which of the following clients should the home health nurse plan to visit first,
based on their laboratory findings? - :answers :A client who is 3 days postoperative
and has a platelets 100,000/mm3 (150,000 to 400,000/mm3)
A client who has a decreased platelet count is at increased risk for bleeding which is a
concerns for the nurse. Therefore, according to the airway, breathing, and circulation
framework, the nurse should see this client first.
A nurse manager observes a newly licensed nurse and an assistive personnel (AP)
arguing about the failure of the AP to restock unit supplies. The AP leaves the room.
Which of the following statements should the nurse manager make to the newly licensed
nurse? - :answers :"I would like for you to approach the AP to resolve the problem."
Encouraging face-to-face communication to resolve a conflict is an appropriate action by
the nurse manager.
A nurse manager is presenting an in-service about preventing readmission of clients due
to complications following joint arthroplasty. Which of the following leadership tasks is
the nurse performing? - :answers :Advocacy
The nurse acts as an advocate by promoting and protecting safety for staff and clients by
providing information that allows staff to act autonomously.
A nurse is caring for a client who is experiencing adverse effects after receiving a new
medication. Which of the following communication tools should the nurse use for
management of this complication? - :answers :SBAR framework
, The nurse should use the SBAR framework to identify the situation, background,
assessment, and recommendation for a specific circumstance. The nurse can focus on
the client's immediate circumstances to promote clinical decision making.
The nurse should use a critical pathway as a cost-effective strategy to guide care for
clients who have a specific medical diagnosis or are undergoing a specific procedure.
The nurse should complete an incident report as part of error reporting and quality
improvement; however, this action does not relate to management of the client's care.
The nurse should use root cause analysis during the quality control process to determine
why a standard is not being met.
A nurse on a quality improvement team is implementing a plan to decrease the rate of
pressure injuries in long-term care facility. Which of the following actions should the
team take to evaluate the effectiveness of the plan? - :answers :Compare data from
clients' records regarding skin integrity with established criteria
A charge nurse is talking with a staff nurse following a workshop on advance directives.
Which of the following statements by the staff nurse demonstrates understanding of
advance directives? - :answers :"A family member of a client can have the living will
overturned in some cases."
Family members have the right to question the mental capacity of the client at the time a
living will was completed; evidence that the client was incompetent could result in the
living will being revoked.