Critical Thinking/Clinical Reasoning/Clinical
Judgment: Rapid Response/Clinical
Emergencies. Exam Questions and Answers
100% Pass
A nurse in a rehabilitation facility is performing the role of a case manager for a group of clients.
Which of the following actions should the nurse take? - ANS Ensure clients receive optimal
care in a cost-effective manner.
The responsibility of the case manager is to ensure clients receive optimal care in a cost-
effective manner. A nurse often fulfills the role of case manager.
A nurse is receiving change-of-shift report for a group of clients. Which of the following clients
should the nurse attend to first? - ANS client who has received nitroglycerin sublingual for
chest pain and requires a 12-lead EKG
first action the nurse should take when using the airway, breathing, circulation approach to
client care is to obtain a 12-lead EKG for the client who is experiencing chest pain
A nurse is planning care for four clients. Which of the following tasks should the nurse delegate
to a licensed practical nurse (LPN)? - ANS perform a wet-to-dry dressing change for a client
who has a pressure ulcer.
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A nurse is planning care for a client who is experiencing residual effects from an ischemic
stroke. The nurse should request a consultation with which of the following members of the
interprofessional care team first? - ANS Speech therapist
A nurse is managing the care for a client who has recent unexplained weight loss and a low
serum albumin level. Which of the following members of the interprofessional care team
should the nurse consult? - ANS registered dietitian
nurse should consult a registered dietitian who will design a therapeutic diet, which will provide
the client with needed nutrition to correct weight and protein loss
A nurse is providing a transfer report to an inpatient rehabilitation facility for a client who has
atrial fibrillation. Which of the following pieces of information is the priority for the nurse to
include in the report? - ANS "Today's INR is 2.0."
The greatest risk to this client is injury from bleeding, due to an increased INR as a result of
receiving anticoagulant therapy for atrial fibrillation; therefore, this is the priority piece of
information the nurse should include in the transfer report.
A nurse is speaking with the provider about a client who has had a change in mental status
since admission. Which of the following statements by the nurse demonstrates the use of
assertive communication? - ANS "I am concerned about the client's rapid change in mental
status."
This statement by the nurse is demonstrating the use of an "I" statement, which is a form of
assertive communication. The use of the "I" statement by the nurse encourages discussion
about the client with the provider and emphasizes the importance of working together for the
benefit of the client.
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