NGN CASE STUDY CERTIFICATION
EVALUATION SCRIPT 2026 CLINICAL QANDA
VERIFIED
◉ A patient who is anxious and has difficulty breathing seeks
treatment after being stung by a wasp. What is the nurse's priority
action?
a. Have the patient lie down.
b. Assess the patient's airway.
c. Administer high-flow oxygen.
d. Remove the stinger from the site.. Answer: ANS: B
The initial action with any patient with difficulty breathing is to
assess and maintain the airway. The other actions also are part of
the emergency management protocol for anaphylaxis, but the
priority is airway maintenance.
◉ Immediately after the nurse administers an intracutaneous
injection of an allergen on the forearm, a patient complains of
itching at the site and of weakness and dizziness. What action should
the nurse take first?
a. Remind the patient to remain calm.
b. Administer subcutaneous epinephrine.
c. Apply a tourniquet above the injection site.
,d. Rub a local antiinflammatory cream on the site.. Answer: ANS: C
Application of a tourniquet will decrease systemic circulation of the
allergen and should be the first reaction. A local antiinflammatory
cream may be applied to the site of a cutaneous test if the itching
persists. Epinephrine will be needed if the allergic reaction
progresses to anaphylaxis. The nurse should assist the patient to
remain calm, but this is not an adequate initial nursing action.
◉ A clinic patient is experiencing an allergic reaction to an unknown
allergen. Which action is most appropriate for the registered nurse
(RN) to delegate to a licensed practical/vocational nurse
(LPN/LVN)?
a. Perform a focused physical assessment.
b. Obtain the health history from the patient.
c. Teach the patient about the various diagnostic studies.
d. Administer skin testing by the cutaneous scratch method..
Answer: ANS: D
LPN/LVNs are educated and licensed to administer medications
under the supervision of an RN. RN-level education and the scope of
practice include assessment of health history, focused physical
assessment, and patient teaching.
◉ The health care provider asks the nurse whether a patient's
angioedema has responded to prescribed therapies. Which
assessment should the nurse perform?
,a. Ask the patient about any clear nasal discharge.
b. Obtain the patient's blood pressure and heart rate.
c. Check for swelling of the patient's lips and tongue.
d. Assess the patient's extremities for wheal and flare lesions..
Answer: ANS: C
Angioedema is characterized by swelling of the eyelids, lips, and
tongue. Wheal and flare lesions, clear nasal drainage, and
hypotension and tachycardia are characteristic of other allergic
reactions.
◉ A nurse has obtained donor tissue typing information about a
patient who is waiting for a kidney transplant. Which results should
be reported to the transplant surgeon?
a. Patient is Rh positive and donor is Rh negative
b. Six antigen matches are present in HLA typing
c. Results of patient-donor cross matching are positive
d. Panel of reactive antibodies (PRA) percentage is low. Answer:
ANS: C
Positive crossmatching is an absolute contraindication to kidney
transplantation, since a hyperacute rejection will occur after the
transplant. The other information indicates that the tissue match
between the patient and potential donor is acceptable
, ◉ A patient who is receiving immunotherapy has just received an
allergen injection. Which assessment finding is most important to
communicate to the health care provider?
a. The patient's IgG level is increased.
b. The injection site is red and swollen.
c. The patient's allergy symptoms have not improved.
d. There is a 2-cm wheal at the site of the allergen injection.. Answer:
ANS: D
A local reaction larger than quarter size may indicate that a decrease
in the allergen dose is needed. An increase in IgG indicates that the
therapy is effective. Redness and swelling at the site are not unusual.
Because immunotherapy usually takes 1 to 2 years to achieve an
effect, an improvement in the patient's symptoms is not expected
after a few months
◉ The function of monocytes in immunity is related to their ability
to:
A. stimulate the production of T and B lymphocytes
B. produce antibodies on exposure to foreign substances
C. bind antigens and stimulate natural killer cell activation
D. capture antigens by phagocytosis and present them to
lymphocytes. Answer: D
Rationale: The mononuclear phagocyte system includes monocytes
in the blood and macrophages found throughout the body.
Mononuclear phagocytes have a critical role in the immune system.
EVALUATION SCRIPT 2026 CLINICAL QANDA
VERIFIED
◉ A patient who is anxious and has difficulty breathing seeks
treatment after being stung by a wasp. What is the nurse's priority
action?
a. Have the patient lie down.
b. Assess the patient's airway.
c. Administer high-flow oxygen.
d. Remove the stinger from the site.. Answer: ANS: B
The initial action with any patient with difficulty breathing is to
assess and maintain the airway. The other actions also are part of
the emergency management protocol for anaphylaxis, but the
priority is airway maintenance.
◉ Immediately after the nurse administers an intracutaneous
injection of an allergen on the forearm, a patient complains of
itching at the site and of weakness and dizziness. What action should
the nurse take first?
a. Remind the patient to remain calm.
b. Administer subcutaneous epinephrine.
c. Apply a tourniquet above the injection site.
,d. Rub a local antiinflammatory cream on the site.. Answer: ANS: C
Application of a tourniquet will decrease systemic circulation of the
allergen and should be the first reaction. A local antiinflammatory
cream may be applied to the site of a cutaneous test if the itching
persists. Epinephrine will be needed if the allergic reaction
progresses to anaphylaxis. The nurse should assist the patient to
remain calm, but this is not an adequate initial nursing action.
◉ A clinic patient is experiencing an allergic reaction to an unknown
allergen. Which action is most appropriate for the registered nurse
(RN) to delegate to a licensed practical/vocational nurse
(LPN/LVN)?
a. Perform a focused physical assessment.
b. Obtain the health history from the patient.
c. Teach the patient about the various diagnostic studies.
d. Administer skin testing by the cutaneous scratch method..
Answer: ANS: D
LPN/LVNs are educated and licensed to administer medications
under the supervision of an RN. RN-level education and the scope of
practice include assessment of health history, focused physical
assessment, and patient teaching.
◉ The health care provider asks the nurse whether a patient's
angioedema has responded to prescribed therapies. Which
assessment should the nurse perform?
,a. Ask the patient about any clear nasal discharge.
b. Obtain the patient's blood pressure and heart rate.
c. Check for swelling of the patient's lips and tongue.
d. Assess the patient's extremities for wheal and flare lesions..
Answer: ANS: C
Angioedema is characterized by swelling of the eyelids, lips, and
tongue. Wheal and flare lesions, clear nasal drainage, and
hypotension and tachycardia are characteristic of other allergic
reactions.
◉ A nurse has obtained donor tissue typing information about a
patient who is waiting for a kidney transplant. Which results should
be reported to the transplant surgeon?
a. Patient is Rh positive and donor is Rh negative
b. Six antigen matches are present in HLA typing
c. Results of patient-donor cross matching are positive
d. Panel of reactive antibodies (PRA) percentage is low. Answer:
ANS: C
Positive crossmatching is an absolute contraindication to kidney
transplantation, since a hyperacute rejection will occur after the
transplant. The other information indicates that the tissue match
between the patient and potential donor is acceptable
, ◉ A patient who is receiving immunotherapy has just received an
allergen injection. Which assessment finding is most important to
communicate to the health care provider?
a. The patient's IgG level is increased.
b. The injection site is red and swollen.
c. The patient's allergy symptoms have not improved.
d. There is a 2-cm wheal at the site of the allergen injection.. Answer:
ANS: D
A local reaction larger than quarter size may indicate that a decrease
in the allergen dose is needed. An increase in IgG indicates that the
therapy is effective. Redness and swelling at the site are not unusual.
Because immunotherapy usually takes 1 to 2 years to achieve an
effect, an improvement in the patient's symptoms is not expected
after a few months
◉ The function of monocytes in immunity is related to their ability
to:
A. stimulate the production of T and B lymphocytes
B. produce antibodies on exposure to foreign substances
C. bind antigens and stimulate natural killer cell activation
D. capture antigens by phagocytosis and present them to
lymphocytes. Answer: D
Rationale: The mononuclear phagocyte system includes monocytes
in the blood and macrophages found throughout the body.
Mononuclear phagocytes have a critical role in the immune system.
