RN Leadership Online Practice 2024/2025 A|
Questions and Answers, 100% Correct| Updated
There has been a community disaster and stable clients must be discharged from a facility to prepare for the influx of new
m m m m m m m m m m m m m m m m m m m m m
casualties. A nurse should identify that which of the following clients is safe to discharge? - correct answera client who has
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multiple sclerosis and reports ataxia
m m m m m
This client is safe to discharge because multiple sclerosis is a chronic disorder and ataxia is an expected finding.
m m m m m m m m m m m m m m m m m m
A nurse on a medical-surgical unit is caring for four clients. The nurse should recognize that which of the following clients
m m m m m m m m m m m m m m m m m m m m
is the priority? - correct answerA client who has peripheral vascular disease and has an absent pulse in the right foot
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When using the airway, breathing, circulation approach to client care, the nurse determines that the priority finding is an
m m m m m m m m m m m m m m m m m m
absent pulse, which indicates no blood flow to the extremity.
m m m m m m m m m m
A nurse finds that a new IV pump has infused 400 mL of solution over 2 hr when the rate was set at 100 mL/hr. After
m m m m m m m m m m m m m m m m m m m m m m m m m
notifying the provider and verifying that the pump was properly programmed, which of the following is the nurse's priority?
m m m m m m m m m m m m m m m m m m m
- correct answerTag the pump for maintenance and acquire a new pump for the client
m m m m m m m m m m m m m m m
The greatest risk is the potential for injury to a client if a nurse uses the pump again before repair; therefore, the priority for
m m m m m m m m m m m m m m m m m m m m m m m
the nurse is to tag the pump for maintenance and acquire a new pump for the client.
m m m m m m m m m m m m m m m m m
A charge nurse is planning care for a group of clients. Which of the following tasks should be delegated to an assistive
m m m m m m m m m m m m m m m m m m m m m
personnel (AP)? select all that apply - correct answerambulating a client who uses a walker, adding thickener to thin liquids
m m m m m m m m m m m m m m m m m m m m
on a client's food tray
m m m m m
Flushing a client's saline lock is incorrect. This is not within the AP's scope of practice.
m m m m m m m m m m m m m m m
Ambulating a client who uses a walker is correct. This is within the AP's scope of practice.
m m m m m m m m m m m m m m m m
Adding thickener to thin liquids on a client's food tray is correct. This is within the AP's scope of practice.
m m m m m m m m m m m m m m m m m m m
Teaching a client how to use an incentive spirometer is incorrect. This is not within the AP's scope of practice.
m m m m m m m m m m m m m m m m m m m
Evaluating a client's gag reflex before mealtime is incorrect. This is not within the AP's scope of practice.
m m m m m m m m m m m m m m m m m
A nurse is caring for a client. Which of the following tasks should the nurse delegate to an assistive personnel (AP)? select
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all that apply - correct answerPlace an absorbent pad on the client's bed, report the client's blood pressure to the nurse, apply
m m m m m m m m m m m m m m m m m m m m m m
barrier cream to the client's buttocks, document the client's vital signs
m m m m m m m m m m m
A charge nurse on a maternal newborn unit is receiving change of shift charge nurse report for a group of newborns. Which
m m m m m m m m m m m m m m m m m m m m m
of the following 3 newborns should the charge nurse identify as requiring priority care? Select 3 newborns the charge nurse
m m m m m m m m m m m m m m m m m m m m
should identify as priority. - correct answerNewborn 5, Newborn 3, Newborn 1
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When prioritizing hypotheses using the urgent vs. non-urgent approach to newborn care, the charge nurse should identify
m m m m m m m m m m m m m m m m
newborn 1, newborn 3, and newborn 5 as requiring priority care based on acuity. Newborn 1 has manifestations of
m m m m m m m m m m m m m m m m m m m
respiratory distress including tachypnea, grunting, nasal flaring, and retractions. The charge nurse should further determine
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if newborn 1 requires prompt interventions. Newborn 3 presents with manifestations of hypoglycemia including blood
m m m m m m m m m m m m m m m
glucose below the expected range, hypothermia, and maternal history of gestational diabetes insulin dependent. Newborn 5
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is 23 hours of age and has not had a successful feeding. The newborn additionally has not voided or passed their first
m m m m m m m m m m m m m m m m m m m m m m
meconium stool. Newborns are expected to have at least one void during the first 24 hours of life, and one meconium stool
m m m m m m m m m m m m m m m m m m m m m m
with in the first 24 to 48 hours of life. While newborns are sleepier during the first 48 hours after birth, the newborn should
m m m m m m m m m m m m m m m m m m m m m m m m
be awoken for feedings at least every 3 hours. These finding indicate that further intervention by the nurse is needed.
m m m m m m m m m m m m m m m m m m m m
A nurse manager is assessing incident reports for the unit. Which of the following client's medical records indicate
m m m m m m m m m m m m m m m m m
professional negligence? Select 2 clients that the nurse manager should recognize have charts that indicate professional
m m m m m m m m m m m m m m m m
negligence. - correct answerClient 4, Client 5
m m m m m m m
When recognizing cues, the nurse should identify client 4 and client 5 have medical records that indicate instances of
m m m m m m m m m m m m m m m m m m
professional negligence. Professional negligence occurs when an individual with professional training fails to practice at the
m m m m m m m m m m m m m m m m
, m level expected of their profession and harm is caused to a client. For professional negligence to occur there must be a
m m m m m m m m m m m m m m m m m m m m
m correlation between the nurse's actions and the harm that came to the client. In client 4's medical record, the nurse failed to
m m m m m m m m m m m m m m m m m m m m m
m administer the client's prescribed antiseizure medication within the indicated time frame and the client experienced a
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m seizure. In client scenario 5's medical record, the nurse administered the client's medications outside the parameters
m m m m m m m m m m m m m m m
m indicated on the prescription and the client experienced syncope and sustained an injury. The nurse should identify these
m m m m m m m m m m m m m m m m m
m two client scenarios as instances of professional negligence.
m m m m m m m
A charge nurse is assisting with the care of a client. Which of the following findings should the charge nurse identify that the
m m m m m m m m m m m m m m m m m m m m m m
client is experiencing an adverse reaction and requires notification of provider and updating the client's plan of care? Select
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6 findings that indicate that client is having an adverse reaction. - correct answerblood pressure, temperature, heart rate,
m m m m m m m m m m m m m m m m m m
respiratory rate, pain level, report by the client
m m m m m m m m
When evaluating outcomes, the nurse should identify hypotension, an increase in temperature, heart rate, and respiratory rate
m m m m m m m m m m m m m m m m
along with reports of abdominal and flank pain as a 6 on a pain scale from 0 to 10 and client report of short of breath and
m m m m m m m m m m m m m m m m m m m m m m m m m m m
chills can indicate the client is experiencing an acute hemolytic reaction to the blood transfusion. The nurse should stop the
m m m m m m m m m m m m m m m m m m m m
transfusion and notify the client's provider immediately. The charge nurse should update the client's plan of care to include
m m m m m m m m m m m m m m m m m m m
interventions to manage the client following an adverse reaction.
m m m m m m m m m
A nurse is caring for a client who has acute diverticulitis and is scheduled for surgery within the next 2 hr. The client tells the
m m m m m m m m m m m m m m m m m m m m m m m m
nurse that they are leaving the hospital. After notifying the surgeon, which of the following actions should the nurse take
m m m m m m m m m m m m m m m m m m m m
next? - correct answerInform the client about the risks they may encounter by leaving the facility
m m m m m m m m m m m m m m m m
Using the safety/risk reduction framwork, the nurse should recognize that the greatest risk to this client is injury from
m m m m m m m m m m m m m m m m m m
peritonitis; therefore, the first action the nurse should take is to inform the client about the risks of not receiving treatment.
m m m m m m m m m m m m m m m m m m m m m
A nurse is reviewing the plan of care for a client following a total hip arthroplasty. Which of the following actions should the
m m m m m m m m m m m m m m m m m m m m m m
nurse plan to take? - correct answerInform the assistive personnel (AP) of the client's weight-bearing status
m m m m m m m m m m m m m m m m
APs can assist clients with ambulation in most cases with appropriate delegation from the nurse. The nurse should inform
m m m m m m m m m m m m m m m m m m
the AP of postoperative prescriptions for weight-bearing as part of safe care delegation.
m m m m m m m m m m m m m
A nurse case manager is planning a teaching session on the use of critical pathways with a group of newly licensed nurses.
m m m m m m m m m m m m m m m m m m m m m
Which of the following information should the nurse include in the teaching? - correct answerCritical pathways prevent
m m m m m m m m m m m m m m m m m
unnecessary expense
m m
Nurses use critical pathways (also called clinical pathways) to implement evidence-based strategies and promote cost-
m m m m m m m m m m m m m m
effective care for clients who have a specific, common diagnosis.
m m m m m m m m m
A nurse is caring for a client who is scheduled for outpatient surgery. Which of the following actions should the nurse take
m m m m m m m m m m m m m m m m m m m m m
to verify the client gave informed consent? - correct answerAsk the client to explain the procedure that is being performed
m m m m m m m m m m m m m m m m m m m m
The nurse should ask the client to explain the procedure that is being performed. This allows the nurse to verify the client's
m m m m m m m m m m m m m m m m m m m m m
understanding of the information provided by the provider prior to witnessing the client's signature on the consent form.
m m m m m m m m m m m m m m m m m m
A nurse is caring for a client who has a terminal illness and voices concern about performing self-care after discharge.
m m m m m m m m m m m m m m m m m m m
Which of the following statements should the nurse make? - correct answer"Your case manager will coordinate the
m m m m m m m m m m m m m m m m m
resources you will need."
m m m m
A grandparent brings their 15-year-old grandchild to the emergency department reporting that they have severe abdominal
m m m m m m m m m m m m m m m
pain and are scheduled for an immediate appendectomy. The nurse confirms that the client's guardians are unavailable.
m m m m m m m m m m m m m m m m m
Which of the following actions is appropriate? - correct answerHave the grandparent sign the consent form
m m m m m m m m m m m m m m m m
The nurse should assist in obtaining informed consent from the client's grandparent in an emergency situation when parents
m m m m m m m m m m m m m m m m m
are not available.
m m m
A charge nurse is observing a newly licensed nurse who is caring for a client who has pulmonary tuberculosis. The charge
m m m m m m m m m m m m m m m m m m m m
nurse should expect the newly licensed nurse to take which of the following actions? - correct answerWear an N95
m m m m m m m m m m m m m m m m m m m
respirator mask when in the client's room
m m m m m m m
The nurse should wear an N95 respirator mask when caring for clients who have suspected pulmonary tuberculosis.
m m m m m m m m m m m m m m m m
Questions and Answers, 100% Correct| Updated
There has been a community disaster and stable clients must be discharged from a facility to prepare for the influx of new
m m m m m m m m m m m m m m m m m m m m m
casualties. A nurse should identify that which of the following clients is safe to discharge? - correct answera client who has
m m m m m m m m m m m m m m m m m m m m m
multiple sclerosis and reports ataxia
m m m m m
This client is safe to discharge because multiple sclerosis is a chronic disorder and ataxia is an expected finding.
m m m m m m m m m m m m m m m m m m
A nurse on a medical-surgical unit is caring for four clients. The nurse should recognize that which of the following clients
m m m m m m m m m m m m m m m m m m m m
is the priority? - correct answerA client who has peripheral vascular disease and has an absent pulse in the right foot
m m m m m m m m m m m m m m m m m m m m m
When using the airway, breathing, circulation approach to client care, the nurse determines that the priority finding is an
m m m m m m m m m m m m m m m m m m
absent pulse, which indicates no blood flow to the extremity.
m m m m m m m m m m
A nurse finds that a new IV pump has infused 400 mL of solution over 2 hr when the rate was set at 100 mL/hr. After
m m m m m m m m m m m m m m m m m m m m m m m m m
notifying the provider and verifying that the pump was properly programmed, which of the following is the nurse's priority?
m m m m m m m m m m m m m m m m m m m
- correct answerTag the pump for maintenance and acquire a new pump for the client
m m m m m m m m m m m m m m m
The greatest risk is the potential for injury to a client if a nurse uses the pump again before repair; therefore, the priority for
m m m m m m m m m m m m m m m m m m m m m m m
the nurse is to tag the pump for maintenance and acquire a new pump for the client.
m m m m m m m m m m m m m m m m m
A charge nurse is planning care for a group of clients. Which of the following tasks should be delegated to an assistive
m m m m m m m m m m m m m m m m m m m m m
personnel (AP)? select all that apply - correct answerambulating a client who uses a walker, adding thickener to thin liquids
m m m m m m m m m m m m m m m m m m m m
on a client's food tray
m m m m m
Flushing a client's saline lock is incorrect. This is not within the AP's scope of practice.
m m m m m m m m m m m m m m m
Ambulating a client who uses a walker is correct. This is within the AP's scope of practice.
m m m m m m m m m m m m m m m m
Adding thickener to thin liquids on a client's food tray is correct. This is within the AP's scope of practice.
m m m m m m m m m m m m m m m m m m m
Teaching a client how to use an incentive spirometer is incorrect. This is not within the AP's scope of practice.
m m m m m m m m m m m m m m m m m m m
Evaluating a client's gag reflex before mealtime is incorrect. This is not within the AP's scope of practice.
m m m m m m m m m m m m m m m m m
A nurse is caring for a client. Which of the following tasks should the nurse delegate to an assistive personnel (AP)? select
m m m m m m m m m m m m m m m m m m m m m
all that apply - correct answerPlace an absorbent pad on the client's bed, report the client's blood pressure to the nurse, apply
m m m m m m m m m m m m m m m m m m m m m m
barrier cream to the client's buttocks, document the client's vital signs
m m m m m m m m m m m
A charge nurse on a maternal newborn unit is receiving change of shift charge nurse report for a group of newborns. Which
m m m m m m m m m m m m m m m m m m m m m
of the following 3 newborns should the charge nurse identify as requiring priority care? Select 3 newborns the charge nurse
m m m m m m m m m m m m m m m m m m m m
should identify as priority. - correct answerNewborn 5, Newborn 3, Newborn 1
m m m m m m m m m m m m
When prioritizing hypotheses using the urgent vs. non-urgent approach to newborn care, the charge nurse should identify
m m m m m m m m m m m m m m m m
newborn 1, newborn 3, and newborn 5 as requiring priority care based on acuity. Newborn 1 has manifestations of
m m m m m m m m m m m m m m m m m m m
respiratory distress including tachypnea, grunting, nasal flaring, and retractions. The charge nurse should further determine
m m m m m m m m m m m m m m m
if newborn 1 requires prompt interventions. Newborn 3 presents with manifestations of hypoglycemia including blood
m m m m m m m m m m m m m m m
glucose below the expected range, hypothermia, and maternal history of gestational diabetes insulin dependent. Newborn 5
m m m m m m m m m m m m m m m m
is 23 hours of age and has not had a successful feeding. The newborn additionally has not voided or passed their first
m m m m m m m m m m m m m m m m m m m m m m
meconium stool. Newborns are expected to have at least one void during the first 24 hours of life, and one meconium stool
m m m m m m m m m m m m m m m m m m m m m m
with in the first 24 to 48 hours of life. While newborns are sleepier during the first 48 hours after birth, the newborn should
m m m m m m m m m m m m m m m m m m m m m m m m
be awoken for feedings at least every 3 hours. These finding indicate that further intervention by the nurse is needed.
m m m m m m m m m m m m m m m m m m m m
A nurse manager is assessing incident reports for the unit. Which of the following client's medical records indicate
m m m m m m m m m m m m m m m m m
professional negligence? Select 2 clients that the nurse manager should recognize have charts that indicate professional
m m m m m m m m m m m m m m m m
negligence. - correct answerClient 4, Client 5
m m m m m m m
When recognizing cues, the nurse should identify client 4 and client 5 have medical records that indicate instances of
m m m m m m m m m m m m m m m m m m
professional negligence. Professional negligence occurs when an individual with professional training fails to practice at the
m m m m m m m m m m m m m m m m
, m level expected of their profession and harm is caused to a client. For professional negligence to occur there must be a
m m m m m m m m m m m m m m m m m m m m
m correlation between the nurse's actions and the harm that came to the client. In client 4's medical record, the nurse failed to
m m m m m m m m m m m m m m m m m m m m m
m administer the client's prescribed antiseizure medication within the indicated time frame and the client experienced a
m m m m m m m m m m m m m m m
m seizure. In client scenario 5's medical record, the nurse administered the client's medications outside the parameters
m m m m m m m m m m m m m m m
m indicated on the prescription and the client experienced syncope and sustained an injury. The nurse should identify these
m m m m m m m m m m m m m m m m m
m two client scenarios as instances of professional negligence.
m m m m m m m
A charge nurse is assisting with the care of a client. Which of the following findings should the charge nurse identify that the
m m m m m m m m m m m m m m m m m m m m m m
client is experiencing an adverse reaction and requires notification of provider and updating the client's plan of care? Select
m m m m m m m m m m m m m m m m m m m
6 findings that indicate that client is having an adverse reaction. - correct answerblood pressure, temperature, heart rate,
m m m m m m m m m m m m m m m m m m
respiratory rate, pain level, report by the client
m m m m m m m m
When evaluating outcomes, the nurse should identify hypotension, an increase in temperature, heart rate, and respiratory rate
m m m m m m m m m m m m m m m m
along with reports of abdominal and flank pain as a 6 on a pain scale from 0 to 10 and client report of short of breath and
m m m m m m m m m m m m m m m m m m m m m m m m m m m
chills can indicate the client is experiencing an acute hemolytic reaction to the blood transfusion. The nurse should stop the
m m m m m m m m m m m m m m m m m m m m
transfusion and notify the client's provider immediately. The charge nurse should update the client's plan of care to include
m m m m m m m m m m m m m m m m m m m
interventions to manage the client following an adverse reaction.
m m m m m m m m m
A nurse is caring for a client who has acute diverticulitis and is scheduled for surgery within the next 2 hr. The client tells the
m m m m m m m m m m m m m m m m m m m m m m m m
nurse that they are leaving the hospital. After notifying the surgeon, which of the following actions should the nurse take
m m m m m m m m m m m m m m m m m m m m
next? - correct answerInform the client about the risks they may encounter by leaving the facility
m m m m m m m m m m m m m m m m
Using the safety/risk reduction framwork, the nurse should recognize that the greatest risk to this client is injury from
m m m m m m m m m m m m m m m m m m
peritonitis; therefore, the first action the nurse should take is to inform the client about the risks of not receiving treatment.
m m m m m m m m m m m m m m m m m m m m m
A nurse is reviewing the plan of care for a client following a total hip arthroplasty. Which of the following actions should the
m m m m m m m m m m m m m m m m m m m m m m
nurse plan to take? - correct answerInform the assistive personnel (AP) of the client's weight-bearing status
m m m m m m m m m m m m m m m m
APs can assist clients with ambulation in most cases with appropriate delegation from the nurse. The nurse should inform
m m m m m m m m m m m m m m m m m m
the AP of postoperative prescriptions for weight-bearing as part of safe care delegation.
m m m m m m m m m m m m m
A nurse case manager is planning a teaching session on the use of critical pathways with a group of newly licensed nurses.
m m m m m m m m m m m m m m m m m m m m m
Which of the following information should the nurse include in the teaching? - correct answerCritical pathways prevent
m m m m m m m m m m m m m m m m m
unnecessary expense
m m
Nurses use critical pathways (also called clinical pathways) to implement evidence-based strategies and promote cost-
m m m m m m m m m m m m m m
effective care for clients who have a specific, common diagnosis.
m m m m m m m m m
A nurse is caring for a client who is scheduled for outpatient surgery. Which of the following actions should the nurse take
m m m m m m m m m m m m m m m m m m m m m
to verify the client gave informed consent? - correct answerAsk the client to explain the procedure that is being performed
m m m m m m m m m m m m m m m m m m m m
The nurse should ask the client to explain the procedure that is being performed. This allows the nurse to verify the client's
m m m m m m m m m m m m m m m m m m m m m
understanding of the information provided by the provider prior to witnessing the client's signature on the consent form.
m m m m m m m m m m m m m m m m m m
A nurse is caring for a client who has a terminal illness and voices concern about performing self-care after discharge.
m m m m m m m m m m m m m m m m m m m
Which of the following statements should the nurse make? - correct answer"Your case manager will coordinate the
m m m m m m m m m m m m m m m m m
resources you will need."
m m m m
A grandparent brings their 15-year-old grandchild to the emergency department reporting that they have severe abdominal
m m m m m m m m m m m m m m m
pain and are scheduled for an immediate appendectomy. The nurse confirms that the client's guardians are unavailable.
m m m m m m m m m m m m m m m m m
Which of the following actions is appropriate? - correct answerHave the grandparent sign the consent form
m m m m m m m m m m m m m m m m
The nurse should assist in obtaining informed consent from the client's grandparent in an emergency situation when parents
m m m m m m m m m m m m m m m m m
are not available.
m m m
A charge nurse is observing a newly licensed nurse who is caring for a client who has pulmonary tuberculosis. The charge
m m m m m m m m m m m m m m m m m m m m
nurse should expect the newly licensed nurse to take which of the following actions? - correct answerWear an N95
m m m m m m m m m m m m m m m m m m m
respirator mask when in the client's room
m m m m m m m
The nurse should wear an N95 respirator mask when caring for clients who have suspected pulmonary tuberculosis.
m m m m m m m m m m m m m m m m