NRNP 6540 PRIMARY CARE ASSESSMENT
AND DIAGNOSTIC REASONING STUDY
GUIDE 2026
◉ A patient is admitted for joint replacement surgery and has a
permanent tracheostomy. Which task is appropriate for the nurse to
delegate to unlicensed assistive personnel (UAP)?
A. Suction the tracheostomy.
B. Check stoma site for skin breakdown.
C. Complete tracheostomy care using sterile technique.
D. Provide oral care with a toothbrush and tonsil suction tube.
Answer: D. Provide oral care with a toothbrush and tonsil suction
tube.
rationale:
Oral care (for a stable patient with a tracheostomy) can be delegated
to UAP. A registered nurse would be responsible for assessments
(e.g., checking the stoma for skin breakdown) and tracheostomy
suctioning and care.
◉ When caring for a patient who is 3 hours postoperative
laryngectomy, what is the nurse's highest priority assessment?
A. Patient comfort
B. Airway patency
,C. Incisional drainage
D. Blood pressure and heart rate
Answer: B. Airway patency
rationale:
Remember the ABCs with prioritization. Airway patency is always
the highest priority and is essential for a patient undergoing surgery
surrounding the upper respiratory system. Comfort, drainage, and
vital signs follow the ABCs in priority.
◉ The patient seeks relief from the symptoms of an upper
respiratory infection (URI) lasting for 5 days. Which patient
assessment should the nurse use to help determine if the URI has
developed into acute sinusitis?
A. Coughing
B. Fever, chills
C. Dust allergy
D. Maxillary pain
Answer: D. Maxillary pain
rationale:
The nurse should assess the patient for sinus pain or pressure as a
clinical indicator of acute sinusitis. Coughing and fever are
nonspecific clinical indicators of a URI. A history of an allergy that is
likely to affect the upper respiratory tract is supportive of the
sinusitis diagnosis but is not specific for sinusitis.
,◉ A patient with a history of tonsillitis reports difficulty breathing.
Which patient assessment data warrants emergency interventions
by the nurse?
A. Bilateral erythema of especially large tonsils
B. Temperature 102.2° F, diaphoresis, and chills
C. Contraction of neck muscles during inspiration
D. β-Hemolytic streptococcus in the throat culture
Answer: C. Contraction of neck muscles during inspiration
Rationale:
Contraction of neck muscles during inspiration indicates that the
patient is using accessory muscles for breathing and is in serious
respiratory distress. The reddened and enlarged tonsils indicate
pharyngitis. The increased temperature, diaphoresis, and chills
indicate an infection, which could be β-hemolytic streptococcus or
fungal infection, but not an emergency situation for the patient.
◉ The nurse teaches a patient about the use of budesonide
intranasal spray for seasonal allergic rhinitis. The nurse determines
that medication teaching is successful if the patient makes which
statement?
A. "My liver function will be checked with blood tests every 2 to 3
months."
B. "The medication will decrease the congestion within 3 to 5
minutes after use."
, C. "I may develop a serious infection because the medication reduces
my immunity."
D. "I will use the medication every day of the season whether I have
symptoms or not."
Answer: D. "I will use the medication every day of the season
whether I have symptoms or not."
rationale:
Budesonide should be started 2 weeks before pollen season starts
and used on a regular basis, not as needed. The spray acts to
decrease inflammation and the effect is not immediate as with
decongestant sprays. At recommended doses, budesonide has only
local effects and will not result in immunosuppression or a systemic
infection. Zafirlukast (Accolate) is a leukotriene receptor antagonist
and may alter liver function tests (LFTs). LFTs must be monitored
periodically in the patient taking zafirlukast.
◉ Which topics will the nurse include in discharge teaching for a
patient who has had a complete laryngectomy? Select all that apply
A. How to obtain a medic alert bracelet
B. Care of the stoma or laryngectomy tube
C. Ways to hide the stoma with a scarf or shirt
D. Use of a smartphone with a text- to speech app
E: Ways to decrease aspiration risk when swallowing
Answer: A. How to obtain a medic alert bracelet
B. Care of the stoma or laryngectomy tube
AND DIAGNOSTIC REASONING STUDY
GUIDE 2026
◉ A patient is admitted for joint replacement surgery and has a
permanent tracheostomy. Which task is appropriate for the nurse to
delegate to unlicensed assistive personnel (UAP)?
A. Suction the tracheostomy.
B. Check stoma site for skin breakdown.
C. Complete tracheostomy care using sterile technique.
D. Provide oral care with a toothbrush and tonsil suction tube.
Answer: D. Provide oral care with a toothbrush and tonsil suction
tube.
rationale:
Oral care (for a stable patient with a tracheostomy) can be delegated
to UAP. A registered nurse would be responsible for assessments
(e.g., checking the stoma for skin breakdown) and tracheostomy
suctioning and care.
◉ When caring for a patient who is 3 hours postoperative
laryngectomy, what is the nurse's highest priority assessment?
A. Patient comfort
B. Airway patency
,C. Incisional drainage
D. Blood pressure and heart rate
Answer: B. Airway patency
rationale:
Remember the ABCs with prioritization. Airway patency is always
the highest priority and is essential for a patient undergoing surgery
surrounding the upper respiratory system. Comfort, drainage, and
vital signs follow the ABCs in priority.
◉ The patient seeks relief from the symptoms of an upper
respiratory infection (URI) lasting for 5 days. Which patient
assessment should the nurse use to help determine if the URI has
developed into acute sinusitis?
A. Coughing
B. Fever, chills
C. Dust allergy
D. Maxillary pain
Answer: D. Maxillary pain
rationale:
The nurse should assess the patient for sinus pain or pressure as a
clinical indicator of acute sinusitis. Coughing and fever are
nonspecific clinical indicators of a URI. A history of an allergy that is
likely to affect the upper respiratory tract is supportive of the
sinusitis diagnosis but is not specific for sinusitis.
,◉ A patient with a history of tonsillitis reports difficulty breathing.
Which patient assessment data warrants emergency interventions
by the nurse?
A. Bilateral erythema of especially large tonsils
B. Temperature 102.2° F, diaphoresis, and chills
C. Contraction of neck muscles during inspiration
D. β-Hemolytic streptococcus in the throat culture
Answer: C. Contraction of neck muscles during inspiration
Rationale:
Contraction of neck muscles during inspiration indicates that the
patient is using accessory muscles for breathing and is in serious
respiratory distress. The reddened and enlarged tonsils indicate
pharyngitis. The increased temperature, diaphoresis, and chills
indicate an infection, which could be β-hemolytic streptococcus or
fungal infection, but not an emergency situation for the patient.
◉ The nurse teaches a patient about the use of budesonide
intranasal spray for seasonal allergic rhinitis. The nurse determines
that medication teaching is successful if the patient makes which
statement?
A. "My liver function will be checked with blood tests every 2 to 3
months."
B. "The medication will decrease the congestion within 3 to 5
minutes after use."
, C. "I may develop a serious infection because the medication reduces
my immunity."
D. "I will use the medication every day of the season whether I have
symptoms or not."
Answer: D. "I will use the medication every day of the season
whether I have symptoms or not."
rationale:
Budesonide should be started 2 weeks before pollen season starts
and used on a regular basis, not as needed. The spray acts to
decrease inflammation and the effect is not immediate as with
decongestant sprays. At recommended doses, budesonide has only
local effects and will not result in immunosuppression or a systemic
infection. Zafirlukast (Accolate) is a leukotriene receptor antagonist
and may alter liver function tests (LFTs). LFTs must be monitored
periodically in the patient taking zafirlukast.
◉ Which topics will the nurse include in discharge teaching for a
patient who has had a complete laryngectomy? Select all that apply
A. How to obtain a medic alert bracelet
B. Care of the stoma or laryngectomy tube
C. Ways to hide the stoma with a scarf or shirt
D. Use of a smartphone with a text- to speech app
E: Ways to decrease aspiration risk when swallowing
Answer: A. How to obtain a medic alert bracelet
B. Care of the stoma or laryngectomy tube
